NCG080201 DMR SW (2)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted w1-:,:111s - - -
CERTIFICATE OF COVERAGE NO...NCGO8- `:i t` SAMPLE COLLECTION YEAR its
kw' --` SAMPLE PERIOD ❑Jan-June ❑✓July-Dec
FACILITY NAME tt;-cs - , g,A-- osi
COUNTY ,.., E.CE1 e ❑Monthly (month)
PERSON COLLECTING SAMPLES �o,1N�t stF{ I5-IA GIN O CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY r,�: - Lab Cert.# ,V� • OCT 0 5 2015 ❑Zpro-flow ❑Water Supply [SA
Comments on sample collection or analysis: OtherCENTRAL FILES
' DWR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A:Vehicle Maintenance Areas Monitoring Requirements n No discharge this period1
Rat. .3 ,T, a, •r,• ks�. N a,� Y 1 +F"ynv v k' ,..1,-.1„,,x. -H x h, ;b .sib, `7 - ary
$g Iy i,, a ,„„ -„,r., Qa a - E.sOU'�5 0 Y;

STORM EVENT CHARACTERISTICS:
Date 041,ArB (first event sampled)
Total Event Precipitation (inches): 3/ '
Date (list each additional event sampled this reporting period,and rainfall amount)
Total Event Precipitation (inches):
Note: If you report a sample value in excess of the benchmark,you must implement Tier 1, Tier Z or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑NO❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑NO❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all"No Discharge"reports, within 30 days of receipt of the lab results(or at end of monitoring period in
the case of"No Discharge"reports)to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION 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 significant penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations."
rr Com ' ,P,11,6"
(Signature of Pd�[t�e) (Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
•
SWU-250 last revised October 25,2012
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