NCG060173 DMR SW (19)

MI -ANNUAL STORMWATER DISCHARGE MO
)RING REPORT
for North Carolina Division of Water Qual�ty Gto
eral Permit No. NCGO6000O
Date submitted - o5 !'<-`
CERTIFICATE OF COVE GE NNCG06.©I
FACILITY NAME VA- 4S C -
COUNTY
PERSON COLLECTING SAMPLES
II_l •IQJ-A t61:y 1
Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
I /
SAMPLE COLLECTION YEAR
FACILITY ACTIVITIES INCLUDE (checl that apply)-
❑ use/process meats use animal byprod
DISCHARGING TO SALTWATERS? ❑YES O
PLEASE REMEMBER TO SIGN ON THE RE E -
Total event rainfall 2 or rF,t No discharge this geriod3
Outfall No. Sample Collected, TSS,, pH,'.. COD, Oil and Grease, Fecal Coliform„ Enterococci •,
mo/dd/yr mg/L Standard units mg/L` mg/C ' Colonies per 100 ml Colonies, per 100 ml
Benchmark'" - -100 or 50 Within�6.0=9.0"' 120' 30 1000`- 500
O D
1 Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on-site rain gauge. y
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 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.
Outfall No., "•
,`Sample Collected,''•'. `:' ' Oil and Grease,
mo/dd/yr • '"Ing `
TSS,
mg/l-'.'
pH,. -
pH,
Standard units
New Motor Oil Usage,
'-Annuafaverage.gal/mo ­
Benchmark
- 30
100 or 50
6.0-9.0
-
' Only applies to facilities that use/process meats.
2 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.
(ifyes, complete Part B)
SWU-249 Last Revised: October 18, 2012
Page 1 of 2

AI -ANNUAL S7
AWATER DISCHARGE N
for North Carolina Division of Water
Date submitted
CERTIFICATE OF COVERA E NO.CG06 D J_g 3
FACILITY NAM 0/b�ins
COUNTY _
PERSON COLLECTING SAMPLES
LABORATORY
Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
DRING REPORT
ner2!,Permit No. NCG060000
SAMPLE COLLECTION YEAR C
FACILITY ACTIVITIES INCLUDE (ch c all that appl
❑ use/process meats [use animal f s/I
DISCHARGING TO SALTWATERS? ❑YESJX4NO
3
R 5.. 1 ?015
v'FFR pEF
PLEASE REMEMBER TO SIGN ON THE R RSE -�
Total event rainfall 2 or No discharae this oeriod3
Outfall No. Sample Collected,.
mo/ddA
,.TSS„
mg/L'' -
pH,,; :
Standard units
COD,
mg/L
OiI and Grease,Fecal
mg /L'
Coliform.,
Colonies per_100 ml
Enterococci-,;
Colonies -per -100 ml "
Benchrrla�k':-`, "; : ::.• r,, ._. ,--,
-1000 50
' Within"6.0•=9.0" '-
•120'
- 30.''1000
500
4 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.
"See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchm applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? yes ❑ no (if ves, complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No: -'Sample bllected;' -, ` Oil and Grease; TSS, pH, New Motor Oil Usage,
" mo%dd/yr /L� mg/1.:'�:Stanilard'units� Annual`averagegal/mo,
Benchmark - 30 100 or SO4 6.0-9.0 -
elf, 4
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 1 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 original and one copy of this DMR including all "No Discharae" 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 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 Pe
7
(Date) ,
I
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•Z of 2