NCG060335_DMR_20230112

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING RE
for North Carolina Division f W
o ater Quality General Permit No. NCG060000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG06 Oa FACILITY NAME
SAMPLE COLLECTION YEAR_.
COUNTY FACILITY ACTIVITIES INCLUDE (checkAl
� hat apply):
PERSON COLLECTING SAMPLES i ❑use/Process meats use animal fats b
Gc. ri2oa �ys'DISCHARGING TO SALTWATERS? []YES NO Yproducts
LABORATORY , ,� �„��s Lab Cert. 4 Z�
Part A: Stormwater aanrk -, t., --�
Q oc.•�4..
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
For sampling _. _- ❑ "VI
" do on -site rain gauge.
p g periods with Table
,identifying
discharge at an 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 benchm
ark 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.
Only applies to facilities that use/process meats.
43 The 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 checkmar
k here.
See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
S WLJ-249
Km, complete Part B)
RECFi\/Fr,
JAN 2 3 2023
CENTRAL FILE:
OWR SECTION'
last Revised: October 19, 2012

*FOR P, N AND PART R MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART IISECTION
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFACE TRIGGER TIER 2
® TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES [] N® REQUIREMENTS. SEE PERMIT PART II SECTION B.
❑ METER AT ANYONE OUTFACE? YES El NO
REGIONAL OFFICE CONTACT NAME:
Division of Water Q
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
"I certify, under penalty of law, that this documeiNY NF® d�� at®achme�t�srvv®re
system designed to assure that qualified personnel properly prepared under my direction or supervision in accordance with a
person or persons who manage the system, or those persons directly responsible for at
p y gather and evaluate the information submitted. Based on my inquiry of the
to the best of my knowledge and belief,'true, accurate, and complete. I am aware
information 'including the possibility of fines and imprisonment and gathering the information, the information submitted is,
that there are significant penalties for submitting false
p ent for knowing violations."
(Date)
Additional copies of this form may be downloaded at: htt : ortal.ncdenr.or web w w / s/su/n dessw#tab 4
SWU-249
Last Revised: October 18, 2012
L..-- 11 - 1,