NCG080583_2020 DMR_20210119 (3)

NCDEQ Division of Energy, Mineral and Land Resources
StormWater Discharge Monitoring Report (DMR) Form for NCG080000
Transit and Transportation
Click here for instructions
Complete, sign, s+ n and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (DMRj Upload form within
30 days of receivi g sampling results. Mail t�e original, signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Covera
a No. NCG08 0 4
Person Collecting Samples: 6
Facility Name: 5C
OW: �-er- -��0-1
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Laboratory Name: P. tit
Facility County: th
cE (e,t SW
Laboratory Cert. No.: 3-770 6
Discharge during this
period: (,Yes ❑ No (i
no, skip to signature and date)
Has your facility impl
mented mandatory Tier response
actions for any benchmark exceedances? [R Yes ❑ No
If so, which Tier (I, II,
r III)? A-94 T -5 5
Part A: Vehicle & Eg1ipment Maintenance Ares — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall ?
Outfall 3
Outfall '�(
Outfall "S
Outfall d
N/A
Receivil,
Stream Class
N/A
Date Sa
ple Collected MM/DD/YYY1Y
Wt[ 2
46529
24-Hou r: Rainfall in inches
00552
Non -Po l
r Oil & Grease in mg/L (15)
IJ
C0530
TSS in rr
#L (100 or 50*)(F?
$
3 J
00400
pH in st
ndard units (6.0-9.0)
'�,
6
-3
7 .O
G, z
NCOIL
New M
gal/mo
or/Hydraulic Oil Usage in
h
_
! 5 O O
11
Part B: Oil/Water Separators & Secondary Containment Areas at Bulk Stations & Terminals — Benchmarks in (Red)
Parameter
Code
Parameter
C itfall
Outfall
Outfall
Outfall
Outfall
N/A
Receivin
Stream Class
N/A
Date Sar
iple Collected MM/DD/Y
46529
24-Hour
Rainfall in inches
00552
Non-Pol
r Oil & Grease in mg/L (15)
C0530
TSS in m
L (100 or 501
00400
pH in st4ndard
units (6.0-9.0)
* Outfalls to OutstanI
ng Resource Waters (ORW),
High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark
S limit of 50 mg/L. All other
Nater classifications have a benchmark of 100 mg/L.
Notes (optional):
I
I
"I certify by my signatl
ire below, under penalty of law, that this document and all attachments were prepared under my direction or
supervision in accord
nce with a system design d to assure that qualified personnel properly gather and evaluate the information
submitted. Based on
y inquiry of the person o� persons who manage the system, or those persons directly responsible for
gathering the informi
tion, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are i
ignificant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations."
I
C13zt
e or Delegated Authorized Individual date
Si6ature of Pedm'itti
T
%v b
S7.2