NCG060114 DMR SW (3)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Qua ityeneral Permit No. NCG060000 RECEIVED
Date submitted 4 Z��ZOI j
-.. ;._ 1 0 A• - SAMPLE COLLECTION YEAR GAJ1 LQ
FACILITY NAME Ur4ll.gv1'y2 a' i `{ oi'p c US l MAIC FACILITY ACTIVITIES INCLUDE(check all that apply): CDEMAYNTI�L FIDS
CERTIFICATE OF COVERAGE NO. .,CG
C ols SECTICJI2016�I
COUNTY 1-61& pi a ❑ use/process meats ❑ use animal fats/byproductws
PERSON COLLECTING SAMPLES : ►, k f .1: I/IL y ,` i. Sr DISCHARGING TO SALTWATERS? OYES XNO
LABORATORY liii0 ogtie U4h r*-iog_IES Lab Cert.# NC II
NC i 377) ) PLEASE REMEMBER TO SIGN ON THE REVERSE -)
USDA * 372,-) „
Part A:Stormwater Benchmarks and2 Monitoring Results Total event rainfall t,kk or ❑ No discharge this period3
Outfall No. Sample Collected, TSS, pH, COD, Oil and Grease, , Fecal Coliforms, Enterococcii,
mo/dd/yr mg/L Standard units mg/L mg/L Colonies per 100 ml Colonies per 100 ml
Benchmark - 100 or 504 Within 6.0-9.0 120 30 1000 500 -
2 01-1-12 - Ile 114 6.310 Iq,S <5. 00
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 jJ no (if yes, 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, Oil and Grease, ' TSS, pH, New Motor Oil Usage,
mo/dd/yr - - -- - -- -mg/L - - -- - mg/L-- - - -Standard,units - Annual average gal/mo • - -
Benchmark - 30 100 or 504 6.0-9.0 -
0 Q
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.
SW!T-749 1 act Rpvicarl• (lrtnhPr 1 R ')fl1')

*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 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO 21
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
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, or those persons directly responsible for gathering the information, the information submitted is,
to the best of-rr`yfk? owledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
informal''n, incl ding the po ility es and imprisonment for knowing violations."
r7' 4- '�
(Signat re of Per, ittee) ( ate)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-249 Last Revised: October 18,2012
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