NCG060168 DMR SW

SEMI` -ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for IVorth•'Carolina Division of Water Quality General Permit No. NCG060000.,
Date submitted, VED
CERTIFICATE -OF COVERAGE NO. NCG06 U SAMPLE COLLECTION YEAR o2D/ S JAN 1 8 2016
FACILITY NAME i LAM ,J FAC_ ILITY ACTIVITIES INCLUDE (check all that apply):
��NT Fi�E
COUNTY
PERSON COLLECTIN SAMZ;FtLabCert.4'
°di use/process meats ❑use animal fats/byproductsR s�C1lOIV'"
dQin� �� DISCHARGING TO SALTWATERS? AYES 54NO .
LABORATORY_Tikylko -j l0
PLEASE REMEMBER•TO. SIGN ON THE REVERSE -i
Part A: Stormwater Benchmarks and M
Totgl,event rainfall 2 �P $ or -]No discharge this
N
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 air 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 55 gallons of new motor oil per month? ❑ yes [Xno (if ves, complete Part B)
PartB Vehicle Maintenance Area Monitoring Results only for facilities averaging > 55 gal of new motor oil/month.
Only applies to'facilities that use/process meats:77
3The total precipitation must be recorded using data from an on-site rain gauge.
4 For sampling periods with no discharge atany outfalls, you must stillsubmifthis discharge monitoring report with a checkmark-here.
See General Pe'rmit.text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
S WU-249
Last Revised:. October 18, 2012

*FOR PART A AND PART B MONITORING RESULTS:
• •A BENCHMARK. EXCEEDANCE TRIGGERS TIE_ R i'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 B.
• TIER 3: ' HAS YOUR. FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NOIN
'IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL•OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail anoriginal and one copy of this DW-includina all "No Discharae" reports, within 30 days of receipt`of thi
monitoring period -in the case of ."No Discharae"• 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: ,Y
"I certify, under penalty of law, thafthis document and all attachments were prepared -under .my direction or supervision in`accordance with a
system designed t6 as'sure 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 informationsubmitted is,
to the best ofsmy knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties.for submitting false
information, induding_the possibility of fines and imprisonment for knowing violations."'
( )
(Signature of. Permittee) ; Date
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWLT.-249 Last Revised: October 18, 2012
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