NCG060182 DMR SW (21)

l
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted —
CERTIFICATE OF COVQRAGE NO. NCG060
FACILITY NAME {' d I a, r, rA K
COUNTY N @ ��
PERSON COLLECTING SAMPLES A,
LABORATORY Lab Cert. # 5-5�2—
Part A: Stormwater Benchmarks and Monitoring Results
Environnf; vital Plan
SAMPLE COLLECTION YEAR OC 615—
FACILITY CTIVITIES INCLUDE (check all that apply):
Buse/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? ❑YES �,__PdO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall z/ Z<br ❑ No discharge this Period
Outfall'No. _` Sample,collectbd,'n
mo/dd/yr
TSS;.
mg/,LLL
pH' `' -GOD,
Stan'dard..units. mg/.0
= Colifo�rii=, Enterococci.,
' ,OiI nd_Gr`ease,�- 'Fecal, 1 " 1�"" � ii`` "
- y mg/L';' '� ,Coforiipst" r5100%mlr,.'` CdI66ies,`per.100}'mF"
Benchmark ' ..- - �- °100or`504
Withi�rr6:d,=9.'0a:
120:,1000.
.100'oesoQ
- 500
L
1 Only applies to facilities that use/process meats.
ZThe 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 U401 (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,v _
�mg/,L
`TSS;:`=
-mg/L'.-Standard.'vnitsr,
_ ' -'� pH;°z"
Ne'W,*'otorAil�Usage,
Annuah.everage gal%rrio�
.Benchmark_
.30
.100'oesoQ
Only applies to facilities that use/process meats.
ZThe 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.
Z:\Environmental\lndustrial\PP-Pdgnm'sPride\PPNC-North Carolina\PPNC01-Marshville\PPNC01-02 SPILL PLANS\2013 Monitoring Form 2

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 rNOF-1
ALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECT NB.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEED OR THE SAME PARAMETER AT ANY ONE OUTFALL? YES O ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES
REGIONAL OFFICE CONTACT NAME:
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 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, 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 Permittee)
t � _
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wq/ws/su/­npdessw#tab-4
Pride\PPNC-North Carolina\PPNC01-Marshville\PPNCO1.02SPILL PLANS\2013
SWU-249
Last Revised October 18, 2012
Monito?i-rfk Form 2