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' Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral an Lan Resources General Permit No. NCG080000
Date submitted 111ZO 2-0
CERTIFICATE OF COVERAGE NO.NCGO8 00 663 SAMPLE COLLECTION YEAR 20 2.o
FACILITY NAME (r a 1",af'lie- i r�G SAMPLE PERIOD ❑Jan-June RI July-Dec
COUNTY U rl G r1"1 or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES r i A narrti�44-
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORYPGr,42 p►rta1,/-1-ic a I Lab Cert.# 0 REcE IV D ❑Zero-flow ❑Water Supply ❑SA
Co ents on s pl collection or analysis: Obther C I C SS C.
f' +ems e 0 on- 5i+e {durt' Co)ieC4i or NOV 3 0 2020
r,r- R,[FI PLEASE REMEMBER TO SIGN ON THE REVERSE --)
Dq�_ F
w !(.E
Did this facility perform Vehicle Maintenance Activities using more than 55 gal dHsGrOM oil per month?'yes ❑no (if yes, complete Part A)
Part A:Vehicle&Equipment Maintenance Areas Monitoring Requirements Of applicable) ❑ No discharge this period2
Outfall No. Date Sample 24-hour rainfall Non-Polar Oil& Total Suspended pH, New Motor or
Collected'(mo/dd/yr) amount,Inches3 Grease mg/L Solids(TS5),mg/L Standard units Hydraulic Oil Usage,
gal/mon
Benchmarks - _ 15 100 . 504 6.0-9.0 -
Parameter Code - 46529 00552 0530 00400
SDo A Io- 28-Z ' 3.0 ND 55, 2 2,97 I000 `ya l/op s
-)
SDo - Q )o -il- za 3,o NID 2, t '7. 9� is+d0
SDo - c ►o - Zg -Za 3 . 0 WO 5, I 7, 75 Per Month
SDd - D 10 -zy- za 3 . 0 N o 9, ii 7, 40
3Do-- E. )o .- Z -. w 3. 0 N D 9 . 5 7,Sq
'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.
4See General Permit text,Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example,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,"<XX mail",where XX is the numerical value of the
detection limit, reporting limit,etc. in mg/L. Conversely,where fecal coliform results exceed the dilution upper limit, report the result as">XX".
Permit Date: 11/1/2018-5/31/2021 t.ceyis_ed 1 2020
Page 1 of 2
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals(If applicable) ❑ No discharge this period2
Total Suspended pH, Non-Polar Oil&
Outfall Date Sample 24-hour rainfall Standard units Grease,
No. Collected) amount, Notes(Optional) Solids,
(mo/dd/yr)
Inches3 mg/t mg/I
r 100 or 504 6.0—9.0 15
Permit , "� � -
Parameter Code
46529 - C0530 00400 00552
Footnotes from Part A also apply to this 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.
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 ONEOUTFALL? YES 0 NO ►;
IF YES,HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES Q NO El
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 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 submitting false information,including the possibility of fines and imprisonment for knowing violations."
) 11 Za/2a
Signature of Permittee to
last revised 1/14/2020
= Permit Date:11/1/2018-5/31/2021
Page 2 of 2
Semi-annual Stormwater Discharge Monitoring Report
Ccr for North Carolina Division of Energy, Mineral and and Resources General Permit No. NCG080000
Date submitted I 1 2 0/Z.p
CERTIFICATE OF COVERAGE NO.NCGO8 Ob 53 SAMPLE COLLECTION YEAR 20 2 C7
FACILITY NAME I r i Ies N\ar he SAMPLE PERIOD ❑Jan-June RI July-Dec
COUNTY a nG m b � or ❑ Monthly' (month)
�j
PERSON COLLECTING SAMPLES t' A e1 f. Ctr-rie_44 DISCHARGING TO CLASS DORW DHQW ❑Trout DPNA
LABORATORY Re. 641)/4-;ca i Lab Cert.# 40 DZero-flow ❑Water Supply ❑SA
Con ents on samplisi collection or analysis: ®'other C.1 Q.SS C
1 +e,S CAcw - Si+e 01Urir1q CoIlecAlon
�f PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month?ayes ❑no (if yes,complete Part A)
Part A:Vehicle&Equipment Maintenance Areas Monitoring Requirements(If applicable) ❑ No discharge this period2
Outfall No. Date Sample 24-hour rainfall Non-Polar Oil& Total Suspended pH, New Motor or
Collected'(mo/dd/yr) amount,Inches3 Grease mg/L Solids(TSS),mg/L Standard units Hydraulic Oil Usage,
gal/mon
Benchmarks - - 15 100 or 504 6.0—9.0 -
Parameter Code - 46529 00552 C0530 00400
SDv - G to--it-zw 3,0 ND G. Z 7.&Z (IooO nci11ons
SDo - N to -z$-La Z.0 ND 12, LI 7. 7gTo f
ail
Pew Mon-f-I)
'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 text,Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example,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,"<XX mil.",where XX is the numerical value of the
detection limit,reporting limit,etc. in mg/L.Conversely,where fecal coliform results exceed the dilution upper limit, report the result as">XX".
Permit Date:11/1/2018-5/31/2021 I sr�Vl/14/2020
Pagea,of 2)
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals(If applicable) ❑ No discharge this period2
Outfall Date Sample 24-hourTotal Suspended pH, Non-Polar Oil&
rainfall e,dard units Grease,
eas
Solids,
No. Collected' amount, Notes(Optional) eas
(mo/dd/yr) Inches3 mg/L
100or504 6.0-9.0 15
Permit limit . - - 00552
Parameter Code
46529 - C0530 00400
Footnotes from Part A also apply to this 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.
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 Q NO Er
IF YES,HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES Q NO
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 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 submitting false information,including the possibility of fines and imprisonment for knowing violations."
Signature of Permittee Date
last revised 1/14/2020
Permit Date: 11/1/2018-5/31/2021 Page 2 of 2