NCG080057_MONITORING INFO_20181108

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV U& (DBws')
DOC TYPE
❑ HISTORICAL FILE
N, MONITORING REPORTS
DOC DATE
❑ -2011 It 01
YYYYM M D D

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Di ' ion.of Water Quality General Permit No. NCG080000
CERTIFICATE OF COVERAGE NO. NCG08
NOV 0 B zora
FACILITY NAME CEtVTRAC ES
COUNTY !/ vv 5EC1`i0,,4
PERSON COLLECTINg SAMPLES i
LABORATORY / Lab Cert. # _ 2fgf__ _
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR aid/�
SAMPLE PERIOD ❑ Jan -June Ff luly-Dec
or ❑ Monthly' month
DISCHARGING TO CLASS ❑ORW ❑HQW []Trout []RNA
❑Zero -flow ❑Water Supply []SA
[]Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
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 A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
15
-
/o ".f
S,
Part 5: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
1 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SVIU-250 last revised April It, 2013
Page 1 of 2

STORM EVENT CHARACTERISTICS:
,y
Date o a W (first event sampled)
Total Event Precipitation (inches): �oZ
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: !f you report a sample value in excess of the benchmark, you must implement Tier 1, Tler 2, or tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER i REQUIREMENTS. SEE PERMIT PART li SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE SAME OUTFALLTRIGGER 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 orfainal and one copy of this DMR, includlna all "No Discharaep reports within 30 days of receipt of the lab results (or at end of monktorina period in
the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Ties
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"1 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."
(Signature of
(D e)
Additional copies of this form may be downloaded at: httartal.ncdenr,or webjwq/ws/sujnpdessw#'tab-4
SWIJ250
last revised April 11, 2013
paap 9 of')

r
Semi -Annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
CERTIFICATE OF COVERAGE NO. NCG080683
Date submitted
FACILITY NAME High Point Fleet Maintenance/Environmental Services
COUNTY GUILFORD
PERSON COLLECTING SAMPLES Ari Lukas/Robbie Baker
LABORATORY City of High -Point Water Quality Lab Cert. # 55
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2018
_SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
or ® Monthly' Ocotber (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
�1�, ryry ❑Zero -flow ❑Water Supply ❑SA
CU ❑Other
NOV 02 tiGiB
EN- S` .`JLES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DW
IV
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new mogt�trdOor month? _ yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period'
OutfaII
No.
Date
Sample C-611le e
mo/ldd/yr
00530
WTotal Suspended
Solid_s, mg/�L
00 To
pH, it
Standard units
0 556
Non -Polar Oil and Gr� era e`/TPH EPA
Method 1664 (SGT�HEIVI mg/LL
New Motor 0i) Usage,
Annual average gal/mo
Benchmark
® -
50 or 101 see permi#
Within G:0 — 4.0
_
15
-
SDO-001A
10/10/2018
35.6
6.3
5
SDO-0016
10/10/2018
23.8
7.13
<5
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
FSample Eollected,
mo/,dd/,yr
00556
Non -Polar Oil Iand Grease/TPH 1 EPA MethodSuspended
GTm 1664 (S-HEM), g/L
00530
Solids,
mg/L
00400
pH,
EStandard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
1 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 April 11, 2013
Page 1 of 2 '

STORM EVENT CHARACTERISTICS:
Date 10/10/2018 (first event sampled)
Total Event Precipitation (inches): 0.28 inches
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 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 it 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 for 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."
ure of Permittee)
1n-33=15�-'
(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 April 11, 2013
! Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted
CERTIFICATE OF COVE E_NO. NCGOB 0 Q
FACILITY NAME Q f d—forJ Aln
COUNTY
PERSON COLLECTING SAMPLES s
LABORATORY cS v�l,- A.Wzo"I Lab Cert. #
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR
SAMPLE PERIOD ❑ Jan -June July -Dec
or ❑ Monthly'_ (month)
RETO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow []Water Supply ❑SA
NOV 15 2017 ❑Other
CENTRAL SE TIONFILEPLEASE REMEMBER TO SIGN ON THE REVERSE 4
�WR SECTION
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 A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
No discharge this periods
Outfall
No. Z
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
15
-
d
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
I 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 April 11, 2013
Pagel of 2

STORM EVENT CHARACTERISTICS:
Date/v i (first event sampled)
Total Event Precipitation (inches): . Y
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 2, or Tler 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 OUTFALLTRIGGER 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:
Mall an original and one cony of this DMR, including all "No Discharge" reports, within 30 days of recelpt of the lab results (or at end of monitoring period in
the case o "No Discharge' &orts 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 property 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."
ii 7 /
(Da(e)
Additional copies of this farm may be downloaded at: http://12ortal.ncdenr.orglweb/wa/wslsu/npddessw#itab-4
SW-250 last revised April 11, 2013
Paee 2 of 2

AtSemi-annual Stormwater Discharge Monitoring Report
� for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG08.Q_
FACILITY NAME Gr ) r
COUNTY LP, -oar /
PERSON COLLECTING SAMPLES
LABORATORY AA91ur1cAat Lab Cert. #i
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR ­?O/a
SAMPLE PERIOD O'Jan-June ❑ July -Dec
or ❑ Monthly' _ (monrhl
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
❑Other
RFr,FIVED PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of AA4&291$er month? Zyes _no
(if yes, report your analytical results in the table immediately below) DWR SECTION
INFORMATION PROCESSING UNIT
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this periods
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
15
-
y
7
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
I 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 April 11, 2013
Paae 1 of 2

STORM EVENT CHARACTERISTICS:
ate i /(P (first event sampled)
Total Event Precipitation (inches):
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 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 ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mall an original and one cane of this DMR, Including all "No Discharge" resorts within 30 days receipt of the lab results for at end of monitorina period in
the case of "No Discharge" reports)
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU FAUST SIGN'Tti1S 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."
of Perm€ttee)
(Date)
Additional copies of this form may be downloaded at: littp://portal.ncdpnr.orvlwet)/wq/ws/sii/nr)tJi!sswtttal)-4
SWU-250 - last revised April 11, 2013
Pase 2 of 2

nnua! Stormwater Discharge Monitoring Re
for North Carolina Division of Water Quality General Permit No.
Date submitted
CERTIFICATE OF COVERAGE No. NCGOS 0 O .5* -%
FACILITYNAME GV1Jlu-?&,G1�1�f,uaw,
COUNTY /!—��---7---� -
PERSON COLLECTING SAMPLES / ,J,,--e ,% 4ws
LABORATORY Lab Cert. # - -
Comments on
or analysis:
Part A: Vehicle Maintenance Areas Monitoring Requirements
CnDv
_ SAMPLE COLLECTION YEAR 6/3—
SAMPLE PERIOD [VJan-June ❑ July -Dec
or rj Monthly'_ _ (month)
DISCHARGING TO CLASS ❑ORW ❑HQW Trout ❑PNA
RECEIVED ❑Zero -flow ❑Water Supply ❑SA
Other
AUG 0 3 2015
CENTRAL FILES
DWR SECTION
PLEASE REMEMBER T : SIGN C. T:-IE REVERSE 4
No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
OOS30
00400
00SS6
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
SO or 100 see permit
Within 6.0 - 9.0
1s
-
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 9: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
Outfali
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
i5
SO or 100 see permit
6.0-9.0
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

STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total Event Precipitation (inches): _
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, rier 2, or Tier 3 re.sponses. 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 Z 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 ❑
1F YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail or original and one cosy of this OMR, including all "No Discharge"reyorts within 30 days of receipt of the lab results for 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
Raic-igh, North Carolina 27644-1617
YOU MU -Sr SIGN THIS CER T IFICA T ION 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."
G !S�
(D te)
Additional copies of this form may be downloaded at: htto:lJnortal.ncdenr.org(web/wq/ws/su/nodessw$ftab-4
SWU-250 last revised October 25, 2012
Page 2 of")

- - Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted 10/14/15 !'�7
SAMPLE COLLECTION YEAR 2015
CERTIFICATE OF COVERAGE NO. � - C7
FACILITY NAME GLWilson Building Company RECEIVED SAMPLE PERIOD ❑ Jan June 'x July -Dec C'
COUNTY Iredell OCT, I a-`-ZOiS-. - - -
or, ❑ Monthly' (month)
_: ,:DISCHARGING TO CLASS ❑ORW ❑HQW []Trout❑PNA.,C
PERSON COLLECTING SAMPLES Danny R. Mlllsaps CENTRAL FILES- - ❑Zero -flaw [:]watersupply ❑SA
LABORATORY Statesville Analytical Lab Cert. # 440 DWR SECTION []Other
on sample collection or analysis: --
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per. month? x yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)' ,�.t~::' _ ; ❑ No discharge this period'
Outfall.
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended_
Solids, mg/L ,
pH,;'` a �r. kT -
Standard -units::: {°::
.: Non=Polar Oil�and Grease/TPH EPA
: : Method 1664 (SGT-HEM), mg/L.:
New'Motor 011;Usage,
:Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 - 9.0
#1
9/25/i5
9.412
55.95
40gal/mo
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable).: ' . — ;`
Outfall
No.'
Date_-
Sample Collected,
mo/dd/yr
:00556`.'. i
00530
00400
Non -Polar Oil and GreasejTPH EPA -Method
1664 (SGT-HEM), mg/L: ;� t.::.:,; '
Total Suspended Solids,-
mg/L ..:._
pH ✓ °3=
Standard units
Permit Limit
-
15
50 or 100 see permit' • . .-
= 6.0 - %0
1 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 April 11, 2013
Page 1 of 2

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1
STORM EVENT CHARACTERISTICS:
f
Date 9/25/2015 (first event sampled)
Total Event Precipitation (inches):.8
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 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 a.
• 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 x
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO x
'REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, includina all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitoring period in
the case of '"No Discharae" reports) ta:
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."
10/14/15
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wglws/su/npdessw#tab-4
SWU-250 last revised April 11, 2013
Page 2 of 2

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