NCG060385_MONITORING INFO_20190703

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
CDC MONITORING REPORTS
DOC DATE
❑ �'D D 3
YYYYMMDD

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Qu lity eneral Permit No. NCG060000
itted Date submQ
CERTIFICATE OF CRVERAGE NO. CG06_L)_3_2 SAMPLE COLLECTION YEAR I l
FACILITY NAME V AtN- $ FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY iara t ❑ use/process meats ❑ use animal fats/byproducts
PERSON coil wrilild SAMPLES ras DISCHARGING TO SALTWATERS? [—]YES ®NO
LABORATORY A v. Leb Cert. # 4o
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results
Total event rainfall 2 .CIO' or ❑ No discharge this aeriod'.
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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.
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19
Did this facility perform Vehicle Maintenance Activities using more than 55 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 teal of new -motor oil/month
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- Only applies to facilities that use/process meats.
z The total precipitation must be recordedusing data from an on -site rain gauge.
3 For sampling periodswithno 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 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 11 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 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
monitorina.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 informationsubmitted. Based on my inquiry of the
person or persons who manage the system, or -those persons directly responsible for gathering4ke 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' a possibility of fines and imprisonment for knowing violations:"
(Signature of
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wo/ws/su/ni)dessw#tab-4
S W U-249
Last Revised: October 18, 2012
Page 2 of 2