NCG060333_DMR_20231205 (1)

w
DEC 15 202';
nl.. t=1L
QUARTERLY STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
G(r b (, b 3 33 Date submitted 12 - i
'ERTIFICATE OF COVERAGE NO. NCG060 0,� � SAMPLE COLLECTION YEAR Ze 2.3
dCI LITY NAME ,t"l l L L L- '1V,,( ,/sflr l FACILITY ACTIVITIES INCLUDE (check all that apply):
AUNTY SaKff $try-
rR50N COLLECTING SAMPLES Eluse/process meats [J use animal fats/byproducts
4BORATORY A MOCVtt.� Lab Cert. N �{ DISCHARGING TO SALTWATERS? AYES �10
Pail A: Stormwater Benchmarks and Monitorine Resnitc
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Ott f 5 ZM
DWR SECTION
�J �P
Total event rainfall z or V No discharge this
......
1311, COD, Oil and Grease, mg/L
mo/dd/yr mg/L Standard units mg/L
chmark 100 or 504 Within 6.0-9.0 120 30
Fecal Coliforml,
Colonies per 100 ml
1000
Enteracoccp,
Colonies per 100 ml
Soo
applies to facilities that us recess meats.
2rhe total precipitation must be recorded using data from an on -site rain gauge.
3For stmpling perlods 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 �o (if es,
cc mplete Part B)
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, I TSS,
mo dd r pH, New Motor Oil Usage,
/ /V
mg/L mg/L Standard units Annual avaraoa val/mn
r Onlyanpiles to facilities that use/process meats.
'The wtal precipitation must be recorded using data from an on -site rain gauge.

F, sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here,
General Permit text, Table 3, Identifying the especially sensitive receiving water classifications where the more protective benchmark
es.
,F)R PART A AND PART B MONITORING RESULTS:
V A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS, SEE PERMIT PART II SECTION B.
0 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 ANYONE OUTFALL? YES ❑
NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
101 an original and one cop r0 this DMR, includln all "No Discharge" reports:, within 30 (1aVs or receipt of the lab results (or crt
fir'd afmonitoring 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
rMh4UST SIGN THIS CERT/f1CAT10N 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
in formation, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
th ere are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
violations."
(Signature of Permittee)
(Date)
Ad ditional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4