NCG080919_DMR_20210719

t Semi-annual Stormwater kcharee Monitorin
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCGO80000
Date submitted 7 - 15 - � i'
CERTIFICATE OF COVERAGE NO. N0008 6 l. I g
FACILITY NAME Hvu.ta, Tro^s oar}c o
COUNTY fn i+-ole 11
PERSON COLLECTING SAMPLES
LABORATORY
Lab Cert. #
IVED
Comments on sample collection or analysis: JUL 2 6 2021
CENTRAL FILES
DWR SECTIOj,)
SAMPLE COLLECTIO
N YEAR 0 1
SAMPLE PERIOD ❑ July -Dec
or Monthly' (month)
DISCHARGING To CLASS ❑ORW ❑HQW [;trout ❑PNA
❑Zero -flow [:]Watersupply [_]SA
❑Other
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? ❑ yes E�no (if ves, complete Part A)
Part A: Vehicle & Equipment Maintenance Areas Monitoring Requirements (if applicable) [;?No discharge this Periodz
Outfall No.
Date Sample Collected'
(mo/dd/yr)
24-hour rainfall amount,
Inches'
Non -Polar Oil & Grease
mg/L
Total Suspended Solids,
mg/L
New Motor or Hydraulic Oil Usage,
gal/mon
Benchmarks
_
-
15
100 or 504
Parameter Code
-
46529
00552
C0530
NCOIL
00 1
0• g
a-7 fjtL
30
45
00:z
O.$
O „ (t
(L
45
003
0.
/L
r, /L
u 3
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z 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.
4 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 me/L", 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 SWU-248, last revised 11/1/2018
Page 1 of 2

Part B: C( rater Separators and Secondary Containment Areas at Petrolj .ulk Stations and Terminals (If applicable) EyNo discharge the : riod'
Outfall
No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Sample Collected'
mo/dd/yr
Total Suspended
Solids,
mg/L
pH,
Standard units
Non -Polar Oil &
Grease,
mg/L
Permit Limit
_
-
-
100 or 504
6.0 — 9.0
15
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 E
• 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 OMR including all "No Discharge" reports within 30 days of receipt of the lab results for 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."
/ V r�
Signature of Permittee
Date
Permit Date:11/1/2018-5/31/2021
SWU-248, last revised 11/1/2018
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