NCG060209 DMR SW (8)

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SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT �29�.
for North Carolina Division of Water Quality eneral Permit No. NCG060000
q Date submitted S�&,'v4`Ipj�_%
CERTIFICATE OF' C VERA E NO. CGa � I SAMPLE COLLECTION YEAR C 6 l
FACILITY NA E d t� i FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY ❑ use/process meats 0 use animal f is/byproducts
PERSON
COL
SAM%ES 0. DISCHARGING TO SALTWATERS? []YES 110
LABORATORY�� Lab Cert. #
PLEASEREMEMBER TO SIGN ON
Total event rainfall IL_
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Only -applies to facilities that use/process meats.
3The total precipitation must be recorded using data from an on-site rain gauge.
a For sampling periods with no discharge at = 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.
Did this facility perform Vehicle Maintenance Activities using more than SS gallons of new motor ail per month? ❑ yes Vno
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3The total precipitation must be recorded using data from an on-site rain. gauge.
3 For sampling periods with no discharge at ggy 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
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*FOR PART A AND TART B MONITORING RESULTS:
a 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 SE ION B.
o TIER 3: HAS YOUR FACILITY. HADA OR MORE BENCHMARK EXCEEDENC FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES NO ❑
IF YES, HAVE YOU CONTACTED THE D Q REGIONAL �C�FF CSE? YE NO
REGIONAL OFFICE CONTACT NAME: � a — W, 6n
Division of Water Quality
Attn: DWQ Central Files
161XMall Service Center
Raleigh, NC 27699-161
"I certify, under penaltylof 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 Perm
3-H-�-'
(Date)
Additional copies of this fo�Irm may be downloaded at: htta://g)ortal.ncdenr.ora/web/wa/ws/su/nodessw#tab-4
SWU-249
Last Revised: October 18, 2012
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