NCG060235 DMR SW (2)

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SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted RO(S
CERTIFICATE OF COVERAGE NO. N-606'c :.- !''-� - SAMPLE COLLECTION YEAR
FACILITY NAME bethoo5 1;2L0. QC.,, FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY,Wq,((4.. _ ❑ use/process meats ❑ use animal fats/byproducts
'�` ' '... DYES ©NO
PERSON-COLLECTING,SSAMPLES AL f-' ._, GING TO SALTWATERS?
LABOFti4TOR1QCc 4n141y"f'i[e. Lab Cert.it 4'7 DEC 0 4 2u15 PLEASE REMEMBER TO SIGN ON THE REVERSE -›
CCN"f�gL Fl.ES ., Total,event rainfall z or ❑ No discharge this period3
Part A:,Sto,rmwater Benchmarks and,Monitoring Results.., DWC� � �,�� ,. r1•
; .:OutfalllNo,; - , :Sample,'C_ollected„! ' TSS, - pH, COD, . Oil'and Grease, FecalColiform Enterococci ,
Eno/Ad/4r_ __ __ rang/,L , _'Standard units, ;; _ ;mg/L, , _ mg/L , `Colonies_per100 ml;_ , Colonies per 100 ml
',Benchmark ' ;i ; - = ; 100,or'504i ! Within,6.0—9.0' i _ 120, 30,- ' 1000. _. _ _ 500
_ :I l ,,. :

*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 0 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 thatqualified 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, incl ding the possibility of•fines:and imprisonment for knowing violations." - -
/ /a/a/A5--
(Sigp.2tur= of Permittee) (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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