NCG060280_DMR_20210108

STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG060000
nn Q Date submitted
CERTIFICATE OF COVE AGE O. NMCGO6 V U Q_ SAMPLE COLLECTION YEAR clQ a o
FACILITY NAME ��
COUNTY SAMPLE PERIOD ❑ Jan -June sty -Dec
PERSON COL LEC ING SAMPLES S_ or ❑ Monthly' (month)
LABORATORY Lab Cert, a DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow Water Suppl ❑SA
getter s� �
Part A: Stormwater Benchmarks and Monitoring Results
FACILITY ACTIVITIES INCLUDE (check all that apply): ,
❑ use/process meats use animal fats/byproducts
PLEASE REMEMBER TO SIGN ON THE REVERSE
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outfall No.
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Only applles to facilities
that use/
ocess meats.
'The total precipitation must be recorded using data from an on -site rain gauge,
3 For sampling periods with no discharge at any outfalis. You must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies,
sMonthly sampling (instead of seml-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ❑ yes VO (Ifyes, complete Part B)
Permit Date:11/1/2018-05/31/2021
SWU-249, Last Revised 11/5/2018
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Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
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Footnotes from Part A also apply to Part B
*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 DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mall an_origlnal copy of this DMR, Including all "No Discharge" resorts, within 30 days of receipt of the lab results for at end of monitorina period In the case
of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 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 violafions." Af
Signature of
ittee
k wo v"
Date
Permit Date: 11/1/2018-05/31/2021 SWU-249, Last Revised 11/5/2018
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