NCG030436_MONITORING INFO_20190815

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
w �� �3CIA ( p
DOC TYPE,
❑ HISTORICAL FILE
LY-MONITORING REPORTS
DOC DATE
❑ a�� ��)
YYYYMMDD

Stormwater Discharge Monitoring Report
North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted g
CERTIFICATE�F COVERAGE NO. N0003 O
FACILITY NA E Ar-f-i.. F'a 1; Lnr
COUNTY
PcF SON COI
LABORATOP
Comments c
G SAMPLES
SAMPLE COLLECTION YEAR c9O 1 l _
SAMPLE PERIOD ❑ Jan -June ©')uly-Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
�,Ar f- 1-1In 1r +, cal Cab Cert. k
❑Zero -flow ❑Water Supply ❑SA
sample collection or analysis: CEIVED Other ^_ (vJ
G 15 2019 PLEASE REMEMBER TO SIGN ON PAGES 2 AND/Olt 3 4
CENTRAL FILES
Part A: Stor water Benchmarks and Monitoring Results DWR SECTION
n No discharge this period?'
Outfall No.
Date Sample
24-hour
rainfall
Total Suspended Solids
pH,
Total Copper
Total Lead
Total Zinc
Non -Polar 0&G/
Total Petroleum
Total Toxic
Collected'
amount,
Standard units
Hydrocarbons
Organics=
(mo/dd/yr)
'r Inches'
Benchmarks
-
F -
100 mg/L or 50 mg/L'
6.0 — 9.0
0.010 mg/L
0.075 mg/L
0.126 mg/L
15 mg/L
1 mg/L
Parameter Coo
F
46529
C0530
00400
01119
01051
01094
00552
_ 78141
i
' Monthly sam iling (instead of sem�-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
' For sampling eriods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
'The total precipitation must be re -orded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
a See General ermit, Section B, Ta le 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies.
s Total Toxic 0 ganics sampling is a plicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic cry= als, 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 u e 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 defini
found in 40 CFR 469.31).
Pei t Date: 11�1/2C11.45/31/2021 I SWU-245, last revised 11/1/2018
Page 1 of 3

Facilities that incorporate
a solver
may be waive
. The solvent manal
Permit. For those
facilities electing
"Based
upon my inquiry of th
(TTO),
certify that to the bes
storm
ater runoff has occurr
solver
management plan inc
Note: Results
rest be reported in
format. Whe
results are below th
limit, reportin1
limit, etc. in mg/L.
Note: If you report a sample
Part 13: Vehidle Maintenance
management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
ement plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
to employ the TTO monitoring waiver, the discharger shall sign the following certification statement:
person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic or
of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
d since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
ided in the Stormwater Pollution Prevention Plan."
'56 r-I ( t ci . L.&) a (t k
Name (Pri name)
Entt,'rpnm��-al Sa�'�-E� and L'-i�al �-►� msr
Title (Print title)
,"45��d 3
Signature j Da e
imerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, NO, or other similar non -numerical
applicable limits, they must be reported in the format, "<XX mg/L", where XX is the numerical value of the detection
in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. see General Permit text.
Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period ?2
0
tfal t a
Datpppe
Sample Collected'
p (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
-
-
15 mg/L
100 mg/L or 5o mg/L'
Param
ter Code
) -
46529
NCOIL
00552
C0530
G
P
9
P
N
Footnotes fro Part A also apply tb Part B
Note: If you r port a sample value in excess of the benchmark, you must implement Tier 1,
Permit Date:11 1/2018-05/31/2021
Tier 2, or Tier 3 responses. see General Permit text.
SWu-245, last revised 11/1/2018
Page 2 of 3

A BENC
HMPRI; FXCELDANCE
• 2 EXCE
DANCES IN A ROW FI
• TIER 3:
HAS YOUR FACILITY
IF YES,
HAVE YOU CONTACTE
REGIONAL OFFICE
CONTACT NAME:
Division of Watf r Quality
Attn: DWQ Cent,al Files
1617 Mail Servi e Center
Raleigh, North Carolina 27699-1617
UGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
kD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES Q"NO
THE DWQ REGIONAL OFFICE? YES Q NO
"I certify, under 1Penalty 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
these persons d rectl t re!pdn. ible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am a mare that t ere are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signature of PY mittee
Permit Date:11 1/2018-05/31/2021
l %Ig
�
Date
SWU-245, last revised 11/1/2018
Page 3 of 3