NCG060216 DMR SW (2)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted k' -9`— 1 �
CERTIFICATE OF CpVERAGE 140. NC606a % �o SAMPLE COLLECTION YEAR
FACILITY NAME u e ` FACILITY ACTIVITIES INCLUDE (check all that apply):
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COUNTY nn 11use/process meats �e animal fats/byproducts
PERSON COLLECTING SAMPLES CLC' 21�2� DISCHARGING TO SALTWATERS? []YES g2fM
LABORATORY_ —JR ,\ Lab Cert. # 31)
Part A: Stormwater Benchmarks and Monitoriniff Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
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ZThe total precipitation must be recorded us AbrD$-site rain gauge. -4�L �� AQ, tO� 1 i m
3 For sampling periods with no discharge at a��vad4Nst still submit this discharge monitoring report with a checkmark here.
M'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 SS gallons of new motor ail per month? ❑ yes ano if yes complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: oniv for facilities averaeino 5, ss aal nf new n;ntnr nillrnnwth
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Only applies t0 WERE Fat use/process meats.
ZThe total precipitation must be recorded using data from an on-site rain gauge.
s For sampling periods with no discharge at = 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.
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LVM-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 II SECTION
• 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 ❑ 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 lob, results for at end of
monitoring beriod in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
163XMail Service Center
Raleigh, NC 27699 -1617 -
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
N 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
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(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.ors/web/wa/ws/su/npdessw#tab-4
SWU 249 Last Revised: October 18, 2012
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