NCG060126 DMR SW (6)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality eneral Permit No. NCG060000
Date submitted % Z 0 l
CERTIFICATE OF COVERAG ENO. NCG06_'0'1 o2
FACILITY NAME
COUNTY , 1o_&e_�
PERSON COLLECTING SAMPLES S
LABORATORY 4 "A /6,L7r c --Lab Cert. #
SAMPLE COLLECTION YEAR 20 /
FACILITY ITIES INCLUDE (chec that apply):
use/process meats use animal fats/ products
DISCHARGING TO SALTWATERS? ❑YES 0146
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall Z or ❑ No discharge this period3
�Outfall,.N " ..m I a . ;> 1 y �.
o Sa "p a?Collected, TSS,,F s„ pH, COp; ,*TO and Grease, Fecal.Cohform , Enterococci
.did ....:5, ., , <x =':.: .. F .✓ %.u... ,,,,.r,.
mo/ddStandard.,umtsK, NO'N'. /L�;Colornes;per 100 mlr .:Colonies°per, 100 m1 .:
`?.a
—
Benchma�k2 s l00 Or504 WI hin
,9 0 120`' w
00 500
V0, ;
unit' appnes to Tacmues inat 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.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no
rart D: venicie maintenance Area monitoring Kesuits: only tor tacilities averaging > 55 gal of new motor oil/month.
- uniy appnes to tacnives tnat 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 anyoutfalls, 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 Last Revised: October 18, 2012
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*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 THPSAME 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 (or at end of
monitoring period in the case of "No Discharae" 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."
Permittee)
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
5MU-249
Last Revised: October 18, 2012
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