NCG190063_MONITORING INFO_20191216

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
n/CG 0003
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
N
DOC TYPE
HISTORICAL FILE
MONITORING REPORTS
DOC DATE
D
YYYYMMDD

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STORMWATER- DISCHARGE OUTFALL (SDO)
GENERAL PERMIT NO. NCG190000
DISCHARGE MONITORING REPORT (DMR)
CERTIFICATE OF COVERAGE (COC) NO.: NCG19001A© RECEI\ V /ER SAMPLE COLLECTION CALENDAR YEAR: %�
I his monitoring report is due at the Division no later than 30 days from
FACILITY NAME: E -)U WOitks nrr 16 2019 the date the facility receives the sampling results from the laboratory.)
SAMPLE COLLECTION NAME: a 14-Ai - V
CENTRAL FILE, FACILITY COUNTY: C'�L CX44/
CERTIFIED LABORATORY:GlrrVIPan /Y)e.nr Lab # I/013 SECTIC' PHONE NO.: ( %a �2D'2' 7Y.;)-3
Part A• Snaeirie Mnnitnrino Remtirements
Outfall
No.
Sample
Collection Date,
mo/dd/ r
Total Rainfall,
inches
00530
TPH by method
1664 (SGT-HEM)
01119
01104
01094
01114
Total Suspended
Solids, m /L
Non -Polar Oil &
Grease, mg/L
Copper" , mg/L
Aluminum", mg/L
Zinc"' , mg/L
Lead ' , mg/L
Freshwater
(Saltwater)
Benchmarks
10o
15
0.010
(0.005)
0.75
0.126
(0.095)
0.075
(0.220)
5
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' If a value is in excess of the benchmark, you must implement the Tier 1 or Tier 2 responses in the General Permit.
Total recoverable metal.
These benchmarks are water hardness dependant. Values shown based on a hardness of 50 mg/L.
Mail original and one copy to:
Division of Water Resources
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Solvent Management Plan Certification:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit requirement for
managing solvents, I certify that to the best of my knowledge and belief, no leak, spill, or dumping of concentrated solvents
into the stormwater or onto 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." n
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 fin s and im isonment for knowing violations."
1 I �V I✓ I
(Si W-Aure of Permitte) (Date)
Permit Date: 6/02/2015-5/31/2020 SWU-253-060515
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Mail an original and one copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR Central Files
1617 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 violations."
(Signature of
�z y
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/Ir/npdes-stormwater
SWU-254 Vehicle Maintenance Activities DMR Last Revised: August / 1, 2014
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