NCG080583_2020 DMR_20210119 (10)

NCDEQ Dii ision of Energy, Mineral and Land Resources
StormWater Discharge Monitoring Report (DMR) Form for NCG080000
Transit and Transportation
02-0 Click here for instructions
Complete, sign, scan and submit the DMR via
30 days of receiving sampling results. Mail the
the Stormwater NPDES Permit Data Monitorin Re ort DMR Upload form within
original, signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG08
Facility Name: Cgkerms
Facility County: jj cUfh
Person Collecting Samples: r y for
Laboratory Name: pkce
Laboratory Cert. No.: 37706'
Discharge during this period: ❑ Yes ❑ No (i
no, skip to signature and date)
Has your facility implemented mandatory Tier iesponse
If so, which Tier (I, II, or III)?
actions for any benchmark exceedances?![ -Yes ❑ No
Part A: Vehicle & Equipment Maintenance Areas
— Benchmarks in (Red)
Outfall i Outfall 3 Outfall Outfall 5' Outfall !�
Y 1113120
ParCodeeter
Parameter
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*)
1150
3or
4C %
17si
00400
pH in standard units (6.0-9.0)
d. 2
2 6- 3
Stations & Terminals - Benchmarks in (Red)
NCOIL New Motor/Hydraulic Oil Usage in
gal/month
j570
tainment Areas at Bulk
Outfall
Part B: Oil/Water Separators & Secondary Cori
Parameter
Code
Parameter
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 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 Primary Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L.
Notes (optional):
"I certify by my signature below, under penalty
supervision in accordance with a system desigr
submitted. Based on my inquiry of the person c
gathering the information, the information sub
aware that there are significant penalties for sL
knowing violations."
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
miffing false information, including the possibility of fines and imprisonment for
Signature of rmittee or Delegated Authorized Individual
1/►3 2
Date
7
A
60.3
5'� 6