NCG060209 DMR SW (7)

CERTIFICATE OF
FACILITY NAME
COUNTY _
PERSON COLLEC
LABORATORY i
Part A:
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water 0,pa_ll`ty General Permit No. NCG060001
Date submitted � --
FEB 2 3 2013
SAMPLE COLLECTION YEAR
as 1 b DENR-LAMS' QUALITY
FACILITY ACTIVITIES INCLUDE (check all that apply): STCRIt";Vagi ER PERM1T T ING
❑ use/process meats use animal fats/byproducts
DISCHARGING TO SALTWATERS? ❑YES g]W
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall" **3 I( or n No
i Onlyapplies to facilities that use/process meats.
?The total precipitation must be recorded using data from an on-site rain gauge.
s For sampling periods with no discharge at= 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 all per month? ❑ yes eno
B: Vehicle Maintenance Area Monitoring Results: only for
> 55 gal of
Only applies to facllitles that use/process meats.
The total precipitation must be recorded using data from an on-site rain gauge.
For sampling periods with no discharge at MM 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
this
(fes complete Part B)

-FOR PART A AND PART B MONITORING 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 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENC FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES o El
IF YES, HAVE YOU CONTACTED THE D Q R GI A LICE? `. _ zta=�-
REGIONAL OFFICE CONTACT NAME: O� \Z -;.-V iA\
Mail an original and one coov of this DMR, includin all "No Discharae" reports, within 30 dans of recelnt of the lab, results (or at end of.
monitoring oer/od In the case. of '"No Discharae" CROWN) to:
Division of Water Quality
Attn: DWQ Central Files
161AMall Service Center
Raleigh, NC 27699-1613
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."
Ile
(Signature of
(Date)
Additional copies of this form may be downloaded at: htta://i)ortal.ncdenr,ora/web/wa/ws/su/nt)dessw#tab-4
SWU-249
Last Revised: October 18, 2012
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