NCG060344 DMR SW (4)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division .f Water Quality General Permit No. N00060000 RECEIVED
`10_ n/ 3 / ate submitted /O—67—o2O/f OCT 19 2015
CERTIFICATE OF CO�VV/E/ AGE NO.. f/C ��6(O�UO(l� O T SAMPLE COLLECTION YEAR a0/r
CENTRAL FILA$
FACILITY NAM C(/��/�'! ,e.+44011., A/ FACILITY ACTIVITIES INCLUDE(check all that apply): LOM SECTION
COUNTY NAV
/ / ❑ use/process meats El use animal fats/byproducts
PERSON COLLECTING SAMPLES /Vp 3i/i7i� el111Z ed DISCHARGING TO SALTWATERS? DYES [110
LABORATORY Lab Cert.#
PLEASE REMEMBER TO SIGN ON THE REVERSE -
Part A:Stormwater Benchmarks and Monitoring Results Total event rainfall2 or ❑No discharge this period3
OutfallNo: -`Sample,Collected;,", T55, '1'," pH, COD, Oil�and�Grease,'Fecal Coliform," Enterococci1, ' -
,y_ -,mo/dd%yr Anig/L ;Standard'units-- mg/L„ ' ': mg/L Colonies per,100,ml ,colonies per 100ml ,
';Benchmark";_: ur / 100 ar 50 '.Within 64.7,9100 7x0'' 30 ,( 1000 5
ie 6 all A It 7!2` a5a4 //fit f�(- I?�irl //I � iG/ �f1a'/[� Wim 'Jot A
W
/244e;2 4441,-ii�' � !a? flow,�ir�ourJ
1 Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on-site rain gauge.
a 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 ❑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
ilio/dd/yr,- - , mg/L' '. ` „r'ng/L Standard'units Annual average gal/mo
Benchmark - 30 ° 100or504 ', 6.0-9.0, -
1 Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on-site rain gauge.
a 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-249 Last Revised:October 18,2012
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*FOR PART A AND PART B MONITORING RESULTS:
ca A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
e 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
e TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO❑
IF YES,HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO❑ _
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, including the possibility of fines and imprisonment for knowing violations."
()J
4.4 2 7 OGT /5—
(Signature
S(Signature of 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:October 18,2012
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