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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCG b� oao9
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ li l (�� I s
YYYYMMDD
STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG060000
Date submitted — (— g lei R 17r� 17 IV F 10
CERTIFICATE OF COVERAGE NO. NCG06O SAMPLE COLLECTION YEAR c�lV 1
DENR-LAND QUALITY
COUNTY FACILITY NAME- 0 . SQI j QQf. SAMPLE PERIOD Jan -June y-
COUNTY��J(;,p u n ❑ ❑Jul Dec STQRMWATER PERAriTTiNG
PERSON COLLE TING SAMPLES or [Monthly' J ctnf� (month)
LABORATORY
Lab Cert. #
Part A: Stormwater Benchmarks and Monitorin¢ Results
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flout' , ❑Water. S�Iy ❑SA
�ther �a l W
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats v se animal fats/byproducts
PLEASE REMEMBER TTP SIGN ON THE REVERSE1
Xj 6 p Latj
Tntol Pvvnt rainfall I nr I Vr In dic,hnrna this na rinrl3
Outfall-No:
-
Date Sample
-Collected, mo/dd/yt
- TSS, .
'mg/L
pH,.', _
Standard units
. _COD,
-mg/L.mg/L
Oil and Grease;
Fecal Coliform,
Colonies per 100 ml
Enterococci,
Colonies per 100 ml
Benchmark
-•' - •
. 100 or 504 -
Within 6.0= 9.0
. .-. 120
--- 30
- 10001
-Soo'
Parameter Code
- -
C0530"
00400
`00340
..• 00556 ..""-"
31616-
61211-
Oniy appues to taauues that use/process meats.
The total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4See 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: 11/1/2018-05/31/2021
SWU-249, Last Revised 11/5/2018
Page 1 of 2
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
' Outfall No.
Date Sam ple1Collected '
,.(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
d,
y`
15 rng/L'.,
ioo mg/L; or 50 mg/V
Parameter Code
-
46529
`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 S TION B.
* TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENC FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES NO
IF YES, HAVE YOU CONTACTED THE DEML� REG �NA4 P �FICE? .Y�St INO
REGIONAL OFFICE CON TACT NAME �,tt�` (,N ; II S—' �.Mh!Y_RC)rl\
Mail an original copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitoring period in the case
of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
161kMail Service Center
Raleigh, NC 27699-167Z,
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 violat;Ks.�
Signature of
Permit Date: 11/l/2018-05/31/2021
9-6-1 y
Date
SWU-249, Last Revised 11/5/2018
Page 2 of 2
STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG060000
Date submitted — �E
CERTIFICATE OF C'Q'�\/ERAGE NO. {N-CG06UOSAMPLE COLLECTION YEARFACILITY
COUNTY NAME \k ;-\ ��e!( It
SAMPLE PERIOD ❑ Jan -tune ❑ July -Dec
' t ^ or [Roivlonthly' Ucanf� (month)
PERSON COLLE TING SAMPLES
LABORATORY
Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero-floy❑Waa gr Sqj2ply ❑SA
ther
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ® use animal fats/byproducts
PLEASE Rr:MEMBER T SIGN ON T E REVERSE 4
-un�- /�p rLot�J
��,
Total event rainfall I or I6RNo discharge this aeriod3
Outfall;tdo.
Date Sample
Collected, rrio/dd/yr
TSS
mg/L ' '
pH,: _ :
; Standard units
'.,COD,
'mg/L
Oil and:Grease
m /4' _
Fecal Collform,
Colonies er 100 mi
Enterococcl,
Colonies er100 ml
Benchmark,p;iRp.
1100`or504'::'Wlthln:6'i0-'9.0
t120
* .-30
10001.
- Soo,
Parameter,'Code,'
" C0530 "
'' . , 00400 .`'
S:00340 „
.,. `'.- ' 00556 :'
31616
61211
' Only applies to facilities that use/process meats.
2The 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
Permit Date: 11/1/2018-05/31/2021
(if ves, complete Part B)
SWU-249, Last Revised 11/5/2018
Page 1 of 2
Part B: Vehicle Maintenance Area Monitorin¢ Results: only for facilities averaeine > SS eal of new motor oil/month
Outfell No
,.
Date Sample Collected
Imo/dd%yr)'' _
24 hour rainfall'emount
i Inches' ; _
t: New Motor II or
.;.. Hydreulic:O11 Usage, S
Non,Poler 0&G/Total
—
_. Petroleurn,H rowrbons
Total Suspended Solids `
'.
Benchmarks`
., s az
x.r��
�.+ �rmd.
.s^._�. a
,aagmg/L,
=100�riiB/L`orSO'mgJLs,
�Parameter.Code'
;.;"± "
�C'. '�, 46429^*
='•.NCOIL '^
`` •;'00432
.•C0330
Footnotes from Part A also apply to Part B
'FOR PART A AND PART B MONITORING RESULTS:
a 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 S TION B.
• TIER 3.p.HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENC FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES 1NO ❑
' _<
IF YES,;HAVE YOU CONTACTED THE D ML��REG�Q`NA Q�FICE7 ((YESl NOD
REGIONAL OFFICE CONTACT NAME: ,��t(W w i I I S-- lX t Ify\ !k. < Grp 45
�)
C5 Sv�— Yc���-� f`+�At \kt� VmW,45flk i
of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1612,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 violatiWs."
Signature of
Permit Date: 11/1/2018-OS/31/2021
Date
SWU-249, Last Revised 11/5/2018
Page 2 of 2