NCG080583_2020 DMR_20210119 (12)

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NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for N G080000
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Click here for instructions
Complete, sign, scan and submit the DMR vi6 the Stormwater NPDES Permit Data Manitorin a ort DMR U pload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the ai ro riate DEMLR Regional Office.
Certificate of Coverage No. NCG08 Q S $ Person Collecting Samples: ' ed'-r i_,,A
Facility Name: S c, I+wC: leer n)��., a ( anti s Laboratory Name: Fti p_ I jAvto. ly-*c o,
Facility County: fell e fkkN_6,WLaboratory Cert. No.: 320
Discharge during this
I eriod: ❑ Yes • No (i
no, skip to signature and date)
Has your facility impl
If so, which Tier (I, ll,
mented mandatory Tier
Inr III)? - t 1%
esponse actions for any benchmark exceedances? KYes [:]No
— Benchmarks in (Red) 1
Part A: Vehicle & Equipment Maintenance Areas
Parameter
Code
Parameter
11 .
Outfall
Outfall
Outfall
Outfall,:;
Outfall.
N/A
Receivi l Stream Class
N/A
Date Safple 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)
NCOIL
New Motor/Hydraulic Oil Usage in
gal/month
i
tainment Areas at Bulk Stations & Terminals — Bechmarks in (Red)
Part B: Oil/Water Separators & Secondary Cor
Parameter_
Code
Parameter'.
Outfall
Outfall
Outfall
-Outfall
OutNI
N/A
Receivi 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)
* Outfalls to Outstanding Resource Waters (ORW) High Quality Waters (HQW), Trout Waters (Tr) and Pri rl )6ry Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L i
I _
Notes (optional): t^ r O
"I certify by my signature below, under penalty of law, that this document and all attachments were prepared under my direction or
supervision in accordance with a system design ed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those perso � �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."
2oL
ignature of enmittee or Delegated Authorizes! Individual Date
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