NCG060173 DMR SW (3)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Qel
y eryeral Permit No. NCG060000
Date submitted l
CERTIFICATE OF COVE GE NO. NCGp6Q ! _3
FACILITY NAME ✓i c�
COUNTY
PERSON COLLECTING SAMPLES
LABORATORY Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
alp
SAMPLE COLLECTION YEAR
FACILITY ACTIVITIES INCLUDE (checall that apply):
❑ use/process meats [ use animal fa yproducts
DISCHARGING TO SALTWATERS? [:]YES
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall or No discharge this period3
,Outfall No. Sample,Collected,
rr mo/dd/yr
TSS, pH," - ;COD,-
mg/L' Standard units mgJL
Oil and Grease,::',,1-,;. ',-Fecal Coliform,,.
- mg/L Colonie's per 100 ml
EnterococciIL
,i, _-
Colonies per, 00 ml -
13enchrnark' -
-100or50 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.
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 benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no (ifyes• complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
; - '; Sample -Collected, � ;
1-OutfaII'N6' _•
mo/dd/yr•°'"
'," Oil'and"Gr`ease;' ` `
' mg/G "
TSS,
mg/L' `'
pH, New Motor -Oil Usage,
Stannard`units: :Annual average:gal/moi,
Benchmark -
30
100 or 50
6.0--9.0-2,-
' 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 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 benchmark applies.
s�ci
SWU-249 Last Revised: October 18, 2012
Page 1 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Qualiv neral Permit No. NCG060000
Date submitted ;J� 9,rr
CERTIFICATE OF COVERApf NO.�f G0601�
FACILITY NAME l/fl" X tl4S
COUNTY
PERSON COLLECTING SAMPLES
LABORATORY Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR S
FACILITY ACTIVITIES INCLUDE (checl II that apply)-
❑ use/process meats se animal fa byproducts
DISCHARGING TO SALTWATERS? []YESO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall or ❑ No discharge this period3
' butfaIIA6.' Sample,Collected, T55, . pH, " COD," .' Oil and Grease, 1,' , "_ Fecal Coliform •, ; Enterococci,,,-
mo/dd/yr mg%L Standard "units mg/L, mgjl Colonies per 100 ml Colonies per 100 ml_
Benchmark' - J 100 or 50°7 Within 6:0=9:0' 120 30 X1000-- 500-
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 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 benchmar 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 -Collected,, " Oil'and Grease; TSS, pH, New Motor Oil Usage,.
mo/dd/yr ','. t . mg/L- ' '"mg/L --,.:Standard units: • . Annual average gal/mo,
Benchmark - 30 100 or i0 - 6.0-9.0 -
ooa
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 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 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 INA 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:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring 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 Permittee)
9z/ rli .> /
(Date)
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