NCG060288 DMR SW (4)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted /4%7,-7'7
7,-/y
CERTIFICATE OF COVERAGE NO. N ,%'2/7
FACILITY
j v SAMPLE COLLECTION YEAR ��
FACILITY NAMJ f4 /o � //-w LIC FACILITY ACTIVITIES INCLUDE(check all that apply):
COUNTY /9I(17i / ❑ ❑ fats/byproducts
use/process meats use animal fats/b roducts
PERSON COLLECTING SAMPLES /00d, v 142 DISCHARGING TO SALTWATERS? OYES 1Q NO
LABORATORY / ,14 )",c< Lab Cert.#
/ PLEASE REMEMBER TO SIGN ON THE REVERSE-
Part A:Stormwater Benchmarks and Monitoring Results Total event rainfall2 /. 6or ❑No discharge this period3
Outfall No: ; ir,iple.Collectec� �TSS;`� pH,: COD, �. ',`Oil`ana Grease, . ' � Fecal>Coliform� Enterococci ,
Standard,units - °mg/C -Colonies per 100 ml' tolonies'per,100'ml
:Benchmark n :> , 100ror 504 Within 6b"..9.0 120`, 30'. `. 1000 500:k
yy 5" (,72 <sv
/2 -(r-fr/ /y .0 cP s/9,r)
/o (o x ,0 0 5-V/0 <_9,
q /O-1.5"--=-/K / 6, 3[o 5-6,D <Si c�
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 Agi o (if yes, complete Part B)
Part B:Vehicle Maintenance Area Monitoring Results:only for facilities averaging>55 gal of new motor oil/month.
�Qutfall No. >Saniple Collected;', Oil and Grease, �;r°F .T55,; _ pH,; N *'PAcitor;g1,Usage,'
n �x mo/dd/yr '�� � mg/L. mg/L'- Standard units' Annual gaversg a al/mom;-
Benchmark_, .' _� :`� w 3U � �, 100 or,5,1f . 64-1.0 , :"s 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.
SWU-249 Last Revised: October 18,2012
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*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 ❑ 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."
COrb •,. Po ..1 /a�c 9/i y -
(Signature of Permittee) ,Yr -Pk (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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