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1SIB
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted 6/26/2019
CERTIFICATE OF COVERAGE NO. NCGO8 0397 SAMPLE COLLECTION YEAR: 2019
FACILITY NAME: Republic Services/3182 winston salem mrf SAMPLE PERIOD ®Jan-June j July-Dec
COUNTY: forsyth or L] Monthly' (month)
PERSON COLLECTING SAMPLES: mark tabaczynski DISCHARGING TO CLASS _^ORW I HQW _Trout FPNA
LABORATORY: NA Lab Cert.# fZero-flow ['Water Supply j 'SA
Comments on sample collection or analysis: I !Other
PLEASE REMEMBER TO SIGN ON THE REVERSE >
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_yes x no
(if yes, report your analytical results in the table immediately below)
Part A:Vehicle Maintenance Areas Monitoring Requirements(It applicable) ; _j No discharge this period'
Outfall Date 00530 00400 00556
No. Sample Collected, Total Suspended pH, Non-Polar Oil and Grease/TPH EPA New Motor Oil Usage,
mo/dd/yr Solids, mg/1 Standard units Method 1664(SGT-HEM),mg/L Annual average gal/mo
Benchmark - 50 or 100 see permit Within 6.0—9.0 15 - J
6/19/2019 3 7.25 2.5 0
i
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals(If applicable)
Outfall Date 00556 00530 00400
I No. i :sample Collected, i Non-Polar Oil and Grease/T Pfi EPA Method i Total Suspended Solids, pH,
mo/dd/yr 1664(SGT-HEM), mg/L mg/L Standard units
Permit Limit - 15 50 or 100 see permit 6.0—9.0
I
1 For sampling periods with no discharge at any single outfall,you must still submit this discharge monitoring report with a checkmark here.
SN`t 1.25t) last revised April 11.20 1
Page 1 ol'2
'1
STORM EVENT CHARACTERISTICS:
Date:06/19/2019(first event sampled)
Total Event Precipitation(inches):1.2
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
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 ANY ONE OUTFALL? YES El NO Q
IF YES,HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑NO❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR,including all "No Discharge"reports, within 30 days of receipt of the lab results(or 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 la that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure
that qualified personnel pro rly gather and evalua ,e information submitted. Based on my inquiry of the person or persons who manage the system,or those persons
directly a onsible for gat ring the information, :in mation submitted is,to the best of my knowledge and belief,true,accurate,and complete. I am aware that
there g 'fie n pena for bmitting fats: or Lion,including the possibility of fines and imprisonment for knowing violations."
'6(A t t ?' ' ,;e;
(Sig ature of Permittee) ( te)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWLI-_.50 last revised April I I.2013
Page 2 of 2
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted 6/26/2019
CERTIFICATE OF COVERAGE NO. NCGO8 0397 SAMPLE COLLECTION YEAR: 2019
FACILITY NAME: Republic Services/ 3182 winston salem hauling SAMPLE PERIOD ❑Jan-June ( 1 July-Dec
COUNTY: forsyth or U Monthly' (month)
PERSON COLLECTING SAMPLES: mark tabaczynski DISCHARGING TO CLASS —ORW HQW ❑Trout PPNA
LABORATORY: NA Lab Cert.# ❑Zero-flow ['Water Supply SA
Comments on sample collection or analysis: _Other
PLEASE REMEMBER TO SIGN ON THE REVERSE -*
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_yes x no
(if yes, report your analytical results in the table immediately below)
Part A:Vehicle Maintenance Areas Monitoring Requirements(If applicable) U No discharge this period'
Outfall r-- Date 00530 00400 00556
No. Sample Collected, Total Suspended pH, Non-Polar Oil and Grease/TPH EPA New Motor Oil Usage,
mo/dd/yr Solids, mg/L Standard units Method 1664(SGT-HEM),mg/L Annual average gal/mo
Benchmark - 50 or 100 see permit Within 6.0—9.0 15 -
6/19/2019 4 7.3 2.5 2000
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall Date 00556 l 00530 00400
No. Sample Collected, Non-Polar Oil and Grease/T PII EPA Method Total Suspended Solids, pH,
mo/dd/yr 1664(SGT-HEM), mg/L mg/L Standard units
Permit Limit - 15 50 or 100 see permit 6.0—9.0
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
Swi -250 last revised April I I.201 3
Pate I of2
STORM EVENT CHARACTERISTICS:
Date:06/19/2019(first event sampled)
Total Event Precipitation(inches): 1.2
Date (list each additional event sampled this reporting period,and rainfall amount)
Total Event Precipitation(inches):
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 ANY ONE OUTFALL? YES ❑NO Ei
IF YES,HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑NO❑
REGIONAL OFFICE CONTACT NAME:
Moil an original and one copy of this DMR,including all "No Discharge"reports, within 30 days of receipt of the lab results(or 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 roperly gather an alupte the information submitted. Based on my inquiry of the person or persons who manage the system,or those persons
directly r sponsible fo athering the info ti ,the information submitted is,to the best of my knowledge and belief,true,accurate,and complete. I am aware that
there a i ificant nalti for submi i f se information,including the possibility of fines and imprisonment for knowing violations."
(S nature of Permittee) (Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdesswlftab-4
SW( -o last revised April I I,20 I
Pate 2of2