NCG060160 DMR SW (2)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted
CERTIFICATE OF CO ERAGE NOhNCG06121L_o SAMPLE COLLECTION YEAR Z�l
FACILITY NAME A11e`/ _%tl C. • FACILITY ACTIVITIES INCLUDE (che all that apply):
COUNTY a f Y1 t.Q AJQ ❑ use/process meats L± use animals/byproducts
PERSON COLLECTING SAMPLES 11741—r f//LL DISCHARGING TO SALTWATERS? []YES [240
LABORATORY le PO&C' _ Lab Cert. #
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitorine Results Total event rainfall 2 6.2S or ❑ No discharge this period'
_Outfall, No. • <. Sample Collected,. „TSS,; ..pH, COD, Oil.and Grease; . F;ecal_CoIliform., Enterococci.
" mo/dd/yr �mg& . Standard units mg/L mg/L - - Colonies per 100 ml Colonies per 100•ml
Benchmark' " ' 100 or'50 1NitFifnIx'=9:0 ' ''120, 30 1000 S00
0 3Z
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 (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.Colleited;"' : ' Oifand Grease'-
mo/dd/yr', . mg/L...' • ti' '
TSS,
mg///U'','.
--pH, New Motor Oil Usage,
Standard units -.Annual average,gal%mo
Benchmark
- 30
i110'or 50
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 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
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*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 FYEIAMEPAIIAMETERATANYONEOUTFALL? 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, includina all "No Discharge" reports, within 30 days of receipt of the lab results for 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."
of Permittee)
//--3-/5-
(Date) --3-/5-
(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
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