NCG080583_2020 DMR_20210119 (14)

i
NCDEQ Di i ion of Energy, Mineral and Land Resources
Stormwater Discha l;e Monitoring Report (DMR) Form for NC6080000
Transit and Transportation
Click here for instructions
Complete, sign, scan and submit the DMR vi
the Stormwater NPDES Permit Data Monitoring 4eport
(DMR) Uoload form within
30 days of receiving sampling results. Mail t
e original, signed hard copy of the DMR to the appropriate
DEMLR Regional Office.
Certificate of Coverage No. NCG08 a 5 $ Person Collecting Samples: ��i Gera
Facility Name: S c k e, chef' tje, ibA a ( a�rti t�S Laboratory Name: ��e. I Ai to,Iy_ c
Facility County: r" lukk�5uc Laboratory Cert. No.: 372U
Discharge during this period: ❑ Yes [3-No (i o, skip to signature and date)
Has your facility implemented mandatory Tier r sponse actions for any benchmark exceedances? KYes ❑ No
If so, which Tier (I, II, or III)? - 11% r I!
Part A: Vehicle & Equipment Maintenance
— Benchmarks in (Red)
Parameter
Code ...
Parameter
Outfall
Outfall'..
Outfall
OutfalF _.:•_ ::
O:utfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/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
I
Part B: Oil/Water Separators & Secondary Co �ainment Areas at Bulk Stations & Terminals — Benchmarks in (Red)
Parameter
Code .
Parameter'.
Outfall
Outfall
Outfall
�.
` O.utfalf
'Oteall
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
j
C0530
TSS in mg/L (100 or 50*)
00400
pH in standard units (6.0-9.0)
* Outfalls to Outstanding Resource Waters (ORW) igh Quality Waters (HQW), Trout Waters (Tr) and Pri bry Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All othe ater classifications have a benchmark of 100 mg/L. il
"I 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 desigred
to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person
persons who manage the system, or those persons directly responsible for
gathering the information, the information sub i
iitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties fors
miffing false information, including the possibility of fines and imprisonment for
knowing violations."
I - lef-2O2J�L
of Vermittee or Delegated Authorizcd Individual