NCG080053_MONITORING INFO_20191202

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCG b
DOC TYPE
❑ HISTORICAL FILE
? MONITORING REPORTS
DOC DATE
�g is a
❑ Qoo
YYYYMMDD

Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable) ❑ No discharge this period'
Outfall ::
No
- -,:"Imo%dd/Yr):
Date Sample;
Collected'
24-hour rainfall
amount,"
r.,,• Inches3c.-'"
Sample Collected'
mo/dd/yr"
,.
.. s -':. -
ljotal Suspended
= Solids;'
?-�..`''mg/L-
pH".. -
Standard unns
Non -Polar Oil &
Grease,
Permit
ti `y ` ,.�
- .;:,�
._fit ,� c:==
1 or r�x
' �.60=90 r 4 -
d15 _
'Paromatereode,:;Y'TT.°
46529 °�. .-.._`
- ._.: . -
_OOorio'
..: %�• C0530 _ -
£ }00400 x -
--.100552 _
Footnotes from Part A also apply to this Part B
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 1, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 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 ANYONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this OMQ including all "No Discharge" reports within 30 days of receipt of the lab results for 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 a are that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
a
Date
Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCGO80000
Date submitted 1 1 �- Z 7-
C
CERTIFICATE OF COVERAGE NO. NCG080 O S 3 SAMPLE COLLECTION YEAR Z 0 19
FACILITY NAME nq 10-5 /Y\pr Kf_+5 I nG SAMPLE PERIOD ❑ Jan -June [`July -Dec
COUNTY or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES ff�f � un ne { f DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY FaCe no I �+;cu I Lab Cert. is L/ V ❑Zero -flow ❑Water Supply ❑SA
Comments on sample collection or analysis: ®Other C I CLS5 C
PLEASE REMEMBER TO SIGN ON THE REVERSE i
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ® yes ❑ no if yes complete Part A)
Part A: Vehicle & Equipment Maintenance Areas Monitoring Requirements (If applicable) ❑ No discharge this period'
Outfall No.
Date Sample Collected'
)mo/dd/yr)
24-hour rainfall amount,
Inches3
Non -Polar Oil & Grease
- mg/L
Total Suspended Solids,
mg/L
New Motor or Hydraulic Oil Usage,
'"—gal/mon
Benchmarks
_
-
1s
100 or SW
Q O )-
ParameterCode
-
"529
00552
C0530
'- COJL
SDO- G
10-30 9
I ,5
D
S z
ve
- H
10-30
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
' For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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 text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, 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 me/L", where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX".
Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018
Page 1 of 2

Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable) ❑ No discharge this period'
Outfall r
No. _ _. '
-
� _ Date Sample, ^
Collected' ;'
'.Imo/dd/1rr1.�
2 -hour rainfall
amount `'
,,
t Inches'..-
Sample Collected'
mo/dd/ r
�.k Y,.
7ata1 Suspended
Solids;'
.;x.mg/Lrmg/L
pH, #
Y Standard units }
Non -Polar Oil & '
Grease
PermrtrtUmrt�-
K t `
- `-
': �
-=' 100or5C _
-`�` ' 60=90 i -
-s`-15 ..
'Par<imetereode�z
46529..,
``="C0530 °
" i ,4';00400
Footnotes from Part A also apply to this 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.
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 original copy of this DMR indudina all "No Discharge" resorts within 30 days of receipt of the lab results (or at end of monitoring period in the
case of "No Discharge" resorts) 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 ere are signifaitnalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signature of PPermittee Date
Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018
Page 2of 2 - -

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral ar)d Land Resources General Permit No. NCGO80000
Date submitted I I —Z-7— 19-
rcoTlclrATc nc rnvcoer_c un nlrrnA G n c� 3 SAMPLE COLLECTION YEAR 2_01 9
FACILITY NAME i f1�Jr 12S ��Ar Ke n C SAMPLE PERIOD ❑ Jan -June July -Dec
COUNTY C> t or El Monthly' (month)
PERSON COLLECTING SAMPLES ( A �1 frtCT i" p���DISCHARGING TO CLASS ❑ORW ❑HQW [:]Trout❑PNA
LABORATORYPaca AnrV CaI Lab Cert. # O 'l ❑Zero -flow pWaterSupply ❑SA
J C G
Comments on sample collection or analysis: DEC 9 2019 ❑other I4SS
CENT RAL FILE,, PLEASE REMEMBER TO SIGN ON THE REVERSE
DW,R
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? 1!1 yes ❑ no if yes complete Part A)
Part A: Vehicle & Equipment Maintenance Areas Monitoring Requirements (If applicable) ❑ No discharge this period
Outfall No.
Date Sample Collected'
(mo/dd/yr)
24-hour rainfall amount,
Inches'
Non -Polar Oil & Grease
mg/L
Total Suspended Solids,
mg/L
New Motor or Hydraulic Oil Usage,
gal/mon
Benchmarks
_
-
is
100 or 50'
Parameter Code
-
46529
00552
C0530
�o
OIL
Soo - R
0-30-19
I •5
D
22,
ova
S - 33
o-30-I
1
N D
1 51 7
po-mon
Soo- C
10-30-19
) •
ND
5 DO-
10-3a-19 1
/,5
N o
IJu
S o e
I 10-SO-I9 1
/, 5 1
N D
3.9
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
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 text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, 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. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX".
Permit Date:11/1/2018-5/31/2021
SWU-248, last revised 11/1/2018
Page 1 of 2