NCG060026 DMR SW (4)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT �� a� moi,
for North Carolina Division of Water Quality General Permit No. NCG060000 VP('„,„
Date submitted I.
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CERTIFICATE OF C VER GEA NCGO6 m� SAMPLE COLLECTION YEAR �6/C NA. '
FACILITY NAS _ k2A/4.0( FACILITY ACTIVITIES INCLUDE(check all that apply):
COUNTY V�> ;� []use/process meats Mile animal fats/byproducts
PERSON COLLECTING SALES DISCHARGING TO SALTWATERS? OYES ONO
LABORATORY - Lab Cert.#
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A:Stormwater Benchmarks
r � Be1 nc^J he ma1 rks and Monitoring Results
Total
Sc) 1 �n Total event
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•Onlyapplies to facilities that use/process meats. ,\k) / ,� I
2The total precipitation must be recorded using data from an on-site rain gauge. -� -' 1 [�V(�
3 For sampling periods with no discharge at lay 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?El yes 0 no (if yes•complete Part B)
Part B:Vehicle Maintenance Area Monitoring Results:only for facilities averaging>55 gal of new motor oil/month.
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Only applies wadi/nes that use/process meats.
The total precipitation must be recorded using data from an on-site rain gauge,
'Par sampilng periods with no discharge at agyr 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 r 17...:.eA.n..�.d 1 0 ,W11,1

*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 SEC ION B.
• TIER 3: HAS YOUR FACILITY.HAD
4 OR MORE BENCHMARK EXCEEDENCES FWHE SAME PARAMETER AT ANY ONE OUTFALL? YES ,❑
• IF YES,HAVE YOU CONTACTED THE DWQ REGIONAL OFFIC ? X.,ES NO
�
REGIONAL OFFICE CONTACT NAME: c � �c kmer I`5 't `e"(4 '
Mail an original and one copv of P
this DMR,includin all"No Dlscharae"reports within 30 dabs of receipt of the lab results for at end o
monitoring period In the case.of"No Dlscharae"reports)to:
Division of Water Quality
Attn: DWQ Central Files
• 161..Mall Service Center
• Raleigh, NC 27699-161k
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 Per
j5:-S"
(Date)
Additional copies of this form may be downloaded at:htto://oortal.ncdenr.ora/web/wa/ws/su/npdesswittab-4
SWU-249 Last Revised:October 18,2012
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