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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. w U& b 3 o a Ca
----------------
DOC TYPE. ❑ HISTORICAL FILE
❑"MONITORING REPORTS
DOC DATE ❑ �/
YYYYMMDD
Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
CERTIFICATE OF COVERAGE NO. N00030000
FACILITY NAME Moen
COUNTY Craven
PERSON COLLECTING SAMPLES Jack Taylor
LABORATORY Environment 1 Lab Cert.» 10
Comments on sample collection or analysis:
Date submitted 9/16/19
SAMPLE COLLECTION YEAR
RECEIVED - SAMPLE PERIOD Jan -June July -Dec
OCT 2 3 2019 or F1 Monthly'
Part A: Stormwater Benchmarks and Monitoring Results
DWR SECTION
2019
DISCHARGING TO CLASS E]ORW E]HQW
❑ Zero -flow ❑
Other
September
Trout A
Water SupplygA
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
n No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfallpH,
amount,
Inches3
Total Suspended Solids
and
Standard units
Total Copper
Total Lead
Total Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organicss
Benchmarks
-
-
100 mg/L or 50 mg/L4
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
SDO-1
SDO-2
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
z 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 identifythe 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
Permit Date: 11/1/2018-05/31/2021
SWU-245, last revised 11/1/2018-
Page 1 of 4
fr,
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).
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."
Name (Print name)
Permit Date: 11/1/2018-05/31/2021
io" lo- 0
Date
SWU-245, last revised 11/1/2018
Page 2 of 4
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 mgjL', 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, Tier 2, or Tier 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 discharge this period?2
Outfall No.
Date Sample Collected'
(mo/dd/yr)
24-hour rainfall amount,
Inches3
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.
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 ElaO IF YES, HAVE YOU
CONTACTED THE DEMLR REGIONAL OFFICE? YES NO ❑ ❑
REGIONAL OFFICE CONTACT NAME:
Permit Date: 11/1/2018-05/31/2021
SWU-245, last revised 11/1/2018
Page 3 of 4
Mail an original 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 properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those
persons directly esponsible for g hering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that theXare sigrfff'icpm: pinalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
MM)l W,`o,�l
Signatur of Permittee I I Date
Permit Date: 11/1/2018-05/31/2021
SWU-245, last revised 11/1/2018
Page 4 of 4