NCG060161_MONITORING INFO_20181129

PERMIT NO.
DOC TYPE
STORMWATER DIVISION CODING SHEET
NCG PERMITS
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE - ZOI o Ifs,
YYYYMMDD

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 11 t5i I K
CERTIFICATE OF COVERAGE NO NCG06 D 1 1p i SAMPLE COLLECTION YEAR _ 2 O 19
FACILITY NAME C� Q�n2_ } �ci Cpq 5 3� [ L _!_ C F c! Y ACTIVITIES INCLUDE (check all that apply)
COUNTY 6__e Q6UX-SDn_ _ EOf [L use/process meats ❑ use animal fats/byproducts
PERSON COLLE ING SAMPLES 1 (0 C, 01 l-R- �N li 2 9 I tKHARGING TO SALTWATERS? YES ®NO
LABORATORY a ca Lab Cert # 40
CENTRAL F ILEA PLEASE REMEMBER TO SIGN ON THE REVERSE -i
DWR SECTION i
Part A Stormwater Benchmarks and Monitoring Results To tat event rainfall z 1 90or ❑ No discharge this period;
outfali No
Sample Collected,
ino/dd/yr
TS5,
mg/L
pH,
Standard units
COD,
MRA
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococd ,
Colonies per 100 mi
Benchmark
200 or 50
Within 6 0 —9 0
120
30
1000
500
O
1a2.t,
+S
2b
.25D
irS
L, O
2-
' Only applies to facilities that use/process meats
The total precipitation must be recorded using data from an on -site rain gauge
3 For sampling periods with no discharge at M outfalls You must still submit this discharge monitoring report with a checkmark here
`See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
Did this facility perform Velvcle Maintenance Activities using more than 55 gallons of new motor oil per month) ❑ yes "no (ifyes, complete Part B)
Part B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new motor oil/month
Outfall No'Ak
„-mo/dd/yr
' Sample Collected,-;
- bil and Grease,''
;- = ' �,m /Lq :
TS5,
mg/i ',=
pH,
Standard units
New Motor Oil Usage,
Annual avers a gal/mo
Benchmark
-
30
100 or 50
6 0-9 0
Only applies to facilities that use/process meats ,
The total precipitation must be recorded using data from an on -site rain gauge
3 For sampling periods with no discharge at anv outfalls, you -must still submit this discharge monitoring report with a checkmark here
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
SWU-249 Las; Revised C iLtobei 18, 2012
13100. 1 ni

*FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECTION B
+ 2 EXCEE DANCES IN A ROW FORTH E SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENT'S SEE PERMIT PART II SECTION B
+ TIER 3 rHAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALO YES ❑ NOX
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? 'YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
4
Mail an or> trial and one Lop 9f this DMR includip all "No Dtschar e" re orts within 30 days o receipt o the lab results or at end Of
monitoring period to the case of "Nd 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 violations "
(51gnature of Per
111101f
(Date -
Additional copies of this form may be downloaded at htt ortal ncdenr org/web/wq/ws/su/npdessw#tab-4
SWU-249 Last Ravi,-d 0 �i 19, 2012
'arr� ? of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Qt4alit General Permit No. NCG060000
Date submitted 1$ -
CERTIFICATE OF C VERAGE NO N G061 J SAMPLE COLLECTION YEAR
FACILITY NAME .� FAACWTY ACTIVITIES INCLUDE (check all that apply)
COUNTY fk=c C E1VCU[] use/process meats ❑use animal fats/byproducts
PERSON COLLEFT ING SA PLE V 2 2PWCHARGING TO SALTWATI:RS? YES XNO
LABORATORY kVCQ., Q � hic tiI Lab Cert # 'A O
CENTFRAL FILES
DWR SECTION
Part A Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE-)
Total event rainfall 2 1,55 r+or ❑ No discharge this period'
Outfall No
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Cohforrn ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 nil
Benchmark
- `
100 or S0
Within 6 0 — 9 0 _
120�
30
1000
500
Na
I I 3
,o
5 q o
S
3,
t0
` Only applies to facilities that use/process meats
ZThe total precipitation must be recorded using data from an on -site rain gauge
a For sampling periods with no discharge at any outfalls You must still submit this discharge monitoring report with a checkmark here
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes &no
Part 8 Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gat of new rotor oil/month
Outfall No' T
'
" sample Collected,
mo/dd/yr,- `'
611 arid'+Grease,"
-mg/L, �f�
TSS,
mg/L' 4
pH,
standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 50
6 0 — 9 0
` Only applies to facilities that use/process meats
z The total precipitation must be recorded using data from an on -site ram gauge
a For sampling periods with no discharge at anv outfalls, you must still submit this discharge monitoring report with a checkmark here
4See General Perm it text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
(f yes, complete Part B)
SWU 249 Last Rcvised Wobai 18, 2012
p,oj+ 1 of l

_ *FOR PART A AND PART B MONITORING RESULTS
+ A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART 11 SECTION B
• 2 EXCEE DANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART Il SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL) YES ❑ NO ER]
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME
Marl an original and one c9py 91 this DMR includingall "No Discharge" re orts within 30 da s o recer t o the lab results or at end o
monitoring aerrod in the case of "No Discharge" reportsjto
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, INC 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, acc ate, and complete I am aware that there are significant penalties for submitting false
information, including tt ie possibility of es and imprisonment for knowing violations "
(Signature
�2
( te) -
Additional copies of this form may be downloaded at htt ortal ncdenr orjz/web/wq/ws/suZnpdessw#tab-4
SWU-249 Last Rt-vised 0 '�r 18 2012
-lap Iof2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No NCG060000
Date submitted —1 \ I 11-I
CERTIFICATE OF COVERAGE NO NCGO6 0 _L o ( ��++ PSAM_PLE COLLECTION YEAR 2 d � -I
FACILITY NAME �� ' S L LLC RECEPA�CILtTTY ACTIVITIES INCLUDE (check all that apply)
COUNTYDEC }}77use/process meats ❑ use animal fats/byproducts
PERSON COLLEC5iNG SAMPLES 1 C 0.G� W o D1 CH ❑ ARGING TO SALTWATERS? []YES ®NO
LABORATORY t 0,U �0.� Lab Cert It 40 _ CENTRAL FILES
uvUK SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE
Part A Stormwater Benchmarks and Monitoring Results
Total event rainfall z or ❑ No discharge this period]
Outfall No
Sample Collected,
mo/dd/yr
TSS, ' "'
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6 0 — 9 0-
-120 ---
30
1000 __ `
Soo -
`t
k
a ii 'S-
-1 t
3(10
so
oS
A3, D
MID L s Q�
M14
Only applies to facilities that use/process meats
xThe total precipitation trust be recorded using data from an on -Site ram gauge
3 For sampling periods with no discharge at any outfalls You must still submit this discharge monitoring report with a checkmark here
4See General Permit text Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month) ❑ yes M no
Part B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new motor oil/month
Outfall IN ,
Sample Collected; t
mo/dd/yr
Oil and Grease,
Tx mg/L' -,
TSS,
- - r mg/L r_
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
30
100 or s0
6 0— 9 0
t Only applies to facilities that use/process meats
2The total precipitation must be recorded using data from an on -Site rain gauge
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
(ifyes, complete Part B)
SWU-249 LatiL Revised Octobei 18, 2012
Pace, 1 of 2

*FOR PART AAND 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 OUTFALL TRIGGER TIER 2 REQUIREMENTS SEE PERMIT PART 11 SECTION B
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALO YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Marl an original and one copy of this DAIR including all "No Dischar e" reportswithin 30 days o receipt o the lab results(or at end a
monitoring period in the case of "No Discharge' reports) to _
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, NC 271699-1617
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, inaludingthe possibility of firyas,and imprisonment for knowing violations "
(Signature of Permitfee)
(Date)
IL
Additional copies of this form may be downloaded at http 11portal ncdenr oWwebLwci/wslsulnpdessw#ttab-4
SWU-249 I Lv t Reviti4d O �r 18 2012
.'agi, ? of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No NCG060000
PC 0 6 li(A Date submitted
CERTIFICATE OF COVERAGE NO NCG06 C Q 0 O
FACILITY NAME C
COUNTY r,
PERSON COLLECTING SAMPLES Y�f CLC,% D 1
LABORATORY Lab Cert # 40
Part A Stormwater Benchmarks and Monitoring Results
RECEIVED
MAY 01 2017
SAMPLE COLLECTION YEAR 4 I -1 CENTRAL FILES
FACILITY ACTIVITIES INCLUDE (cheek all that apply) DWFZ SECTION
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS7 RYES fZNO
PLEASE REMEMBER TO SIGN ON THE REVERSE -)
Total event rarnfall 1_1A9 or n No discharge this penod3
Outfall No
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,,
mg/L
oil and Grease,
mg/L
Fecal Colrforrn ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6 0 — 9 0
120
30
1000
Soo
1
4 3
11
as -1
G ,�
59 o
s o
A
N A
DO
31
0
tj 1A
NIA
` Only applies to facilities that use/process meats
2The total precipitation must be recorded using data from an on -site rain gauge
3 For sampling periods with no discharge at any outfalls You must still submit this discharge monitoring report with a checkmark here
°See General Permit text, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes tKno
Part B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new motor oil/month
Outfall No'�
Sample Collected,
mo/dd/yr
Oil and Grease,
, .mg/L "`
z' TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
30
100 or 50
6 0 — 9 0
Only applies to facilities that use/process meats
The total precipitation must be recorded using data from an on -site rain gauge
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
(if Yes, complete Part B)
SWU-249 Last R,_vved Octobei 18, 2012
Pai?c, l of 2

*FOR PART A AND PART B MONITORING RESULTS
0 A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECTION B
0 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 OUTFALL7 YES ❑ NO M
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Marl an orr ►nal and one copy of this DMR including all "No Discharge" reports, within 30 days of receipt of the lab results or at end v
monitoring 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, i�uirgPvWsAi1ity of fr s a d imprisonment for knowing violations "
of Permitteej
Additional copies of this form may be downloaded at htt ortal ncdenr or web w ws su n dessw#tab-4
SWU-249 Lui Rcvi%ed O �i 18 2012
gage')oft

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT RECEIVED
for North Carolina Division of Water Quality General Permit No NCG060000
Date submitted —t 14-j 1-1 JAN 2 0 2017
FILES
CERTIFICATE OF COVERAGE NO NCG06 0 D L) Q SAMPLE COLLECTION Y€AR O I i0 CEWTCENTRALCENTRALC S
FACILITY N ME FACILITY ACTIVITIES INCLUDE (check all that apply) EN SA
COUNTY Y1 S r1 ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES W-0 1 DISCHARGING TO SALTWATERS) ❑YES MNO
LABORATORY
Lab Cert #
Part A Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE -)
Total event rainfall 1 or K No discharge this period3
Outfall No
Sample Collected,
mo/dd/yr
TSS,
mg/L
PH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coldorm ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or SO
Within 6 0 — 9 0
120
30
1000
S00
` Only applies to facilities that use/process meats
The total precipitation must be recorded using data from an on -site ram gauge
3 For sampling periods with no discharge at a y outfalls You must still submit this discharge monitoring report with a checkmark Here
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month) ❑ yes R1 no
Part B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new motor oiVmonth
,Dutfall Now k
Saf1' 0l4`Collected,"t'
,ma/dd/yr '
"- 0il and Grease; '
m LS 4e
- TSS,
mg/L V%t
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 50
6 0 — 9 0
only applies to facilities that use/process meats
The total precipitation must be recorded using data from an on -site rain gauge
3 For sampling periods with no discharge at 2U outfalls, you must still submit this discharge monitoring report with a checkmark here
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
(ifves• complete Part B)
SWU-249 Last Revised October 18, 2012
Page I of

*FOR PART AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART It 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 ANYONE OUTFALL? YES ❑ NO II
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE:? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
Mail an orr rnal and one copy of this DMR including all "No Discharge" reports, within 30 days of receipt of the lab results or at end o
monitoring 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
"l 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 o y knowledge and belief, true, accurate, and complete I am aware that there are significant penalties for submitting false
informati9fi, in lu iing'f k pAsibility gPftlnes and imprisonment for knowing violations "
(Signature of Permittee) (Date)
Additional copies of this form may be downloaded at http /(portal ncdenr orgjweb/w9/ws/su/npdessw#tab-4
SWU-249 ti ` Lass Revised O 'gr 18, 26i2
'age 2 of 2

SEMI-ANN
for North Carolina Division of Water Quality General Permit No NCG060000
Date submitted
V
CERTIFICATE OF <:�OVERAGENO NCG06 o i I SAMPLE COLLECTION YEAR 2-
SAMPLE
FACILITY NAME C� j-Q.rV J 6p � s 1� u C FACILITY ACTIVITIES INCLUDE (check all that apply)
COUNTY use/process meats ❑ use animal fats/byprod ncts_
PERSON COLLECTING SAMPLES `—r�GCC� Iti3c 1 JD r j;? 1 DIS`CHTRGING TO SALTWATERS7 YES RN
LABORATORY_ &cc ANA � C+g � Lab Cert li �� �tJ�L Z
JUL 2 2 2415 PLEASE REMEMBER TO SIGN ON THE REVERSE -i
CENT %AL FILES
Part A Stormwater Benchmarks and Monitoring Results tmnrrJ Total event rainfall 0.-7St3r 0 No discharge this period`
Outfall No
Sample Collected,
mo/dd/yr
TSS
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform
Colonies per 100 mi
Enterococci
Colonies per 100 ml
Benchmark
1D0 or 50
Within 6 0 - 9 0
120
30
1000
500
s/
4o
(, o 2
�
ri I D <50
NIA
tJ)A
b ff; 1 A6
Tq. 5'
2 2-S
tjD C s a
A
1�
Only applies to facilities that use/process meats
a The total precipita Lion must be recorded using data from an on sits rain gauge
For sampling periods with no discharge at a� outfalls You must still submit this discharge monitoring report with a the ckmark here
'See General Permi t text Table 3 identifying the espen-Ay sensitive receiving water classifications where the more protective be nchm-irk ipplies
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month')Q yer, P"no (if yes, complete Part B)
Part B Vehicle M aintenance Area Monitoring Results only for facilities averaging > SS gal of new motor oil/month
outfall No
Sample Collected,
mo/dd/yr
DU and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
30
100 or 50
6 0 - 9 0
-
only applies to facilities that use/process meats
2The total precipitation must be recorded using data from an on site rain gauge
i For sampling perio cls with no discharge at any outfalls you must till submit this discharge monitoring report with a checkmark here
°See General Permit text Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies
"W l l 2 lr} I N RLVI%Ld l h t0hei IX 201
a

• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECTION 8
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFAU 1 RIGGER TIER Z REQUIREMENTS SEE PERMIT PART II SECTION 8
• TIER 3 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR 1 HE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO L.
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME
Marl an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or^ot end o
monitoring 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 tinder 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, inclu.*g thekossil).}Iity of fiW s and imprisonment for knowing violations "
(Signature of Permi
7//�A
(Date)
Additional copies of this form may be downloaded at htt )portal n(-denr org/web/wc�ws/su/imdesswNtab 4
bIvlI 249
I I'll RL VI"Ld t) i 1'i 2012
�'1t:u1'uI2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water quality General Permit No. NCG060000
Date submitted -7 -S 1 S-
CE RTI F I CATE OF COVERAGE NO NCG06_0 1 V I SAMPLE COLLECTION YEAR -01 S
FACILITY NAME C FACILITY ACTIVITIES INCLUDE (check all that apply)
COUNTYRECEwEMse/process meats []use animal fats/byproducts
PERSON COLLECTING �MPLE��pO- rt JUL
ORLAIBORATOMC�p%VRGINGTOSALTWATERS? ❑YES ENO
Labl4CENTRAL FIDES PLEASE REMEMBER TO SIGN ON THE REVERSE �
QWFi SECTIONPart A Stormwater Benchmarks and Monitoring Results Total event rainfall Zt), �3 or ❑ No dischorge this perlod3
Outfall No ;
Sample Collected,
mo/dd/yr �''
TSS,,
'mg/L
r pH,
Standard units
COD,
mg/L
Oil and Grease,
mgJL
Fecal Coliform ,
5 Colonies per 100 ml
Enterococcl ,
Colonies per 100 ml
Benchmark'
t -
100 or 50
Within 6 0 - 9 0
' 120
30
1000
500
+a t75
3
112 0
9z
q 4z
to
a
a.
Sb
s
o
` Only applies to facilities that use/process meats
2 The total precipitation must be recorded using data from an on site rain gauge
a For sampling periods with no discharge at any outfalls You must still submit this discharge monitoring report with a checkmark here
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes (�no
Part B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new motor oil/month
1;Outfall No ' +;
Sample Collected,
'mo/ /y
4 %Od and Grease,
t .. g/
TSS,
t mg/L „-
pH,
= Standard units
New Motor oil Usage,
Annual average gal/mo
Benchmark 'r�• t
- .�
f ' 301`
100 or 50
6 0 — 9 0
y -
' Only applies to facilities that use/process meats
2The total precipitation must be recorded using data from an on site rain gauge
3 For sampling periods with no discharge at any outfalls you must still submit this discharge monitoring report with a checkmark here
°See General Permit text Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
(if ves• complete Part B)
SWU 249 Last Revised October 18, 2012
Paine 1 of 2

*FOR PART A AND PART B MONITORING RESULTS
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PARTIII. 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 X
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 wrthrn 0 days of receipt of the lab resrilts (or at end of
monrtorinq_perrod in the case of "No Discharge" reports) to
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, NC 2769911617
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„ueSludin,&.t�e pAsibilip(ToTymes and imprisonment for knowing violations "
of
7 J—
(Dat )
Additional copies of this form may be downloaded at http //portal ncdenr org/web/wq/ws/su/npdessw#tab-4
SWU-249 Last Revised October 18 2012
Page ') of 2

SEMIANNUAL STORMWATER DISCHARGE MONITORING REPORT RECEIVED
for North Carolina Division of Water uality General Permit No NCG060000
16
I G I CENTRAL FILES
Date submitted 11 10 i J` NOV ���+3
CERTIFICATE OF COVERAGE NO NCG060 SAMPLE COLLECTION YEAR 1� plR SECTION
FACILITY NAME _._ +v FACILITY ACTIVITIES INCLUDE (check all that apply)
COUNTY {bp.v. ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES act Wo I�C- DISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY ,.S -P-A Lab Cert # L 4t�
Part A Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE ->
Total event rainfall z or n No discharge this period'
Outfall No
Sample Collected,
mo/dd/yr
`` T5S,"�
mg/V
pH,
Standard units
COD, ,♦♦
mg/L ,
Oil and Grease,
mg/L
Fecal Cohform ,
Colonies per 100 mi
Enterococci ,
Colonies per 100 ml
Benchmark z
' -
`100 or 50,
Within 6 0 - 9 0
12W,
30
1000
500
11,31 is
51b
(0- 313"
o
o�
Oita ij
�Sb
�.lal'
U
SO
1 Only applies to facilities that use/process meats
2 The total precipitation must be recorded using data from an on site rain gauge
3 For sampling periods with no discharge at any outfalls You must still submit this discharge monitoring report with a checkmark here
45ee General Permit text, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes N no
Part B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new motor oil/month
Outfall No �"
Sample Collected, t
-mo/dd/yr,,,,^,,1
Oil and Grease,
mg/I. Mn ;
' TSS,
mg/L "" Y
pH,
Standard units "
New Motor Oil Usage,
Annual average gal/mo
Benchmark
- '
`: 30 -
100 or 50
6 0 - 9 0
-
Only applies to facilities that use/process meats
z The total precipitation must be recorded using data from an on site rain gauge
3 For sampling periods with no discharge at anv outfalls, you must still submit this discharge monitoring report with a checkmark here
45ee General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
IN
(if yes, complete Part B)
SWU-249 Last Revised October 18 2012
Pate I of 2

*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 FXCEEDENCFS FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME
40
Marl an original and one copy of this DMR, including all "No Discharae" reports, within 30 days of receipt of the lab results for at end of
monitonnncoenod 1n the rase of "No Discharge" reports) to
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617 w 'y
f i
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
information, ino�i g po i4
(Signature of Permittee)
f, true, te, and complete I am aware that there are significant penalties for submitting false
f fin and prisonment for knowing violations "
(Da e)
Additional copies of this form may be downloaded at http //portal ncdenr org/web/wq/ws/su/npdessw#tab 4
t
SWU-249 Last Revised October 18 2012
Page 2of2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Q allty General Permit No NCG060000
Date submitted [ - I
CERTIFICATE OF COVERAGE NO NCG06 r.-�1 lLp I
FACILITY NAME
COUNTY S
PERSON COLLECTING SAMPLES -`t—C cLKAi L_ Q01
LABORATORY1�rnfLS CL,4 "J +vreS Lab Cert #
Part A Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2-0 1 A -
RECEIVED
DEC 18 2014
CENTRAL FILES
DWR SECTraN
FACILITY ACTIVITIES INCLUDE (check all that applyj
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS) DYES J�JNO
PLEASI REMEMBER TO SIGN ON THE REVFRSL -)
Total event rainfall � 1 31 or ❑ No discharge this perfod3
Outfall No
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Conform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6 0 — 9 0
120
30
1000
Soo
�, �-
- G 4
ll G C>
2-
L S C>
i�
D-L
400
L'. $
o
Only applies to facilities that use/process meats
The total precipitation must be recorded using data from an on site rain gauge
3 For sampling periods with no discharge at any outfalls You must still submit this discharge monitoring report with -i checkmark here
4See General Permit text Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes [5� no
Part B Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new motor oil/month
Outfall No
Sample Collected,
mo/dd/yr
1 Oil and Grease,
mg/L 4
TSS,
mg/L AY' A
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
30
100 or 50
6 0 — 9 0
' Only applies to facilities that use/process meats
2 The total precipitation must be recorded using data from an on site rain gauge
3 For sampling periods with no discharge at any outfalls you must still submit this discharge monitoring report with a checkmark here
4See General Permit text, Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies
(if yes complete Part 13)
SWU 249
l itit Rcvise0 OciobCi 18 2012
Pave I of 2

*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
Marl an original and one copy of this DMR, rnclud►ng all "No Discharge" reports, within 30 days of receipt of the lab results (or at end o
monitoring 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 t
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, curate, and complete I am aware that there are significant penalties for submitting false
information, igetoling tye jyi possty of fa s a d imprisonment for knowing violations "
(Signature of Permitt (Date
Additional copies of this form may be downloaded at http //portal ncdenr orR/web/wq/ws/su/npdessw11tab 4
kSWU 249 I'a"I Revned O c 18 2012
I aif,c 2 of 2

Semi-annual Stormwater Discharge Monitoring Report DECEIVED
for North Carolina Division of Water Quality General Permit No NCG080000 AUG 0 6 2014
Date submitted 8' �\ \`4
` [ CENTRAL FILES
_ _SAMPLE COLLECTION YEAR Jug\`1 btu DW0180G
CERTIFICATE OF COVERAGE NO NCG08 � � � L
FACILITY NAME �s4or �� (�� , 1 RG _ SAMPLE PERIOD ❑Jan -June ❑July -Dec
COUNTY or & Monthlyl� frnont�
PERSON COLLECTING SAMPLES _ DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY Lab Cert # []zero -flow [:]Water Supply []SA
Comments on sample collectio�ntor analysis - - [$dOtherq
<� PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of nag �i��� _ yes Ono
R
(if yes report your analytical results in the table immediately below) G
AUG 0 6 2014
Part A Vehicle Maintenance Areas Monitoring Requirements (If applicable) ` `_ CENTRAL FILES ❑ No discharge this period'
Outfall
No
~Date-
Sample Collected,~
mo/dd/y�
ri 00530
00400? a
Y 0556
x
Total Suspended
<< Solids, mg/L -
' `,'pH,;s ,N'`
Standardhunits r
.Non -Polar Oil and Grease/TPH`EPA
Method 1664 (SGT-HEM), rxig/L
New=Motor Oil Usage,
Annual ave age gal/rno
Benchmark
= '
50 or 100 see permit
Within 6 6 — 9 0
i5
PartB Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable)
Outfall
f No
Date ,, a,
T"k,_,5 , C.r It
-Sample Collected, t
Im77o/dd/yr. Ta
, I - , 00556 u ���� � ;�
00530
�.'.Q0400 ->
Non -Polar Oiland Grease/TPA EPA Method'
1664 (SGT-HEM); mg/L `,ter 3
`r;; Total Suspended Solids;`
mg/L
�5tan%QXits
Kermit Limit w
x� _
w.�, 15 _ _'�
50 or 100 see permit
F 6 09 0�
�'Lt-Z01Ark3
,O
LOS 0
—V
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

it
STORM EVENT CHARACTERISTICS
Date-71
ZI r (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 Il 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 ONF 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 signiricant penalties for submitting false information including the possibility of fines and imprisonment for knowing violations "
(Signature of Permittee)
?1, iLi
(Date)
Additional copies of this form may be downloaded at http /I_portal ncdenr ore/web wg/ws/su/npdessw#tab 4
S W U-250
last revised April 11, 2013
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water quallty General Permit No NCG060000
Date submitted _ `+
CERTIFICATE OF COVERAGE NO NCG060 i SAMPLE COLT ECTION YEAR 2-014
FACILITY NAME u C FACII. I rY ACTIVITIES INCLUDE jcht_ck Al that ipplyj
COUNTY � �v � � _ [Isc/process Meat% El tisc animal fat%/bypruducts
PERSON COLLECTING SAMPI L5—1(-C,- . Wol _ DISCHARGING TO SALTWATEIIS� (- IYES 5(I1\10
LABORATORY_ rv.k5_rt`rrnv _S.__ L-1b Cert it
Part A Stormwattr Benchmarks -ind Monitoring IIC%ltlt%
Outf Ill
kS4nchrri it
Wit
f'1 f A -if W MI MfO It i()',K,N ON 1111 kf Vf k"i -r
lolol e vi of fotnjull I lO5 w I I No rlr (lultip this potlrlfl
No
_
Simple Co11c-Cited
TSS
pH
COD
Oil and Grc ise
FCC 11 Coliform�
Nnterncoct.Il
Intl/dd/yr
rig/1
Standard units
--mg/L
ni}/t. — -_
Colonrrt pit r 100 ml
C0I01111L% pt_r 100 nit
�100 or 504
Wilhlm 6 0 — 1) 0-
170
_ 1000
k
10
r00
�^
— to, —��I_29
Iz1'4----I-°�-
-3
---�-
_ Sot
_�=��__ --
- tNz ---
W 3S----
--LSe_
_ '`'�A—
tirlly i1)lliie ir1 f I�IIIIIt 111 it 13 t /plot t Int it JUL Y
111( lot ll pit r 111Ii 11wrl 11111 1 Ill et ( otffr d I1 iiii it it i 11(1Fri Ilk rill lit r 1111 t ki( ( 1 1 2�14
` �i i� ! RA
I l,l II11111111t jIL'r I(SSI bull It Ilil (11 t h Ii ICI 11 Illy Ulltl ill /Uk! Intl 1 11 I111111It Lilt ( I 1 1 111 t IrlUIllrI i11111 1! 111 t It III Ir )� I t
1�1 t Ctt lit 1 11 1 e Irillt II 51 I IhIt r Idt rrlltylnl lilt t ill I I illy 111 IIIV It tt Ivirli W lit 111 i Itll 1tlUll W114 it Ills I11�rRY1(f/yZl}i�a,
n nit film III' II iIlI1i
Did thl, f,icillty 13t.rfarnl Vr hlcl€ M iintt n mu- Artivitlt % u5inp rnore th in S5 Valion% of new motor oil lit r month? L—I v( I Ili) ILt yt (mltlllt if f IrI P)
, t u kh k,rlo Mzrntr n Mcil Arc. i Monitorinil Result% only for f`i(il{ties averaVinl, > 16 t, ll of new rnotoi oil/month
Dutfall No
Sample Cnllc ct(-d,
mio/dd/yr
oiland Grease
rig/L
755 — —
mg/L _
- --T pH ---
_ Standird units
New Motor Oil D% ire--
Annual average g-J/nio
Bi-richm-irk
30
100 or 504
—i
6 0 - 9 0
-
Or)iy 11)plit to I lLliltlt- u1 it it c /prtx t lilt n,
Ihi tot II 17r Cf 113tI9lIUi1 rnt, I ht rt c ur dl ci mir i, cl )t i f rorn won It t r wi Y lupt
`I LII lnlplinj period,, with no (it-( hart,( It lc)y nkltf ills YOU 11111%I 1111 uhnllt thls ell ch Irl c mumloring rr poi t with 1 t ht r klmark h(_rt
lL,e GCS)0 11 I'Crinit text f INO i ICirntlfyn)[I t11e t pCc1111y St n IIIVi r1 ct Iv(rig w)tt r c11 ilic ition whirr Ihi rnoi � piolt t iwc he nit hest irk ipplii
SbVI, ! I`I I 1,1 hit � IA (I c >(.luht 111 't112
I i-t I �tl

A BI NCI ]MARK l-XCI I DANCI I RIGGt RS TIER 1 REQUIREMENTS SEI PFRMI 1 PAR I It 51 C f ION B
• l I XCI f OANCI S IN A ROW I OR I I II SAML PARAMf 1 I R Al Ill) SAM[ 011I I AI ! I RIG(i1 R I IER 2 REQUIREMENTS Sl Lilt RMI I PAP I II SLCI ION B
• TIFR 3 I IAS YCIUR f ACII:IY HAD 4 OR MORE M W HIVIARK I XCI f A NCI S I O R I l d ')AMf PARAMI 11 R AI ANY ONL 01,111 AI I' YI S NO k
IF YrS I IAvr YC)11 (0)N I AC H ID i M I )WO Iil CIONAI (�I f !Cl YES 1" NO"
fil (110NAt Oi FICI CO)NIACI NAMI
Mail an original and one copy of this DIME?, including all No Disehorrlctcpoi ts,_within 30 days of rcaceipt of the lob results (or at end o
monrtoring_penod in the cast of "No Discharge" reports) to
I)1vl Inn of W it( r oil Illty
At It) DWO C(,ntr 01II(_
101 / M III )Olvl(.( C('nt( I
k lit 11dh NO, 77099 1617
YOU MUST SIGN THIS CrL10It ICAIION IOR ANY INFORMA7ION REPORl'LD
I(( Itlfy tlil(f+_r 11( 11 illy cif I Iw III It till (ltlt 1.1111( lit llld III <111 I( hill( Ill W( if I)I( 1) IT( 11 (111(h I Illy (11111( 1101) of ,till! IV1 Wll Ill 11 ( ()l(1 ill(( Willi Y
yeti Ill III II'rI( d to IS ll1( lh It (Ill IlIf1( d I)( 1 onm 11)iopi: rly 1' Ilh( r vil f ( V III] III tll( 1111(lrlll ItlOII tlhlllllt( (i B l,(_cl wl Illy 111(pwy of III(_
I)(?I I)Il or 1)( 1 ,01), WhO Ill Ill r1'( f11( y,1[0(tl Ol tllc),( 1)(_r art, (ill('(tly r( ,pllll Ihl( hil 1' lih( 1111fr Ill( lnfcwn It1on th( Itllornl 1t1OII tlhrilltl(_(l I
I Iht hl `t of Illy knoWl( dg( Irl(1 h( It( f trll( lf((lr )to w(f G(-)MI)I01' 1 1111 cIW 111 t11,11 t11('10 11(_ ,IgIllfic.lilt 1)('II,IItE(" f()I (Il-ImIltllll( fll,(_
111fn1In-it lolI Iry,+m'ding lJlr^No ( r Iy nt Inca nnllrI,(Mill ('Ilt for knowlnll viol -)ttow
(SIl;11113ture of Permtttee (Date)
Additl(in ll (+)I)1( of till, Juml Ill ly h( clC)wWo 1(l( (t It 1111I) ii}1(r(t ll 111+I_nr ml IW( Ili+l(lit- , ('i 11)+h ,wilt (1) 11
%wlI )1(l I r1 iti