NCG060161_MONITORING INFO_20190711

4"
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V C D U
DOC TYPE
❑ HISTORICAL FILE
CYMONITORING REPORTS
DOC DATE
❑ 0� ioj 1 0-7 I r
YYYYMMDD

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Q ality General Permit No. NCG060000
Date submitted =1 I 10,
CERTIFICATE OF COVERAGE NO. NCG06-0.0 Q Q SAMPLE COLLECTION YEAR -0 � - I
FACILITY NAME (2nS ri C L _L - FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Q r�cLt CSOr1 ^ I'�1=irM v ® ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING,SAMPLES T( aLC. j n 11 4 1 9 DISCHARGING TO SALTWATERS? [—]YES �4NO
LABORATORY Po, Ct Lab Cert. # 40
CENTR/aL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE
DWR SECTION ,
Part A: Stormwater Benchmarks and Monitoring Results ., Total,event rainfall Z W'or ❑ No discharge this period'
Outfall No .
'Sample`Collected'S
gyp._,•
mo%dd%yr,.
's yYTSS,
'mg/L�
^t pH
'.Standard -units'"
CC)D .
t
"mg%L
Od and Grease,
1).. ' '. .r.0.
' 'mg%L
Fecal Coldorm ,
. .. ., t. Y..
. Colonies per 300 ml
Enterococci , ,
.•
`Colonies•per100 ml`
68iichmark ` ?
`r.
. 100.or 50 77
'i
+120 a
3t)
1000
`. -' S00
C5j 0-
_.. .
"�'
iY
Only applies to facilities.that use/process meats.
a The total precipitation must be recorded using data from anon -site rain gauge.,, ,;',..
a For sampling periods with no discharge at any outfalls. You must still submft.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
.. 9....-.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfali No is
ndd/Yr.f1s
> SampleiColli'& d 4
.
',, YOiI and Grease
''' " '`
+ « ��;Ya fnur%AwVta3 .
x,:;: ncrx �m IYv U
g/ n Po
pH
Standatd.unrts
- r
New Motor Oil Usage,
Ann'iial;average gai/most'
Benchmark•,;"a,
..
30 •;._
-. 100°or`50, .:;;
: 6.0 d9.0' .. .
(if ves, complete Part B)
Only appiie"s to facilities'fhafuse%process meats - -
t the totaLprecipitatiori must Wrecorded using data from zi,n on -site rain gauge.
' For sampling.periods with no.discharge at outfalls„you'muststiil submit this dischaege,monitoring report with;a checkmark here.
"See General, Perm it;text, Table:3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 last Reviscd: October 18, 2012
Paee 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 INA ROW -FOR THE SAME PARAMETER AT -THE -SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER'3: `HAS'YOLIR'FACILITY kADA C)R.MORE.BENCHMARK EXCEEDENCES FOR THE SAME P.ARAMETER.AT.ANYONE OUTFALL? YES —]NOW
IF YES, HAVE YOU CONTACTED THE. DWQ REGIONAL OFFICE? YES. Q NO -
REGIONAL OFFICE CONTACT NAME; -- -" -- --
-Mail an original and one copes this DMR. including all "No Diseharge" reports; -within 30 do-s-,ofreceiptof:the lab results (or at end of
monitoring period in thecase of "No Discharge"reports) to:.
Divisionof 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 document -and all -attachments were prepared under' ny-direction o.r supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the mformatiorrsubmitted. _Based on my inquiry of the
person or persons who manage the system, or -those persons directiy,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'faIse
information mcludkng the possibility of -fines and ,imprisonment forrknowing violations"
i
(Signature; of Permittee), (Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wg/ws/sg/npdesswHtab-4
SWU-249 l Last Revised: O r I81 2012
1 „)age�2,pf 2