NCG060161 DMR SW (3)

SEMI-ANNUAL ST• : 1/ A e l . it . 1 • ► • :! ► • • • •
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 17I pis i�,
CERTIFICATE OF COVERAGE NO. NCG05' Ci (� I
`' � .— SAMPLE COLLECTION YEAR 2o I 4®
FACILITY NAME �Le/ma�T P9f S 1 , L-t-C FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY 04../KeLq,{s01..]
PERSON COLLECTING SAMPLES ""'j–�Gi`. leo ) ��_+ I I use/process meats � � use animal fats/byproductsn C-y fiTT-• I N RGING TO SALTWATERS? I IYES —"NO
LABORATORY P .0 I- ly l-it w- 1 Lab Cert. # f/C /2 t,i' 4z� "-��
JUL 2 2 2016 PLEASE REMEMBER TO SIGN ON THE REVERSE
Part A:Stormwater Benchmarks and MonitoringResults
CENTRAL FILES �7�orNo discharge r"P.IR SEr'TIONI Total event rainfall 20P I this period3
Outfall No. Sample Collected, TSS, pH, COD, Oil and Grease, Fecal Coliforms, Enterococcis,
mo/dd/yr mg/L Standard units mg/L mg/L Colonies per 100 ml Colonies per 100 ml
Benchmark - 100 or SO4 Within 6.0–9.0 120 30 1,000 500
coG (q/S /( 40 ( Vol 02 - nS b 6-.o N/A Iv)l
00fo/i.J/t 8q.S (,,.2_ 22. AJ c) Cs,o
of r} N� +
I
s 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 l✓rno (if yes, complete Part B)
Part B: Vehicle M aintenance 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
I Only applies to facilities that use/process meats
'The 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.
SWU ?49 Last Revised October 18, 201

*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 I�
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES NO 1 1
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 my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false
information, inclu• g the sossib'lity of fi -s and imprisonment for knowing violations."
7//I
r -
(Signature o Permittee) (Date
)
Additional copies of this form may be downloaded at http•//portal.ncdenr org/web/wq/ws/su/npdessw#tab-4
•
SWU-249 Last Revised 0 n 18, 2012
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