NCG030670_DMR_20210105 (2)

Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted
CERTIFICATE OF
FACILITY NA E
COUNTY
PERSON COLLE(
Comments on sample
NO.NCGO, O_tVZ
analysis:
Cert. N
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2--C CJ
SAMPLE PERIOD ❑ Jan -June �ily-Dec
or ❑ Monthly' /month)
Rf�!^ ISCHARGINGTOCLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow 5�lUater Supply ❑SA
BAN 11 2021 ` ❑other
Ci �fY,ILF) PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
y-t,.r. 1. N
No discharge this period?'
Outfall No.
Date Sample
p
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
and
Standard units
Total Copper
Total Lead
Total Zinc
Non -Polar O&G/Toxic
Total Petroleum
Hydrocarbons
Total Organics'
Organics
Benchmarks
-
-
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 Code
-
46529
C0530
00400
01119
01051
01094
00552
78141
' 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.
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).
Permit Date: 11/1/2018-05/31/2021 SWIJ-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 Stor water Pollution Prevention Plan."
1 GJt�af
Name (Print name)
Titl ri t ti )
l
Si atux 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 mi/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 I, Tier 2, or rer 3 responses. See General Permit text
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No discharae this oeriod?2
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
-
-
-
1S mg/L
100 mg/L or 50 mg/0
Parameter Code
-
5
NCOIL
00S52
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 rer 1, Tler 2, or rer 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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