NCG100095_DMR_20210311

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
CERTIFICATE OF COVERAGE NO. NCG100095
FACILITY NAME LKO Self Service Raleigh
PERSON COLLECTING SAMPLE(S) Shelly Smith
CERTIFIED LABORATORY(S) Test America lab Nashville Labli
Part A: Stormwater Benchmarks and Monitoring Results
RECF
MAR 15 2021
EN) RAL FIL-Eg
nw SLCT10N
SAMPLES COLLECTED DURING CALENDAR YEAR: 2020
(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.)
COUNTY Wake
PHONE NO. [phone]
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
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
No.
Date
Sample d/ Collected,
mo/dyear
Total
Rainfall,
Inches
OD400
00530
77023
01051
78141
pH,
Standard
Units
Total Suspended
Solids (T55),
mg/L
Non -polar
O&G/T16
(Method 64
SGT-HEM),m L
Ethylene Glycol,
mg/L
Lead, Total
Lead,
mg/L
TotalToxic
Organks3,
mg/L
Benchmark
-
-
6.0-9.01
100/502
1S
8,000
(Tiers 2 and 3
0.03
1.0
Oatfall 001
11/11/20
Meter Broken
7.7
<4.8
10
<0.020
Exempt
Note: If you report a sampled value in 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.
1See 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 6-9.
2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters.
3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122.
Form SW U-251, lost revised October 25, 2012
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STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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:
- — — off oN1 nag`ement Pran-CL-rtftutlmStowmenr— -
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics (TTO), I
certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas 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 included in the Stormwater Pollution Prevention Plan."
Name (Print name)
Title (Print titl
Signature Date
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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
—thosepersons-direcTiy-responsible for -gathering -the information,_the_infarmation_submittedlss 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.
, /�Zo'z/
(Signature bf Permittee Designee (Date)
Form SWU-251, fast revised October 25, 2012
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