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Home My WebLink AboutNCG060235_MONITORING INFO_20200121RT� D STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. lq( G O () 3 S DOC TYPE ❑ HISTORICAL FILE [])(MONITORING REPORTS DOC DATE ❑ DDc) C) 0 a YYYYMMDD STORMWATER DISCHARGE MONITORING REPORT for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG060000 Date submitted I i �120 CERTIFICATE OF COVERAGE N0. NCG06Q _ SAMPLE COLLECTION YEAR a 3 ao I FACILITY NAME �4 SAMPLE PERIOD ❑ lan-June � July -Dec COUNTY ct or ❑ Monthly' (month) PERSON COLLECTING qSAMPLES e-t L „u LABORATORY�gce F:r?w� lce Lab Cert. tl Co-] DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA ❑Zero -flow [:]WaterSupply ❑SA ❑Other L/1/L RECEIVED FACILITY ACTIVITIES INCLUDE (check all that apply): JAN 212020 ❑ use/process meats ❑ use animal fats/byproducts CENTRAL FILES DVtrR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE 4 Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall' or ❑ No discharge this Outfall.No. ' Date Sample ,Collected, mo[dd/yr - TSS, . mg/L pH, - Standard units - COD, mg/L ,! Oifand Grease, mg/L ,� �.. , 1ecal;Coliform, j I�.Colonies;per 300 ml '. iEnterococci, Golonieslper SOO,mI, Benchmark - 100,or'SW Within 6.0-9.0, 120' 30 '10001 ,5001 ... s �. Parameter Code ' -' , ' C0530 00400 - - 00340.1�- j .,_,00556 1 ,• y; 31616 o a:_'i �,,,, 61211,a1y-_�-;� rJ , p IJ 1,1 t j I I I 1 Only applies to facilities that use/process meats. 2The 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 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies. 'Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall. Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ❑ yes ❑ no (if yes, complete Par Im Permit Date: 11/1/2018-05/31/2021 SWU-249, Last Revised 11/5/2018 1 Page 1 of 2 Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 eal of new motor oil/month. Outfall No. ` Date Sample Collected (mo/dd/yr) 24-hour rainfall amount, Inches New Motor Oil or Hydraulic Oil: Usage Non-PolarO&G/Total Petroleum Hydrocarbons Total'Suspended'Solids F Benchmarks = - - - 15 mg/L 100img/kor 50mg/L4, ., ParameterCode - 46529 NCOIL 00552 rC0530 Footnotes from Part A also apply to Part B *FOR PART A AND PART B MONITORING RESULTS • A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION.B. •, i2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SE • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE'SAME PARAMETER AT ANY ONE OUTFALL? EYES IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑ REGIONAL' OFFICE CONTACT NAME: i o/ "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 inaccordance,with a s designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or pers manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowle belief, true, accur , and complete. 'I am aware that there are significant penalties forsubmitting false information, including the possibility of imorisonment or k owing violations." of Permittee • Permit Date: 11/1/2018-05/31/2021 Date :•- - SWU-249, Last is,wno e and ies and I ised 11/5/2018 Page 2 of'2 0r.5_ Environmental Quality Stor-mwater-Discharge-Outfall-(SDO) �+ -Qualitative Monitoring Report For guidance onfi/ling oul thisjornt, please visit https://deq.nc.goy/a.bout/divisions/energy-mineral-land-resources/ n pdes-storm orate r-gps Permit No.: N/C/ / / / / / / / or Certificate of Coverage No.: N/C/G/0/(o/ 00/3/S Eacility,Name:II//"bor j, S �1ZZa— Uc County: or, Ve Phone No. . 9 I Q —7 7q _ So ,5� Inspector: Date of Inspection: t a Time of 1 Total Event Precipitation (inches): 1 t e)ck --t All permits require qualitative monitoring to be 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 been at least 72 hour's prior. The 72-hour storm interval does not apply ifthe permittee is able 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/(crrtify that this report is accurate and complete to the best of my knowledge: of Permittee or Designee) 1. , Outfall Description: Outfall No. I Structure (pipe, ditch, etc.): Te_le N Receiving Stream:, , , n i , Describe the industrial activities that occur within the outfall I�nl u-F�d G�t�ilN4. (/��.f f_t-•0�4CIN9. ,fl Page I of 2 5 W U-2d2, Last modified 06/01/2018 2. Color: Describe the colo_r_of the discha ge using basiocolors,(red,_brown,_blue,.etc.).and.tint_ (light, medium, dark) as descriptors chlorine odor, etc.): charge.may_have..(. i s e. I; weak 4. Clarity: Choose the number which best describes the'clarity of the discharge, where 1 is clear and 5 is very cloudy: l j 4 5 5. Floating Solids: Choose the number which 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: I 3 4 5 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: I C2 3 4 5 7. Is there any foam in the stormwater discharge? o Yes 6-ON 0. 8. Is there an oil sheen in the stormwater discharge? oYes o'( o. 9. Is there evidence of erosion or deposition at the outfall? o Yes VNo. 10. Other Obvious Indicators of Stormwater Pollution: List and describe Note: Low clarity, high solids, acid/or the presence of foam, oil sheen, or erosion/deposition may be indicative of pollutant exposure. These conditions warrant further investigation. Page 2 of 2 SWU-242_ Last modified 06/01/2018 (�55'ceAnalXical* arw.pecalabs.cam Laboratory Report Robert Pawelczak Domino's Pizza Dist of NC 3100 Waterfield Drive Garner, INC 27529 Project: Stonnwater 12/23 Pace Project No.: 92458478 Pace Analytical Services, LLC 6701 Conference Drive Raleigh, NC 27607 (919)8344984 Page 1 of 1 Report Date: 01/07/2020 Date Received:12/23/2019 Sample: STORMWATER Method Lab ID: Parameters 92458478001 Collected: 12/23/19 05:15 Matrix: Results Units Report Limit Water Analyzed Qualifiers EPA 1664B Oil and Grease ND mg/L 5.0 01/07/20 11:45 SM 9222D-2006 Fecal Coliforms ND CFU/100 mL 1.0 12/24/19 11:50 SM 254OD-2011 Total Suspended Solids ND mg/L 2.8 12/27/19 15:40 SM 4500-H+B-2011 pH at 25 Degrees C 4.9 Std. Units 0.10 12/29/19 17:10 H3 SM 5220D-2011 Chemical Oxygen Demand ND mg/L 25.0 12/26/19 16:33 ANALYTE QUALIFIERS H3 Sample was received or analysis requested beyond the recognized method holding time. Reviewed by: Chris Derouen (828)254-7176 christopher.derouen@pacelabs.com Pace Analytical Services Raleigh 6701 Conference Drive, Raleigh, NC 27607 North Carolina Wastewater Certification #: 67 Pace Analytical Services Charlotte 9800 Kincey Ave. Ste 100, Huntersville, NC 28078 Louisiana/NELAP Certification # LA170028 North Carolina Drinking Water Certification #: 37706 North Carolina Field Services Certification #: 5342 North Carolina Wastewater Certification #: 12 Pace Analytical Services Asheville 2225 Riverside Drive, Asheville, NC 28804 Florida/NELAP Certification #: E87648 Massachusetts Certification #: M-NCO30 North Carolina Drinking Water Certification #: 37712 North Carolina Bioassay Certification #: 16 North Carolina Drinking Water Certification #: 37731 South Carolina Certification #: 99006001 Florida/NELAP Certification #: E87627 Kentucky UST Certification #: 84 Urginia/VELAP Certification #: 460221 North Carolina Wastewater Certification #: 40 South Carolina Certification #: 99030001 VirginiafVELAP Certification #: 460222 Page i of 4 laooretMreceMng samples: AshevlgeQ EdenO Greenwood❑ HUrtersvllle❑ Halelghg Mechanksvllie[] tllentName: r Project! WO# : 92458478 Cowler. UFeaUPS 6USPS ` ZZ a. .CDent 111111111❑Pace I II I II II I I III ❑Cnlnmerdal ❑pd�er 92498478 Custody Seal Present? ❑Yes ❑NdSeastntact? ❑Yes []No Date/bltubterx a bmnwngcwnentr. 43- Pacidng Matedal: ❑Bubble Wrap bubble Bags []None ❑ Other Blaksgkal Tism Froten? Thermometer. iTpe oflce: et []Blue QNorm D� ❑NO QN/A 81R Burs 16.W I Tav,ee S Cooler Temp('C): I . g CorfeNon Factor: htroct C( 0,0. / C' Temp should be above f eetng to tiC Cooler Temp Corrected (Y): QSampbsout oftrmp aNeda Semplason ke,Wo ft WMW USDA Reguhatrd5ali (j�NIA. water sample) has tam Did samples WWnare In a quarendne Zone wtthln the Unhted States: Ck NY, or SC (check maps)? Dtd samples arylLetehgm a krelpr spume (Mtsnatknatly, and L Rush Turn Around TlmseRequested? _ •D'a 'tr 1'191A 1 4, Correct Contairen Used? is QNa QWa 6. SamPle labels Match CAC?15QQNe QWA 9. Trip Blank Present? QYn QNo a 1 11. COMMENPSAWPLE DISCREPANCY CIIFM NOTIflCAT10N/RESOIlITION tot ID of split contalllem . Person contacted: Review: . Project Manager SRF Ravlew: Data/Flme: Date: Date: Flekl Dam Regvtredi QYes Quo Page 2 of 4 *Check marktophalf ofbox HpHand/or dechlodnationb project WO# 92458478 verified and within the acceptance range for preservation sampler. PM: COI Due Dale: 01/08/20 E. Vtloln: VOA, cnarom,roGOil and Grease, Dao/aots(water)Doc,Will CLIENT: 81—Dominos "Bottom half of box is to list number of bottle 111 ilk moons ilk ilk ilk M ilk ilk IN 0 611 ilk ONE 0 ilk 111 soon pH Adjustment Log for Preserved Samples Sample ID Type of Presemeva pN upon receipt Date prasemtlon adjusted Time prazemtlon /mpunt of Presemtiva tot9 adjusted added NOW: Whenever there b a discrepancy aeectina NarthCaronne eomplianca tampWk a COW ofm6 form win be tent Out athold, Inm"a presenmtlre, at of temp, Inca" tmntalnara. Page 3 of 4 I a CHAIN -OF -CUSTODY / Analytical Request Document The Clair gO-QuioOy Is a LEGAL DOCUMENT. All relevant (lads must be competed accurately. 61 .R % NMMMMM■M■■■MINES IM■■■N■HIM■E _.,.. +f� m. -. .. _.:.: r.:.r 3 -''-1-• �T 6WJ1"li,.'ggh�+I'.+ �IMEM _