NCG060216 DMR SW (3)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT RECEIVED
for North Carolina Division of Water Qualit General Permit No. NCG060000
Date submitted �` — S M""
E 3 Q 2016
CERTIFICATE OF COVERAGE NO. N00060 �Z i G SAMPLE COLLECTION YEAR Q O IR --449 QUAAUTY
FACILITY NAME FACILITY ACTIVITIES INCLUDE (check all that apply`PFMA K4 M.4rn.m
COUNTY Cb '. 0. ❑ use/process meats (se_ anim�a-l•,f�a/byproducts
PERSON COLLECTING SAMPLES W�� DISCHARGING TO SALTWATERS? [:]YESL XO
LABORATOL_L_'_-4a b Cert.-.�
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
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Part A: Stormwater Benchmarks and Monitoring Results T_+_1 11 S
. , event ramfa or No discharge this per�oa
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Onlyapplies to facilities that u /
se 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. C
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 oil per month? ❑ yes (if yes, complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results• only fnr farilitioc nuarsnine *,cc Meal .as ..e.......aa.a.. _II
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-•••, -1-r --- -- •ur,na•ca L1111 U0alli ocess meats.
3The total precipitation must be recorded using data from an on-site rain gauge.
s 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

*FOR PART A AND PART B MONITORING RESULTS:
v A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
o TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO [Lk'
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one copy of this DMR, includina all "No Dlscharae" reports, within 30 dans of receipt of the lab'results !or at end of
monitorina Qeriod in the case. of "No Dlscharae" reports) to:
Division of Water Quality
Attn: DWQ Central Files
161oZMail 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 Permittee)
M -Z -4'y
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wa/ws/su/npdessw#tab-4
SWU-249
Last Revised: October 18, 2012
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