NCG080841 DMR SW (2)

r
Semi-annual Stormwater Discharge Monitoring Re ort
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted — I L- 4- /_5-
CERTIFICATE OF COVERAGE N0. MGM R, ' j
FACILITY NAME"
00 PO Li s ®os��� sr no�j
COUNTY A 6 Q S
PERSON COLLECT G SAMPLES �KW
LABORATORY (S M b �p i
Cert. # �" ���'-` '�
Comments on sample collection or analysis:_
SAMPLE COLLECTION YEAR 26 Ir
SAMPLE PERIOD ❑ Jan -June ED -J ally -Dec
RECEIvor ❑ Monthly' month
DISCHARGING TO CLASS ❑ORvu
JET 3 0 Z015 �� ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
CENTRAL FILES ❑Other
QW -R -q-ECTION
Part A: Vehicle Maintenance Areas Monitoring Requirements PLEASE REMEMBER TO SIGN ON THE REVERSE --)�
❑ No discharge this period'
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes
(if yes, report your analytical results in the table immediately below) _no
all, B: 011iwater Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Otgtfall
'
No. Saimple_ �"fi, .VI✓���•. _ h ori L If _ - �- v. � - - r5` - -" - - - -
_'Colle ted No E iILL :00530 ; : _ B
;.: t�-P�I�r.ozdire��eiTPN,EPAYR�eth'. "V~} 04,00
o/dc9fYrT dd, , i'�ita6 Ssp;rad e9_ oliid _
64;,ijSGT FIEi1A
ermit•Limit
tandard•`units
it 71" -i -
S < 7
1 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoringreport with th a checkmark here.
SWU-250
last revised October 25, 2012

STORM EVENT CHARACTERISTICS:
®ate // is " (first event sampled)
Total Event Precipitation (inches): 0 -5 -
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event (Precipitation (inches)-
Alote, If you report a sample value in excess of the benchmark, you must implement Tier P, Tier Z, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
e A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART It SECTION B.
e 2 EXCEEDANCES INA ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B
6 TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES 0 NO []
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES [' NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one coot/ of this DMR. including all 'Wo Discharge" reports o<uith 3®dai✓s ®f receipt of the lab results for at end of 2jgdkorena ®ereod in
the case of "iso DeschrZrae" reP*rts} to.
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
®t➢ �+�t82ST 51GsN TMIIS CiERT9FICe4TION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief,,true, accurate, and complete. I am aware that
there are signifiant penalties for submitt!Afalse information, including the possibility of fines and imprisonment for knowing violations."
/v
(Signature
9Z-Zl-Ij
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.ora/web/wa/ws/suJnr)dessw#tab-4
S W U-250
last revised October 25, 2012
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