NCG060344 DMR SW (7)

SEMS-Ai\iNd. 'AL ST®P,MWATEim, D SCCC1ARGE Pt/101170RM* REPORT
for NI•,rth Carolina Division of Water Quality General Permit No, iNI00060000
Date submitted €Y AF- ....1D/7
oCe7CERTIFICATE OF CO RAGE NO.. NCG06_� �y SAMPLE COLLECTION YEAR 477040,FACILITY!MAIM dZi/3! „, /,13/./.. �/ S / FACILITY ACTIVITIES INCLUDE(check
COUNTY (,GU2/7 use/process meats u alls that apply):
❑ /p ❑ use animal,f is/byproducts
PERSON COLLECTING SAMPLES — 'i rt ill, ` QI,SCHARGING TO SALTWATERS? DYES �YNO
LABORATORY Lab Cert.# a �/ �,�Y
FFA 06 2017 PLEASE REMEMBER TO SIGN ON THE REVERSE 3
Part A:Stormwater Benchmarks and Monitoring Results o r L FILES Total event rainfall2 or No discharge this period3
Outfall No. _ Sample Collected, T55, pH, `C'= N,,N Oil and Grease, Fecal Coliform'', Enterococci1,
mo/dd/yr mg/L - Standard units mg/L mg/L Colonies per 100 ml Colonies per 100 ml
Benchmark, 100 or 50° Within 6.0—9.0 120 30 1000 500
A .s ,�p/.fo ,Ian, '%/, X k /a ' / ' Gii'` - 0L / o.. 4 / ,;.4r1.�
'1
ryzorfI/./-- L / .e i, / air•. ' i3 fili2i /
I
1 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.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?❑yes gno (if yes, complete Part B)
Part B:Vehicle Maintenance Area Monitoring Results:only for facilities averaging>55 gal of new motor oil/month.
Outfall No. Sample Collected, Oil and Grease, TSS, pH, New Motor Oil Usage,
mo/dd/yr mg/L mg/L Standard units Annual average gal/mo
Benchmark - 30 100 or 504
6.0-9.0 -
1 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.
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.
o 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
e TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO B.
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 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."
& \r/9-/V,;),0/
(Signature of Permittee) (Date)
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
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