NCG080583_2020 DMR_20210119 (6)

NCDEQ Divi Jon of Energy, Mineral and Land Resources
I
Stormwater Discharge Monitoring Report (DMR) Farm for NCG080000
Transit and Transportation
Click here for instructions
Complete, sign, scan and submit the DMR vi� the Stormwater NPDES Permit Data Monitoring Report (DMR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DEMLR R gional Office.
Certificate of Coverage No. NCG08 Q S.. $
Person Collecting Samples:
Facility Name: S c k,%e: aAr
Laboratory Name:( iY o ly-eta (
Facility County:
Laboratory Cert. No.:37?U)6
Discharge during this period: ❑ Yes No (i
o, skip to signature and date)
Has your facility implemented mandatory Tier
sponse actions for any benchmark exceedances? FYes [-]No
If so, which Tier (I, II, or 111)? - 11%
i
Part A: Vehicle & Equipment Maintenance Ar s — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Ciutfall a
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YY
1
46529
24-Hour Rainfall in inches
00552
Non -Polar Oil & Grease in mg/L (15
C0530
TSS in mg/L (100 or 50*)
00400
pH in standard units (6.0-9.0)
FNCOIL
New Motor/Hydraulic Oil Usage in
gal/month
Part B: Oil/Water Separators & Secondary Co ainment Areas at Bulk Stations & Terminals — B chmarks in (Red)
Parameter
Code .
. .. Parameter'
...i
Outfall
Outfall
Outfall
.:
O.utfalf
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/
I
46529
24-Hour Rainfall in inches
00552
Non -Polar Oil & Grease in mg/L (15
C0530
TSS in mg/L (100 or 50*)
00400
pH in standard units (6.0 — 9.0)
* Outfalls to Outstanding Resource Waters (i
have a benchmark TSS limit of 50 mg/L. All
"I certify by my signature below, under penalt
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."
Quality Waters (HQW), Trout Waters (Tr) and Pri
r classifications have a benchmark of 100 mg/L
F law, that this document and all attachments w
i to assure that qualified personnel properly gat
persons who manage the system, or those pers4
itted is, to the best of my knowledge and belief,
mitting false information, including the possibilil
of Pereittee or Delegated Authorize! Individual
Nursery Areas (PNA)
e prepared under my direction or
!r and evaluate the information
s directly responsible for
ue, accurate, and complete. I am
of fines and imprisonment for