NCG060133_MONITORING INFO_20150409

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
oam
YYYYM M DD

;;►
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted I '02 g Zo 1°I
CERTIFICATE OF COVERAGE NO. NCG06D 133 SAMPLE COLLECTION YEAR rYu1�
FACILITY NAME QQ�ti CK+rb[r t-c•cd R)j I 1 FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY ❑ use/process meats [] use animal fats/byproducts
n{�
PERSON COLLECTING SAMPLES REC�"1Vj7,7i]�CHARGING TO 5ALTINATERS? AYES 210
LABORATORY Lab Cert. # FEB n e
PLEASE REMEMBER TO SIGN ON THE REVERSE -3
WR SEC? IO- z
Part A: Stormwater Benchmarks and Monitoring Results fatal event rainfall or o 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
-
100 or 50
within 6.0 — 9.0
120
30
1000
S00
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 gU outfalls. You must still submit this discharge monitoring report with a checkmark here.
'See General Permittext, 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 ono
Part 13: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new -motor oil/month.
Outfall No.
Sample Collected,
mo/dd/ r
Oil and Grease,
mg/L
TSS,
mg/L
ply,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or SO
6.0 —9.0
-
2 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 anj 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 yes, complete Part B)
SWU-249 Last Revised: October 18, 2012
Page 1 of 2

,a
'FOR PART A AND PART B MONITORING RESULTS:
0 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:
Mail an oricrinal and one tope of this DMR, including all "No Discharge" reports, within 30 dabs of receipt o fthe 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."
(Signature of Permittee)
ti ag I o
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.ore/web/wa/ws/su/nodessw#tab-4
SWU-249 Last Revised: October 18, 2012
Page 2, of 2

*FOR PART A AND PART B MONITORING RESULTS:
0 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 II SECTION B.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FORT E SAME PARAMETER AT ANYONE OUTFALL? YES []NO2'
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mall an arf final and one copy of this DMR including all "Na Dischar e" reports wlthfn 30 day s a recef t o the !ab results or at end of
monftorfngperiod in the case of "No Discharge" reports} to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1517
YOU MUST SIGN T141S 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."
(Signature of Permittee)
Ci hq�
(Date)
Additional copies of this form may be downloaded at: httl2:Zlportal.ncgenr.org/webLwq/­ws/­su/nLdessw#tab-4
SWU 249
Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT RECEIVED
for North Carolina Divisions of Water Qjpaity General Permit No. NCG060000
Date submitted 9IIX$P 2 4 ZQ iij
CERTIFICATE OF CqVERAGE N NCGOS9 3 SAMPLE COLLECTION YEAR ROD CZNTRAf AIL
FACILITY NA . ryjli bq&tt �c�c� MA FACILITY ACTIVITIES INCLUDE (check all that apply): DWR SE CTlt7,,\
COUNTY ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES DISCHARGING TO SALTWATERS? []YES ®NO
LABORATORY Lab Cert. #
PLEASE REMEMBER TO SIGN ON THE REVERSE 3
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall s or ® No discharge this period'
Outfall No.
Sample Collected,
mo/dd/ r
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enteracoccl ,
Colonies per 100 ml
Benchmark
100 or 50
Within 6.0— 9.0
120
30 J
1000
Soo
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 ay 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? 0 yes ❑ no 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,
mo/dd/yr
Oil 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
-
1 Only applies to facilities that use/process meats.
zThe total precipitation must be recorded using data from an on -site rain gauge.
s For sampling periods with no discharge at�yn outfalls, you must still submit this discharge monitoring report with a checkmark here.
"See General Permit text, Table 3, identifyingthe especially sensitive receiving water ciassifcations where the more protective benchmark applies.
5WU-249 Last Revised: October 18, 2012
Page l.of 2

Gf✓ A& K
STATE OF NORTH CAROLINA REC V ED
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES APR 2 20i8
GENERAL PERMIT NO. NCG464040 CENTRAL FILESDWR SECTION
CERTIFICATE OF COVERAGE No. NCG060133
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Cargill, Incorporated
is hereby authorized to discharge stormwater from a facility located at:
Cargill Feed & Nutrition Barber
9150 Statesville Blvd.
Cleveland
Rowan County
to receiving waters designated as Withrow Creek, a Class C waterbody in the Yadkin River
Basin; in accordance with the effluent limitations, monitoring requirements, and other conditions
set forth in Parts I, II, I11, and IV of General Permit No. NCG060000 as attached.
This certificate of coverage shall become effective April 24, 2018.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 24, 2018.
for William E. Vinson, Jr., P.E., Interim Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

MLA &
NCDENR
Fm­M . NRVR Rsou
Division of Energy, Mineral & Land Resources
Land Quality Section/Stormwater Permitting
National Pollutant Discharge Elimination System
PERMIT NAME/OWNERSHIP CHANGE FORM
1. Please enter the permit number for which the change is requested.
FOR AGENCY USE oNI.Y
Date Received
Year
Nkonth
Day
NPDES Permit
(or) Certificate of Coverage
N
N Cl ;G 0 1 6 10 1 1 13 3
II. Permit status pfigr to requested change.
a.
Permit issued to (company name):
Southern States Cooperative, Inc.
b.
Person legally responsible for permit:
Jim Moore
First MI Last
ED
Vice President
aecE
FEB 26 2411
Title
PO Box26234
�C) QUALITY
Permit Holder Mailing Address
DENR-gyp pERMITTING
Richmond VA 23260
STORM HATER
City State Zip
( 804 ) 281-1000 ( )
Phone Fax
c.
Facility name (discharge):
Southern States Coop - Cleveland Feed Mill
d.
Facility address:
9150 Statesville Blvd
Address
Cleveland NC 27013
City State Zip
e.
Facility contact person:
Glen Fisher ( 704) 278-2941
First / M1 / Last Phone
Ili. Please provide the following for the requested change (revised permit).
a. Request for change is a result of: ■* Change in ownership of the facility
■0 Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
d. Facility name (discharge):
e. Facility address:
f. Facility contact person:
Cargill, Incorporated
Susan Haas
First MI Last
Global Business Operational Leader
_
Title
15407 McGinty Road West
Permit Holder Mailing Address
Wayzata MN 55391
City State Zip
{ 800 ) 227-4455 [e-mail]
Phone E-mail Address
Cargill Feed & Nutrition Barber
9150 Statesville Blvd
Address
Cleveland NC 27013
City State Zip
Glen Fisher
First Mi Last
( 704 ) 278-2941 Glen [e-mail]
Phone E-mail Address
IV. Permit contact information (if different from the person legally responsible for the permit)
Revised Jan. 27, 2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact: Sherrie Suttles
First M 1 Last
EHS Lead, North America
Title
2400 Industrial Drive
Mailing Address
Sidney OH 45365
City State Zip
( 937 ) 205-4153 Sherr-ie—[e-mail]
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
■0 Yes
❑ No (please explain)
VL Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
■❑ This completed application is required for both name change and/or ownership change
requests.
■❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, , attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this
application package will be returned as incomplete.
Signature
APPLICANT CERTIFICATION
Date
1, Susan Haas , attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this
applica ackage wi be returned as incomplete.
as (A- f�?
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014

MAP 5/M I PAR 5JP l3/IN L/IN I C/C I PART iNT This certifies that there are no delinquent ad valorem real estate taxes, which the
270 1 037 22 Rowan County Tax Collector is charged with collecting, that are a lien on:
Rowan County Assessors office Property Identification Number 270 037
This is not a certification that the Rowan County Property Identification Number
matches this Deed description.
Record and return to: Tanya Parnell CWR 09-25-2017 11:55:24
Rowan Co. Tax Collections Manager Clerk Date/Tlme
First American Title Insurance Company Type: CONSOLIDATED REAL PROPERTY
801 Nicollet Mall, Suite 1900 Recorded: 9/25/2017 12:07:40 PM
Minneapolis, MN 55402 Fee Amt: $26.00 Page 1 of 5
Attn: Kathy EstenZ2 Y970son Revenue Tax: $0.00
Al 13 5 - 8 � ,41-S Rowan, NC
J. E. Brindle Register of Deeds
Prepared by:
Christina J. Fulham
Ropes & Gray LLP
800 Boylston Street
Boston, MA 02199-3600
SPECIAL WARRANTY DEED
BK 1296 PG 945
THIS SPECIAL WARRANTY DEED is made effective as of , 2017
by and between Southern States Cooperative, Incorporated, a Virginia corporation, with a
principal mailing address of6606 West Broad Street, Richmond, VA 23230 (hereinafter "Grantor"),
and Cargill, Incorporated, a Delaware corporation, with a principal mailing address of 15407
McGinty Road West, Wayzata, MN 55391 (hereinafter "Grantee").
Grantor, in consideration of the sum of One and no/100 Dollar ($1.00) and other good and
valuable consideration, to it paid by Grantee, the receipt of which is hereby acknowledged, conveys,
confines and warrants to Grantee, its successors and assigns, the following described real estate in
Rowan County, North Carolina, more particularly described in Exhibit A (attached hereto and made
apart hereof) (the' a '), together with all hereditaments and appurtenances belonging thereto
and all improvements and buildings thereon, subject to those exceptions set forth in Exhibit B
(attached hereto and made a part hereon and to the extent they lawfully affect the Property (the
"Permitted Encumbrances").
Said Property having been previously conveyed to Grantor by instruments recorded in
Book 623, Page 911, and Book 1028, Page 218 of the Rowan County Recorder's Office.
AND Grantor hereby covenants with Grantee, and its successors in interest, that Grantor
holds the Property by title in fee simple; that it has good and lawful authority to sell and convey the
same; that the Property is free and clear of all liens and encumbrances whatsoever, except for the
Permitted Encumbrances; and Grantor covenants to WARRANT and DEFEND the Property against
the lawful claims of all persons whomsoever claiming by, through or under Grantor, except for
those matters which are Permitted Encumbrances, but against no others.
[SIGNATURE PAGE FOLLOWS]
Parcel ID No. 270037
submitted electronically by "First American NCs Minneapolis"
6489C'in compliance with North Carolina statutes governing recordable documents
and the terms of the submitter agreement with the Rowan County Register of Deeds.
;ook: 1296 Page: 945 Page 1 of 5

Executed under seal as of the date first set forth above.
SOUTHERN STATES COOPERATIVE,
INCORPORATED, a Virginia corporation
By: 91��
Name: %E'o eJ-f L. ,046--
Title: SEc•,Pz7-5716 '
STATE OF I//�c53iNii9 ) .
:SS
COUNTY OF e �d iX l eo )
I certify that the following person personally appeared before one this day, acknowledging to me
that he/she signed the foregoing document: Qiee4 L. —AMA E 11rr 1' Se7116—XW
[insert name of principal). 57;b72E.5 C'odPe�eAw v,! c; �PArEA.
Date: 2017
votary Public:
My commission expires:
[affix Notarial Seal]
Emestine C. White
Commonwealth of Virginia
Notary Public
Commission No. 2707130
My Commission ExOre's 0317-71—
Prepared by:
Christina J. Fulham
Ropes & Gray LLP
Prudential Tower
800 Boylston Street
Boston MA 02199-3600
Signature Page to Cleveland NC Deed
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Exhibit A
Legal Description
LYING AND BEING IN CLEVELAND TOWNSHIP, ROWAN COUNTY, N. C., AND BEING
THAT TRACT OF LAND FORMERLY KNOWN AS THE JEROME LAIL PROPERTY
LYING ON THE WESTERN SIDE OF NORTH CAROLINA MIDLAND RAILROAD AND
ON THE NORTHERN SIDE OF U. S. HIGHWAY NO. 70 AND BEING ADJACENT TO THE
PROPERTY OF CLYDE WALLER, MRS. ALLIE NAIL, AND WILLIAM AND GEORGE
KEASLER ON THE WEST AND ADJACENT TO THE NORTH CAROLINA MIDLAND
RAILROAD ON THE EAST AND BEING MORE FULLY DESCRIBED AS FOLLOWS:
BEGINNING AT A NAIL IN A BOTTLE CAP LOCATED IN THE CENTER LINE OF THE
NORTH CAROLINA MIDLAND RAILROAD AT THE POINT WHERE SAID RAILROAD
CENTER LINE INTERSECTS THE NORTHERN RIGHT-OF-WAY LINE OF U. S.
HIGHWAY NO. 70 AND RUNS THENCE ALONG THE CENTER LINE OF THE NORTH
CAROLINA MIDLAND RAILROAD AND ALONG THE CENTER LINE OF THE SPUR
TRACK RUNNING FROM THE NORTH CAROLINA MIDLAND RAILROAD TO THE
WESTERN NORTH CAROLINA RAILROAD IN TEN COURSES AS FOLLOWS: (1) NORTH
11-52 EAST 335.6 FEET TO A NAIL IN A CAP; (2) NORTH 11-59 EAST 1054 FEET TO THE
POINT OF THE SWITCH ON THE SPUR LINE; (3) NORTH 5-49 EAST 200 FEET TO A
POINT; (4) NORTH 0-49 WEST 123.8 FEET TO A POINT OF THE SWITCH; (5) NORTH 7-
27 WEST 200 FEET; (6) NORTH 19-45 WEST 200 FEET; (7) NORTH 30-06 WEST 200 FEET
TO A NAIL IN A CAP; (8) NORTH 39-42 WEST 200 FEET TO A POINT; (9) NORTH 50-53
WEST 200 FEET TO A POINT; AND (10) NORTH 59-49 WEST 62.9 FEET TO A NAIL IN A
CAP; THENCE ALONG THE LINES OF WILLL M AND GEORGE KEASLER AND MRS.
ALLIE NAIL, SOUTH 6-00 WEST (PASSING AN IRON STAKE AT 82.5 FEET) 1515.39
FEET TO A LARGE POPLAR TREE SIX INCHES IN DIAMETER WHICH HAS A NAIL IN
A CAP ON THE NORTH SIDE OF THE TREE IN ITS CENTER LINE; THENCE ALONG
THE LINE OF CLYDE S. WALLER, SOUTH 3-58 WEST 927.78 FEET TO AN IRON IN THE
CENTER LINE OF THE BRANCH, THIS POINT ALSO BEING IN THE NORTHERN
RIGHT-OF-WAY LINE OF U. S. HIGHWAY NO. 70; THENCE ALONG THE NORTHERN
RIGHT-OF-WAY LINE OF U. S. HIGHWAY NO. 70, SOUTH 74-52 EAST 463.44 FEET TO
THE POINT OF BEGINNING, CONTAINING A TOTAL ACREAGE OF 29.58 ACRES AND
AN ACREAGE LYING OUTSIDE OF THE RIGHT-OF-WAY LINE OF THE NORTH
CAROLINA MIDLAND RAILROAD AND THE SPUR TRACK OF 26.4 ACRES.
THE FOREGOING TRACT IS SHOWN ON A MAP ENTITLED "MAP PREPARED FOR J. P.
LAIL" BY HUDSON AND ALMOND, REGISTERED SURVEYORS,
THE FOREGOING PROPERTY IS SUBJECT TO THE RIGHT-OF-WAY OF THE NORTH
CAROLINA MIDLAND RAILROAD AND THE WESTERN NORTH CAROLINA
RAILROAD.
LESS AND EXCEPT:
RIGHT OF WAY LEFT
64890325 1 A-1
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POINT OF BEGINNING BEING A POINT IN THE WEST LINE OF THE UNDERSIGNED,
AND BEING N. 0642-30 E., 110.38 FEET FROM A POINT IN THE CENTERLINE OF -L2-,
STA. 152+00; THENCE TO A POINT ON A BEARING OF S. 78-30-30 E., A DISTANCE OF
417.8 FEET (127.36 METERS); THENCE TO A POINT ON A BEARING OF S. 08-15-30 W.,
A DISTANCE OF 27.0 FEET (8.24 METERS); THENCE TO A POINT ON A BEARING OF N.
78-30-30 W., A DISTANCE OF 414.1 FEET (126.21 METERS); THENCE TO A POINT ON A
BEARING OF N. 00-21-30 E., A DISTANCE OF 27.5 FEET (8.39 METERS); RETURNING
TO THE POINT AND PLACE OF BEGINNING.
For Grantor's title see General Warranty Deed of FCX, Inc. dated February 17, 1986 and recorded
in Book 623, Page 911 with the Register of Deeds, Rowan County, North Carolina; see also Deed
for Highway Right of Way to Department of Transportation, an agency of the State of North
Carolina, dated September 7, 2004 and recorded with said Deeds in Book 1028, Page 218.
64890325] A-2
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Exhibit B
Permitted Encumbrances
Taxes and assessments not yet due and owing in the year 2017 and subsequent years.
2. Right(s) of way to Department of Transportation, an agency of the State of North Carolina
recorded in Book 1028, Page 218, Rowan County Registry.
3. Terms, provisions, covenants, conditions, easements and restrictions as provided in Right
of Way of North Carolina Midland Railroad and Western North Carolina Railroad contained in
Deed, recorded in Book 623, Page 911, Rowan County Registry.
4. Easement Deed by Court Order in Settlement of Landowner Action to' Qwest
Communications Company, LLC recorded in Book 1222, Page 882, Rowan County Registry.
5. Easement to Duke Energy Carolinas, LLC, a North Carolina limited liability company
recorded in Book 1266, Page 168, Rowan County Registry.
64890325_1
,00k: 1296 Page: 945 Page 5 of 5

*FOR PARTAAND 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 B.
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO Er
REGIONAL OFFICE CONTACT NAM E:
Mail an on final and one copy Pf 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 Dis_charge'reporter 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."
(Signature of Permittee)
(Date)
Additional copies of this form may be downloaded at: http:I _portal,ncdenr.or web w ws su n dessw#tab-4
SWU-249
Last Revised: October 18, 2012
Page 2, of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Qu lit erlera8 Permit No. N00060000
Date submitted � -� " I � 1-1
CERTIFICATE OF COV RAGE NO. NCG06 O 1 Z3
FACILITY NAME o-42ifn Cb_r_( —
COUNTY �Swcv,
PERSON COLLECTING SAMPLES
LABORATORY - Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTINN YEAR
ail 1� �©
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats 15-Use animal fats/byproducts
DISCHARGING TO SALTWATERS? [YES [NC NO
PLEASE REMEMBER TO SIGN ON THE REVERSE —.>
Total event rainfoll 2 or ❑ 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 Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
Soo
Only applies to facilities that use/process meats. DWR SECTION
2The total precipitation must be recorded using data from an on -site rain gauge. INFORMATION PROCESSING UNP
3 For sampling periods with no discharge ate 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? Dyes ❑ no if es 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,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L i
pH,
Standard units
New Motor Oil Usage,
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 awn r outfalls, you must still submit: this discharge monitoring.report with a checkmark here.
'see Genera! Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: October 19, 2012
Page 1 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Qual-ty General Permit No. NCG060000
Date submitted r]
CERTIFICATE OF COVERAGE NO. NCG06b 1?i � RECEIVE AMPLE COLLECTION YEAR
FACILITY NAME ,:5Ctkdf^ ` L clerk j�g rbcf „ „ 0 c 2017 FACILITY ACTIVITIES INCLUDE (chec Il that apply):
COUNTY �ta W CIS _ ❑ use/process meats use animal fats/byproducts
PERSON COLLECTING SAMPLES r_ tT LESDISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY "' Lab Cert. # SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE j
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall a or ❑ No discharge this period3
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mel.
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 8.0 — 9.0
120
30
1000
Soo
Only applies to facilities that use/process meats.
2The 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.
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 if es 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,
mo/dd/yr
Oil 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.
9 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.
SWU-249 Last Revised: October 18, 2012
Page 1 of 2

Ar
*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER I REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALLTRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• TIERS: 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:
Mail an ari final and one My of this DMR including g all "No Dischar e" re orts within 30 days a recei t a the lab results or at end of
monitoring period in the case of "No Discharge" reportsl 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."
(Signature of Permittee)
�3rn
(Date)
Additional copies of this form may be downloaded at:.http:/Zportal.ncdenr.org/web/`wq/ws/�su/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012
Page 2, of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. N_CG060000 REcEIVED
Date submitted 1— 10- t7
CERTIFICATE OF COVERAGE NO. NCG06_L_L S
FACIJJTYNA
COUNTY
PERSON COLLECTING SAMPLES .
LABORATORY 1VJA Lab Cert. #
Part A-- Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR JAN I 2 201?
FACILITY ACTIVITIES INCLUDE (Shecall that apply): CENTRAL FILES
11 use/process meats Lq'use animal fats/byproductpWR SECTION+
DISCHARGING TO SALTWATERS? AYES ONO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall2 or No discharge this perloaa
Outfall Nb.
-Sample Collected,
JSS,
rn
pH,_,
j_joil and-;609ase,•
Fecal Cclifarm
&bniet'per
Enterococcl",
n es_per rhi
Benchmark,
f,
100 or'Se
-Withih'SM — 9.0
_30.
.1000
00
-A
0
4_1
-
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 ate outfalls. You must still submit this discharge monitoring report with a checkmark here.
ASee 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? C] yes r
o Cifyes , complete Part 8)
Part 13: Vehicle Maintenance Area Monitoring Results: only for facilifies. averaging > 55 gal of new motor oil/month.
sample, Colld
a`d"-'G'reageif :A-.'
JSS
.K.-
.
;e
ardcun!W-:�RAR�afa�
Zre
Benchmark
_:30
100 or W
I 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 My 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
Page 1 of 2

*FOR PARTAAND PARTS MONITORING: RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMITPART II SECTION B.
• 2 DCCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SEC71ON B.
a TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK ©CCEEDENCES FOR THE SAME PARAMETER AT ANYONE QUTFALL? YES ONO[]
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES [] NO
REGIONAL OFFICE CONTACT NAME:
Mail an original and one My o this DMR includin oll "Na Disthar e" re arts within �a d s receipt o the lob results or at end a
monitoring eriod in the case o 'No Discharge' re orts 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, orthose 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."
(Signature of Permittee)
a 9 o7t17
(Date)
Additional copies of this form may be downloaded at: htt2:Lportal.ncdenr.org_Iweb/wg/wsLsu/npdessw#tab-4
SWU249 Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT RECEIVED
for North Carolina Division of Water ijgalit- G eral Permit No. NCGO60000 AUG 08 2016
Date submitted �"
CERTIFICATE OF CO ERA-r� E NO. NCG06 01 2 SAMPLE COLLECTION YEAR O(y \ D CENTRAL FILES
"Z.� DWR SECTION
FACILITY NAME �UYk sTICJ _ FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY _ QW gr-_ _ _. - ❑ use/process meats 4 use animal fats/byproducts
PERSON COLLECTING SAMPLES DISCHARGING TO SALTWATERS? ❑YES XNO
LABORATORY Lab Cert. # _
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE —.�
Total event rainfall 2 or ❑ 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 Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
100 or SO
Within 6.0 — 9.0
120
30
1000
500
w�
r
1 Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 Forsampling periods with no discharge at any outfalls. You rrLust 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 if es complete Part 13)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/d d/yr
Oil 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
-
1 Only applies to facilities that use/process meats.
zThe 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
Page 1 of 2

*FOR PART A 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 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 ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICIi? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
Mail an original and one My of this DMR includin all "No Discharge re arts within 30 da a recei t o the lab results or at end o
monitoring erlad in the case o "No Discharge" re orts to
Division of Water Quality
Attn: DWQ Central Files
161.7 Mail Service Center
Raleigh, NC 27699-1.617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMA TION RF_PORT,ED:
"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, includingthe possibility of fines and imprisonment for knowing Violations."
(Signature of Permittee)
(Date)
Additional copies of this form maybe downloaded at: http://Portal.ncdenr.or web w ws su n dessw##tab-4
SWU-249
Last Revised: October 18, 2012
Page 2, of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000 3
Date submitted o2/�1(0
CERTIFICATE OF COVERAgiE NO. NCG06 0 13 3 SAMPLE COLLECTION YEAR 20 J S
FACILITY NAME 0h FACILITY ACTIVITIES INCLUDE (check all that apply): COMA
COUNTY 91"CREGEN 00 use/process meats use animal fats/byproducts
PERSON COLLECTING SAMPLES 1� 1DISCHARGING TO SALTWATERS? DYES [ENO
LABORATORY Lab Cert. # MAR3 2016 _
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE
�/.YI/11LI
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall ` or No discharge this period
TS!° H COD, - ; Oil and,Grease Fecal Coliform , ' =Enterococci ,
Oatfall No. Sammloe/dadl/y�ted, mg/L ° .Standard units mg/L -" mg/L Co[onies'per!100,m1;
P
r a'
p,
F ;Colonies per 100..m1
Benchmark _ 100 or-50 ' "WithW6.0 9.0. , . 12030 ' i000 a 500_
l
;i
vniy appiie5 w iaLiuues u;aL UbUIPIuLe» 111CULD.
2The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at ate( 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 {if ves• complete Part B)
Part R! Vehicle Maintenance Area Monitoring Results: only for facilities averaEine > 55 eat of new motor oil/month.
Outfall'No
Sa mo/ddl�yted,
Grease,
Oil'a mg/L
mg/L
PH,
Standard units
New Motor
Annual'aver gle gal Usagee mo,
:Benchmark
�. � �� __ „��,
30•
100 or 504
6.0 — 9.0
V111y a pps'c. LV 16blllllc.] LI.. - F4Gi.� n�u ate,
zThe 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.
SWU-249 Last Revised: October 18, 2012
Page 1 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.
• TI€R 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:
Mail an original and one copy of this DMR including all "No Dischamo" 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 MUSTSIGN 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. 1 am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
o
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wq/­ws/su/npdessw#tab:4
S W U-249
"a°CIC
Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water quaH y General Permit No. NCG060000
Date submitted I i 11"3
CERTIFICATE OF COVERAGE NO. NCG06Q-1 D j—_
FACILITY NAME 526ks
COUNTY R,a W,%r,
PERSON COLLECTING SAMPLES
LABORATORY
Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR O 15 RErF=IV9:D
FACILITY ACTIVITIES INCLUDE (check all that apply): NOV 16 2015
❑ use/process meats [_use animal fats/byproduc"ENTRAL. FILES
DISCHARGING TO SALTWATERS? DYES ❑ IO DWR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall 1 or n No discharge this Deriod3
Dutfa"II Na.
Sa'mple Collected,
T55,
pH;'�^" I,Nllli'I'
IlEtand
img/,L artl,;,umts'�li III
li, CQD,,N t
I!I�IIIII I� �LILmg/Llryil; ;�;,
'O1lrandGr ae se,
�h, �mg%L
Fecal Caliiorm ,
Colonies per 10D ml
Enterococci ,
Colonies per 1oQ ml
rBe chmark�
-
�10'0 o.r 50�
[V4littiini6y0 9y0�1
�Il llllplll'iIh12Di('ul'I::t l'4C1
r Ilu l" 30
i000
5Qp
1 Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at AU 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.
Lz
rr�
Did this facility perform Vehicle Maintenance Activities using more than S5 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.
Sample Collected,
mo/,dd/,yr
Oil and Grease;
mg/L
`:�T55 °�` "
:ing/,L
^'' „#pH,
z.
*St andarcl�unitsAnnual
°`
New Motor Oil Usage,
average gal/mo
FBenchmark=
-
30
=:;100 6650r
6:0; 4:D;l
Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at air 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 19, 2012
Page 1 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 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 !ab 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, 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, v
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."
(Signature of Permittee)
�%Ig )
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wg(ws/su/npdessw#tab-4
S W U-249
Last Revised: October 18, 2012
Page 2 of 2

0—el
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water li y General Permit No. NCG060000
Date submitted Q
V
CERTIFICATE OF COVERAQE_N,O. NCG06 �J- 3 RED OLLECTION YEAR 1
FACILITY ME �+�J' `� �+� ck� ^ C C�c1cn� �ACIMT-ACTIVITIES INCLUDE (check all that apply): = %:
COUNTY L-10n APR 13 20 ] use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES ).Cr DISCHARGING TO SALTWATERS7 []YES 2<0
LABORATORY Lab Cert. # RAL SAFILES
CTI
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitorine Results
Total event rainfall 2 or I P( o discharge this period'
Outfall No.
Sample''Collectetl,
mo/dd/yr ;J
"T. SS'l" �^
mg/L� p, i
+'' y'pH;'
LStandard;umts:
COD,
mg/L $
Oil'and Grease,
mg/L
Fecal Coliform ;
� 'Coio'nies per,;Y100!m1 3
Enterocodi" .,
r rColonies p'er;100:m1
Benchmark
' -
1DO or 50} 4
WitFiln,6.0 — 9A .'
12U.
.` 30
1600 ...'
"- SW
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 Lino (if es complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall:No 5ampleCnllected;* P 011pa dg�Lease, mg�� €StandaHd^units Ann Mator'011 Usage,
.a
mo/ddlYr F ' " ' ' ual average gal/mo
Benchmark h : 30 100'or 50
vary cfppllea LU iot.uir.icb LFICK UDtZfPrucryo rnt:au.
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.
SWU-249 Last Revised: October 18, 2012
Page 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.
• 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 OUTFALL? YES ❑ NO 2 -
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, includincl 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" reportsj 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."
(Signature of Permittee)
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/nl)dessw#tab-4
S W U-249
Last Revised: October 18, 2012
Page 2of2