NCG060282_MONITORING INFO_20200121

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
4c, GO
DOC TYPE
❑ HISTORICAL FILE
❑XMONITORING REPORTS
a ��� o f a
DOC DATE
❑
YYYYMMDD

STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG060000
1 Date submitted
FACILITY NAME CERTIFICATE OFC(OBVFcRA�GE \(�O.tNCC�G06�1
COUNTY �r)
PERSON COLLECTING SAMPLESJY[F�,\
LABORATORY f8 L Lab Ce . N � 1
Part A: Stormwater Benchmarks and Monitoring Results
RECP\/1=CI
SAMPLE COLLECTION YEAR a o q JAN 21 2620
CENTIRAL FILES
SAMPLE PERIOD ❑ Jan -June [July -Dec DWR SECTION
or ❑ Monthly (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
(❑Z ro-flo}Q�� ❑Water Supply ❑SA
Other V14TT ,r Sin/
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats Mse animal fats/byproducts
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
I
Total event rainfall Z3 1 or ❑ No discharge this period3
Outfalt:No
Date Sample
Collected, mo)dd/ r
'' TSS
m /L ...
pH,
Standard 'units +
,,COD
. , m' L ,,
Cl end Grease
m /L :°`
.-Fecal Collfoim,
Colonies er:A00 ml
Enterococcl,.
j{olonles er:100 ml
8enchmdrk
1000':"
500i
ParameteGCode
a'C0536?
a''^' 100400 ,4, ,
+ 4Y003401
K^ 00556d:r
"" 116161
61211
• unly applies to taclllties 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.
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? ves ❑ no (If ves, complete Part B)
Permit Date:11/1/2018-05/31/2021
SWU-249, Last Revised 11/5/2018
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Part B: Vehicle Maintenance Area Monitorine Results: only for facilities averaeine> 55 eal of new mntnr nil/mnnth
r
0utfallNoTotalSufpandediSollds;;
Date Sempla Collected
24"hou`r ralnfall,emount r
.aI chae: 7 y
! Naw�Mot4r Oil ors "t
Hydraulli011Ucagef
Non Poler'0&Q/Total
;P�trvleui_nHydrocar ons-
tR
C .J
_
9anthmgrks
rk
�l �y f �y
a.h ., n..
W 1
-s..ti,= y
If
{
�,-100mg/L'or 80�mg/L :x.
Parameter -Code
'46529du
Footnotes trom 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
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ©NO
REGIONAL OFFICE CONTACT NAME:
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
_ 1612,Mail Service, Center
Raleigh, NC 27699-1612,
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: 11/1/2018-05/31/2021
Date
SWU-249, Last Revised 11/5/2018
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