NCG030612_MONITORING INFO_20190703

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO. /v u& 03 a
DOC TYPE. ❑ HISTORICAL FILE
�1 MONITORING REPORTS
DOC DATE ❑ ��) �� �`�
YYYYMMDD

KC-.
Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit littps://deq.iic.gov/about/divisiotis/energy-mineral-land-resources/
n p d e s-s to rm w ate r- g p s
PermitNo.: N/C/6/0/3/0/0/0/Ol or Certificate of Coverage No.: N/C/G/ 10/3/0/(v/l/ a
Facility Name: rr (�rw-y� S
County: GL i I i-Uej /W1n5K-P 4WPhoneNo.
Inspector: R I 3AdeR
Date of Inspection:
Time of Inspection
-,�M'19
33(0 - Co (oa- O 113
Ptoh„
a oo � J6ti .
z
Total Event Precipitation (inches): 0• IQ
CEtiTr�t� al
ptn✓R SECTIp ��
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signat^, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No. Structure (pipe, ditch, etc.):
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
Page I of 2
S W U-242, Last modified 06/01 /2018

. .,
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
1 2 3 4 5
" 7. Is there any foam in the stormwater discharge? O Yes O No.
8. Is there an oil sheen in the stormwater discharge? OYes O No.
9. Is there evidence of erosion or deposition at the outfall? .O Yes O No.
10. Other Obvious Indicators of Stormwater pollution:
List and describe
'I
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.
i
Page 2 of 2
SWU-242, Last modified 06/01/2018

4
Weather History for Greensboro, NC I Weather Underground
Page 1 of 4
Greensboro, NC A
Piedmont Triad International
0
Weather Almanac for KGSO - June, 2019
June
28
View
Friday, June 28, 2019
Daily I Weekly I Monthly I Custom
Temperature
Mean Temperature
Max Temperature
Min Temperature
Degree Days
Heating Degree Days
Month to date heating degree days
Since 1 June heating degree days
Since 1 July heating degree days
Cooling Degree Days
Month to date cooling degree days
Year to date cooling degree days
Since 1 June cooling degree days
O 4:05 PM EDT on July 01, 2019 (GMT -0400)
Average Record
78 °F
87 °F 99 °F (1959)
68 °F 51 °F (1927)
0
13
5
5
3617
281
440
281
https://api.wunderground.com/history/airport/KGSO/2019/6/28/DailyHistory.html?&regdb.... 7/1 /2019

'4
Weather History for Greensboro, NC I Weather Underground
Page 2 of
Moisture
Dew Point
Average Humidity
Maximum Humidity
Minimum Humidity
Precipitation
Precipitation
Month to date precipitation
Year to date precipitation
Wind
Wind Speed
Max Wind Speed
Max Gust Speed
T = Trace of Precipitation, MM = Missing Value
Average
0.12 in
Record
1.53 in (2011)
3.49
20.19
Source: NWS Daily Summary
https://api.wunderground.com/history/airport/KGSO/2019/6/2S/DailyHistory.htm1?&regdb.... 7/ 1 /2019

r r �
Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted LO -AS - 19
CERTIFICATE OF COVERAGE NO. NrC1G03 D toL a
FACILITY NAME LL YUm 5
COUNTY LLi Q-6 I W; CG'''
PERSON COLLECTING SAMPL S Dt—� c11/
LABORATORY Lab Cert. #
Comments on sample collection or analysis: JUL 0 3 2019
' Til. FI -
DWr� EC77p-'
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR
SAMPLE PERIOD ❑ lan-June JMJuly-Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HC(W ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
[]Other
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
P< No discharge this period?Z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
pH
Standard units
Total'Copper
Total Lead
Total Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organicss
Benchmarks. -
-
-
100 mg/L or SO.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
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfali.
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

f r
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."
P / aade2
Name (Print name)
"FF1Ci 114 n7AnA e2
Title int ti e)
SijKature
6-a8-19
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/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 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/O
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 1, or Tier 3 responses. See General Permit text.
Permit Date:11/1/2018-05/31/2021 --.SWU-245,last revised 11/1/2018' - -
--- -- _.. - --- - -.--- - -. -_ _. - Page 2of3

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 DEMUR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original coov 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 responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware there are significant penalties/lor submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signature of Permittee
Permit Date:11/1/2018-05/31/2021
6-as- iq
Date
SWU-245, last revised 11/1/2018
Page 3 of 3 _ -

U
J
Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted 7- 1- l 9
CERTIFICATE OF COVERAGE NO. NCG030 g
FACILITY NAME Irene4;ak j (Aw�'• C s
COUNTY G�'.1 W r1 n''
PERSON COLLECTING SAMPLES Cc-
LABORATORY' JrA (,HLS Lab Cert. q
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 20 l I
SAMPLE PERIOD [g an -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
� \/Cn ❑Zero -flow ❑Water Supply ❑SA
JUL G 5 ;;'9 ❑Other
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
DWR SECTION
❑ No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total
Total Suspended Solids
pH,
Standard units
Total Copper
Total Lead
Total Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organ
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
Gu. wk I
C-5-II
6 (i`A
LS M71
Oc+tc11 of
6-5-11
tL
51q9
LS^P/L
4 \t }
6-5-+1
IZ
5.91
LSr`��L
1 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.
4 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 i.^.to 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."
/Ql/ /vA
Name (Print /name)
Sr/ v / Ai' o q% *97
Title (Print title)
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 me/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 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?z
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-OS/31/2021 SWU-245, last revised 11/1/2018
Page 2 of 3