NCG080607_MONITORING INFO_20200113

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
ljc G 6 � b o o7
DOC TYPE
0 HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ 0 d 13
YYYYMMDD

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCGO80000
CERTIFICATE OF COVERAGE NO. NC 08 O
FACILITY NAME /VG A: r 6 0 Q.r
COUNTY ftl, i' Ir-VI Ta
PERSON COLLECTING SAMPLES S 1 M Zf%c
LABORATORY prig ry-, Lab Cert. N
Comments on sample collection or analysis:
Date submitted 17S�,ft 2 DZ.D
►/' SAMPLE COLLECTION YEAR
1 SAMPLE PERIOD ❑ Jan -June July -Dec
or ❑ Monthly' (month)
`r 4� cDISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
rtf�Z —RECEIVED ❑Zero -flow ❑Water Supply ❑SA
❑Other
JAN 13 2020
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTRAL FILES
Did this facility perform Vehicle Maintenance Activities using more than i IGiicalm oil per month?12 yes ❑ no (if ves, complete Part A)
Part A: Vehicle & Equipment Maintenance Areas Monitoring Requirements (if applicable) ❑ No discharge this period'
Outfall No.
Date Sample Collected'
(mo/dd/yr)
24-hour rainfall amount,
Inches'
Non -Polar Oil & Grease
mg/L
Total Suspended Solids,
mg/L
New Motor or Hydraulic Oil Usage,
gal/mon
Benchmarks
_
-
15
100 or 504
Parameter Code
-
46S29
00552
C0530
NCOIL
DOS
12 !
6 in
< 1. 7 in L
oo
> S I
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outtall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The 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 text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, 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. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX".
Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018
Page 1 of 2

Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable) ❑ No discharge this periodz
Outfall
No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Sample Collected'
mo/dd/yr
Total Suspended
Solids,
mg/L
pH,
Standard units
Non -Polar Oil &
Grease,
mg/L
iPermltLlmmt ss,t
100 or, 504
.6.0-9.0 ..
15
Parameter Codea -
-
46529
- -
- C0530-
00400
00552
Footnotes from Part A also apply to this 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.
FOR PARTA AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• .2 EXCEEDANCES IN:A ROW FOR THE SAME PARAMETER'AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 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 DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this DMR, including all "No Discharae" reports, within 30 days of receipt of the lab results for at end of manitorina 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 that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signature of Permittee
Permit Date: 11/1/2018-5/31/2021
t' Date.
SWU-248, last revised 11/1/2018
Page 2 of 2
J

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calendar Year 7-40/55
Individual NPDES Permit No.
Certificate of Coverage (COC) No.
or
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: /1IC. Ai, N,+- i o Tom` GU 0.x4
County:
Phone Number: (ibV) 39 1 r% Total no. of SDOs monitored
Outfall No. OUFj
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No E�-'
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No [j[�
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes Eg" No ❑
ovvu-tov - ueneric Hnnuai umn
Last mvised W 12018

Additional Outfall Attachment
Outfall No.
Is this outfall currently in Tier 2.(monitored monthly)? Yes ❑ No ❑
Was`this outfall ever in Tier.2 (monitored 'monthly) during the past year? Yes ❑ No ❑
If'this outfall vias•in Tier 2 last year, why'was'monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No ❑
SW U-264 - Generic Annual DMR
Last mvfswl 1101/2018
J

I
I
r
"I certify, under penalty of law, that this document avid 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
Date j_-44A �vCa
For questions, contact your local Regional Office:
DEMLR Regional Office Contact Information:
2090 US Highway 70
Swannanoa, NC 28778
[phone]
3800 Barrett Drive
Raleigh, NC 27609
[phone]
50 Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
[phone]
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
943 Washington Square Mall
Washington, NC 27889
[phone]
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
SW U-264 - Generic Annual DMR
Last revised 61012018

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