NCG080583_2020 DMR_20210119 (9)

NCDEQ Di ision of Energy, Mineral and Land Resources
Stormwater Discha ge Monitoring Report (DMR) Form for NCGO80000
Transit and Transportation
Click here for instructions
I
Complete, sign, scan and submit the DMR vi
30 days of receiving sampling results. Mail t
the Stormwater NPDES Permit Data Monitoring
a ort DMR Upload form within
ro riate DEMLR Regional Office.
e original, signed hard copy of the DMR to the a
Certificate of Coverage No. NCG08 Q 5 $ I Person Collecting Samples: �;orLer-A_
Facility Name: S (,k,ve: �r- lV� tb� a ( a�r,,rfs Laboratory Name: Pa,,e- AID A -y*c & (
Facility County: Atckkrihx Laboratory Cert. No.: 3'7'?U G
Discharge during this period: ❑ Yes RLNo (i no, skip to signature and date)
Has your facility implemented mandatory Tier sponse actions for any benchmark exceedances? fZ Yes ❑ No
If so, which Tier (I, II, or III)? - I It
Part A: Vehicle & Equipment Maintenance
— Benchmarks in (Red)
Parameter
Code.
Parameter
-Outfall
Outfall
OutfaQ
,
Outfall
Outfall';
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
C0530
TSS in mg/L (100 or 50*)
I
00400
pH in standard units (6.0 — 9.0)
NCOIL
New Motor/Hydraulic Oil Usage in
gal/month
Part B: Oil/Water Separators & Secondary Co inment Areas at Bulk Stations & Terminals — Benchmarks in (Red)
Parameter
Code
parameter `
Outfall
Outfall
Outfall f
Outfalt '.
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 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 Prin ory Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All othe ater classifications have a benchmark of 100 mg/L. I!
"I certify by my signa
supervision in accorc
submitted. Based on
gathering the inform
aware that there are
knowing violations."
below, under penalty
f law, that this document and all attachments were prepared under my direction or
e with a system desigr
d to assure that qualified personnel properly gather and evaluate the information
inquiry of the person d,
persons who manage the system, or those persons directly responsible for
n, the information sub
i nitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
iificant penalties fors
miffing false information, including the possibility of fines and imprisonment for
of P mitta or Delegated Authonz4l Individual