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Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using>55 gal of new motor oil/month—averaged over a calendar year.
In Tier 2
pli TPH using method Total Suspended Event Total New Motor Oil #of Months
Outfall Date Samplea Monthly
(Standard 1664A SGT-HEM Solids Duration Rainfall Usage in Tier 2
No. Collected Units) (mg/L) (mg/0 (minutes) (in) (gal/month) Monitoring? Sa'mpling2
(mo/dd/yr)1 (Yin)
6-92 152 1002'3
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL(INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR (including all"No Flow" &"No Discharge" reports)within 30 days of receipt of sample (or at end of monitoring period
in case of"No Flow")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 a are that there are significant penalties for submitting false information,including the possibility of fines and imprisonment for knowing violations."
wwiczofi ;at. /-2„:2O/7
(Signature of Permittee) (Date)
Permit Date.7/1/2011-60/30/2015 Last Revised 7/13/11
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