NCG210034_MONITORING INFO_20181115

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V a 10 3�
DOC TYPE
❑HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ �L)N I I )
YYYYMMDD

Semi-annual Stormwater„Discharge Monitoring Report
for North Carolina DEMLR Gen ral Perm t No. NCG210000
Date submitted 11 1,5'
CERTIFICATE OF COVERAGE NO. NQG21 Q -a 3-
FACILITYNAME T & 1—G� rj2,Mp2nT_
COUNTY
PERSON CpLLECTIN SAMPLER ArKLG �( QrnS
LABORATORY,m�r
_ 1'1 P r , 4 coe-1 Lab Cert. # I
Comments on sample collection or analysts:
SAMPLE COLLECTION YEAR g2,_(9 19
SAM PLE PERIOD ❑ Jan -June N July -Dec
or ❑ Monthly' Imonthl
DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
❑Zero -flaw ❑Water Supply SA
Other C_'lass a Yo� C�n �► 4ve+r
PLEASE REMEMBER TO SIGN ON THE REVERSE 3
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
n No discharae this aerlod?a
Outfafi No.
Date Sample
Collected'
mo/dd/ r
24-hour rainfall
amount,
Inches
Chemical Oxygen Demand
Total Suspended Sallds
Benchmarks
120 mg/L
100 m3/L or 50 mg/L
O
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
3 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites maybe eligible for a waiver of the rain gauge requirement.
' See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies,
Note: Results must be reported in numerical format. For exaMple. do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they mu;;tbeleaorted In the format. "<XX ma/L". where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note: !f 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.
Permit Date: B/l/2013.7/31/201$ SWU-245, last revised 7/31/2013
Page 1 of 2

Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No dischnrae this period?'
Outfall No:
Date Sample
Collected,
(mo/dd/yr
24-hour rainfall
amount,
Inches'
Non -polar O&G by EPA
1664 SGT-HEM}
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or 50 mg/L
Footnotes from Part A also apply to this Part B
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 PQRTA AND PART B MONITORING RESULTS:
+ A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS, SEE PERMIT PART 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTPALL 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 ❑
1F YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an orlalnal and one copy of this DMR, Indudin_a_all "No Discharge" reports, within 30 days of {AFelpt_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 MU5T-5IGN 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.
am aware that there are significant penalties for subm Ing false Information, including the posslbllity of fines and Imprisonment for knowing violations."
--7
, .
u, u s-1 jr'
(Signature of ermittee) (Date)
Permit Date: B/1/2013.7/31/201B SWU-245, last revised 7/31/2013
Page 2 of 2

STORMWATER DISCHARGE OUTFAT I.. (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO. NCG210�.,® (This monitoring report is'due at the Division no later than 30 days from
the date the facility receives the sampling results from the -laboratory.)
FACILITY NAME ro 4 &fm ,e i— C01nPakij
PERSON COLLECTING AMPLES Arcege T)mnls
CERTIFIED LABORATORY a Lab #l(f�:
Lab #
Part A: Specific Monitoring Requirements)
COUNTY 0�7-{-� am
RECEr' U0. (moo_'
AU
G 0 L'L�JE SIGN ON THE REVERSE 4
CENTRAL FILES
Outfaii
No.
Date
Sample Collected,
mold
Total Rainfall,
inches
00530
00340
Total Suspended Solids,
pH,
Standard units
Chemical Oxygen Demand (COD),
Benciumark*
_
-
100
Within 6.0 — 9.0
120
�!3
D©
'Monitoring is required only if the facility stores exposed pines of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed_ The facility shall
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier 1 or Tier 2 responses in the General Permit.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical monitoring waiver, the
discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report"
Name (Print name)
Title (Print title)
(Signature)
(Date)
S WU-245-072808
Page 1 of 2

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIMIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
Yes ❑ No (If yes, complete Part 13)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Collected,
molddlyr '
00400
00556
00530
Total Rainfall,
inches
New Motor Oil Usage,
Annual average gallmo
pH,
Standard units
Oil and Grease,
mg/L
Total Suspended Solids,
m91L
Benchmark*
_
_
-
6.0 - 9.0
30
100
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you- must implement Tier 1 or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attm Central Files
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED IN PARTS A AND/OR B:-
"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
lmowledge and belief, true, accurate, and complete. I am aware that. there are significant penalties forsubmittingfalse information, including the
possibility of fines and imprisonment f9r knowing violations."
of Permittee)
7 - zS-
(Date)
SWU-245-072808
Page 2 of 2

STORMWATER DISCHARGE OUTFA...LT. (SDO)
MONITORING REPORT nn
GENERAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO. NCG21❑0 ©03 ® (This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the.laboratory.)
FACILITY NAME J' O wn I er �p m how,
PERSON COLLEcnNG SkMPLES M a S
CERTIFIED LABORATORY n er%'+c k Lab #
Lab #1
Part A: Specific Monitoring Requirementsi
RECEJ On+M er
$ ENO.( Ifo1 517 - H
JAN 2 5 2AASE SIGN ON THE REVERSE -)
CENTRAL FILES
DWR SECTtON
outran
No.
Date
Sample Collected,
mold
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
WWL
p131
Standard units -
Chemical Oxygen Demand (COD),
Benchmark*
-
-
100
Within 6.0 - 9.0
120
.O
,S
'Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or Iess, the certification below must be signed_ The facility shall
also record and maintain a Iog in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier 1 or Tier 2 responses in the General Permit.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical monitoring waiver, the
discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report"
Name (Print name)
Title (Print title)
(Signature)
(Date)
S WU-24S-072808
Page 1 of 2

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIF.S USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
0 Yes ❑ No (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outrall
No.
Date
Sample Collected,
molddlyr '
00400
. 00556
00630
Total Rainfall,
inches
New Motor Oil Usage,
Annual average gallmo
pH,
Standard units
Oil and Grease,
n19L
Total Suspended Solids,
mgli,
Benchmark*
-
-
-
6.0 — 9.0
30
100
,S
L
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pIT), you. must implement Tier I or Tier 2 responses in the General Permit.
Matz original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED IN PARTS A AND/OR B:
"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 imprisoameut f owing violations."
L
(Signature of Permittee)
/-L-)F.
(Date)
SWU-245-072808
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR: A O I
CERTIFICATE OF COVERAGE NO. NCG210❑0 ©Q (This monitoring report is'due at the Division no later than 30 days from
the date the facility receives the sampling results from the -laboratory.)
FACILITY NAME o (Am er 1 nt*40on4
PERSON COLLECTING SAMP
10 04-
CERTIFIED LABORATORY a r- Lab #
Lab #
Part A. Specific Monitoring Requirements)
COUNTYjTQAf,_9VM16Cj
PHONE NO. (q lQ) -1 6 - t
PLEASE SIGN ON THE REVERSE RECO ED
JUN 12 201 ?
Outfall
No.
Date
Sample Collected,
mold
Total Rainfall
inches
00530
00400
00340
Total Suspended Soli
uspen� Solids,
p13,
Standard units
""'
Chemical Oxygen Demand {COD),
Benchmark*
-
-
100
Within 6.0 - 9.0
120
-
, M2
A_rq
17'RgL FIL
R SECrro�
'Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed. The facility shall
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier 1 or Tier 2 responses in the General Permit.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical monitoring waiver, the
discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or
other similar materials were stored exposed (either to incident precipitation or to stormwater runt on) for longer than seven (7)
days before removal since filing the last discharge monitoring report"
Name (Print name)
Title (Print title)
(Signature)
(Date)
SWU-245-072808
Page 1 df 2

DID THIS FACILITY PERFORM VEHICLE MAIlVTENANCE ACTMES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
0 Yes ❑ No (1f yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Oaffall
No.
Date
Sample Collected,
molddlyr
00400
00556
00530
Total Rainfall,
inches
New Motor Oil Usage,
Annual average gal/mo
pH,
Standard omits
Oil and Grease,
mg/L
Total Suspended Solids,
mg/L
Benchmark*
-
-
-
&0 - 9.0
30
100
As -1
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pM, you must implement Tier 1 or Tier 2 responses in the General Permit.
Mai original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigb, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORINIATION REPORTED IN PARTS A AND/OR B:-
"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 aiid 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 Permittee)
0/- k- /%
(Date)
S WU-245-072808
Page 2 of 2

STORMWATER DISCHARGE OUTFA.LL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO. NCG210 D[�]® {This monitoring report is�due at the Division no later than 30 days from
the date the facility receives thesamplingresults from the.laboratory.)
FACILTTY NAME urn e-r o c h EC E I VE D PHONE O. ' f O) � j jI
PERSON COLLECTING SAMP ES a `S
CERTIFIED LABORATORY Vf I e- r ' e a Lab #- r b �q-- DEC 2 8- 2016
Lab # PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirement' CENTRAL FILESDWR SECTION
0111-t-fall
No.
Date
Sample Collected,
mo/ddtvr
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
pH, -
Standard units
Chemical Oxygen Demand (COD),
Benchmark*
-
-
100
Within 6.0 — 9.0
120
t}-
,p
Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed. The facility shall
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier 1 or Tier 2 responses in the General Permit.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical monitoring waiver, the
discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for
analytical monitoring, i certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or
other similar materials were stored erposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since fi3ing the last discharge monitoring report."
Name (Print name)
Title (Print title)
(Signature)
(Date)
SWU-245-072808
Page 1 of 2

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE A_CTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
® Yes ❑ No (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample Collected,
mo/ddfyr
00400
00556
00530
Total Rainfall,
inches
New Motor OR Usage,
Annual average gallmo
pH,
Standard units
Oil and Grease,
mg/L
Total Suspended Solids,
mg/L
Benchmark*
-
-
-
6.0 — 9.01
30
100
,2
G
G
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pM, you must implement Tier I or Tier 2 responses in the General Permit_
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORNIATION REPORTED IN PARTS A AND/OR B:
"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 info ination 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 of5wes and imprisonment fpr knowing violations." y
of Permittee)
1
12,-21 I
(Date)
SWU-245-072808
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR D I
CERTIFICATE OF COVERAGE NO. NCG201[6][N[� (This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the. laboratory.)
FACILITY NAME um er o m Par+
PERSON COLLECTING S MP n� C f n
CERTIFIED LABORATORY -e r L e G Lab # i n
Part A: Specific Monitoring Requirements` Lab # FILES
111
1 s
1 11, 1 �Zlil_
I W 14 Lai 91 Do e LIMM [rJVJW_WJF,,ff-1JJ=
PLEASE SIGN ON THE REVERSE 4
Outfail
No.
Date
Sample Collected,
mold
Total Rainfall,
inches
00530 DW
00400
00340
Total Sagwaded Solids,
pH, -
Standard traits
Chemical Oxygen Demand (COD),
mgtL
Benchmark*
-
-
100
Within 6.0 — 9.0
120
0�Ito
�i
'Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on -ite for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed. The facility shall
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
*Note_ If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier 1 or Tier 2 responses in the General Permit.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical monitoring waiver, the
discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips,')ark, mulch or
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report."
Name (Print name)
Title (Print title)
(Signature)
(Date)
SWU-245-072808
Page 1 of 2

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
C4 Yes ❑ No (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Oatfall
No.
Date
Sample Collected,
mo/dd/yr '
00400
. 00556
00530
Total Rainfall,
inches
New Motor Oil Usage,
Annual average gal/mo
pH,
Standard units
Oil and Grease,
mg/L
Total Suspended Solids,
mg/L
Benchmark*
-
-
-
6.0 — 9.0
30
100
os
-
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier 1 or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Ralei North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED IN PARTS A AND/OR B-
"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 hoes and imprisonment f9x-kno ing violations." �-
(Signature of Permittee)
(Date)
SWU-245-072808
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000 nn SAMPLES COLLECTED DURING CALENDAR YEAR: 0
CERTIFICATE OF COVERAGE NO. NGG21©®©�! RECEWOnitoring report is -due at the Division no later than 30 days from
the date the facility receives the sampling results from the.laboratory.)
FACILITY NAME J . _ wnL er DEC 2 2 20i4
COUNTY D. 2r
PERSON COLLECTING 9AP4P ES RAL FILES PHONE NO. fo - L 1
CERTIFIED LABORATORY �' ` Lab # I 4.ZffWL3 SECTION
Lab # PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements)
Outfall
No.
Date
Sample Collected,
mold
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
pH, "
Standard units
Chemical Oxygen Demand (COD),
Benchmark*
-
- s
100
Within 6.0 - 9.0
120
f 10 1
.:
F
3
1
'Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed. The facility shall
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whom.
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier I or Tier 2 responses in the General Permit.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical monitoring waiver, the
discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch or
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than seven (7)
days before removal since filing the last discharge monitoring report."
Name (Print name)
Title (Print title)
(Signature)
(Date)
SWU-245-072808
Page I of 2

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
N Yes ❑ No (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfali
No.
Date
Sample Collected,
mo/dd/yr '
1 00400
. 00556
00530
Total Rainfall,
inches
New Motor Oil Usage,
Annual average gal/mo
pH,
Standard units
Oil and Grease,
mg/L
Total Suspended Solids,
mg/L
Benchmark*
-
-
-
6.0 — 9.0
30
100
bob,
'!rZ
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier 1 or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED IN PARTS A AND/OR B:
"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 f9r knowing violations."
L 1; 1
of Permittee) (Date)
SWU-245-072808
Page 2 of 2

STORMWATER DISCHARGE OU FALL (SDO)
MONITORING REPORT
GENERAL PERMIT NO. NCG210000 SAMPLES COLLECTED DURING CALENDAR YEAR: o I
CERTIFICATE OF COVERAGE NO. NCG2100®Q (This monitoring report is'due at the Division no later than 30 days from
the date the facility receives the sampling results from the.laboratory.)
A
FACII.IT'Y NAME Gr �r a n � � � �, I � D
COUNTYD n-er fr
PERSON COLLECTING S E5 n V PHONE NO.
CERTYFM LABORATORY Lab #
Lab # J UN 15 L rv, ►5 PLEASE SIGN ON THE REVERSE 4
Part A: Specific Monitoring Requirements' CENTRAL FILES
DWR SECTION-
Outfall
No.
Date
Sample Collected,
mo/ddlyr
Total Rainfall,
inches
00530
00400
00340
Total Suspended Solids,
pH, -
Standard units
Chemical Oxygen Demand (COD),
Benchmark*
-
-
100
Within 6.0 — 9.0
120
O -
,
J
`Monitoring is required only if the facility stores exposed piles of sawdust, wood chips, bark, mulch, or other similar material on site for longer than seven (7) days.
If the facility elects not to monitor because accumulated material is removed within seven (7) days or less, the certification below must be signed_ The facility shall
also record and maintain a log in its SPPP (Stormwater Pollution Prevention Plan) of dates when material is generated and removed, how, and by whorn-
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you must implement Tier 1 or Tier 2 responses in the General Permit.
Facilities that do not store exposed (either exposed to incident precipitation or exposed to stormwater run on) piles of sawdust, wood chips, bark, mulch, or other similar material for
longer than seven (7) days on site may so certify, and the requirement for analytical monitoring may be waived. For those facilities that qualify for the analytical monitoring waiver, the
discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement fi
analytical monitoring, I certify that to the best of my knowledge and belief, no piles of sawdust, wood chips, bark, mulch.or-0
other similar materials were stored exposed (either to incident precipitation or to stormwater run on) for longer than'en (7)
days before removal since filing the last discharge monitoring report." _ /(
Name (Print name)
Title(Print title) coop
(Signature) (Date)
SWU-245-072808
Page 1 of 2

DID THIS FACILITY PERFORM VEHICLE MAINTENANCE ACTIVIES USING MORE THAN 55 GALLONS OF NEW MOTOR OIL PER MONTH, ON
AVERAGE, IN THE CALENDAR YEAR?
0 Yes ❑ No (If yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfa11
No.
Date
Sample Collected,
mo/dd/yr
00400
. 00556
00530
Total Rainfall,
inches
New Motor Oil Usage,
Annual average galhato
pH,
Standard units
Oil and Grease,
mg/L
Total Suspended Solids,
nwx
Benchmark*
-
-
-
6.0 — 9.0
30
100
DS
*Note: If you report a value in excess of the benchmark value, or outside the benchmark range (for pH), you: must implement Tier 1 or Tier 2 responses in the General Permit.
Mail original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Rafe" North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY iNFORINiATION REPORTED IN PARTS A AND/OR B:
"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
imowledge 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 f9r knowing violations."
(Signature of Permittee)
Ate)
SWU-245-072808
Page 2 of 2