NCG060102 DMR SW (2)

SEMv D-ANNUAL STORMWA ITER DDSCHARGE viONITOR�i��9G REPORT
for North CaroDu a D°IMMSaorn of\\Afator o uanty Genera Pernik No. NCG 6®(0©O
Date submitted 1-8-11.9
CERTIFICATE OF COVERAGE N..,NCG06 O ( O A.z SAMPLE CsLLECTION YEAR a2 0/5
FACILITY NAME Pe*b VE FA,4 5- lnvc. CA UG£ ..$rinojS FAC G-t FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY /Lf OOge use/process meats n use animal fats/byproducts
PERSON COLLECTING SAMPLES Edward 6veenC/6o4/ S 5cms DISCHARGING TO SALTWATERS? FIVES *o
LABORATORY Lab Cert.#
RECLINED J
PLEASE REMEMBER TO SIGN ON THE REVERSE -
JAN 11 2016 • ,;
Part A: Stormwater Benchmarks and Monitoring Results . TOt d vent rainfall 2/,125 or ❑ No discharge this period3
Outfall No. Sample Collected, TSS, - pH, COD, CEi'v 1 b i���ase, - . Fecal-Coliform1, Enterccocci1,
mo/dd/yr _mg/L Standard units mg/L DVl'1� mg/L - Colonies per 100 ml Colonies per 100 ml -
Benchmark - 100 or 504 - Within 6.0—9.0 120 30 _1000 - 500
/ `/,a/�l his 3t 8-0 r 5 ,���4 M0.-
AMO kW0AF r — - — r ----
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? FI yes no (if yes, complete Part B)
Part B:Vehicle Maintenance Area Monitoring Results: only for facilities averaging> 55 gal of new motor oil/m:•:nth.
Outfall No. Sample Collected, - Oil and'Grease,, TSS, pN, - New Motor Oil Usage,
- - mo/dd/yr ` - ` rag/L - mg/L Standard units -- Annual average gal/mo
Benchmark - 30 100 or 504 6.0—9.0 -
/ /;/%A�s �l 31 g,oHm,f goo _Mc 0.017
,v/A
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.
SW1J-249
T.Act RPvicPri• nrtnher 1R ')(11')

*FOR PART A AND PART B MONITORING RESULTS:
o 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 I! SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES NO I t•-i
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES NO
REGIONAL OFFICE CONTACT NAME:
•
Mail an original and one copy of this *MR, including all "No Discharge"rreporrtswithin 30 dais o, rreceejit a the lab results or at end a,-
monitoring period in the case if°6,'o 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."
£eL' :Q !
(Signature of Permittee) (Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
Tv\rLT 249 Last Revised: Or r 18,2012
__gage 2 of.2