NCG060216 DMR SW

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT RECEIV15
for North Carolina Division of Water Quality General Permit No. NCGO60000
Date submitted c J U L 0 6 2015
CERTIFICATE OF CQVERAGE NO. NCG06 - - SAMPLE COLLECTION YEAR Iy CENTRAL FILES
FACILITY NAME 1--G c �� FACILITY ACTIVITIES INCLUDE (check all that apply): SWR SECTION
COUNTY C ct ❑ use/process meats Pose animal fats/byproducts
PERSON COLLECTING MPLES DISCHARGING TO SALTWATERS? AYES OgNO
LABORATORY L-- Lab Cert. # a �
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitorine Results
Total event rainfall 2 l .S or M Nn dicrharne this nPrinW
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Zuniy-applies to tacilities that use process meats. w90 L `$ e ouz,
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.
4See 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 SS gallons of new motor oil per month? ❑ yes [ino f yes complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaninn > 55 nal of new motor all/month
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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.
a3For sampling periods with no discharge at M outfalls, you must still submit this discharge monitoring report with a checkmark here.
See General Permit text, Table 3, Identlfying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: October 18. 2012

*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.A.
• 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:
Mall an orlainal and one cony of this DMR. Includina all "No Discharge" reports, within 30 days of receipt of the lab- results for at end of
monitoring period In the case of "No Discharae" reoortsl to:
Division of Water Quality
Attn: DWQ Central Files
163XMail 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, including the possibility of fines and Imprisonment for knowing violations."
(Signature of
- - 1,5
GIN I
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.ore/web/wa/ws/su/npdessw#tab-4
SWM -249
Last Revised: October 18, 2012
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