NCG060168 DMR SW (3)

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 6-9-//,
CERTIFICATE OF COVERAGE Ni Nti 1 k_ - SAMPLE COLLECTION YEAR 4
FACILITY NAME T15 if7I)$h I(E 4 FACILITY ACTIVITIES INCLUDEcheck all t
COUNTY , dgecpchh
❑ ( hat apply):
PERSON COLLECTING SAMPLES r /J use/process meats ❑ use animal fats/byproducts
LABORATORY erJ11144/A 2 Lab Cert.# qe9 z u VED
GTO SALTWATERS? OYES NO
JUN 1 3 AEASE REMEMBER TO SIGN ON THE REVERSE -
Part A:Stormwater Benchmarks and Monitoring Results CFNTRAI PPI mal event rainfall z �$ or ❑No discharge this period3
Outfall No. , -Sample,Collected,: TSS, , "f ' '" -
rrio/ _ _ ,, , ,pH., ., ` , CO WR SE( ii ,6nd`Grease, , _,,Fecal,Coli 1 1
dil/yr- mg%L � �S#andard�u �{-4 � form„�-,.r ;•., Enterococci,
nits 4
Benchmark -• ° 6:0='90` 1 pL mg/L~” Colonies per100,Inc, ,Colonies;per 100,mh,
/ `• ,100 :W50 " Within - %30 `' '
�-'/7 //o ®� '1000- ; .500,.
d 6-J7- !� /�O �,�� �ao �S Nle 14/A
3 S /7-t, ela-g <
5' S- /7-l?, 4 01.7 6. I% c2o < S
.S S- / 7- /4, /S G . a <oaa < `'vl`9 toId/if m
1 Only applies to facilities that use/process meats. 5 Nf� N�
'The 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?0 yes ►t no (if ves, complete Part B)
Part B:Vehicle Maintenance Area Monitoring Results:only for facilities averaging>55 gal of new motor oil/month.
Outfall-NO:;' ,Sam' 1 °-• -_
pe5,Collected,; "Oil and,Grease,"•- - TSS,
.- ,,- - --: mo%dd �� - "` - -'-' -.: � _ -- - ,_, pH, New Motor Oil Usage ,
/Y _ _-- ;mg/L,:a -:„ni/L,_,.,;,,„ � ;"Stan"dard'�ynts� ,',Arinu i ,
i
Benchmark - '30 100 a °average gal%Qii`6:
or 504 6:0-9.0 _
1 Only applies to facilities that use/process meats.
-
'The 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

1
*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 Dir
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."
6,1q4
(Signature of Per ittee) (Date)
•
Additional copies of this form maybe downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-249 Last Revised: October 18,2012
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