NCG060326 DMR SW

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SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000 RECEIVED"
Date submitted 1-25— J to FEB 0 4 7016
CERTIFICATE OF COVERAGE NO. NCG06 G 2 (r, SAMPLE COLLECTION YEAR 2_0l� CENTRAL FILES
FACILITY NAME (Z,�..,. p /�(r,�-(Q,` l FACILITY ACTIVITIES INCLUDE (check all that apply): --WR SECTIOPl
COUNTY �l D use/process meats E] use animal fats/byproducts
PERSON COLLECTINGSAMPLES _ � o t--�. a DISCHARGING TO SALTWATERS? ❑YES 29NO
LABORATORY CSn Lab Cert. # 3 -7-7-7-
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitorin Results '
g Total event rainfall Z Z or No discharge this period
Outfall No. Sample. Collected TSS; pH,. COD, Orland GreaseFecal Coliform ,,
Enterococci;,
.
mo[dd/yr mg/L 5#andard units.:mg/L mg/L Colonies per 100m1 Colonies;per l00 m1
Benchmark 100'or.50 ° Wittin.5.0=9:0 120 ""` " -
30 1000: 500.
Ezl o S S.z-z
q t S
2/,40 i5 .-73 so
1 Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on-site rain gauge.
4 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 � no (ifyes• complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No: Sample Collected, Oil4nd�Gr6ase; TSS; pH, New Motor Oil'Usage,,
g/L mg/Eh x N 6Standard:units`t> ' Annual average gal/mo
Benchmark - 30 100:or'50 6.0 = 9A _
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 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.
SWU-249
Last Revised: October 18, 2012
D...,o i , r n

*FOR PART A AND PART -BNONITORING- 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 B.
• 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 daysof'receWr f1he,lab results for at end of
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 FORANY 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 per-sons,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."
,04-
(Signature of Permittee)
1-X3 -i Co
(Date) - -
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-2! 0 Last Revised ober 18, 2012
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