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SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
_ Date submitted 1'1fiGW (bf 201b f;�ir�''?,olb
CERTIFICATE OF COVERAGE NOJ_48__
2 � SAMPLE COLLECTION YEAR 2is0�
FACILITY NAME _�i IOriMS
COUNTY _' l;� FACILITY ACTIVITIES INCLUDE (check all that apply):
use/process meats E] use animal fats/byproducts
PERSON COLLECTING SAMPLES i V1/0.'�^5�yt DISCHARGING TO SALTWATERS? [YES []NO
R4 Lab Cert. # :kLt
Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on-site rain gauge. CENTRAL FILES
3 For sampling DWR SECTION
p g periods with no discharge at any 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 55 gallons of new motor oil per month? yes Ono (if ves• complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities
Outfall No. Sample Collected, Oil and Grease,
mo/dd/vr M, /l
Benchmark
00 '-,
> 55 gal of new motor oil/month
TSS, pH, New Motor Oil Usage,
mg/L Standard units Annual average gal/mc
100 or 504 6.0-9.0 _
s. 7. sr a
' Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on-site rain gauge.
aFor 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.
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PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results
Total event rainfall ZC)•So
or ❑ No discharge this period'
Outfall No. Sample Collected, TSS, pH,
mo/dd/yr mg/L • Standard
COD,
Oil and Grease,
Fecal Coliform',_ Enterococci",
- units
Benchmark - 100 or 504, ,Within 6.0 - 9.0
mg/L
120
mg/L
_
Colonies'per 100 ml Colonies per loom[
a0 3 •5�
/i,iC
30
«
1000 Soo
jinn
Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on-site rain gauge. CENTRAL FILES
3 For sampling DWR SECTION
p g periods with no discharge at any 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 55 gallons of new motor oil per month? yes Ono (if ves• complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities
Outfall No. Sample Collected, Oil and Grease,
mo/dd/vr M, /l
Benchmark
00 '-,
> 55 gal of new motor oil/month
TSS, pH, New Motor Oil Usage,
mg/L Standard units Annual average gal/mc
100 or 504 6.0-9.0 _
s. 7. sr a
' Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on-site rain gauge.
aFor 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.
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Environmental Plan
*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
2 EXCEEDANCES INA ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B. rr
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES [&NO ❑h�.�(
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES EK NO ❑ (0Q .3
REGIONAL OFFICE CONTACT NAME: Yohn )AtAk �
Mail an original and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results (or at end of monitorina
period in the case of "No Discharae" 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.offines and imprisonment for knowing violations."
� . _,.
ffm 01. 0, � �
(Signature of Permitt
5/r6//
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
if
SWU-249 Last Revised: October 18, 2012
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