NCG030224_DMR_20201027

Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted October 2020
CERTIFICATE OF COVERAGE NO. NCGO3 0 2 2 4 SAMPLE COLLECTION YEAR 2020
FACILITY NAME clarios SAMPLE PERIOD ci Jan-June Q July-Dec
COUNTY Forsyth or ❑Monthly1 (month)
PERSON COLLECTING SAMPLES Glenn Price (-� �-+ DISCHARGING TO CLASS DORW DHQW ❑Trout ❑PNA
LABORATORY Research&Analytical Labs Lab Cert.# 34 I .'EC E RIr-D ❑Zero-flow ❑Water Supply USA
Comments on sample collection or analysis: NOV O 9 ['Other2�2�
CCJt f Rf;L )^I( PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 --)
DWR SECTION
Part A:Stormwater Benchmarks and Monitoring Results
0 No discharge this period?2
Date Sample 24-hour rainfall Non-Polar O&G/
H
p
Outfall No. Total Suspended Solids P ' Total Copper Total Lead Total Zinc Total Petroleum Total Toxic
Collected1 amount, Standard units 5
(mo/dd/yr) Inches3 Hydrocarbons Organics
Benchmarks - - 100 mg/L or 50 mg/L4 6.0—9.0 0.010 mg/L 0.075 mg/L 0.126 mg/L 15 mg/L 1 mg/L
Parameter Code - 46529 C0530 00400 01119 01051 01094 00552 78141
001 09/25/2020 3.2 <5 6.89 <0.005 <0.005 <0.01 <5
'Monthly sampling(instead of semi-annual)must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall,you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on-site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
"See General Permit,Section B,Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations,manufacture semiconductors,manufacture
electronic crystals,or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample(for metal finishing use the definition as found in 40 CFR 433.11;for semiconductor
manufacture use the definition as found in 40 CFR 469.12;for electronic crystal manufacture use the definition as found in 40 CFR 469.22;and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date:11/1/2018-05/31/2021 SWU-245,last revised 11/1/2018
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify,and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver,the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO),I certify that to the best of my knowledge and belief,no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Preveenn on Plan."
1749-!-f,ecc MM
Name(Print name)
CALi.���I Afed Irz • ihaet
Title(Print title
lb/Z91202/0
Signatur Date
Note:Results must be reported in numerical format. Do not report Below Detection Limit,BDL,<PQL,Non-detect,ND,or other similar non-numerical
format. When results are below the applicable limits,they must be reported in the format,"<)0X midi.",where XX is the numerical value of the detection
limit,reporting limit,etc. in mg/L.
Note: If you report a sample value in excess of the benchmark,you must implement Tier 1,Tier 2,or Tier 3 responses. See General Permit text
Part B: Vehicle Maintenance Area Monitoring Results:only for facilities averaging>55 gal of new oil per month.
❑No discharge this period?2
Outfall No. Date Sample Collected1 24-hour rainfall amount, New Motor Oil or Non-Polar OWTotal Total Suspended
(mo/dd/yr) Inches3 Hydraulic Oil Usage Petroleum Hydrocarbons Solids
Benchmarks - - - 15 mg/L 100 mg/L or 50 mg/L°
Parameter Code - 46529 NCOIL 00552 C0530
Footnotes from Part A also apply to Part B
Note: If you report a sample value in excess of the benchmark,you must implement Tier 1,Tier 2,or Tier 3 responses. See General Permit text
Permit Date:11/1/2018-05/31/2021 SWU-245,last revised 11/1/2018
Page 2 of 3

FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑NO 1p
IF YES,HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES 0 NO 1.4
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this DMR,including all"No Discharge"reports,within 30 days of receipt of the lab results(or at end of monitoring period in the
case of"No Discharge"reports)to:
Division of Water Quality
Attn:DWQ Central Files
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify,under penalty of law,that this document and all attachments were prepared under my direction or supervision in accordance with a system designed 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 persons directly responsible for gat ring the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and complete. I
am aware that re are si ' scant e ties for submitting false information,including the possibility of fines and imprisonment for knowing violations."
/0/2 7
Signature of Permittee Date
Permit Date:11/1/2018-05/31/2021 SWU-245,last revised 11/1/2018
Page 3 of 3

Research & Analytical
_ ��.-- Laboratories, Inc. CHAIN OF CUSTODY RECORD
Analytical /Process Consultations
Phone[phone]
Water/Wastewater Misc.
Company Clar/os Job No.
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Contact Phone Sampler Signature Ts' _ ci) a'
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Sample Number Temp Res. Chlorine Sample 6 e U U U U U
Date Time Comp.Grab o Removed Matrix Sample Location/I.D. e ; Q $ . ; c/ 2- a a(Lab t'sc Only) C Cl. Y or N _(S or NV)_ ~ ry ''' ''' V) _ Requested Analysis
n6I3 Lt -GI / /Zo //of x w Outfall 001 11 4 4 1 1 1 TSS,Min O&C,TTO,Pb
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Relinqu hed By 7el1'ime Receive By Remarks:
Relinquished By Date/Time Received By
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On Ice Sample Temperature at receipt 1 . 5 '(_