NCG060385_MONITORING INFO_20200102

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
c G
DOC TYPE
❑ HISTORICAL FILE
[ MONITORING REPORTS
DOC DATE
❑ V'04 (-2 )
YYYYMMDD

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Qu lity� General Permit No. NCG060000
Date submitted
CERTIFICATE OF ConVERAGE NO. N G060 3 V SAMPLE COLLECTION YEAR �01q__
FACILITY NAME V n.�ra zf6s �/��'FACILITY ACTIVITIES INCLUDE (check ail that apply):
COUNTY r, �d—V 6 ° use/process meats ❑ use /p ❑ use animal fats/byproducts
PERSON COLLEglfilGt SAMPLEES jAg 09 2B20 DISCHARGING TOSALTWATERS7 ❑YES ®NO
LABORATORY Y' V w,n. gbcc k b Cert. # 40
n_E" PLEASE REMEMBER TO SIGN ON THE REVERSE 4
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Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall 21 11 r 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.
' 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 JK no (if es complete Part B)
Part.B: Vehicle. Maintenance Area Monitoring Results: oniv for facilities averaging > 55 gal of new motor nil/mnnth
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Umy applies co racmues that use/process meats.
2The total precipitation must be recorded using data from anon -site. rain gauge.
' 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 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 ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑ .
REGIONAL OFFICE CONTACT NAME:
Mail an originat and one copy of this DMR including all "No Discharae" 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
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 aie significant penalties for submitting false
information, includipg the possibility of fines and imprisonment for knowing violations:"
(Signature
la LaD Liq
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012
Page 2 of 2