NCG060335 DMR SW (2)

SEMI-ANNUAL STORMWATER DISCHARGE M
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for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted /'/a /-&
CERTIFICATE OF COVERAGE NO. NCG06„Q !1a:
FACILITY NAME &6 Ore r,rnc Xn /4",+A `ze"i/ /n%//
COUNTY dsan
PERSON COLLECTING SAMPLES J)/n 69� 4�G�� ,61,,,r0.t"
LABORATORYLab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR o96/S
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats Ouse animal fats/byproducts
DISCHARGING TO SALTWATERS? ❑YES D NO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
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I11CdLJ. CENTRAL FILES
The total precipitation must be recorded using data from an on-site rain gauge. DWR SECTION
43 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 Q no
Part B. Vehicle Maintenance Area Monitoring Results: only for facilities avera in > 55 a) of n t it
1xOi�tfallNo , S I r� wy x g g g ew mo
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y y ,z x z _ sip Vis . pH,
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y pp o acl ides t at use/process meats.
The total precipitation must be recorded using data from an on-site rain gauge.
43For 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.
(ifyes, complete Part 13)
SWU-249
Last Revised: October 18, 2012
Nap. 1 ofd

*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 FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO PJ
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 (or 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."
(Sign ture of Permittee) �1 (Date)
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Additional copies of this form may be downloaded at: http://portal.ncdenr,org/web/wo/ws/su/npdessw#tab-4
SW -249
Last Revised; October 18, 2012
Nap ? of 9