NCG080210 DMR SW (3)

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted
CERTIFICATE OF COVERAGE NO. SAMPLE COLLECTION YEAR 20 15"
SAMPLE PERIOD E 'ian-June ['July-Dec
FACILITY NAME 1Z�IA,(�(,1L' S�RUIGES �i�t� /'e4/�61/q�N
COUNTY B i RK E or ❑Monthlyl (month)
PERSON COLLECTING SAMPLES tokiA116 Go066(iVS DISCHARGING-TO-CLASS-❑ORW- ❑HQW!❑Trout—❑PNA--
LABORATORY PA CZ Ar1AEYTCA L Lab Cert.# 377/2 ` 4/0 RECEIVED ❑Zero-flow [Water Supply ESA
Comments on sample collection or analysis: ['Other`�RoTii er ,/o : 9225"23,39 OCT 0 9 2015
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE -*
DWR SECTION
Part A:Vehicle Maintenance Areas Monitoring Requirements ❑ No discharge this periods
".Outfall.: Date , . `.00530 00400 00556, . _
S s' nd` H° Nuri-Polar Oil and Grease"TPH'EPA r. `=New Mot"or;�Dil Usa e
/ g �•° -
mo dd' .:,• Solids"mg/L :Standard;units ;Method,166 '(SGT HEM)t=rrig/l`4 '_' Agnua,average:.gat%mq.
$ei�ctiinark," - ;'S0�raOp;seeperinit '1Alit_ � _ _
a-s-/2045- 901 O2 I�I.D
05m 1111M% 0 s '^‘,1)
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_yes _no
(if yes, report your analytical results in the table immediately below)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfall ;Date i ;0055d 00530,: ,00400
ANOSample Collett d, ;Nonri)die sOil.and:Grease/TRH EPA:Method. Total Suspended Solids� pH,
Perrxlitaiiri�t',; , , r 5, . 50or:100seePerrbit
For sampling periods with no discharge at any single outfall,you must still submit this discharge monitoring report with a checkmark here.
SWU-250 last revised October 25,2012
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I
STORM EVENT CHARACTERISTICS:/
Date 5/29/6(first event sampled)
Total Event Precipitation (inches): 5 6
Date /✓A (list each additional event§ampled this reporting period,and rainfall amount)
Total Event Precipitation (inches): /141
Note: If you report a sample value in excess of the benchmark,you must implement Tier 1, Tier 2,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[r
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."
it-4(71-1 ....,--/4.---1--e-,--7 5-- 3 /..S.--
(Signature of Permittee) (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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