NCG060026 DMR SW (5)

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SEMIANNUAL STORMW o�',, ��`��um `
ATER DISCHARGE MONITORING REPORT 6,t,,nt. ,,./ ,���
for North Carolina Division of Water Quality General Permit No. NCGOG0000 '` �� �>±,t',.,rr ��,��,
Date submitted k\L' 3c — / "�%'i,r,,,,,✓
CERTIFICATE OF CO ERAGE O`NCGO6O o a 5 1- SAMPLE COLLECTION YEAR oma® 0
FACILITY NAM .Q A 6 L1 od�yy .7 C)to 11n`NQ), FACILITY ACTIVITIES INCLUDE(check all that apply):
COUNTY e •�` .� , V
PERSON COLLECTING SA `•T1 S `'t1-*--) \ 1 0 use/process meats Wise animal fats/byproducts
6 v • ii.k. DISCHARGING TO SALTWATERS? OYES WO
LABORATORY . 1 . ,u.• ,.: ' Lab Cert.It 'ilk
PLEASE REMEMBER TO SIGN ON THE REVERSE 4 !
Part A:Stormwater Benchmarks and Monitorin Results2 a
)�4,:� t H.,, g Total event rainfall or ❑No discharge this period
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.3 \t- 1 6 '; O rjA 1 8 '3 G O G S A/A Ai A.
a Onlyappiles 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 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?0 yes EMS (if ves,complete Part B)
part B:Vehicle Maintenance Area Monitoring Results:only for facilities avers in_ >55 gal of new motor oil month.
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Only applies to facilities that use/process meats.
the total precipitation must be recorded using data from an on-site rain gauge. r°/
or sampling periods with no discharge atm 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.
WU 249

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTIONS.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II5 TION B.
TIER 3: HAS
• YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR E SAME PARAMETER AT ANY ONE OUTFALL? YES (VL NO J
• IF YES,HAVE YOU CONTACTEDfTHE Dwot VGIOINAL OFF,IFE? NYES ❑NO
REGIONAL OFFICE CONTACT Ns ME: f� h l IR qv
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Mail an ori!inal and one co> ,o this DMR inclurdin> al "N• %ischar e"re sorts within 30 da s a recei s t a the lab•resu ts or at end o
' monitoring period in the case.of"No Discharge"reports)to:
• 1Division of Water Quality '
Attn: DWQ Central Files
161Mall Service Center
Raleigh, NC 27699-161. ,
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 oerinittee) • (Date)
Additional copies of this form may be downloaded at: tt•: •ortala c•enr.or: we• • ws su •dessw#tab-4
SWU 249 Last Revised:October 13,2012
Page 2 of 2.
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