NCG080583_2020 DMR_20210119 (11)

Fe-5 20.)_.
NCDEQ Di 'sion of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Farm for NCGO80000
Transit and Transportation
Click here for instructions
Complete, sign, scan and submit the DMR v
30 days of receiving sampling results. Mail
a the Stormwater NPDES Permit Data Monitoring Report (DMR) Upload form within
he original, signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG08
Facility Name: Sr_krv_,,&er" lVcL-lb--%a(
Facility County: r" luk4cr`
arr;-6-s
Person Collecting Samples:
Laboratory Name: R."e- �►o•ly-Ei�a
Laboratory Cert. No.: 3720 6
Discharge during this period: ❑ Yes [KNo (i
Frro, skip to signature and date)
Has your facility implemented mandatory Tier
If so, which Tier (I, II, or III)? - 11l
esponse actions for any benchmark exceedances? Yes ❑ No
Part A: Vehicle & Equipment Maintenance Are
as — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YY
Y
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)
NCOIL
New Motor/Hydraulic Oil Usage in
gal/month
Areas at Bulk Stations & Terminals — Benchmarks in (Red)
Part B: Oil/Water Separators & Secondary Containment
Parameter
Codeeter
param
70utfall
Outfall
G
Outfall
Outfall
N/A
Receiving Stream Class
_
N/A
Date Sample Collected MM/DD/YY
46529
1 24-Hour Rainfall in inches
00552
Non -Polar Oil & Grease in mg/L (15
C0530
TSS in mg/L (1W or 50*)
00400
pH in standard units (6.0-9.0)
* Outfalls to Outstanding Resource Waters (ORW)
have a benchmark TSS limit of 50 mg/L. All other
High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
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 inouiry of the person
of law, that this document and all attachments were prepared under my direction or
ed to assure that qualified personnel properly gather and evaluate the information
r persons who manage the system. or those Derso s directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for s bmitting false information, including the possibility of fines and imprisonment for
knowing violations."
/-- ) -q-2 f
or Delegated Authorized Individual Date