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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v
DOC TYPE
❑HISTORICAL FILE
L6, MONITORING REPORTS
DOC DATE
❑ �0)"oo I C-�
YYYYMMDD
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG080000
Date submitted
CERTIFICATE OF COVERAGE No. �NCG08 b ) -7 X
FACILITY NAME
COUNTY
PERSON COLLEC�TING}SAMPLES
`,
LABORATORY Y1 C�1 1 lion _ I Lab Cert. 4 UL I q —o o 1
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR r 0 17_
SAMPLE PERIOD ❑ Jan -June 21uly-Dec
_ or El monthly' month
REC EN"C 1ARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
A� g �QZO ❑Zero -flow ❑Water Supply ❑SA
❑Other
CE NTf?�4%L FILES
S,E TION PLEASE REMEMBER TO SIGN ON THE REVERSE 4
D1rJ� ���-CTI�i�
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? Dyes ❑ no (if yes, complete Part A)
Part A: Vehicle & Equipment Maintenance Areas Monitoring Requirements (If applicable) ❑ No discharge this periodz
Outfall No.
Date Sample Collected'
(mo/dd/yr)
24-hour rainfall amount,
Inches3
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 Cade
-
46529
00552
C0530
NCOIL
y
`00
/60
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
'The 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 me/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
Enviranmenrof
Quality
Stormwater Discharge Outfall (SDQ)
Qualitative Monitoring Report
For guidance on filling our this form, please visit https://deq.ne.gov/about/divisions/energy-mineral-land-resources/
n pdes-storm water-gps
Permit No.: N_ICI 1 J. I 1 / I / or Certificate of Coverage No.: NICIGQ1. � I o l.d � l 21
PacilityName: 1. _Emsz h�i3V � 1� _ (RAM --- Phone No.
County: i jA,l,
Inspector:
Date of Inspection: n
Time of Inspection:
Total Event Precipitation (inches): `�i q
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or
1. Outfall Description:
Outfall No. I
Receiving Stream:
Structur (pipe (ditch, etc.):
Describe the industrial activities that occur within the outfall drainage area:
4
Page 1 of 2
SWU-242, Last modified 06/01/2018
fnviranmenial
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit https:Hdeq.nc.gov/about/divisions/energy-mineral-tand-resources/
npdes-stormwater-gps
Permit No.: N_/C/ /. l I 1 I 1 I or Certificate of Coverage No.: N/C/G/ n/ ?lb /p�1-71 a�
�.,cl
Facility Name: a �n-'�a i�I� _Fl4�ll�77, � ---.
County: � K) _ Phone No. 1 �I — 7 % 7'
Inspector: �e-: U r`
Date of Inspection: 0
Time of Inspection: c
Total Event Precipitation (inches): I �ffi
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
onal Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or
1. Outfall Description:
Outfall No. 9-
Receiving Stream:
Structure (pipe, ditch, etc.): �",-
Describe the industrial activities that occur within the outfall drainage area:
Page 1 of 2
SWU-242, Last modified 06/0 [1201 B