NCG060280_MONITORING INFO_20190201

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /V C& C� oak
DOGTYPE El HISTORICAL FILE
N� MONITORING REPORTS
DOC.DATE ❑ .c2Q/ � 0
YYYYMMDD '""

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted R Q
— 1 n
CERTIFICATE OF COV AGE N . NCG06 O SAMPLE COLLECTION YEAR RIVED
FACILITY NAP FACILITY ACTIVITIES INCLUDE (check all that apply): Zd�g
COUNTY ❑ use/process meats use animal fats/byproducts FEB 0
PERSON COLLECTI G S'AMF&LES ` DISCHARGING TO SALTWATERS? DYES PM
LABORATORY �� (a Lab Cert. # CENTRAL TILES
WR
PLEASE REMEMBER TO SIGN ON THE REVERSE � �',WR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
Total event rainfall 2
_1 lI or ❑ No discharge this period3
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
m /L
Fecal Collform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0 - 9.0
120
30
1000
50o
S
Sl Aa
' Only applies to facilities that use/process meats.
ZThe total precipitation most be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at �ny 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.
Outfall No.
Sample Collected,
mo dd r
Oil'and Grease,
m L
TSS,
m L
pH, '
Standard,units
New Motor Oil Usage,
Annual averse al/mo
Benchmark
-
30
100 or 50
6.0 — 9.0
-
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.
°See 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
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:
Marl 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
161,tMail Service Center
Raleigh, NC 27699-1612
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
E- g-
(Date)
Additional copies of this form may be downloaded at: http-://portal.ncdenr.org/weblwq/ws/`­su/npdessw#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 Quali y G neral Permit No. NCG060000
Date submitted -�—
CERTIFICATE OF COVE AGE �. GO SAMPLE COLLECTION YEAR
FACILITY NAME 1 ���� FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY ❑ use/process meats [(use animas ats/byproducts
PERSON COLLEC ING SAMPLES «� 6l Cry JUL i DISCHARGING TO SALTWATERS? [:]YES NO
LABORATORY \INN r� 9 La ert. # _,r ,17i: I-iLLs
R St-�C TIC"'' PLEASE REMEMBER TO SIGN:ON THE REVERSE �i
Part A: Stormwater Benchmarks and Monitoring Results
Total event rainfall it z or ❑ No discharge this period3
Outfap No'
Sample Collected,
t nmo/dd/,yr�Staridard.units;
i *T55;
PH'
x COD,' `:
9f,. `�rng :
OII`arid Grease, ,
S :mg/i
Fecai;Coiiferm ,
Colbriies pe f100 ml <,.
-Enterococci ;
:Colonies p'e"r 100 mlir
Beriihmarkf
100or"50.,
WitHiri'°.6.0 .:9:0.
} t120`.?._- a
30 f
Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from anon -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 Vno
Part B; Vehicle Maintenance Area Monitoring Results. only for facilities averaging > 55 gal of new motor oil/month.
Out#aIIFNo °Sample,Collected,Oil
and Grease; k< r
mg/,L'-;Standard-unftsNf.,
,� TSS,u
pli,
New Motar bil Usage,V.
Annual,average:gal/mo,:�
10070r.50 _
'6:0 " 9.0.
.
Only applies to facilities that use/process meats.
3 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.
(if yes, completes t B)
SWU-249 Last Revised: October 18, 2012
Page 1 of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCETRIGGERS.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 .
• 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 original and one: ca o
-this DMR Includin
all.'No
Discharge" reports, within 30 days of receipt of the lob -results or at end o
monitoring period in the case of
"No Discharge" rep
ortsl
to: .
Division of'WaterQuality.
Attn: DWQ Central Files
161;LMail Service Center
Raleigh, NC 27699-1612-
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 thatqualified 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. possifjility of fines and -imprisonment for knowing violations."
(Signature of. Perm
.(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/­
ws su n dessw#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 Qualit G eral Permit No. NCG060000
Date submitted v 1(ft a�
p 9 z013
CERTIFICATE OF CO AGE 1 O. (C�06 � i} SAMPLE COLLECTION YEAR Q Sri D
FACILITY N ME 2 t `\ , FACILITY ACTIVITIES INCLUDE (ch k all that apply): �MwAt� p��!?Y
COUNTY '❑ use/process meats Muse animal is/byproducts & 1�'NG
PERSON COLLECTING SAMPLES - a t C'c� DISCHARGING TO SALTWATERS? ❑YES animal
LABORATORY �lf\\C�C ab ert. #
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
it
Total event rainfall Z or ❑ No discharge this period'
Outfall No,
Sample Collected,
mo/dd/ r
TSS,
m L
pH,
Standard units
COD,
mg/L
Oil and Grease,
m /L
Fecal Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100or50
Within 6.0 - 9.0
120
30
1000
500
©-
6
s
Iv
JUL
1 Only applies to facilities that use/process meats. j f
ZThe total precipitation must be recorded using data from an on -site rain gauge' ' Qs ``�"`G 1L�S' 4
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 Vno
Part B: 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,
m 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.
2The total precipitation must be recorded using data from an on -site rain gauge.
a For sampling periods with no discharge at an 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.
IVED
0 2018
Cttt7 AL FILES
(if yes, complete Part B)
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
• 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 for at end o�
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality ? .
Attn: DWQ Central Files
1612Mail Service Center
Raleigh, NC 27699-1612
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 Pkrmittee)
( Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wq/ws/su/�dessw#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 Qu't a y G nPral Permit No. NCG060000
Date submitted
CERTIFICATE OF CO AGE NO. C�Ob U SAMPLE COLLECTION YEAR O O
FACILITY N ME Q , FACILITY ACTIVITIES INCLUDE (ch k all that apply):
COUNTY ❑ use/process meats Muse animal is/byproducts
PERSON COLLECTING SAMP ES -' � a t rr� DISCHARGING TO SALTWATERS? ❑YES [�NaO
LABORATORY—' "�ab ert. f#
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
if
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall z -a or ❑ No discharge this period'
Outfall No., °
,Sample Collected,
mo/dd/, r•
-- TSS'
m L . `
pH °
;Standard units
.,;COD? `"
=s,mg/L.
'' OII '6&Grease,
m" /L . , '''
FecaKoliform•,
-Colonies'. er,100 ml, .
Enterococci ,
" Coloniivper>100 mI
Benchmark
100'0r 50,
z'.Wlthln�6'0' ',9.D .
' -"120
30- .` " •
1000'
S00 `
r
6
. 0QsL5
IV
1 Only applies to facilities that use/process meats. �.
ZThe total precipitation must be recorded using data from an on site rain gauge' '� �`��' �`S� l +�j 1 �l'S Ou t��..
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 {/no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfali No *'
:; Seniple;Collected,
;OII°and Grease,
TSS;
pH,,
Standard:units-
Ndw-Motor Oil Usage,
;AnnuaI'ayera e`gal/mo .
Benchmark
- '
30 `<
'100-or•50
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 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 mast Revised: October 18, 2012
Page 1 of 2

*FOR PART A AND PART B MONITORING RESULTS:
e 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 SECTIO
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES [:]NOV
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 o
monitoring period in the case of "No Discharge" reports) to.
MUST SIGN THIS CERTIFICATION
.Division of Water Quality-
Attn: DWQ Central Files
161;LMail Service Center
Raleigh, NC 27699-1612-
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 PArmittee)
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wglws/su/npdessw#tab-4
S W U-249
V
Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality GR
eral Permit No. NCGO60000
Date submitted (; " 4 s
CERTIFICATE OF COVERAGE O. NCGO 4 $(�
FACILITY NAME ! C: t
COUNTY �MU
PERSON COLLECTING SAM
LABORATORY Ec-' i (bPLES " ab ert. #
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 15) 1�)
O
FACILITY ACTIVITIES INCLUDE (ch ck all that apply):
���44 �QJB
❑ use/process meats [use anima fats/byproducts �'OF
DISCHARGING TO SALTWATERS? DYES []NO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall oL 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 Collform ,
Colonies per 100 ml
£nterococcl ,
Colonies per 100 ml
Benchmark
100 or 50
Within 6.0 — 9.0
120
30
1000
500
R R
S r 1 V 4 V
4;zO 5*
- w
Only applies to facilities that use/process meats. `s�.1� aS O u-�S��e, C�\�o ��� arl �G e.' +
3 The total precipitation must be recorded using data from an on -site rain gauge. t 1 ��,
For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here. O a. t \j
°10
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 dno
Part B: 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,
m /L
TSS,
m L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
100 or 504
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.
S W U-249
(if yes, complete Part B)
0PC-I QED
yUN � � 2aoe
gTR1',L FILE
�NJR �s�GT30�=
Last Revised: October 18, 20 ] 2
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 11 SECTIC+.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO fW
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one cape of this DMR, including all "Na 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
161;LMail 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)
Zti
Additional copies of this form may be downloaded at: httpl/portal.ncdenr.org/web/wo/ws/su/npdessw#tab-4/portal.ncdenr.org/web/wo/ws/su/npdessw#tab-4
S W U-249 Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT Q
for North Carolina Division of Water Quality General Permit No. NCG060000 "EI; 1 5 2017-
Date submitted a - / S r q
CERTIFICATE OF COV RAGE NO. G 6 U Q SAMPLE COLLECTION YEAR 1 as
FACILITY NAME FACILITY ACTIVITIES INCLUDE (ch ck all that apply):
COUNTY �l \ (1 ❑ use/process meats use animal fats/byproducts
PERSON COLLECTING SAMP ES _ �2� �CQnll DISCHARGING TO SALTWATERS? ❑YES animal
LABORATORY R1S "CiC. La ert. # 1 4
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
1 11
Total event rainfall Z �Z, 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
Enterococcl ,
Colonies per 100 ml
Benchmark
100or50
Within 6.0 — 9.0
120
30
1000
500
+
A/
1 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.
°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 N(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.
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 1 of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER ! REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION .
• 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 DW 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
161*A-Mail Service Center
Raleigh, NC 27699-1612—
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
" IS —
(Date)
Additional copies of this form may be downloaded'at: http:/Ipprtal.ncdenr.org/web/wp/s/su/npdessw#tab-4
S W U-249
Last Re%,ised:-Oc_iob'zr:.118'.-20j2-=--- ---
_ Page 2 of 2

CERTIFICATE OF
FACILITY NAME
COUNTY
PERSON COLLET:
LABORATORY_.
SEMI' ANNUAL STORMWATER DISCHARGE MONITORING REPORT �e��j/
� �Q
for North Carolina Division of Water Quall�v General Permit No. it C 060000 .ICI( 03 Z017
Date. aubmitted— 6 ` SS
R I~� �EHR-L,q a
�. NCGd6� $ 17 SAMPLE COLLECTION YEAR _ ch'ok all that apply):
W47ER OUALN.
l �l 05 2FACILITY ACTIVITIES INCLUDE [
rN7Rr�t, rfiwt� ❑ use/process meats Muse animal is/byproducts
g , _ C�_ � DISCHARGING TO SALTWATERS? ]YES qNNO
l UA Cert. # - C
PLEASE REMEMBER To SIGN ON THE REVERSE 4
fks aitd Monitorinn Results Total event rainfall � 1�2� b or ❑ luo dlschar /fie this periac�
a only applies to facilities that use/process meats. e4l-�
The total precipitation must be recorded using data f man on-sl rain gauge.
For sampling periods with no discharge at gm outfalls. You must still submit this discharge monitoring report with a checkmar here.
4See General Permit text, Table 3, Identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this faclllty perform Vehicle Maintenance Activities using more than 55 gallons of new motor all per month? ❑ yes R/no [If YA.& complete Part e}
he total precipltatlai must be recorded usil II data from an on -sloe rain gauge, .
kor sampling periods with no discharge atiy 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 r ,-. rf __.f _ 7. !1 .. _t « 10 11M n

I
I
I
*FOR PARTA AND PART R MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER- 1 REQWRENIENTS. 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
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL7 YES ❑ NO
IF YES, HAVE YOU CONTACTED,THE DWQ REGIONAL OFFICE' YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Divislon of Water Quality
Attn: DWQ Central File's
162AMall Service Center
Raleigh, NC 27699-161a.
" 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 forgathering 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 violatlons:"
(Signature of
C- as - f q
(Date)
Additional copies of this form may be downloaded at: o s 4
SWCU 249
n.
Last Revised: October 18, 2012
Page 2 of 2

for
CERTIFICATE OF C AGE O. IVGG
FACILITY NAME Q.
COUNTY
PERSON COLLEC ING SAMPL�S
LABORATORY EW'4� QN C` 2.iY1
th Carolina Division of -Water Quail General. Permit No. NCG060 00
Date submitted 1 E — a� --/ G,
SAMPLE COLLECTION YEAR a V LZ
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats P�e animaf�f�ts/byproducts
o ror(� DISCHARGING TO SALTWATERS? ❑YES o
Cert. #
PLEASEREMEMBER TO SIGN ON THE REVERSE 4
VE D
Willy app+iCM is IaLmues Tnar use/p1oL;e55 meats.
zThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at Mjy outfalls. You must still submit this discharge monitoring report with a checkmark here. r,'.71 0 7 2016
°See General Permit text, Table 3, Identifying the especially sensitive recelving water classifications where the more protective benchmark applies. I « LG,fJd QUALITY
Did this faculty perform Vehicle Malnteriance Activities using more than 55 gallons of new motor all per month? ❑yes
L'7 no f ff ices. complete Part B)
B: Vehicle Maintenance Area Monitbring Results: only for facilities aueraBfnit > 55 gal of new motor
s�-
" Only applies to facilities that use/process meats.
2The total precipitation must be recorded usiti$ data from an on -site rain gauge,
3 I or sampling periods with no discharge atMy 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.

*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 ATTHE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION .
o 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:
Mallon orialn9l agd one cogyaol this D R l 1 1 1 s e� 0 0 o t e obles t or a end o
monitorina oerlad 1n the case. of'Wo Dlschorae" rrenorts! to:
Division of Water Quality
Attn: DWQ Central Files
161XMail Service Center
Raleigh, NC 27699-161;?L
"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 geilef, 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
A- I�
(Date)
Additional copies of this form may be downloaded at: o a c s essw a -4
SAW--249
_ Last Revised: October 18, 2D12
r. Page 2 of 2 „

SEMI-ANNUAL STORMINATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCGos0000
Date submitted
CERTIFICATE OF COV=ITL
8 SAMPLE COLLECTION YEAR ao
FACILITY ME FACILITY ACTIVITIES INCLUDE (che all that apply):
COUNTY - ❑ use/process meats use animal is/byproducts
PERSON COLLE NG SAMPL S . Lk?l DISCHARGING TO SALTWATERS? []YES 09NO
LABORATORY } Lab Cart. #
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
.11
uniy-appnes ro racuives tnai use/process means.
ZThe 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.
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 all per month? ❑ yes Vno (if yes • complete Part B)
B: Vehicle Maintenance Area Monitoring Results: only for faclilties averaffIri i > 55 Ltal of new motor
'Only applies to facliitles that use/process meats.
The total precipitation must be recorded usinj data from an an -site rein gauge,
1 kor sarnp�ing periods with no discharge at gay 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.
RECEI ED
DEN1R-L,rkNQ, OUAOTY
STORN!IWATER PERMITTING
1 R 9110
SI-'Z�i� Y ner Aev;earl• llrtn;+v`
T

*FOR PART A AND ERf'PMONITORING 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 11 SECTION P.
* TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO IV
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO
REGIONAL OFFICE CONTACT NAME:
M911 an original d o e ogy-offts D R nc! d I u c e" !t 0 a 1 tolthelab- su or at end o.
monitoring aeriod (n' the case. of "No D1scha�e"reports to: -
Division of Water Quality
Attn: DWQ Central Files
163AMall Service Center
Raleigh, NC 27699-161;�.
YOU USTS k THIS C R FIC ION EQR ANY MMMTION REPOW0.
"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
�--13�-� '
(Date)
Additional copies of this form may be downloaded at:http://Portal.ncd-enr.org/vveb/­wa/wsLs_Wlnp-dess2Mgb-4
SVM 249
r.
Last Revised: October 18, 2012
Page 2. of 2 ,.

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for -North Carolina Dlvlslon' of Water Quallty General -Permit No. NCIS060000
Date submitted t)r ( %..& 16"
CERTIFICATE OF COVE GE 8 SAMPLE COLLECTION YEAR
FACILITY ME � `I FACILITY ACTIVITIES INCLUDE (che all that a131310
COUNTY ❑ use/process meats use animal is/byproducts
PERSON COLLEC G SA S Luse, DISCHARGING TO SALTWATERSF MYES ENO
LABDRATORY Lab Cert. #
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
ri
umy-appiies io racemes iner use/process means.
ZThe total precipitation must be recorded using data from an on site rain gauge.
a For sampling periods with no discharge at lM 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 now motor all per month? ❑ yes Vno (if ve& complete Part B)
B: Vehicle Maintenance Area
for facilities averaninn a 5S -nal of new motor
RC-CE ED
m 2 5 2016
DEt�,R-LAPID QUALITY
STORMWATER PERWTTING
Only aPPlIes to facilities that use/process meats.
The total precipitation must be recorded Using data tram an on-51te rain gouge, .
1 for sampling periods with no discharge at aM 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.
SVIU-249 r net iDm..nn.�• flntnhs, 7 R 7n1'7.

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION a.
v 2 EXCEEDAPICE5 IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRI93GUR -riER a REQWREMENTS. sEE PERMIT PART if SECTiOnr .
o TIER 9: HAS YOUR FACILITY. HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES 0 NO lV
If YES, HAVE YOU CONTACTED THE DWQ. REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
a! a ! a -and emud-this !. ! !" ! a ce t e! s is r e d o.
monitarina Derlad� the case b "No�lscJr4r�tese axta :
Division of Water Quality
Attn:.DWQ Central Files
161XMail Service Center
Ralelgh, NC 27699-161;;,
YOU MUST SIGN THIS CER?7FlCATION FOR ANY INYORMA]'lO $MER
"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 forgathering 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
_1:j3
(Date)
Additional copies of this form may be downloaded at: httl):Iji2o-rtalsncdenr.orgjwgblga/w5l5ul�n ssw#t b-j
SWU-249
Last Revised: October 18, 2012
Page 2 of 2

F9LEC(opy
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000 RECEIVED
Date submitted
CERTIFICATE OF COT,,G N CG 6 SAMPLE COLLECTION YEAR 22 20�5
FACILITY NAMEe FACILITY ACTIVITIES INCLUDE (check all that apply): 1314:?113l.1Al.ITY
COUNTY �4 ❑ use/process meats use animal is/byproducts
PERSON COLLECTING SAMP ES b e, DISCHARGING TO SALTWATERS? [_]YES [UNO
LABORATORYLab Cert. #
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall z nS or No discharge this period'
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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 recelving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 5S gallons of new motor oil per month? ❑ yes Dino (if }des, complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results; only for facilities averaging > 55 gal of new motor oil/month.
c
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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 tent, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
S WLI-249
Last Revised: October 18, 2012

*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 II SECTION
+ 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 on oLl inal and one copy of this DMR incl din all "No Discharge" reports ithin 30 days of recel t o the lab results for at end o
munitorina period In the case. o "No Dischar e" reports) to:
Division of Water Quality
Attn: DWQ Central Files
161,7,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
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/­wq/­ws/su/npdessw#tab-4
SWU-249
Lest Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water.Quality General Permit No, NCGO60000
Date submitted 1)--
CERTIFICATE OF COVE GEAN N 6� SAMPLE COLLECTION YEAR Sk 0
FACILITY NA \ FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY k" ❑ use/process meats use animal fats/byproducts
PERSON COLLECTii iG AMP. ES C' QS ��S DISCHARGING TO SALTWATERS? [:]YES [DNW
LABORATORY t\�\ M Lab Cert: #
' PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part Ac Stormwater Benchmarks and Monitoring Results
RECEIVED-
JUL 0 $ 2015
CENTRAL FILES
DWR SECTION
l�
Total event rainfall' e 3 or ❑ No discharge this period'
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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 an_y outfails. 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 Qlno (if yes, complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
F'f,;t - � - �- ;
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1 Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on-slte 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

*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
o TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCE5 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 on anal and one copy of this DMR includin all "No Discha e" reports, within 30 days of receipt of the lab results for at end o
manitarina pieriod in the case o "No Discharge" marts) to:
Division of Water Quality
Attn: DWQ Central Files
161XMall 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 possibijty of fines an Imprisonment for knowing violations."
(Signature of Permittee).
1 — —
(Date)
Additional copies of this form may be downloaded at: http:/Iportal.ncdenr.6re/web/wa/ws/su/npdessw#tab-4
SWIJ-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 I— — i S
CERTIFICATE OF COV AGE O. NCGO d a $ 0 SAMPLE COLLECTION YEAR
FACILITY NAME AV � FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY ❑use/process meats use anim,-a-) �f /byproducts
PERSON COLLECTING SAMPLES M s? S U DISCHARGING TO SALTWATERS? []YESPhO
LABORATORY L{'o Lab Cert. #
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results
r�
Total event rainfall 2 3� or ❑ No discharge this Peria
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t-n� N
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1 Only -applies to facilities that use/process meats. L FILES
ZThe total precipitation must be recorded using data from an on -site rain gauge. DWR SECTION
3 For sampling periods with no discharge at any outfalis. 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 8)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor ail/month.
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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 MY outfalis, 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.
5WU-249 Last Revised: October 18. 2012

*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
o 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 on anal and one copy of this DMR including all "No Discharge" re arts within 30 days of receipt of the lob -results for at end o
manitaring Period in the case o "No Discharge" reports) to: -
Division of Water Quality
Attn: DWQ Central Files
161cWail 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, ^ 1
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
(Date) '
Additional copies of this form may be downloaded at: http://Portal.ncdenr.orglweb/wq/ws/su/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012
Page 2 of 2

RECEIVED
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT JUN 3 0 2C V
for North Carolina Division of Water Quality General Permit Permit No. NCG060000 CENTRAL FILE
t
Date submitted _ C ` / 6 r ) T �WQ/B0G
CERTIFICATE OF COVE AGE NO. GO6 O SAMPLE COLLECTION YEAR O
FACILITY NAME FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY ; ❑ use/process meats se animal fats/byproducts
PERSON COLLEC ri• .:SAMPLES DISCHARGING TO SALTWATERS? ❑YES E]NK —
LABORATORY IyIiN PIZ Lab Cert. # _2�Z
' PLEASE REMEMBER TO SIGN ON THE REVERSE 4
i/
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall 2 .\!E; or ❑ No discharge this period3
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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 awn r 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 S5 gallons of new motor oil per month? ❑ yes io (if yes• complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Du#fail?foJJ"Sa}��•Ple?Cbllected
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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.
°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

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
w 2 EXC£EDANCES 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 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" reeortsl to:
Division of Water Quality
Attn: DWQ Central Files
1616-.Mail Service Center
Raleigh, NC 2762Li1 -r7.
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 Pkrmlittee)
c G - c-f
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.orgLweb/wq/ws/su/npdessw#tab-4
SWU-249
Last Revised: October 18, 2012
Page 2 of 2