NCG030373_MONITORING INFO_20200122

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/jC G o 3 D3-73
DOC TYPE
❑ HISTORICAL FILE
❑MONITORING REPORTS
DOC DATE
❑ b� O a
YYYYM M D D

Dear Madam/Sir,
Please Use these documents, Stormwater Discharge Monitoring Report, & Stormwater
Discharge Outfall Qualitative Monitoring Report, to Replace Same Reports Submitted
1-15-2020. The Previous Reports did not have the Sample collection Year, Sample period,
Discharging to class Marked.
Thanks,
Wayne Naylor 01/16/2020
RPrE{WED
JAN 2 2 2020
CEN i ml- FILES
DWR SECTION

Environmental
Qualify
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling aul this form, please vis
n
PerrnitNo.: N/C/,G/00l0/0/D/C)/ or
Facility Name:
County: Sa wt c, /
Inspector:
Date of Inspection:
Time of Inspection:
/ I
Total Event Precipitation (inches): l e I
,ater-gps
of Coverage No.: N/C/G/,0�3./.0/3/ l /,'
Phone No. 6 z r— -J �C-? - 11 a
All permits require qualitative monitoring to lic performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event! must have heed at least 72 hours prior. 'The 72-hour storm
interval does not apply if the permittee is ableI to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of/Permittee or
1. Outfall Description:
Outfall No. .1 Structure
Receiving Stream:
�OW r ef
Describe the i ustrial act�vibes rat oe(
r--. , t1 - // , . _ -
ditch, etc.): G r' 14 _`j,n LRDJ FI,- Lj�' 4 y
w �'L s, C s � G � aI v' �Y ��sii-•
hin the outfall drainage areaST 4 fl
Page I of 2
S W U-242, Last modified 06/01/2018

2. Color: Describe the color of
(light, medium, dark) as descriptors: _
using basic colors (red, brown, blue, etc.) and tint
la I �
3. Odor: Describe any distinct odors dial die discharge may have (i.e.,
chlorine odor, etc.): �J �% C) t �) -e
strongly of oil, weak
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
1 <T 3 4 5
5. Floating Solids: Choose the number! which best describes the amount of floating solids in the
stonmwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
I 2! 3 4 5
i
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
1 (1) 3 4 5
7. Is there any foam in the stormwater
8. Is there an oil sheen in the stormwai
9. Is there evidence of erosion or dept
to. Other Obvious Indicators of Storr
List and describe
C L:zk-4t G^ ylieo
;charge? o Yes ® No
discharge'? OYes ® No.
ion at the outfall'? c Yes ® No
titer Pollution:
t�ln/y c-C/
I
I
I
I
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further invesfigation.
Page 2 of 2
S W U-242, Last modified 06/0I /20J 8

Stormwater Discharge Monitoring Report
for North"Carolina Division -of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted 1 — ( �o- oZ �O
19
CERTIFICATE OF COVERAGE NO. NCG03D,� - - - - --- - SAMPLE.COLLECTION YEAR o� G
FACILITY NAME. G% L, C LG �i t� n7 �C ,Cry =Wl SAMPLE PERIOD.[ JanAune_ � July -Dec, _
COUNTY or. ❑ Monthly! (month)
PERSON COLLECTI G SAMPLES J� l4 L D� DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY I i f,i L r n� l!1 c Lati Cert. # I l R El F-!, --® ❑Zero -flow' ❑Water Supply FSA
Commetits on sample collection cr analysis: - — _ [Other
— - JAN2220'
CEIv7itAL F S PLEASE REMEMBER TO SIGN OWPAGES 2 AND/OR 3 4
GWR SECTION
Part A: Stormwater Benchmarks and Monitoring Results -
__ n No discharge this periodj'
~ Outfall No.
,...rR,.>�> r- ..
Date Sample •
Collected'
(mo/dd/yr)
:.,�. _.
24-flour rainfall
amount,
Inches",,s_;e
:r8:•.;,••. .-.-.
Total Suspended Solids
_ .. a ..:.,.,
.;..
pH;
Standard units
;,
c.= ..
Total Copper
.: •.a •:
Total Lead
:.
--•
Total Zinc
4,.-
Non-PolarO&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organics5
Benchmarks
100 mg/L or 50 mg/O
6.0 - 9.0
0.010 mg/L
0.075 mg/L
0.126 mg/L
15 mg/L
1 mg/L
PararrieterCode
46529
C0530
00400
01119
01051
01094
00552
78241
/
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outtall.
2 For sampling periods with no discharge at any•single outfall, you must still submit this discharge monitoring report with a checkmark here.
'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent.Guidelines for the facility, subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use.the definition as -found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found.in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31). - - -
Permit Date:11/1/2018-05/31/202s-�...--5 U 24
- -- Page 1 of 3

Facilities that incorporate.a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification. statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report: I further certify that this facility is implementing the all the provisions of the
solvent management plan, included in the Stormwater Pollution Prevention Plan.".
Name (Print name)
Title (Print title)
Signature
Date
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format "<XX mg/L" where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
Outfall No.
Date Sample Collecte&l
(mo/dd/yr)
24-hour rainfall amount,
Inches'
New Motor Oil or
Hydraulic Oil Usage
Non -Polar O&G/ Total
Petroleum Hydrocarbons
Total Suspended
Solids
Benchmarks
c
15 mg/L
100 mg/L or 5o mg/L4
Parameter Code
46529
NCOIL
00552
CO530
Footnotes from Part A also apply to Part B
Note: If you report o sample value in excess of the benchmark, you must Implement Tler 1, Tler 2, or Tier 3 responses. See General Permit text.
Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 2 of 3
a'

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 ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal coov of this DMR, indudlna 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, North Carolina 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.
am aware that there are signific4nt penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signature of
Permit Date: 11/1/2018-05/31/2021
-lb-,;� -E)
Date
-SWU-245, last revised 11/1/2018_ _
Page 3 of 3

FP-1b
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
jC V OSD3 % 3
DOC TYPE
❑ HISTORICAL FILE
C MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

for North Carolina
Stormwater= Discharge -Monitoring Report -
Division of Energy, Mineral and Land Resources General
Date submitted '�=� s a fl
CERTIFICATE OF COVERAGE NO. NCG03-0
FACILITY NAME .0 K i Lb4 r p
COUNTY rv1� c v*+
PERSON COLLECTIN SAMPLES
LABORATORY ML( - t RaCL _ Lab Cert. #
Comments on sample collection or analysis: -
Part A: Stormiivater Benchmarks and Monitoring'Results
Permit No.'NCG030000
SAMPLE COLLECTION YEAR _
SAMPLE PERIOD ❑ Jan -June ❑July -Dec --
or �E�DISCHARGING TO CLASS t❑ORW ❑HQW ❑Trout th❑PNA
JAN 2.2 2020 ❑Zero -flow' ❑Water supply ❑SA
❑Other
GEN I r<1L FILES
DWR SECTION
PLEASE REMEMBER TO SIGN ON PAGES 2-AND/OR 3 4
n No discharge this period?'
Outfall No.
...
Date Sample
Collected'
(mo/dd/yr).
`24-hour rainfall
amount,
Inches'•- :.
''
Total Suspended Solids
_
pH;
its
Standard uni
_
Total Copper
Total Lead
Total Zinc
Non-PolarO&G/
Total Petroleum
. Hydrocarbons
Total Toxic
Organics s
Benchmarks
100 mg/L or 50 mg/O
6.0 — 9.0
0.010 mg/L
0.075 mg/L
0.126 mg/L
15 mg/L
1 mg/L
Parameter Code':
46529
C0530 -
00400
01119
01051
01094
00552
78141
`i 't.
vo•S
C
G 'ror
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outran.
'For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
'The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies.
s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12; for electronic crystal manufacture use the definition as found.in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
- . L
Permit Date:11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a -list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
Name (Print name)
Title (Print title)
Signature
Date
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicable limits, they must be reported in the format, "<XX ma/L", where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
—Note:-If you report a sample value in excess of the benchmark, you must implement Tier 1, rier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample Collected''14-hour
(mo/dd/yr)
rainfall amount,
Inches'
New Motor Oil or
Hydraulic Oil Usage
Non -Polar O&G/ Total
Petroleum Hydrocarbons
Total Suspended
Solids
Benchmarks
15 mg/L
100 mg/L or 50 mg/L4
Parameter Code
46S29
NCOIL
00552
C0530
Footnotes from Part A also apply to Part B
Note: If you report a sample value in excess of the benchmark, you must Implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 2 of 3

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 11 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 DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original coov of this DMR, includina_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, North Carolina 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 signi9cant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signature of
-J�5=a D
Date
Permit Date: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 3 of 3

Stormwater
For guidance on filling out this form, please visit
np
PermitNo.: N/C/.G/03/V/D/,Q/D or(
Facility Name:;((
County: S
Inspector: LQ�
Date of Inspection:
Time of inspection:
Total Event Precipitation (inches):
V �
Environmental
Quality
�scharge Outfall (SDO)
Monitoring Report
of Coverage No.: N/C/G/CO to 0/.73/
Phone No.
All permits require qualitative monitoring to lie performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event most have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for I
local storm events during the sampling period,'and the permittee obtains approval from the local DEMLR
Regional Office.
1
By this signature, I certify that this report is
(Signature of Permittee or
1. Outfall Description:
Outfall No. �i Structure (p.
Receiving Stream:
�ot�5a�3 �vw�.t�cGt�G4,kSrt l�4
Describe t e industrial activities that occur
i H ;54,;, r7 or QS TN14
and complete to the best of my knowledge:
ditch, etc.): 6rp-b4 5� i15 7`G✓ s al
hzlIj g6,/
hin the outffallll drainage area: N(' : d �ti Sl
Page I of 2
S WU-242, Last nmditied 06/01 /2018

2. Color: Describe the color of the
(light, mediwn, dark) as descriptors:
using basic colors (red, brown, blue, etc.) and tint
,i/ LroaT
3. Odor: Describe any distinct
chlorine odor, etc.): f?/p jZ
have (i.e., smells strongly of oil, weak
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 2 3 4 5
5. Floating Solids: Choose the number i hich best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
1 2 3 4 5
6. Suspended Solids: Choose the numb) r which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids Iand 5 is extremely muddy:
1 %2�,) 3 4 5
7. Is there any foam in the stormwater
8. is there an oil sheen in the stormwa
9. Is there evidence of erosion or dep
10. Other Obvious"" Indicators
of Ston
List and describe
Note: Low clarity, high solids, and/or the
indicative of pollutant exposure. These cc
charge? O Yes jO No.
discharge? 0Ycs allo.
ion at the outfall'? o Yes o No.
ater Pollution:
u
0
I
a
0 of foam, oil sheen, or erosion/deposition may be
warrant further investigation.
Page 2 of 2
S WU-242, Last modified 06/01 /2018