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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
[YWONITORING REPORTS
DOC DATE
❑ I -7 y
YYYYMMDD
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Resources General Permit No. NCG060000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG06Q1$'S__ (r`�rt r5/ )PLE COLLECTION YEAR aO I S
FACILITY NAME �_ync G.rwd LL L REv FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY ,S a r rj J11� 2 4 019 ❑v -use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES 5 c,r. x L3D'jt - L FR_I.SEgfARGING TO SALTWATERS? ❑� YES NO
LABORATORY (h". Le.L, Lab Cert. # / T� CT10N
PLEASE REMEMBER TO SIGN ON THE REVERSE
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall or M No discharge this period3
Outfall No.
le Collected,
rnmo/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
001
0f
iA c ow
uniy appues 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 no (if yes, complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaeine > 55 eal of new motor nil/mnnth
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
100oc50
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.
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 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 [f-
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 of
monitoring period in the case of "No Discharge" reports/ to:
Division of Water Resources
Attn: DWR 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, incl ding the possibility of fines and imprisonment for knowing violations."
(Signature of Pe ittee) (D e)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wq/ws/su/npdesswHtab-4
SWU-249 Last Revised: October 18, 2012
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