NCG060163 DMR SW

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted P� '101 W6
CERTIFICATE OF COVERAGE NO. • r . �l SAMPLE COLLECTION YEAR �� tS
OV
FACILITY NAME 1 0 �(�Qlr� NU k CWd ale (Z-MOJ_ \ FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY use/process meats 1:1 use animal fats/byproducts
PERSON COLLECTING SAMPLES a � `5 (� � �N p .3 "� EMl ING TO SALTWATERS? DYES XNO
LABORATORY ���i�� 0(>l�u�'t-� Lab Cert. # 1C) AVS ,I 2015
PLEASE REMEMBER TO SIGN ON THE REVERSE
AW RAL i+ll_E
Part A• Stormwater Benchmarks and Monitoring Results '' IR SF-CTION Total event rainfall z or ❑ No discharge this period'
Outfall No. Sample,Collected;:
mo/dd/yr-.
Benchmark, -
a rTSS;; F, ' 3pH,r; = >t;a 'r" ' a,COD,A ; {:.7,'.Oil.and Grease;;- ,Fecal,Coliformt,tt Enterococci
mg/L_ Standard'mg/L.=;K .~w �mg/,L ColoniesPper-,100 ml - Colonies pbK100
�` _ '30
100 or 504 Vllithiri:5.0 - 9A 120 1000,
2 S
4 <2
/_S.0
30 100;o� 50
6.0 --:9.0
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.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes 9 no
Part B: Vehicle Maintenance Area Monitoring Results: only for`facilities averaging > 55 gal -of new motor oil/month.
Outfall No.
Sample Collectetl,;.:
mo/dd%yi.
` ` °Oil°and'Grea'se; :! TSS 'y` "' pH N {! New:Motor` Oil°Us'age;'�
,'
mg/l =':f '``mg/L r = ' Standard units` Annual aver'age'gal/
Benchmark
-
30 100;o� 50
6.0 --:9.0
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.
(ifyes, complete Part B)
SWU-249 Last Revised: October 18, 2012
Page 1 of 2

*FOR PART A AND PART R 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 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 -OR MORE BENCH MARK-EXCEEDENCES,FOR-THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? "YES E] -Nb N
REGIONAL OFFICE CONTACT NAME:
Mail an original and -one -copy-of this.DIV1R ncluding" 'No-Discfiarae""reports, w.;j iin 30 dans"of'receip `bf tie -lab results for at end of
monitoring period in fki case of "No
I)i.viisidn of Water Quality.
;Attn: DWQ;Central-Files
161—TIVlail'-Service Center,
_ .Raleigh;;NG2,7.699;16"17
YOU MUST SIGN, THIS CERTIFICATION FOR.ANY_INF_ORMATION-REPORTED:
"I certify, under penalty -of law,,that"this documentsand"_all attachments were -prepared under, my -direction or supervision in accordance with a
system designed to assure that qualified persohnelproperly-gatherand-evaluate tl"e_information,submitted., Based -on. my."inq`uiry of the
person or persons who manage the;system,,o"raf%ose`-personsdirecfly responsible;for gathering the -information, the information's'ubrnitted is,
to the best of my knowledge and belief,"true;';accurate; and"complete: 1- m- awarelth'at tFjere are,significant- penalties fo,r.submitting false
information, including the possibility -of fines and imprisonment for"knowing Violations'
(Signature of Permittee)
Additional copies of this form may be downloaded at: http://portal:ncdehr.org/web/w4/ws/s'u/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012
Pana 'i of') e