NCG060173 DMR SW (6)

IVED
MAY 0 7 2015
;EMI -ANNUAL STI
ATER DISCHARGE MONITORING RI
for North Carolina Division of Water Qua14 G4neral
DENR-LAND QUALITY Date submitted �
STORMWATER PINATFIND
CERTIFICATE OF COVER E NO. CG06! �� SAMPLE COLLECTION YEAR ' S
FACILITY NAME c� C FACILITY ACTIVITIES INCLUDE (cfec that apply):
COUNTYnn use/process meats se animal fa yproducts
PERSON COLLEC NG SAMPLE 0 P, DISCHARGING TO SALTWATERS? ]YES 0
LABORATORY MiSlyLab Cert. # t7
No. NCG060000
PLEASE REMEMBER TO SIGN ON THE REVERSE -i
Part A: Stormwater Benchmarks and Monitoring Results
Total event rainfall z or ❑ No discharge this period'
Outfall No
Sample Collected,
mo/dd/yr.
TSS, pH,; COD, Grease, Fecal Coliform , Enterococcii,
Standard units _ ., mg/L .: Colonies er 100 ml `_ Colonies per. ml .:
mg/L : mg/L p
;Benchmark 100 or`50°. Withm 6.0: 9.0 ''' 120
30
1000., 5
0?
41'"19/
I!O
All" �✓.�-
Unly dpplleb LU IdGllllle] UldL uDc/PIUU=C nICOL].
zThe total precipitation must be recorded using data from an rain gauge.
3 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 (if yes, complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for tacilities averaging > ss gall of new motor onjmonin.
-til+fall Nnr. Samolp•Collected. .Oi'I and Grease. "T55 pH` New MotoiI
Benchmark 30::. l00 or 50
Unly dppllC] LU.IdU11LIt=1 Ll ldl U]C/ 111 VL C» IIICOL�,
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.
°See 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
Page 1 of 2

SEMI-ANNUAL STORMWATER DI
for North Carolina Division of Water C
�j Date submitted
CERTIFICATE OF COVER E NO. CG06 6) !13
FACILITY NAME (�
COUNTY
PERSON COLLECT G SAMP/L�E_
LABORATORY VPW W9'Ij Lab Cert. # y�l�
Part A: Stormwater Benchmarks and Monitoring Results
RGE MONITOI
General Permit
SAMPLE COLLECTION YEAR_(
FACILITY ACTIVITIES INCLUDE (ch
❑ use/process meats
DISCHARGING TO SALTWATERS?
G REPORT
NCG060000
©Cs
that apply):
e animal fa yproducts
]YES 0
PLEASE REMEMBER TO SIGN ON THE REVERSE -i
Total event rainfall Z a y or n No discharge this
Outfall No Sample Collected, TSS, pH, . COD, � OUand Grease, ; ,[ Fecal CoUform , Enterococa„� ;
-'I mo/dd/vr., I mg/L': 1.'�Stanla ard;umts': I m'g/L ;?L. mg/L;, , ;:I , Co 6616S0er100 ml .' I ,,Colonies per 100,mI :,:I
1 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
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more p
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per
Part B:.Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor
Outfall `No
-S Cbl Qil and Grease, _e.TSS, pHA
ark here.
benchma applies.
es ❑ no
sage,
If8enchinark ' I .I. 100 or 50°
_ 6 0 -; 9.0
::.
30..
Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on-site fain gauge.
3 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.
(if yes, complete Part B)
SWU-249 ( Last.Revised: October 18, 2012
I Page I of 2

*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 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 .0 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 for 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."
R,FffA
(Signature of Permittee)
Sy ��
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
S WU-249
Last Revised: October 18, 2012
Page 2 of 2