NCG060230 DMR SW (4)

SEI-ANNUf,L STtRM\f'/n,TEED, DISCHARGE '.. • NITORING EP,•RT
fir North Carolina Division of Water Quality General Permit No. N00060000
Date submitted 1 l IV l I
CERTIFICATE OF COVERAGE NO. NCG06� Z SAMPLE COLLECTION YEAR Z014
FACILITY NAME elm,* g Molle r j c. FACILITY ACTIVITIES INCLUDE (check all that apply):
• COUNTY W*l1e ❑ use/process meats ❑use animal fats/byproducts
PERSON COLLECTING SAMPLES QPtfGt Coe�In DISCHARGING TO SALTWATERS? DYES [NO
LABORATORY Pt Of Lab Cert.# q i
PLEASE REMEMBER TO SIGN ON THE REVERSE -
Part A:Stormwater Benchmarks and Monitoring Results Total event rainfall 2 or ❑No discharge this period3
Outfall No. Sample Collected, TSS, pH, COD, I Oil and Grease, Fecal Coliforms, Enterococcal,
mo/dd/yr mg/L Standard units mg/L mg/L Colonies per 100 ml Colonies per 100 ml
Benchmark - 100 or 504 Within 6.0—9.0 120 30 1000 500
1 511019 (oil i.Z
Z 51191/L, ZS.o 7•f
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 Usage,
mo/dd/yr mg/L mg/L Standard units Annual average gal/mo
Benchmark - 30 100 or 504 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.
s 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
Page 1 of 2

*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.
o TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO f
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."
7/Iz//6
(Signer_r_RI
ermittee) (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
Page 2 of 2

SEMI-A JNUiA L STORIVIWATER DISCHARGE MONITORING REP* RT
f•,r North Carolina Division if Water Quality General Permit No, N00060000
Date submitted d a t a %6
CERTIFICATE OF COVERAGE NO. NCGO6 O _a.1 I SAMPLE COLLECTION YEAR 2 O I C
FACILITY NAME et AM- " Loutiic vvc l INC- FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY �ilavUUL11 p] 1 ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Pj uat ore.*Cti• DISCHARGING TO SALTWATERS? DYES 'NO
LABORATORY Do op Lab Cert.# 4
PLEASE REMEMBER TO SIGN ON THE REVERSE -3
Part A:Stormwater Benchmarks and Monitoring Results Total event rainfall 2 or ❑No discharge this period3
Outfall No. Sample Collected, TSS, pH, COD, Oil and Grease, Fecal Coliforms, Enterococcal,
_ mo/dd/yr mg/L Standard units mg/L mg/L Colonies per 100 ml Colonies per 100 ml
Benchmark - 100 or 504 Within 6.0—9.0 120 30 1000 500
p 4Iz$ I lb 11.4, 6 •y -
2- 61243116 4.2- 6.G.
1 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- NI 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, 1 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 -
1 Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on-site rain gauge.
s 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
Page 1 of 2

*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.
0 TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ N. N'
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES D 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."
(Signaturp-rmittee) (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
Page 2 of 2

SEMI-ANNU A STtRMWATER DISCHARGE MONITORING REPORT
for Mirth Carolina Divisi.n of Water Quality General Permit No. NCG060000
Date submitted 1117.116
CERTIFICATE OF COVERAGE NO. NCG06_2 J Z Q' SAMPLE COLLECTION YEAR o1 CL
FACILITY NAME NAM- I'- P�w� sl-1 2.D,)-vu 9iM N., FACILITY ACTIVITIES INCLUDE(check all that apply):
COUNTY %Arvin h ❑ use/process meats ❑use animal fats/byproducts
PERSON COLLECTING SAMPLES Ames b l ac kw'Q i t DISCHARGING TO SALTWATERS? EYES E NO
LABORATORY -P610.4- Lab Cert.# q f
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A:Stormwater Benchmarks and Monitoring Results Total event rainfall2 •s0 or E No discharge this period3
Outfall No. Sample Collected, TSS, pH, COD, Oil and Grease, Fecal Coliforms, Enterococci',
mo/dd/yr mg/L Standard units mg/L mg/L Colonies per 100 ml Colonies per 100 ml
Benchmark - 100 or 504 Within 6.0—9.0 120 30 1000 500
I 501116 I S1 1. 3
1 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 n 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 Usage,
mo/dd/yr mg/L mg/L Standard units Annual average gal/mo
Benchmark - 30 100 or 504 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.
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-249 Last Revised: October 18,2012
Page 1 of 2

*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.
o TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO y
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 •t 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."
,, ,R441/4.,___ ifl z//6
(Signat/a 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
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 12 July 2016
CERTIFICATE OF COVERAGE N0031 .4118Marlik SAMPLE COLLECTION YEAR 2016
FACILITY NAME Innopsec Active Chemicals FACILITY ACTIVITIES INCLUDE(check all that apply):
COUNTY Rowan ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES DISCHARGING TO SALTWATERS? DYES NO
LABORATORY Statesville Analytical Lab Cert.# 440 ir‘Fr\IE
'�FLc - PLEASE REMEMBER TO SIGN ON THE REVERSE )
3UL
1 5 2016
Part A:Stormwater Benchmarks and Monitoring Results Total event rainfall 2 1.2" or ❑ No discharge this period3
Outfall No. Sample Collected, TSS, pH, COIY,17a v.:C'M'1Oil-andi-Grease, Fecal Coliform", Enterococcal,
mo/dd/yr ut
mg/L Standard units ,*„.r,cmg/,L�i1 t "� r`��4 mg/L Colonies per 100 ml Colonies per 100 ml
Benchmark - '100 or 504: Within 6.0—9.0 ” 120 30 1000' 500
001 06/16/2016 23.778 6.74 38 <5.2 N/A N/A
1 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 facilityperform Vehicle Maintenance Activities usingmore than 55gallons of new motor oilper month? yes no (if yes, complete Part
❑ ® p 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 Usage,
mo/dd/yr mg/L mg/L Standard units * Annual average gal/mo
Benchmark - 30 100 or 504 .6.0—9.0 -
"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.
SWU-249 Last Revised: October 18,2012
Page 1 of 2

*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 Q
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."
7'4,),i‘
(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
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No, N00060000
Date submitted 111%_1/6
CERTIFICATE OF COVERAGE NO. NCG06_a Z L�i, SAMPLE COLLECTION YEAR Z O I 4
FACILITY NAME Pt awl- %I CripiCal i3lvO FACILITY ACTIVITIES INCLUDE(check all that apply):
COUNTY IN k ICY ❑ use/process meats ❑use animal fats/byproducts
PERSON COLLECTING SAMPLES 'DaA\ald S-4rd1 iu9 DISCHARGING TO SALTWATERS? DYES [NO
LABORATORY PAtse._ Lab Cert.# of P
PLEASE REMEMBER TO SIGN ON THE REVERSE -->
Part A:Stormwater Benchmarks and Monitoring Results Total event rainfall2 1 ir— or ❑No discharge 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 504 Within 6.0—9.0 120 30 1000 500
l 61241I10 2,,. ` 4 .o
1 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 rig no (if yes, complete Part B)
Part B:Vehicle Maintenance Area Monitoring Results:only for facilities averaging>55 gal of new motor oil/month. .
Oil and Grease,No. Sample Collected, 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 -
1 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.
SWU-249 Last Revised: October 18,2012
Page 1 of 2

*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 SECTION B.
O TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO0
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"t 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."
7/fz/r�
(Signator- ./P. mittee) (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
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. N00060000
Date submitted July 5, 2016
CERTIFICATE OF COVERAGE NO. NCGO6 0 1 8 2 SAMPLE COLLECTION YEAR 2016
FACILITY NAME Pilgrim's Pride Corporation, Marshville Plant FACILITY ACTIVITIES INCLUDE(check all that apply):
COUNTY Union X use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Stan Hildreth DISCHARGING TO SALTWATERS? FIVES [X1NO
LABORATORY K & W Laboratories Lab Cert.# 559
PLEASE REMEMBER TO SIGN ON THE REVERSE -
Part A:Stormwater Benchmarks and Monitoring Results Total event rainfall z or ❑ No discharge this period3
Outfall No. Sample Collected, TSS, pH, COD, Oil and Grease, Fecal Coliform'', Enterococci'',
mo/dd/yr mg/L _ Standard units mg/L mg/L Colonies per 100 ml Colonies per 100 ml
Benchmark - 100 or 504 Within 6.0—9.0 120 30 1000 500
Due to un-qualified rainfall events in JL ne 2016, staff was not able to collect any storr water sample this month.
1 Only applies to facilities that use/process meats.
ZThe 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 ®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 Usage,
mo/dd/yr mg/L mg/L Standard units Annual average gal/mo
Benchmark - 30 100 or 504 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.
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-249 Last Revised: October 18,2012
Page 1 of 2

*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 X- NO EI
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES IX NO n
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."
(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
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 7-)7--/e2
CERTIFICATE OF COVERAGE NOINCGOCOAIL i SAMPLE COLLECTION YEAR 6770/ RECEIVED
FACILITY NAME 4I1N/ 2 OP-41e 7ra-,(P-3 FACILITY ACTIVITIES INCLUDE(check all that apply): JUL 18 2O16
COUNTY Ctrs//r02D E] use/process meats ❑use animal fats/byproducts
PERSON COLLECTING SAMPLES iGi rF c &GkmVVR aa,6 DISCHARGING TO SALTWATERS? DYES ENO D
LABORATORY/665614Ra-h4- Ji-Ly1 Lab Cert.# g V wR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE-)
Part A:Stormwater Benchmarks and Monitoring Results Total event rainfall2 or ❑No discharge this period3
Outfall No. Sample Collected, TSS, pH, COD, OIl and Grease, Fecal Colfform', Enterococcal,
mo/dd/yr mg/L Standard units mg/L mg/L Colonies per 100 ml Colonies per 100 ml
Benchmark 100 or 504 Within 6.0—9.0 120 30 1000 500
67RV/6 /vv 6. 55 l(aq -C 5 N/A- .
'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.
°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?[❑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 Usage,
mo/dd/yr mg/L mg/L Standard units Annual average gal/mo
Benchmark - 30 100 or 504 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.
3 For sampling periods with no discharge at any 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.

*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
IF YES,HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES 0 NO 0
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."
9áwiit
(Sig f Permittee)
o4 (Date)
•
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
,Nin I n.n t In .