NCG030537_DMR_20210303 (1)

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Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted 03/n3�1
CERTIFICATE OF COVERAGE NO. NC^G'/03Q � � j SAMPLE COLLECTION YEAR 0-07-1
FACILITYNAME S �i�nL•'Stq tESvi ll2PiltnF- SAMPLEPERIOD QJan-June ©July -Dec
COUNTY Ire 01� or Monthly' JQY1 6L✓A (month)
PERSON COLLECTING SAMPLES AACAA DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY Lab Cert.q ❑Zero -flow [—]Water Supply ❑SA
Comments on sample collection or analysis: KECEIVED CSibther C I aff C,
kA a 0 8 Z021 PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
Part A: Stormwater Benchmarks and Monitoring Results CENTRAL FILES
nWR SECTION n No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
PH � units
Standard
Total Copper
Total Lead
Total Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organics'
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
oit-451-zl
0•Ll
L2.
•02
0.0 13
0.00
.Sci
cy.q 15
UlAived
' 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.
'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.
'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: 11/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 1 of 3
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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."
_TJ n Brown
Name (Print name)
Vi,ce Pr(!5ic)erA
Title (Print title)
iafoc� 310312-t
S" ature Date
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, NO, 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.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tfer2, or Tier3 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'
(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 50 mg/L4
Parameter code
-
46529
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

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FOR PART AAND PART 8 MONITORING RESULTS:
,FYe,
A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
i�
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
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TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO ❑
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IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
Noy
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this DMR 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
p
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"9 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 significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
-M 3 ) to
Sign re of Permittee Date
Permit Date: ll/1/2018-05/31/2021
SWU-245, last revised 11/1/2018
Page 3 of 3

EF-239
CHANGE OF RECORD
#
Date
Description
1
11/6/2007
New document
2
01/27/2011
3 Year Review — No changes needed to form at this time.
3
02/10/2014
Updated form
4
02/23/2017
3 Year Review — No changes needed to form at this time.
5
04/23/2019
Updated forms to 11/l/2018 updated revised forms.
Sampler.---4 S.H.E.---4 EMS Rec.
Revision Date: 04/23/2019 - Revision No: 05 Retention Period: 5 years

EF-238
704 253 6542 Nov 2 2007 02:25pm P801/002
EF-238 _ •
d A
Stormwater Discharge OWA (SDO)
Qualitative Monitoring Report
4
Permit No.: N!C/_/ l,_./___ —,L j— f or Certificate of Coverage No.: N/C!G/ /—J_/� /-
Facility Name: tAtj4S0 MVr d* t.SV i1kPI N C.
County: `VQ&%% C OUIn Phone No, Acik- TIT- 9CYM
inspector: 14 S
Date of Inspection: d k Io'Z I 2v2l
r
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
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(Signature of P 'ttee or Designee)
1. Outfall Description
Outfall No. Structure (pipe, ditch, etc.) 2 h
Receiving Stream:
Describe the industrial activities that occur within the'outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, `
dark) as descriptors: C1 Q CA1r
3. Odor
Describe an di inct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor, ;
etc.)-
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4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 2 3 4 5 6 7 . 8 9 10
f
Page 1
SwU-242-020705
Sampler.---4E.H.S.---4EMS Rec.
Revision Date: 12/23/2015- Revision No: 04 Retention Period: 5 years

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704 253 6542 Nov 2 2007 02:25pm P002/002
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5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered A.floatmg solids: ;
T.: '
�1 2 3 4 5 6' 7 8 9 10
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6. Suspended Solids.
Choose the number which best descriibes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
Q2 3 4 5 6• _ 7 8 9, 10 '•
7. Foam =
Is there any foam in the stonnwater discharge? Yes No
8. Oil Sheen _
Is there an oil sheen in the stortawater discharge? Yes No
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9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes No '
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes Qo
11. Other Obvious Indicators of Sitormwater Pollution .
__ . _...._ _-..._.. List -and describe A)JeAAY1'lWt-t-d.i
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Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion maybe
indicative of conditions that warrant farther investigation and corrective action.
Page 2 '.
5WU 242-020705
d
Sampler.---4E.H. S.----> EMS Ree.
Revision Date: 12/23/2015- Revision No: 04 Retention Period: 5 years

EF-238
704 253 6542 Nov 2 2007 02:25Fm P001/002
EF-238
' NA
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N/C! l 1..��1� 1 1 or Certificate of Coverage No.: NICIGI 1—J. f l I
Facility Name: NJ'u
County: I Y Phone No. 'lost- VI
Inspector: __Qai+Nn V�
Date of Inspection: 0110-1( tio?_ j
By this sigt,ature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
a
1. Outfall Description
Outfall No. 2— Structure (pipe, ditch, etc.) to
Receiving Stream: `
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc) and tint ('light, medium, '
dark) as descriptors: Olt
3. Odor a..
Describe any, 'nct odors that the discharge may have_(Le., smells strongly of oil, weak chlorine .odor,
etc.) "
4. Clarity
Choose the number which best describes the clarity of the discharge where l is clear and 10 is very -
cloudy:
1 2 3 4 5 6 7 8 9 10
Page 1
swrJ-242-020705
Sampler.---4E.H. S .---->EMS Rec.

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EF-238
704 253 6542 Nov 2 2187 02:25pm P002/802
S. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids: ;
(D 2 3 4 5 6 7 8 9 1p
ry
6. Suspended Solids
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Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
O2 3 4 S 6 7 8 9 10
7. Foam
Is there any foam in the stoanwater discharge? Yes No i
S. Oil Sheen
1:
Is there an all sheen in the stormwater discharge? Yes o
9. Deposition at Ontfall
Is there deposition of material (sedunent, etc.) at or immediately below the outfall? Yes No
L
10. Erosion at Oatfall
Is there erosion at or immediately below the outfall? Yes (Ea
11. Other Obvious Indicators of Stormwater Pollution
List and describe Zl .sediw��t,�lk a�rouc� d�at�
qr-(AVeA O1ge
C� j o�1 •12ot�. `: .
5 dv►s� ���i�>� Dh an U nco eye •�
•.4
1 •1
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion maybe
indicative of conditions that warrant furtber investigation and corrective action.
t
Page 2
SWU 242.020705
Sampler.---4E.H.S.---->EMS Rec.
Rnvi.inn bate: 12/9.1/9.015- RPvisinn Nn: 04 Retention Period: S vearq

EF-238
704 253 6542 Nov 2 2007 02:25pn P681/002
EF-238
t�',,
1
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: NIG���(, f 3/� /� fQl i�j or Certificate of Coverage No.: NIGQI��
Facility Name: pew() n i of Uv' ohn h - S R- 1UAF `
County: IV eA titPhone No, 2
Inspector. 6A i K-u-
Date of Inspection: U 2 ' 2 I
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Sig6t& oftc&Kttm or Desi ee)
1. Outfall Description
Outfall No. �2- StructureG (pipe, ditch, etc-) t
Receiving Stream: sutypry,L G W i U n t*t/I:v
Describe the industrial activities that occur within the outfall drainage axes: T", s2v 10 � r _
1M �OL yl) d E Q.r\ (i q v1 GYrIn Ci G
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}
2. Color
r
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, `
dark) as descriptors: U Q V"
3. Odor
Describe any diet'To
ct odors that the discharge may have (Le., smells strongly of oil, weak chlorine odor,
etc.)
r
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 2 3 4 5 6 7 8 9 10
Page 1
SWU-242-MOM
Sampler.---->E.H.S.---4EMS Rec.
Revision Date: 12/23/2015- Revision No: 04 Retention Period: 5 years

r
EF-238
704 253 6542 Nov 2 2007 02:25pm P002/002
5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids: ;
1 O 3 4 5 6 7 8 9 10
r.
6. suspended solids
Y
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy.-
1 2 3 4 5 6 7 8 9 10 '
7. Foam
Is there any foam in the stormwater discharge? Yes No -
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No
9. Deposition at OutfaU
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes Eo
'
•S
10. Erosion at Oulfall
Is there erosion at or immediately below the outfall? Yes o
11. Other Obvious Indicators of Siormwater Pollution
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion maybe
indicative of conditions that warrant further investigation and corrective action.
.s
Page 2
5WU-242.020705
Sampler.---4E.H.S.---->EMS Rec.
Revision Date: 12/23/2015- Revision No: 04 Retention Period: 5 years