NCG060126_DMR_20210226

STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG060000
CERTIFICATE OF COVI
FACILITY NAME LQ
COUNTY
PERSON COLLECTING
Cert. ff
IF—AJ
Date submitted a `C
9If
RECEIVED
MAR 0 8 2021
CENTWAL FILES
DWR SECTION
Part A: Stormwater Benchmarks and
Outfell No. ogle $Ample ;
Gal(Mct demo/tl�/yj
nchmork
SAMPLE COLLECTION YEAR OS O a 1
SAMPLE PERIOD ❑ Jan -June ❑ J ly-Dec
or 510(onthlys ¢ month
DISCHARGING TO CLASS ❑ORW ❑HC;W Trout ❑PNA
❑Zero -flow ❑Water Suppl ❑SA
her ' Vj
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats use animal fats/byproducts
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
ll
or No discharge this
prrtli ilritef000c
0. Ir Cdiogleb eh
8 8121t
' Only applies to facilities that use/process meats.
] The total precipitation must be recorded using data from an on -site rain gauge.
' For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
^See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
=Monthly sampling (instead of seml-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ❑ yes [P(no (if es complete Part B)
Permit Date: 11/1/2018-05/31/2021
SWU-249, Last Revised 11/5/2018
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5«
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No,
Date Sample Collected
(mo/dd/yr)
24•hour rainfall amount,
Inches
Now Motor Oil or
Hydraulic 011 Usage
Non -Polar O&0/Total
Petroleum Hydrocarbons
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or 50 mg1V
Parameter ode
46529
NCOIL
OOSS2
CO530
Footnotes from Part A also apply to Part B
*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 SECTIO�.
* TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ 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, NC 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 violay ons."_
Signature of
a- ac- a 4
Date
Permit Date: 11/1/2018-05/31/2021 SWU-249, Last Revised 11/5/2018
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