NCG100140_DMR_20210305

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
RECEIVED
CERTIFICATE OF COVERAGE NO. NCG100 - i ? o MAR 15 2021
SAMPLES COLLECTED DURING CALENDAR YEAR: 3o a I
(This monitoring report shall be received by the Division no later than 30 days
from the date the facility receives the sampling results from the laboratory.)
FACILITY NAME Gu. L-Rome Ldre.Ci<er 4 Au%o Sal S-Rc
PERSON COLLECTING SAMPLE(S) _ Eifere,+4- Guv-n-n
CERTIFIED LABORATORY(S) ±ac e A na-)i +* a..L � Lab # g2 5J 951900) and
Services LLC LabuF519oo 2
Part A: Stormwater Benchmarks and Monitoring Results
COUNTY Rartdo[p11
PHONE NO. 3( 34 y3l- 73-1S
PLEASE. REMEMFiFR TO SIGN ON THE REVERSE -i
For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or 'No Discharge" within
30 days of the end of that period to comply with permit reporting requirements.
Outfall
Date
00400
00530
•-••
77023
01051
78141
No.
Sample Collected,
Total
pH,
Total Suspended
Non -polar
Ethylene Glycol,
Lead, Total
Total Toxic
[
mo/dd/year
Rainfall,
Standard
Solids (TSS),
O&G/TPH
mg/L
Recoverable,
3
Inches
Units
mg/L
(Meth od1664
mg/L
Organics ,
SGT-HEM), mg/L
game
Benchmark
6.0-9.01
100/502
15
8,000
(Tiers 2and 3)
0.03
1.0
5tormuw.l-ar
1-3-300-0
/a
7.7
5(v,3
N D
N
S,y LL_q IL
LI and Ajra,
—
Know
os = r_0l on
f LL �rFt
an L1 a�_ e�of'-i'
Bl n --5. S
L e eo use
�eVer
L -Ti
�
me.T o L0.
NDt Sure
i
Lso
Note: If
[le pone14
rt I d I
be Lis+�
No
stJer r.
—
,�ry1_cr
—$esk We
ea„ Ao
you repo a samp a va ue rn excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General
Permit.
c.9/L
t See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this
benchmark range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on site or local rain gauge (or local precipitation data) must be
documented to demonstrate background concentrations were below the benchmark pH range of E-9.
See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters.
3
For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table It of Chapter 40 Code of federal Regulations (CFR) Part 122.
Form SWU-25;._ ;oar revised Orfober 25, 2012
Page 1 of 2

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ wa' ive monitoring of total toxic organises. 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 allowed such a waiver, the
discharger shall sign the following certification statement:
Solvent Management Plan Certification Statement
"Basedupon my inquiry of the person or persons directly respol-Isible for managing compliance with the permit monitoring requirement for total toxic organics ("lTO,
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater oriareas 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 all the provisions of the solvent
management plan inciuded in the Stormwater Pollution Prevention Plan,."
Name (Print name)
Tale (Print title)
Signature
Mail Original and one copy to: Y
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raieigh, North Carolina 27699-161.7 -
Date
"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 property 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."
3 — S-- 4-o 2-
(Date)
Form SWU -251, lost revised October 25; 2012
Page 2 of 2