NCG080583_2020 DMR_20210119 (8)

NCDEQ Di
i�ion of Energy, Mineral and Land Resources
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Stormwater Discha
ge Monitoring Report(DMR) Form for N
G080000
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
e original, signed hard copy of the DMR to the appro2riate DEMLR Regional Office.
30 days of receiving sampling results. Mail t
Certificate of Coverage No. NCG08 (� S. $
Person Collecting Samples:
Facility Name: Sc.k^e,,4Ar lvcL_-tb^a(
arri-6_1
LaboratoryName: %.,P- /Aine.Iy*ca(
Facility County: rlcck4eN
Laboratory Cert. No.: ?U 6
Discharge during this period: ❑ Yes X No (i)
pro, skip to signature and date)
Has your facility implemented mandatory Tier ii
sponse actions for any benchmark exceedances? 19 Yes []No
If so, which Tier (I, II, or III)? - I
s — Benchmarks in (Red)
Outfall Outfall Outfall. Outfall ; . Outfall
Part A: Vehicle & Equipment Maintenance Are
Parameter
Parameter
Code
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD
46529
24-Hour Rainfall in inches
00552
Non -Polar oil & Grease in mg/L (15
I
C0530
TSS in mg/L (100 or 50*)
00400
pH in standard units (6.0-9.0)
New Motor/Hydraulic Oil Usage in
�I
NCOIL
gal/month
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Pinment Areas at Bulk Stations & Terminals — Benchmarks in (Red)
Part B: Oil/Water Separators & Secondary Coil
Parameter
Parameter
Outfall
Outfall
.Ou0all
;OutIall
Outfall
Code:
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
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 (ORW) High Quality Waters (HQW), Trout Waters (Tr) and Prir, r6ry Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L All other ater classifications have a benchmark of 100 mg/L.
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Notes (optional): ,) to At 1 O Z v
N certify by my signature below, under penalty f law, that this document and all attachments were prepared under my direction or
supervision in accordance with a system desigd to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person c persons who manage the system, or those personns directly responsible for
gathering the information, the information sub nitted is, to the best of my knowledge and belief, rue, accurate, and complete. I am
aware that there are significant penalties for sL bmitting false information, including the possibility of fines and imprisonment for
knowing violations."
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Zgnature o Permdiee or Delegated Authorized Individual Pate
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