NCG080272_MONITORING INFO_20190705

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
Q4 MONITORING REPORTS
DOC DATE
❑ b� .� -7 D
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
I MONITORING REPORT
M
GENERAL PERMIT NO. NCG080000
CERTIFICATE OF COVERAGE NO. NCGO8
FACILITY NAME o
PERSON COLLECTING SAMPL
ES
CERTIFIED LABORATORYv v',r Lab #
Lab #
SAMPLES COLLECTED DURING CALENDAR YEAR: 20 1
(This monitoring report is due at4he Division no later than 30 days from
the date the facility receives the ampling results from the laboratory.)
COUNTY M3III —
PHONE NO. tim ) / -2 V—
PLEASE SIGN ON THE REVERSE
Part A: Vehicle Maintenance Areas Monitoring Requirements
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Zyes __no
(if yes, report your analytical results in the table immediately below)
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Note: if you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier I or Tier 2 responses.
See General Permit text.
PartB: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals
ample" ollected
0H 30,4
WL
-v
units
...... .
Permit umtL.
....... .
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STORM EVENT C CTERISTICS:
Date irst event sampled)
I IT9 (f 1�
Total V�l nt Precipitation (inches):
Date— (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
RECENF-D
JUL 0 5 2019
CENTRAL HLES
DWR SECTION
Mail Original and one copy to:
Division of Water Quality
.Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
SWU-250-102107
Pagel of

"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."
67 az 20/9
(Date)
S WU-250-102107
Parer 9 of

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Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N/G / /_/� `/� / / / or Certificate of Coverage No.: N/C/G/
Facility Na e:
County: a Phone No. -
Inspector: N a I n
Date of Inspection: '-e4
By this signature, 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. I Structure (pipe, ditch, etc.) �.
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:. C c c
2. Color
Describe the color of the discharge ush
_ter ,
dark) as descriptors: _bra
3. Odor
Describe any
etc.) A
4. Clarity
colors (red, brown, blue, etc.) and tint (light, medium,
that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 2 13 ) 4 5 6 7 8 9 10
Page I
SWU-242-020705

5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 2 (3) 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 2� 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes Ar
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes No
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes AF6.
11. Other Obvious Indiitc'ators of Stormwater Pollution
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion maybe
indicative of conditions that warrant further investigation and corrective'action.
Page 2
SWU-242-020705

Permit No.:
Facility
County:
Inspectc
Date of
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
or Certificate of Coverage No.: N/C/GL0/�Q/ /z//
—� —
this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee 6r Designee)
1. Outfall Description
Outfall No. Structure (pipe, ditch, etc.
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area: .
2. Color
Describe the color of the
dark) as descriptors:
colors (red, brown, blue, etc.) and tint (light, medium,
3. Odor
Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.) it i(),.J V-�
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy: /�
1 2 0 3) 4 5 6 7 8 9 10
Page I
SWU-242-020705

S. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids:
1 2 U 4 5 6 7 8 9 10
6. Suspended Solids
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
1 3 4 5 6 7 8 9 10
7. Foam %�
Is there any foam in the stormwater discharge? Yes iz
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes
11. Other Obvious Indicators of Stormwater Pollution
List and describe /lJU/✓{C
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion maybe
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU-242-020705