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SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality G neral Permit No. NCG060000 `
Date submitted 9-'4'a�-/ �
CERTIFICATE OF COV A E N NCGO6,t 1; SAMPLE COLLECTION YEAR ckQ 1 0 ® ®�
FACILITY NAME b • • • i �bC'o - - lel�` , FACILITY ACTIVITIES INCLUDE(che all that apply): 2.
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COUNTY (�11� • r-�
e� 0 use/process meats use animal f /byproductsG
PERSON COLLECTING SA PLES 4!»P,N. DISCHARGING TO SALTWATERS? DYES
LABORATORY Lab C # a 1)-r) R A
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
(64
PPart A:Stormwater Benchmarks and Monitoring Results z sl
', p •, s., 7 Total event rainfall or • No discharge this period3e b 1,' n l - l � �. ,: � Pf iia •k }S{ to Y u a v a _ T •
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1 Only applies to facilities that use/process meats. X- 141). d � q� 't'Y� c 4 1 M�
2The total precipitation must be recorded using data from an on-site rain gauge. �� �� ,
3 For sampling periods with no discharge at Au 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.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?Elles 0 no (if yffli,complete Part B)
'art B:Vehicle Maintenance Area Monitoring Results:only for facilities averaging>55 gal of new motor oil/month.
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only applies to facilities that use/process meats.
The total precipltatlon must be recorded using data from an on-slt�e rale gauge,haS �r``� -p�`''C�ce e,c\ a `�e'O - O`1l 5 cc t, i
l or sampling periods with no discharge at gum 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.
WU-349 •
r--a rs...A....A.A..e..1.....10 O111 O
*,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 II SECTIOlUlf
N .
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES 0 NO
• IF YES,HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES 0 NO 0
REGIONAL OFFICE CONTACT NAME:
this DMR,includin all"No Discharae"reports within 30 dans of receipt of the lab results(or at endue
Mail an original and one control P
monitoring period in the case.of"No Discharae"resorts)to:
• Division of Water Quality
Attn: DWQ Central Files
16147.Mail Service Center
• Raleigh, NC 27699-161&
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 •ossibility of fines and imprisonment for knowing violations."
IAS
(Signature of Permittee) • (Date)
Additional copies of this form may be downloaded at: tt•: •orta. c•enr o : we• w• ws su •dessw#tab-4
Last Revised:October 18,2012
SWU-249 Page 2 of 2 .,