NCG060173 DMR SW

STORMWA'
for North Carolina Division of Water Qua
Date submitted
CERTIFICATE OF COVE GEN NCG06j9
FACILITY NAME \(4L(' ti!Tac
COUNTY
PERSON COLLECTING SAMPLES
LABORATORY Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
R E MONITORING REPORT
G neral Permit No. NCG060000
I /p ✓� j
SAMPLE COLLECTION YEAR j
FACILITY ACTIVITIES INCLUDE (chec that apply)-
❑ use/process meats use animal f byproduc
DISCHARGING TO SALTWATERS? [F]YES O r
PLEASE REMEMBER TO SIGN ON THE RE E 4
Total event rainfall 2 or No discharge this period
Outfall No_. Sample Collected, TSS„ pH,; , -;,COD, : Oil and Grease, Fecal Coliform„ .-Enterococci ,
rn da
/yr" ''mg/'L Standard units mg/L~ mg/L- Colonies per,100 ml Colonies per --100 ml
Benchmark 100 or 50 Within'6:0=9.0 120' 30 '' 1000 500
1 Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on-site rain gauge. y
3 For sampling periods with no discharge at anyoutfalls. 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 ❑ 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; - ' TSS, pH, = New Motor Oil Usage,
mo/dd/yr ,- mg%L ' mg/1:' `:'= Standard 'u'riits :Annual average gal/mo
Benchmark - 30 100 or 504 6.0-9.0 -
1 Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on-site rain gauge.
3 For sampling periods with no discharge at anv 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

RMWAT
DISCHARGE MONITORI
for North Carolina Division of Water
Date submitted
CERTIFICATE OF COVERA E NO. CG060 J_ 73
FACILITY NAM �/`n[�ss
COUNTY
PERSON COLLECTING SAMPLES
LABORATORY.
Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
ener
87M
rmit No. NCG060000
SAMPLE COLLECTION YEAR
FACILITY ACTIVITIES INCLUDE (ch
use/process meats
DISCHARGING TO SALTWATERS?
PLEASE REMEMBER TO SIGN ON THE
Total event rainfall Z
Outfall No_. Sample Collected,
= mo/dd/yr
TSS,,
' mg/L
pH,,, .
Standard units
_ ,,COD, „ ,
mg/L
Oil and -Grease,
mg/L'
Fecal Coliform;,-
Colonies per 100 ml
Enterococci;,;
Colonies per -100 ml
Benchmark' " -
300 or SO4.3Within
6:0'= 9:0-,'
120 '
'30
1000
500
1 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 benchm$iWapplies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Ryes ❑ no (if yes, complete Part B)
Part B: Vehicle Maintenance Area Monitorine Results: only for facilities averaging > 55 gal of new motor oil/month.
'Outfall No: -, '- ;-'Sample Collected,'', -' = Oil and -Grease, TSS, pH, New Motor Oil Usage,
Standard 'units ''Annual'avew age gal/mo -
Benchmark - 30 100 or SO 6.0-9.0 -
1 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 R 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
monitoring period in the case of "No Discharae" 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 Perm
7 9N i 5
( Date)
Additional copies of this form may be downloaded at:.http://portal.ncdenr.org/web/wq/`ws/su/ni)dessw#tab-4
SWU-249
Last Revised: October 18, 2012
Page Z of 2