NCG060209 DMR SW (20)

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SEMIIANNUAL STORMWATER DISCHARGE-MONITORING REPORT
for North Carolina Division of•Water Quality G eras Pernik No. fICGO6®aOO
Date submltted t — R— 11
CERTIFICATE OF COVER GE NO,NCGO6 4 SAMPLE COLLECTION YEAR ® ! _
FACILITY NAME 1'1\ ZCcu,)� WgcSaU,j ae� kt\ FACILITY ACTIVITIES INCLUDE(check all that apply):
COUNTY O use/process meatsanimal fiats/byparamluacts
PERSON COLLECTI G SAMPLES c *er SC DISCHARGING TO SALTWATERS? OYES ONO
LABORATORY Ec NI QN�.Cv� Lab Cert.* QS,
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part AlStormwater Benchmarks and Monitorin: ResultsIl 'I
r i{ :,,� ,�ra!F:,-,- a��t Benchmarks
r( , , 'n 7 -, Total event ml ,1 -e
� , i 4 � 1 or No discharge this rdo
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Only'applies to facilities that use/process meats.
!The total precipitation must be recorded uslpg data from an on-site rain gauge.
!For sampling periods with no discharge at gmi 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 INlainteeiance Activities using more then 55 gallons of new motor all par month?O yes grit) (fes complete Part B)
Part B:Vehicle Maintenance Area Monitprin Results:onI for facilities avers 1n >Si :al of new motor oil/month.
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JAN 31 201/
• — fc2.\ilJV}&_\tl e.--k4a�\dJ:l1+YiN 6Only applies to facilities that use/process meats.
The total prgvlpllatluq must la CflCoCdi�(���t
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��d����from an mitt rain oauQeA
or sampling periods with no discharge ata*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.
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RIM T_94n

*Fon PACT A AND PART a_MONITORING RESULTS:
® A BENCHMARK EXCEEDANCE TRIGGERS TIER 9,REQUIREMENTS. SEE PERMIT PART n SECTION B.
© 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE
EXCEEDENCUTFOR THE SAME PARAMETER AT ANY ONE OUTFALL?PART VES n�R!®0
® TIER 3: HAS YOUR FACILITY.HbD 4 OR MORE BENCHMARK
• IF YES,HAVE YOU CONTACTED THE DWQ REC�IONI Q��I, �Y ` `4-is-
4.,
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REGIONAL OFFICE CONTACT NAME: (..L nC L
Mail®a o Inal and me camel this DMIR.Ircludlnf8 all"Na•Dlschafaae"°reaortsn wlthI 30 de Of recent®fir tha llogrresuBtsend
• moal��erlad In the case.arlillo Dlscharae""report to:
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Division of Water Quality
Attn: DWQ Central Files
167dZMall Service Center
• Raleigh,NC 27699-161x.
•
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 posslbilIty of fines and imprisonment for knowing violations."
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gspgrset:are ay PorrMItt®e8 • Mete')
Additional copies of this form may be downloaded at: i • ..o. 1. •e, o e• 1 s 1 ••essw• ab
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SWU 249Last Revised:October 18,2012
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