NCG060282 DMR SW (3)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000 JAN 2 0 2016
Date submitted ��
CERTIFICATE OF C01
ERAGE O. NCG06y SAMPLE COLLECTION YEAR `� O
FACILITY NAME QCb ` FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY ❑ use/process meats Fuse animal f is/byproducts
PERSON COLLECTING SAMPLES",'- h!� _ DISCHARGING TO SALTWATERS? []YES BANO
LABORATORY Lab`C-drt. # 3 11 n
PLEASE REMEMBER TO SIGN ON THE REVERSE 3
Part Ac Stormwater Benchmarks and Monitoring Results Total event rainfall Z� tl or [1 No discharge this
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Onlyapplles'to facilities that use/process meats. I ZThe total precipitation must be recorded using data from an on-site rain gauge. Iv o� oC\ �
aFor sampling periods with no discharge at env outfalls. You must still submlt 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? [Vyes ❑ no es complete Part Bj
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oll/month.
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Z Only applies to facilities that use/pr ocess meats.
ZThe total precipitation must be recorded using data froO(
m an on-site rain.gauge.�q$ CGn�('C2Se�1
s For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with �heckmark here. ,
"See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249
T .... D-.,:.va- n. +-I— I s Im 1)

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 2 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 HADA OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO jtK
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 Discharae"reports, within ao dans of receipt of the /alr re ulis for at end
monitorina oerlod In the case. of "No Discharge" reports) for
Division of WateLFIles ty
Attn: DWQ Centr161XIVIail ServicerRaleigh, NC 276
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
Q_
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.ors/web/wa/ws/su/npdessw#tab-4
SWU-249
Last Revised: October 18, 2012
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