NCG060282_DMR_20201230

STORMWATER-DISCHARGE MONITORING REPORT
for North Carolina Division of Energy, Mineral and: Land Resources General Permit No. NCGO60000
CERTIFICATE OF
FACILITY NAME
COUNTY ` n
PERSON COLLEC
LABORATORY_
�V k roG�e.cri
Part A: Stormwater Benchmarks and Monito
Date submitted
JAN 04 2.021
CENTF�AL MILE;_
DVIR SECITION
Results
SAMPLE COLLECTION YEAR a
SAMPLE PERIOD ❑ Jan -June fly -Dec
or [] Monthlys (month)
DISCHARGING TO CLASS ❑ORW ❑HCI;w []Trout ❑PNA
Dero-flloiy. ❑water Su ly []SA
�9tlier SS L' r
FACILITY ACTIVITIES. INCLUDE (check all that apply):
❑ use/process meats �USe animalatsJbyproducts
PLEASE. REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall I or No discharge this period'
01ml
C� n n
1 Only applies to facilities that use/process meats..
'The total precipitation must be.recorded using data from anon-slte rain gauge.
aFar sampling periods with no discharge at AU outfails. You must stlil submit.thls dlscharge'monitoring report with a checkmark here.
See General Permit text, fable 1, Identifying the especially sensitive receiving water classifications where the more protective benchmark -applies.
Wonthly 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 usfng more than 55 gallons ofnew.oll'per month? Vyes ❑ 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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Part B: Vehicle Maintenance Area Monitoring. Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfajl No,'
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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 11 SECTION
* TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES © NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES Q NO
REGIONAL OFFICE CONTACT NAME:
Malt an orlainal copy of this DMR, Includina all "No Discharae" reports, within 30 days of receipt of the lab results for at end of monitorina period In the case
of "No Discharge" reports) to:
Division of Water Quality
Attn: OWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUSTSIGN 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 violajions." A
Signature of
Ira-Q3-Q0
Date
Permit Date:11/1/2018-05/31/2021 SWU-2749, Last Revised 11/5/2018
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