NCG060174 DMR SW (6)

'7 Environn �1tal Plan
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted oZ 3%Ila
CERTIFICATE OF COVERAGE NO. NC Z _ y
FACILITY NAME WG fimS
COUNTY Lee
PERSON COLLECTING SAMPLES Vir�S� 1 V\IC�,tScsr
LABORATORY MA Lab Cert. # 34
SAMPLE COLLECTION YEAR C7611.
FACILITY ACTIVITIES -INCLUDE (check all that apply):
2/use/process r, -,eats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? AYES WNO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
z ❑ N d' th' 43
Part A: Stormwater Benchmarks and Monitoring Kesuits Total event rainfall or o ish
1 Only applies to facilities that use/process meats. DWR SECTION
2The 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.
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? Q yes ❑ no (ifyes, complete Part B)
Part B• Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No. Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
c Urge is perio
Outfall No. Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform", Enterococcil,
Colonies per 100 ml Colonies per 100 ml
Benchmark -
100 or 504
Within 6.0 — 9.0
120
30
1000 500
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CENTRAL FILES
1 Only applies to facilities that use/process meats. DWR SECTION
2The 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.
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? Q yes ❑ no (ifyes, complete Part B)
Part B• Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No. Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH, New Motor Oil Usage,
Standard units Annual average gal/mo
Benchmark -
30
100 or 504
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1 Only applies to facilities that use/process meats.
2The 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.
4See 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 IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II sF&ON B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENC S FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES � NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES FNO ❑
REGIONAL OFFICE CONTACT NAME: %-,A 4.1®1"
Mail an original and one copy of this DMR, includina all "No Discharge" reports, within 30 days of receipt of the lab results (or 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, o hose 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 fip and imprisonment for knowing violations."
(Signature o oee)
mi
. ,z z 3 /a
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdt:nr.ore/web/wq/ws/su/npdessw#tab-4
SWU-249
Last Revised: October 18, 2012
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