HomeMy WebLinkAboutNCG100210_MONITORING INFO_20150120STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ a 0
YYYYM M DD
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
CERTIFICATE OF COVERAGE NO. NCG100 2_,� SAMPLES COLLECTED DURING CALENDAR YEAR:. Z0 1
9
(This monitoring report shall be received by the Division no later than 30 days
from the date the facility receives the sampling results from the laboratory.)
FACILITY NAME AT-LocaC.I S�� C CCUNTY C ��
PERSON COLLECTING SAMPLE(S) PHO E�,N1O. (eZZB
CERTIFIED LABORATORY(S) Lab # RECE. / 1)
Lab # PLEASE REMEMBER TO SIGN ON THE REVERSE 4
JAN 2 Q LUJ C�
Part A: Stormwater Benchmarks and Monitoring Results CENTRAL FILES
DWR SECTION
For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within
30 days of the end of that period to comply with permit reporting requirements. +�
Outfall
No.
-Date
Sample Collected,
mo/dd/year
Total
Rainfall,
inches
00400
00530
----
77023
01051•.•
78141
pH,
Standard
Units
Total Suspended
Solids (TSS),.e
mg/L` - .
Non -polar
O&G/TPH
(Method 1664`
SGT-HEM), mg/L
'Ethylene Glycol,
mg/L
,°
Lead, Total ;.
Recoverable,
mg/L
Total Toxic
3 Organics,
mg/L.
Benchmark
-
-
1
6.0 — 9.0
z
100/50
15
8,000
(Tiers 2 and 3)
0.03 A
1.0
7
IPA
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General
Permit.
1See If pH values outside this range are recorded in sampled Stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark
range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented
to demonstrate background concentrations were below the benchmark pH range of 6-9.
2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters.
3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122.
Form SWU-251, last revised October25, 2012
Page 1 of 2
a aw
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the
discharger shall sign the following certification statement:
Solvent Management Plan 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),
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 all the provisions of the solvent
management plan included in the Stonrwater Pollution Prevention Plan."
o rn a
Name (Print name) nQ �
`JY, Zo Ca C1� �t
Title (Print title,)n
Si
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Date
"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. I
am aware that there are significant penalties fggflbmitting false information, including the possibility of fines and imprisonment for knowing violations."
(S
ittee or Designee)
-/ --I5-
(Date)
Form SW U-251, lost revised October 25, 2012
Page 2 of 2
STORMWATER DISCHARGE OUTFALL(SDO)
MONITORING REPORT
CERTIFICATE OF COVERAGE NO. NCG100 2_I S
FACILITY NAME C 1C-I S
PERSON COLLECTING SAMPLE(S) 'ems `t c7GlC_
CERTIFIED LABORATORY(S) Lab #
Lab #
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLES COLLECTED DURING CALENDAR YEAR: ZD i q
(This monitoring report shall be received by the Division no later than 30 days
from the date the facility receives the sampling results from the laboratory.)
COUNTY r!
PHONE NO. ( iO3;7— -
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within
30 days of the end of that period to comply with permit reporting requirements.
Outfall
No.
Date
Sample Collected,
mo/dd/year
Total.
Rainfall,
inches
00400•
00530
----
77023
01051
78141
pH,
Standard
Units
Total Suspended
Solids (TSS),
mg/L
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), mg/L
Ethylene Glycol,
mg/L
Lead, Total
Recoverable,
mg/L
Total Toxic
prganics3,
mg/L
Benchmark
-
-
6.0 — 9.01
1D0/50Z
15
$,D00
(Tiers 2 and 3)
0.03
1.0
I.Z
ON
Loof
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General
Permit.
1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark
range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented
to demonstrate background concentrations were below the benchmark pH range of 6-9.
2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters.
3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122.
Form SWU-251, last revised October 25, 2012
Page 1 of 2
a
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the
discharger shall sign the following certification statement:
Solvent Management Plan 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 all the provisions of the solvent
management plan included in the Stormwater Pollution Prevention Plan."
aL:9�- �2 Mq+1CY-,k-
Name (Print name)
Title (Print title) _
Date
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
1-f 1 S-
"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. I
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
or Designee)
1-1--
(Date)
Form SWU-251, last revised October 25, 2012
Page 2 of 2
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
CERTIFICATE OF COVERAGE NO. NCG100 2 1 0
FACILITY NAME Ci Auto Used
PERSON COLLECTING SAMPLE(S) Bob Bobbitt
CERTIFIED LABORATORY(S) Test America Pensacola Lab # 314
Lab #
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLES COLLECTED DURING CALENDAR YEAR: 2013
(This monitoring report shall be received by the Division no later than 30 days
from the date the facility receives the sampling results from the laboratory.)
COUNTY Warren
PHONE NO. ( 252 ) 586-7463
RECEIVESIDAEMEMBER TO SIGN ON THE REVERSE -)
JUL 0 2 2014
CENTRAL FILES
For sampling periods with no discharge, you must submit this discharge rr9W0#e0 Gorm noting "No Flow" or "No Discharge" within
30 days of the end of that period to comply with permit reporting requirements.
Outfall
No.
Date
Sample Collected,
mo/dd/year
Total
Rainfall,
inches
00400
00530
----
77023
01051
78141
pH,
Standard
Units
Total Suspended
Solids (TS5),
mg/L
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), mg/L
Ethylene Glycol,
mg/L
Lead, Total
Recoverable,
mg/L
Total Toxic
3
Organics ,
mg/L
Benchmark
-
-
6.0 — 9.01
100/50z
15
8,000
(Tiers 2 and 3)
0.03
1.0
001
06/27/2013
0.25
6.9
2100
4.5
33*
0.90
Exempt
001
12/26/2013
0.25
7.0
19
2.6
3.4
0.035
Exempt
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General
Permit.
*Result invalid due to laboratory error (sample exceeded acceptable temperature). please see the two attached pages.
1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark
range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented
to demonstrate background concentrations were below the benchmark pH range of 6-9.
2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters.
3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122.
Form SWU-251, last revised October25, 2012
Page 1 of 2
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the
discharger shall sign the following certification statement:
Solvent Management Plan 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 all the provisions of the solvent management plan
included in the Stormwater Pollution Prevention Plan."
� I l eim
Name (Print name)
ownr r (Mnyb.r( - ffa �r
Ti nt title)
ignatu Dake
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
or Designee)
Form SWU-251, last revised October 25, 2012
Page 2 of 2
A��r�
w►� A
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http://portal.nedenr.org/web/wq/ws/su/nt)dessw#tab4
Permit No.: NICI_
Facility Name: 1
County:
Inspector! Bob
Date of Inspection:
Time of Inspection:
Certificate of Coverage No.: NIC1G1—b D/ 01!R111-0
Total Event Precipitation (inches): „ J5
Was this a Representative Storm Event? (See information below) [R Yes ❑ No
Please check vour permit to verify if Qualitative Monitoring must be perrorrned during a representative
storm event (requrrenrents vary).
-A`Re "Representative Stone Event" is a storm event that measures greater
p es greater than 0.1 inches of rainfall and that
is preceded by at least 72 hours (3 clays) in which no storm event measuring greater than 0.1 inches has
occurred. A single storm event may contain up to 10 consecutive hours of no precipitation.
By this signature. I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permitlie)or Design
1. Outfall Description:-
Outfall No. 00 1 Structure (pipe, ditch) I C1 _
Receiving Stream: tt..t�
Describe the indkstrial activities that occur wijhin the outt'all drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
me
dium, edium, dark) as descriptors: t
tcowf\ I I I ayyt
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): f)Or" L
Page 1 of 2
SWU-242-20120613
r
4. Clarity: Choose the number which best describes the clarity of the discharge, where l is clear
and 5 is very cloudy:
1 2 3 G 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:
1 G 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where l is no solids and 5 is extremely muddy:
1 2 3 a 5
7. Is there any foam in the stormwater discharge? Yes No
S. Is there an oil sheen in the stormwater discharge? Yes No
9. Is there evidence of erosion or deposition at the outfall? Yes bo
14). Other Obvious Indicators of Stormwater Pollution:
List and describe fA
Note: Low clarity, high solids, and/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-242-20120613