NCG060306_MONITORING INFO_20190128

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V Cc,,;C6plot
DOC TYPE
❑HISTORICAL FILE
\MONITORING REPORTS
DOC DATE
;r,olcl or g
❑ j§5]j��
YYYYMMDD

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted /_ 9' ` f q
CERTIFICATE OF COVERAGE NO. NCG060306
FACILITY NAME Purina Animal Nutrition LLC
COUNTY Irede'll
PERSON COLLECTING SAMPLES Chad White
LABORATORY_WA A Lab Cert. # N/A
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2018
RECEIVED FACILITY ACTIVITIES INCLUDE (check all that apply):
f� ❑ use/process meats Z use animal fats/byproducts
JAN 2 8 2019 DISCHARGING TO SALTWATERS? ❑YES ®NO
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
0VJR SECTION
Total event rainfall z N/A or ❑ No discharge this period
Outfallmol
.H
, "I
Sam le
p .p;#
Colle toed;
. . � _
". , TSS �
,��'Y
rr
�
�-
H,
Ittanclardjunits
fir,. COD„s. ��� �- a
rrtg/L w :
�w
I,Oil'antlGrease,ing/L
;,
Fecal
'". - 1
coNfa�rm ,
Enterocacci�,l,
+;y•. h
Golonies3per�..
�,mo/tld/yr,�
79.
P
_,n ..ww-�. s
Benchmarksr,
,,�yy'�m ."g1,'Nf
�, _,�.=
.� _,.,,, ..._
100;`050
`�' Y Y ",
Within6 09.0, ,_%
t '."9 t
i „120�- y a, .''?,�
4
Y.'r'6 : x
.. , _ "�30,;,��
,.;1.
.:1000
001 '
N/A
Unable to Obtain Sample
Unable to Obtain Sample
Unable to Obtain Sample
Unable to Obtain Sample
N/A
N/A
in Designated Timeframe
in Designated Timeframe
in Designated Timeframe
in Designated Timeframe
002
N/A
Unable to Obtain Sample
Unable to Obtain Sample
Unable to Obtain Sample
Unable to Obtain Sample
N/A
N/A
in Designated Timeframe
In Designated Timeframe
in Designated Timeframe
in Designated Timeframe
003
N/A
Unable to Obtain Sample
Unable to Obtain Sample
Unable to Obtain Sample
Unable to Obtain Sample
N/A
N/A
in Designated Timeframe
in Designated Timeframe
I in Designated Timeframe
I in Designated Timeframe
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 as 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.
�N
OutfallR o
'Sam 1`e..Calleciecl
p y '
4h'9W:.d'xi' Iti
K' •,Mm.a/,tltl/,y�.�
'� " '�` ` ,�� '*
Oil and Grease
I i [
' mg/,L yw
ror w k x �TSSd
, r ti
W ��
,� . f_mg/,Lt
.. ..- pH,
Staridartl,units'
k
New Motor OIIyIJys�a�en "
.{^ +� �e•'�:;1F 'cu"1 ve F,
i4nnualaveragegal/,mop:.,
Benchmark:"
�' �..,30a
^lo_Ororl50y ° r�
: • ,6 Dt="'9
NIA
NIA
N/A
N/A
N/A
N/A
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 yes, complete part B)
SWU-249 Last Revised: October 18, 2012
Page 1 of 2

A
*FOR PART A 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 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 lab results or at end
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 inqui ry 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."
Z' --Z- 9-1 9
(Signature of Permittee) (Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wct/ws/sulnpdessw#tab-4
SWU-249 Last Revised: October• 19, 2012
Page 2 of 2

-jort
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted��.`�'-S'
CERTIFICATE OF COVERAGE NO. NCG060306 SAMPLE COLLECTION YEAR 2018
FACILITY NAME Purina Animal Nutrition LLC FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Iredell ❑ use/process meats ® use animal fats/byproducts
PERSON COLLECTING SAMPLES Chad White DISCHARGING TO SALTWATERS? []YES ®NO
LABORATORY N/A Lab Cert. # N/A
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE ­)'
Total event rainfall Z N/A or ❑ No discharge this period
Outfall No.
Sample Collected,
mn/,dd/,yr
T55,
mg/,L
pH,
Standard units
COD,
mg/.L
Oii and Grease,
mg/,LIIIIIIIIIIIIIIIIIII
Fecal Caliform
jCA1oniesjperj100 ml
Enteracocci ,
Colonies per 140 ml
Benchmark
100 or 50j
Within 6.4 _ 9.0
120
3.0
1004
500
001
N/A
Unable to obtain
sample in time
Unable to obtain
sample in time
Unable to obtain
sample in time
Unable to obtain
sample in time
N/A
N/A
002
N/A
Unable to obtain
sample in time
Unable to obtain
sample in time
Unable to obtain
sample in time
Unable to obtain
sample in time
N/A
N/A
003
N/A
Unable to obtain
sample in time
Unable to obtain
sample In time
Unable to obtain
sample in time
Unable to obtain
sample in time
N/A
N/A
' 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 aM 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
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
jWLd5rease,a/,tld/yr gll
mg/,L
Standard units
An_ nual average gal/,ma
Benchmark
�3'.0'
100 o,r 50�
6..0-9A
N/A
N/A
N/A
N/A
N/A
N/A
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 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 Revised: October 18, 2012
Page] of 2

*FOR PART A AND PART 8 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 It 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 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."
*-7
ature-of'Permi
7 z `r,_'s?
(Date}_~
Additional copies of this form may be downloaded at: htta://gortal.ncdenr.are/web/wp/ws/su/ngdessw#tab-4
S W U-249
Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water �ualit General Permit No. NCG060000
Date submitted tl� 00�1s�
CERTIFICATE OF COVERAGE NO. NCG060306
FACILITY NAME Purina Animal Nutrition LLC
COUNTY Iredell
PERSON COLLECTING SAMPLES Dustin Davis
LABORATORY N A Lab Cert. # N A
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2017
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ® use animal fats/byproducts
DISCHARGING TO SALTWATERS? DYES ®NO
r'F N1ED PLEASE REMEMBER TO SIGN ON THE REVERSE 4
l % Total event rainfall 2 N A or Ej No discharge this period
Outfall No.
Sample
TSS,
pH,
OII and Grease, mg/L
Fecal
Enteracocci ,
Collected,
mg/L
Standard units t_
L R
Coll orml,
mo/dd/yr
��
'� -'
Colonies
per 1Q0 ml
N
Benchmarks
100 or 50�
WltKIn 6.0 — 9A
120
3D
1000
001
N/A
Unable to Obtain Sample
Unable to Obtain Sample
Unable to Obtain Sample
Unable to Obtain Sample
N/A
N/A
in Designated Timeframe
In Designated Timeframe
in Designated Timeframe
in Designated Timeframe
002
N/A
Unable to Obtain Sample •
Unable to Obtain Sample
Unable to Obtain Sample
Unable to Obtain sample
N/A
N/A
in Designated Timeframe
In Designated Timeframe
in Designated Timeframe
in Designated Timeframe
003
N/A
Unable to Obtain Sample
In Designated Timeframe
Unable to Obtain Sample
I In Designated Timeframe
Unable to Obtain Sample
In Designated Timeframe
Unable to Obtain Sample
In Designated Timeframe
N/A
N/A
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.
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.
Outfall No.
Sampl11 Fc —te dM
mo/.dd/i r
Oil and Grease,
mg/,I
TSS,
mg11L
pH,
Standard units
New Motor III Usage,
Annual average galma
Benchmark
30
10_0 or - A=
EEff6r0 9.0
N/A
N/A
N/A
N/A
N/A
N/A
$ 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.
(ifyes, complete Part B)
SWU-249 fast Revised: October f 8, 2012
Page i of 2

J
*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
+ 2 EXCEEDANCES 1N 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 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."
(Signature of Permittee)
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.or./web/wq/ws sLulnpdessw#tab-4
S W U-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
Date submitted 1 1- % % ""/ 7
RECEIVED
CERTIFICATE OF COVERAGE NO. NtG060306 SAMPLE COLLECTION YEAR 2017
FACILITY NAME Purina Animal Nutrition LLC NOV 2 2 2017 FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Iredell ❑ use/process meats ® use animal fats/byproducts
GWR SECTiOPi
PERSON COLLECTING SAMPLES Dustin Davis CENTRAL FILES DISCHARGING TO SALTWATERS? [:]YES ®NO
LABORATORY N/A Lab Cert. # N/A
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results
Total event rainfall 2 NL or No discharge this period3
'�"
O.utfall No.
11 I�
Sample Collected,
'ISS,
pH,
COD;
Oil ar"nd Grease,
F cal Coliform ,
Enterocaccfa,�
ma/,dd/. r
mg/I.
Standard[units
mg/.L.
mg/T
C 'I nies er 100 ml
,�
Colanl.es ar 100RW
€B n hmar.k
100 ar 50
WithinT.00 — 9!011
INN51-26JU9130
1000
5007117
001
N/A
Adverse Climatic
Adverse Climatic
Adverse Climatic
Adverse Climatic
N/A
N/A
Conditions
Conditions
Conditions
Conditions
002
N/A
Adverse Climatic
Adverse Climatic
Adverse Climatic
Adverse Climatic
N/A
N/A
Conditions
Conditions
Conditions
Conditions
003
N/A
Adverse Climatic
Adverse Climatic
Adverse Climatic
Adverse Climatic
N/A
N/A
Conditions
Conditions
Conditions
Conditions
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 aU 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
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
OutfallNa. Sampf/Ca�
llected, "" TSS, pW, New Motor Oik°Usage, . . OII and Grease;
d/,Vr mg/L mg/,L Standard units Annual average g m0
B nchm l0 9 N 100 or 50 0.0 9.0 -
N/A N/A N/A N/A N/A N/A
u111y dyP11t , to iauFnicb uIaL UbCIPruLcoa incatb.
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-244 Last Revised: October 18, 2012
Page] 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 origlinal and one copy of this DMR including all "No Discharge" reports, within 30 da s of receipt of the lab results(or at end o
monitorinn _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)
11-t 7-r".
(Date)
Additional copies of this form may be downloaded at: http://p(irtal.ncdenr.org/webZwaLws/­s-u/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. NCG060000
Date submitted 7'A,'/%
CERTIFICATE OF COVERAGE NO. NCG060306
FACILITY NAME Purina Animal Nutrition LLC
COUNTY Iredell
PERSON COLLECTING SAMPLES Dustin Davis
LABORATORY Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
RECE,vPjjPLE COLLECTION YEAR 2027
ILITY ACTIVITIES INCLUDE (check all that apply):
JUL 2 8 2017 ❑ use/process meats ® use animal fats/byproducts
CENTRAL FILEDIISCHARGING TO SALTWATERS? []YES®NO
DWR SECTION
PLEASE REMEMBER To SIGN ON THE REVERSE 4
Total event rainfall z N/A or ❑ No discharge this period3
Outfall Na.le
„�..�
Collectetl,
rt
T55,
mg/,L
pH,
Standard units
2 COD,,.
mg/,L
Oil antl Grease,.
mg/.L
:i F al Galiform ,
Colanies per 100,m1,
.v,.�. N
Enterococcimo/.dd/,
Colonies er 100;
�Benchma kj
�' -
100 or S0M
Within 6.0 — 9.0
�120
, g30
—1000
5U0
001
N/A
Non -Qualifying
Rain Events
Non-Quallfying
Rain Events
Non -Qualifying
Rain Events
Non -Qualifying
Rain Events
N/A
N/A
002
N/A
Non -Qualifying
Rain Events
Non -Qualifying
Rain Events
Non -Qualifying
Rain Events
Non -Qualifying
Rain Events
N/A
N/A
003
N/A
Non -Qualifying
Rain Events
Non -Qualifying
Rain Events
Non -Qualifying
Rain Events
Non -Qualifying
Rain Events
N/A
N/A
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 ® no (ifyes• complete Part 8)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No. Sam_ ple Gallected, Oil and Grease, T55, pH, N w Motor Oil Usage,
mo/,dtl/,yr mg/,L mg/,L i Sta.ndaFdd units Annual average gal/,mo
ti n h a k 30 100;or 50. 6 0 VIM
N/A N/A N/A N/A N/A N/A
r ' r
vruy apYnc> w iauuucn uiai nicaLa.
2The 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.
°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 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:
r
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" repartsl 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 Perm
7 Z,5�
( ate)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
S WU-249
Last Revised: October 18, 2012
Page 2 of 2