NCG060209 DMR SW (2)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted. � -3 - I S
CERTIFICATE OF COVERAGE NO. NcrawO a (Y1
FACILITY NAME
COUNTY 'J) Lk -0\' r\
PERSON COLLECTING SAMPLES
LABORATORY Lab Cart. #
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR WS f111:CS,1VED
FACILITY ACTIVITIES INCLUDE (check all that apply): FEB 102015
E] use/process meats [rue animal fats/byproductitE/VTF�A
DISCHARGING TO SALTWATERS? [:]YES E3100 DwR I PIONLFs
PLEASEREMEMBER TO SIGN ON THE REVERSEc
Total event rainfall 2 or * A. +1.1� ---j
2 -1111 uI I w=aa Ica L.P.
The total precipitation must be recorded using data from an on-site rain gauge. 1:5-At�L)LAZ��- No PLOQ
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 all per month? El yes El no
Part B: Vehicle Maintenance Area Monitoring Results! only for faelliffinc2unmalne % ra eml nf nassir 9"! o%*~ ..11 /w.—m&16
10-IN
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ow
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M-11-1
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MO 1-000, HIRE
121,21%
n.1 It
Offif i
2 -1111 uI I w=aa Ica L.P.
The total precipitation must be recorded using data from an on-site rain gauge. 1:5-At�L)LAZ��- No PLOQ
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 all per month? El yes El no
Part B: Vehicle Maintenance Area Monitoring Results! only for faelliffinc2unmalne % ra eml nf nassir 9"! o%*~ ..11 /w.—m&16
10-IN
poapp0
t, gil DO A ON,
0 R Pr,
T
n.1 It
(ties2 y u =0 4. (ties that use/process meats.
The total precipitation must be recorded using data from an on-site rain gauge.
aFor 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.
(if yes complete Part B)
SW'U-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 11 SE ON B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCE FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ R GIO A OFFIC ?� YES NO ❑
REGIONAL OFFICE CONTACT NAME: �• -
Mail on orlainal and one copy of this DMR, includina ail "No Discharae" reports, within 30 days of recelpt of the lab -results for at end of
monitoring perlod in the case of "No Discharae" reports) to:
Division of Water Quality
Attn: DWQ Central Files
161XMail 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
� -3 -) S -
(Date)
Additional copies of this form may be downloaded at: http:Hportal.ncdenr.ors/web/wa/ws/su/npdessw#tab-4
SW -249 Last Revised: October 18, 2012
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