NCG100095_MONITORING INFO_20200103

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
- G ) o o b S
DOC TYPE
❑ HISTORICAL FILE
IA MONITORING REPORTS
DOC DATE
❑ Dc), b 0 I Q
YYYYM M D D

Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG100000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG10 0 0 9 cJ
FACILITY NAME I.KQ Self Service Raleigh
COUNTY wake --
PERSON COLLECTING SAMPLES ShellY Snlith IAN p 3 2020
LABORATORY EwotinslestAnleriw Lab Savannah Lab Cert. fl 269
Comments on sample collection or analysis: i"ILEC
None DWR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2019
SAMPLE PERIOD ❑ Jan -June [W] July -Dec
or ❑ Monthly'_ /month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow []WaterSupply ❑SA
❑Other
PLEASE REMEMBER 10 SIGN ON PAGES 2 AND/OR 3 3
T_a..l .. 'A n r1
C"C ,, r
ter, J ." or
LJ lvo olscnarge
this penoo
mple
pH,
Total Suspended
Non -polar
O&G/TPH
Lead, Total
Total Toxic
New Motor or
ected,
Standard
Solids (TSS),
(Method 1664
Ethylene Gfycol,
Recoverable,
3
Organics
Hydraulic Oil
d/year
Units
m L
g/
SGT-HEM), mg/L
mg/L
m g/L
,
mg/L
Usage,
gal/mo
-
6.0-9.01100
or 50
15
8,000
QDaate
(Tiers 2 and 3)
0.075
1.0-
00400
C0530
00552
77023
01051
2/2019
6.4
13
24
78141
NCOIL
1.9
0.011
Exempt
110.9allons
Note: If you report a sampled value in excess of the benchmark valua.
Permit
„sue P- Y­ ,u,L inipiement 1 ier 1 or I ter 2 responses in the General
'If pH values outside this range are recorded in sampled Stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark
range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must he documented
to demonstrate background concentrations were below the benchmark pH range of 6-9.
25ee General Permit 1-able 1, identifying the especially sensitive receiving waters classifications where the more protective benchmark applies.
'For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table It of Chapter 40 Code of Federal Regulations (CF-R) Part 122.
"Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
'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.
"For sampling periods with no discharge at any single outfall, you rnust still submit this discharge monitoring report with a checkniark here.
Pr_•rmil Date_: -I I/I/2018-05/3:1/2.021
Foini SWU-757, Last Revised IL7/7/2019
?6
Page I of 2

Far liti,s that incorporate a solvent nanagement plan into the Stormwaler Pollution Prevention Plan may request that D[MI_R waive monitoring of total toxic organics. The solvent
management plan shall include a list of the total toxic organic compounds useJ along with other requirements listed in the General Permit I -or those facilities allowed such a waiver,
the discharger shall sign the following certification statement:
Solvent Monagement Plon CectiJication Statement
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement For total toxic organics (TTO), I
certify that to the hest of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report I further certify that this facility is implementing all the provisions of the solvent
management plan included in the Stormwater Pollution Prevention Plan."
Name (Print name)
Mail Original to:
Division of Water Quality
Attn: Central Files
1617 Mail Service
Center
Raleigh, North Carolina 27699-1617
"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.
am aware that there are significant penalties for submitting false information. including the possibility of fines and imprisonment for knowing violations."
Date
Permit Date: 1I/l/2018-05/31/2021
Form SWU-251, Last Revised '11/1/2018
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