NCG080583_2020 DMR_20210119 (5)

NCDEQ Di psion of Energy, Mineral and Land Resources
E
Stormwater Discha ge Monitoring Report (DMR) Form for NC6080000
Transit and Transportation
Click here for instructions
Complete, sign, scn and submit the DMR vi the Stormwater NPDES Permit Data Monitoring Report {DMR) Upload form within
30 days of receiving sampling results. Mail t e original, signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Covera
No. NCG08 Q s 15 131
Person Collecting Samples: C, Ci L&r-`l
Facility Name: S c,
wt: cl sr' wev ibm a (
at, ve,
LaboratoryName: wly-��a I
Facility County: el
k14-1kw
Laboratory Cert. No.: 3720 6
Discharge during this)
eriod: ❑ Yes
Vj No (i
no, skip to signature and date) s
Has your facility impl
mented mandatory Tier
sponse actions for any benchmark exceedances? [ Yes ❑ No
If so, which Tier (1,11,
r III)? - 11%
I i
Part A: Vehicle & Equipment Maintenance Ar s — Benchmarks in (Red)
Pareter
Cod
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall.
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YY
46529
24-Hour Rainfall in inches
00552
Non -Polar Oil & Grease in mg/L (15
C0530
TSS in /L (100 or 50*)
00400
pH in st ndard units (6.0-9.0)
F_
NCOIL
New Motor/Hydraulic Oil Usage in
gal/month
I�
Part B: Oil/Water Separators & Secondary Co tainment Areas at Bulk Stations & Terminals — Benchmarks in (Red)
Parameter.
Code
Parameter .
Outfall.
Outfall
.Outfall .'``
-Outfalt
Outfall
N/A
Receiving Stream Class
i
N/A
Date Sample Collected MM/DD/YY
46529
24-Hour Rainfall in inches
00552
Non -Polar Oil & Grease in mg/L (15
C0530
TSS in nqg/L (100 or 50")
00400
pH in standard units (6.0-9.0)
" Outfalls to Outstanding Resource Waters (ORW) High Quality Waters (HQW), Trout Waters (Tr) and Pri nfiry Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All othe water classifications have a benchmark of 100 mg/L
"I certify by my signature below, under penalti
supervision in accordance with a system desig
submitted. Based on my inquiry of the person
gathering the information, the information sul
aware that there are significant penalties for s
knowing violations." �1
f law, that this document and all attachments were prepared under my direction or
I to assure that qualified personnel properly gather and evaluate the information
persons who manage the system, or those persons directly responsible for
itted is, to the best of my knowledge and belief, true, accurate, and complete. I am
mitting false information, including the possibility of fines and imprisonment for
I-Ig-zoz
of f 4mittee or Delegated Authoriz4d Individual