NCG060209 DMR SW (19)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT®,°,�• ' •
for North Carolina Division of Water Quality General Permit No. NCG060000 1 1940
Date submitted $— 1 r / C
CERTIFICATE OF COVERAGE NO.NCGO6®% O�, 1 SAMPLE COLLECTION YEAR f ‘() I c •i>,,
FACILITY NAME —rZCot6c% o,CSaW�2ecX..NM\\ FACILITY ACTIVITIES
��,,. � INCLUDE(check all that apply):
COUNTY c
(� C\ 0 use/process meats Bine animal fats/byproducts
PERSON COLLECTING SAMPLES DISCHARGING TO SALTWATERS? DYES Del
LABORATORY Lab Cert.#
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A:Stormwater Benchmarks
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i Only'applies to facilities that use/process meats. V
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!The total precipitation must be recorded using data from an on-site rain gauge. '
s For sampling periods with no discharge at grit'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?D yes 0 no (if_tea,complete Part B)
Part B:Vehicle Maintenance Area Monitoring Results:onl for facilities averaging>55 gal of new motor oil/month.
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Only applies to facilities that use/process meats.
The total preclpitatIon must he recorded using data from an on-site rain gauge,
I for sampling periods with no discharge at=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 249
T . .ne..:. .t.n..«,.t.�_10 "Irvin

*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 N B.
o TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENC FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES NO❑
IF YES,HAVE OFFIOU CONTACTED THE E CONTACTNAMEDIAlp li►� IU'`MOSICE\. \ NO❑
REGIONAL ,y,�� w `
\44\VttiO
*-\-\k S 51 l \s 5����0(1 �(`n0(1 \` •(`mc\\ ate\n
Mail an oris final and one co- .o this DMR i than! all"No ►Ischar,e"re orts within SO da s o, recei t o the lab results or at end o
monitoring period in the case.of"No Discharge"reports)to:
Division of Water Quality
Attn: DWQ Central Files
161(7.Mail Service Center
• Raleigh, NC 27699-16177.
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 possibilit of fines and imprisonment for knowing violations."
CP
(Signature of Permittee) • (Date)
Additional copies of this form may be downloaded at: tt.: •orta .ncde r.o we• w• ws su n•dessw#tab-4
Last Revised:October 18,2012
SWU-249 Page 2 of 2 .,