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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
D7 MONITORING REPORTS
DOC DATE
❑ l7 j 1 a
YYYYMMDD
STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG060000
CERTIFICATE OF COVERAGE NO. NCG06_a i 1
FACILITY NAME R,1! ems
COUNTY 1 00
PERSON COLLECTING SAMPLES
LABORATORY
Date submitted O -{- 'Lr7 26(c?
SAMPLE COLLECTION YEAR 201 1
SAMPLE PERIOD ❑ Jan -June ❑ July -Dec
or RMonthly5 SV4{- (month)
Lab Cent. # DISCHARGING TO CLASS
RECEIVED
❑ORW ❑HQW ❑Trout
❑Zero -flow ❑Water Supply
[]Other Clot S C
❑PNA
❑SA
NOV 12 zol§ACILITY ACTIVITIES INCLUDE (check all that apply):
CENTRAL FILES use/process meats ❑ use animal fats/byproducts
DWR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE -->
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall 2 or No discharge this period]
Outfall No.
Date Sample
Collected, mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliform,
Colonies per 100 ml
Enterococci,
Colonies per 100 ml
Benchmark
100 or 504
Within 6.0 — 9.0
120
30
10001
Soot
Parameter Code
C0530
00400
00340
00556
31616
61211
Only applies to facilities that use/process meats.
'The total precipitation must be recorded using data from an on -site rain gauge.
' For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
'Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ❑ yes ❑ no (ifyes, complete Part B)
Permit Date: 11/i/2018-OS/31/2021 SWU-249, Last Revised 11/5/2018
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Date sample Collected
(mo/dd/yr)
24 hour rainfall amount;
Inches
Ne`w Motor Oil or
Hydraulic Oil Usage
—' Non -Polar O&G/Total—
Petroleum Hydrocarbons
Outfall No.
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or 5o mg/L4
Parameter Code
46S29
NCOIL
00552
C0530
Footnotes from Part A also apply to Part B
*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 EXCEEDENyCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ® NO ❑
IF YES, HAVE YOU CONTACTED THE DEMUR REGIONAL OFFICE? YES P] NO ❑
REGIONAL OFFICE CONTACT NAME: �,hr. l 1a�les l
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, NC 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 df Permittee
ate
Permit Dat, ./l/2018-05/31/2021 SWU-249, Last Revs. 11/5/2018