NCG060209 DMR SW (4)

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SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT F?I�CE/v
for North Carolina Division of Water 9uality General Permit No. NCG060000J,r�t 5 C
Date submitted 2015
rn� STpRMWq ER pQUALITy
CERTIFICATE OF COVERAGE NO. NCG06 �Q SAMPLE COLLECTION YEAR a � 1 If
FACILITY NAME �C _ o,� FACILITY ACTIVITIES INCLUDE (ch all that apply): ERM11T1NG
COUNTY u ❑ use/process meatsuse animal f is/byproducts
PERSON COLLECTI G SAMPLES 41 DISCHARGING TO SALTWATERS? []YES QNO
LABORATORY i5�t c Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
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3The 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.
Did this facility perform Vehicle Maintenance Activities using more than SS gallons of new motor all per month? ❑ yes �no if es complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 al of new motor il/ th
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ZThe total precipitation must be recorded using data from an on-site rain gauge.
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.
SW -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 SEION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDEN S FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑
IF YES, HAVE YOU CONTACTED THE DQ R GION L OFFICE?, \` ES NO ❑
REGIONAL OFFICE CONTACT NAME: T
Mail an oriainal and one coon of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab, results for at end of
monitoring aeriod In the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
_ 161aCMail 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
i-a_I
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.ors/web/wa/ws/su/nndessw#tab-4
SWU-249 Last Revised: October 18, 2012
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