NCG060279 DMR SW

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT �t; r ;
for North Carolina Division of Water Quality General Permit No. NCG060000 ' 5 2015
Date submitted ro" ' �� L)ENR-[_AJ'VD QWILITY
W,ATER PERMITT1i11G
CERTIFICATE OF CO ERAGE NO. NC606 �r SAMPLE COLLECTION YEAR go I s
FACILITY NAME inT FACILITY ACTIVITIES INCLUDE (ch k all that apply):
COUNTY lx Eluse/process meats use animal fats/byproducts
PERSON COLLECTING SAMPLES DISCHARGING TO SALTWATERS? AYES NO
LABORATORY_Cny�c���e,M L Cert. # RLi
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part Ai Stormwater Benchmarks and Moniterina Racults rn+.,j a„an+ rnlnfn1/ 2 .8 11 n No, +11— narinro
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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 env 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 faclllty 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 facilities averaging > 55 gal of new motor oil/month.
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The total precipitation must be recorded using data from an on-site rain gauge.
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.
NW -249

*FOR PART A AND PART 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 SECTIO.
® TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER ATANY ONE OUTFALL? YES 0 No
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 Discharge" reports, within 30 dabs of receipt of the lab results for at end of
monitoring period in the case. of "No Discharae" resorts) to:
Division of Water Quality
Attn: DWQ Central Files
161dCMall Service Center
Raleigh, INC 27699-1617,
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"1 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
0- (; - 16 --
(Date)
Additional copies of this form may be downloaded at: http:/-/Portal.ncdenr.org/­w---eb/­wq/­ws/su/­npdessw#tab-4
SWU-249
Last Revised: October 18, 2012
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