NCG060209 DMR SW (14)

CERTIFICATE OF
FACILITY NAME
COUNTY Ji
PERSON COLLEC
LABORATORY
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Ruality General Permit No. NC6060000
Date submitted —L — t S
SAMPLES
Lob Cart. #
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR '-DN0 1 -5 <,S,
FACILITY ACTIVITIES INCLUDE (check all that apply):
F1 use/process meats -[use animal f s/byprodui
DISCHARGING TO SALTWATERS? []YES M 0 ;rC
PLEASEREMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall 2 ar rV-11Nn disrhamp this nprihtI3
11
20 IV
IN, M
*1 r
WiNIffl-May, IN
...........
WHOM
W 7, Wil
11111, VERY
N,
ME 5W
Ira
Only-appliesto tacuities that use/process meats. -T -Lo W
The total precipitation must be recorded using data from an on-site rain gauge. GEISJV (3 F
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 SS gallons of new motor oil per month? El yes F-1 no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averanIne > 55 nal of now motor all/month.
Only applies to facllitles that use/process meats.
The 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.
'See General Permit text, Table 3, Identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(i es complete Part B)
SVM -249 Last Revised: October 18. 2012
MI•NOR.
Only applies to facllitles that use/process meats.
The 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.
'See General Permit text, Table 3, Identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(i es complete Part B)
SVM -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 II SE TION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCgS FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES NO 0
IF YES, HAVE YOU CONTACTED THE D Q-REIONA�L�Q�F`CE? NO
REGIONAL OFFICE CONTACT NAME: N \� 5 'M� �& .,,\
i v� mon�\n��
Mail an original and one copy of this DMR, including all "No Discharae" reports, within 30 days of receipt of the lob results for at end of
monitorina loeriod in the case. of "No Discharge"' reports) to:
Division of Water Quality
Attn: DWQ Central Files
161X 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 posobility of finejAnd imprisonment for knowing violations."
(Signature of Permittee)
is
(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-
V -�