NCG060209 DMR SW (10)

CERTIFICATE OF
FACILITY NAME
COUNTY _:3>
PERSON COLLEC
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water ualiT!!Irl GPermit No. NCG060000
Date submitted —�
No. P0, —; r.,A, 4
�nf
SAMPLES
LABORATORY Lab Cert. #
Part Ai Stormwater Benchmarks and
CENED
SAMPLE COLLECTION YEAR
FACILITY ACTIVITIES INCLUDE (checy all that apply): t@x1k4!ft0MrjK
❑ use/process meats use animal fa s/byproductltiltiTi7t?fes
DISCHARGING TO SALTWATERS? []YES W
� 1
PH , n
�,"Elm MMETEM-M!
''�,�1sk4�rli�`-�s
TO SIGN ON THE REVERSE 4
or
2 Onlyapplles to facilities that use/process meats. J n_ Ii The total precipitation must be recorded using data from an on-site rain gauge. �N ,iFLO
4 For sampling periods with no discharge at any outfalls. You must still submit this dlschar� monitoringreport with a checkmark here.
See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where he more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than SS gallons of new motor all per month? ❑ yes ❑ no
Part B: Vehicle Maintenance Area Mnnitnrina Racultee nnly fnr \ GC -.J —i ..—..... —&—...CI
- y -1--,r
; 1 3 ff�--
�i3$��r{
ZTh
ll���`' �'' �1����'t v �i¢�WE
t Lutes `! etf'.y� �ifL�.{y.14f 'i'��`J1S1"'u f �ia93��+
ir.r-inrr�-��rrrr<frnr rrA�nw
- ---. _
—--
�- ey orN11=0 LU 1ocmucs mar use process meats.
a total precipitation must be recorded using data from an on-site rain gauge.
For sampling periods with no discharge at PM 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.
this
(if ves• complete Part B)
SWU-249
Last Revised: October 18- 2012

*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 IIS TION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES 9 No ❑
IF YES, HAVE YOU CONTACTED THE D Q R GIO A OF ICE? 1((E NO ❑
REGIONAL OFFICE CONTACT NAME: y
Mail an oriainal and one copy of this DMR, including all "No Discharge" reports, within 30 dabs of receipt of the lab, results for at end of
monitorina 6s*d in the case of "No Discharae" reports) to:
Division of Water Quality
Attn: DWQ Central Files
161XMall 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."
(Signature of
La-j"H 5
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wa/ws/su/npdessw#tab-4
SWU-249
Last Revised: October 18, 2012
Page 2. of 2