NCG030244_MONITORING INFO_20190711

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
E � U ;J a `l
N
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ cq / -7 % /
YYYYM M D D

Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted Cn
CERTIFICATE OF COVERAGE NO. NCG03 Z y y SAMPLE COLLECTION YEAR ZJ��
FACILITY NAME SAMPLE PERIOD gJan-June ❑ July -Dec
COUNTY N or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES CDISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY \,N'O ^L �C\t Lab[ert.# \<<iGr�c,(y[n RECEIVED ❑Zero -flow [:]watersupply ❑SA
-) , n)' .
Comments on sample collection or analysis: JUL 11 2019 Other C.'
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
GANR SECTION
No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Total Suspended Solids
pH,
Standard units
Total Copper
Total Lead
Total Zinc
Non -Polar O&G/Total
Total Petroleum
Hydrocarbons
Toxic
Organicss
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
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0
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Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 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 SWU-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 Stormwater Pollution Prevention Plan."
Name (Print name)
Title (Print title)
3 -�f., L�
Signature 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 mg/I.", 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.
❑ No discharge this period?'
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
CO530
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

1,-
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
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal coov of this DMR, including all "No Discharae" reports, within 30 days of receipt of the lab results for at end of monitorina 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 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."
Signature of Permittee
Permit Date: 11/1/2018-05/31/2021
\0-`0-10\0\
Date
SWU-245, last revised 11/1/2018
Page 3 of 3

.Wb
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calendar Year RECPNIED
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or JUL 11 Z019
Certificate of Coverage (COC) No. NCGQ❑3 51I_21FQS
CENTFtpi.. i=11.E3
DWR SvECTION
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: OZs G,
County:5��.
Phone Number:( �e -A27L.\ Total no. of SDOs monitored
Outfall No. Z
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No Ey/
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units)
Total
Rainfall,
inches
Benchmark
Date Sample
Collected,
me Sam y
N/A
Elm
_
ME
-
IN
ME
ME
SW U-264 - Generic Annual DMR
Last revised 61012018

Additional Outfall Attachment
Outfall No
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No ❑
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SW U-264 - Generic Annual DMR
Last revised 610112018
w

" 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."
Signature
Date
For questions, contact your local Regional Office:
DEMLR Regional Office Contact Information:
2090 US Highway 70
Swannanoa, NC 28778
[phone]
3800 Barrett Drive
Raleigh, NC 27609
[phone]
450 Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
[phone]
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
943 Washington Square Mall
Washington, NC 27889
[phone]
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
SWU-264 - Generic Annual DMR
Last revised 610112018