NCG060344 DMR SW

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG06 OO�Q SAMPLE COLLECTION YEAR
FACILITY NAME kZ �G FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY W00
❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES �PR/� RGING TO SALTWATERS? ❑YES [✓��110
LABORATORY ,e lr dab Cert. # � �
SEP 17 215 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitorine Results CENTRei r,. _ _ r„+„ l __#..,,;., �� 2 a/ __ n
Outfall No. Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
Brioni
mg/L
— �•-�•• �•••��.. . ur u ivu ui�wnurye ung perr0a
Oil and Grease, Fecal ColiformL, Enterococcil,
mg/L Colonies per 100 ml Colonies per 100 ml
Benchmark -
100 or 50
Within 6.0-9.0
120
30 1000 500
Willy aNNuw w iaun1.11=3 L110L use, process Il led U.
3The total precipitation must be recorded using data from an on-site rain gauge.
3 For sampling periods with no discharge at anyoutfalls. 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 55 gallons of new motor oil per month? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of naw mn+nr .,w.,,.,.,+h
Outfall No. Sample Collected, Oil and Grease, TSS, pH, New Motor Oil Usage,
mo/dd/yr mg/L mg/L Standard units Annual average gal/mo
Benchmark - 30 100 or 504 6.0-9.0
vhry appnes to raciuties that use/process meats.
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.
(if es complete Part B)
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.
O 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 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."
l'� anis
(Signature of Permittee) (Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw4tab-4
SWU-249
Last Revised: October 18, 2012
Page 2 of 2