NCG060279 DMR SW (3)

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SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT -
for North Carolina Division of Water Quality General Permit No. N00060000
Date submitted C•" a a-/c /��J /j
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CERTIFICATE OF CO RAGE N 0.f GS+ � - SAMPLE COLLECTION YEAR
FACILITY NAME 'O.5 0.C`L\ •• •. k" \ FACILITY ACTIVITIES INCLUDE(check all that apply):
COUNTY 1 ' ' `— _ - O use/process meats ifse animal fats/byproducts
PERSON COLLECT! G SA LES - 1� RGING TO SALTWATERS? OYES
LABORATORY Ln.U1 Cc eco LLaSCH_AW10
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E REMEMBER TO SIGN ON THE REVERSE 4
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Part A:Stormwater Benchmarks and Monitoring Results c Total event rain z period3 i xf� 1' a ` ,l,x n 1 ,_ ,.,r 7.2 i, �-n n r fall �ot or O No discharge this
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1 Onlyapplies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on-site rain gauge.
a11 For sampling periods with no discharge at gnoutfalls.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?E(yes O no (if ves.complete Part B)
PartbbB:Vehicle Maintenance Area Monitoring Results:only for facilities_averaging>55 gal of new motor oil/month.
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Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on-site rain gauge.
aFor 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.
SWU-249
T.Sist RAvisAf1'C]etnhPr 1R 2n12

*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
• 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 Discharae"reports, within 30 dans of receipt of the lab results for at end of
• monitoring period in the case of"No Discharge"reports)to:
• Division of Water Quality
Attn: DWQ Central Files
16147.Mail 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."
2C
(Signature of Permitt ) (Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.ore/web/wa/ws/su/nodessw#tab-4
SWU-249 Last Revised:October 18,2012
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