NCG030305_DMR_20200828

Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCGO30000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG03Q
FACILITY NAME
COUNTY_�Cty��
PERSON COLLECTING)SAMPLEs l_Ty�plD
LABORATORY hL0t- Lab Cert. # IU I Pr
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 20W
IFds4e,,�) SAMPLE PERIOD 2 Jan -June ❑ July -Dec
or Monthly' month
D JP or
TO CLASS ❑ORW HCLW []Trout❑PNA
RE1�E10D�_rj ❑Zero-flown❑Water Supply []SA
SEP 0 8 2020 Mother
CENT RJ,L FILES PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
DWR SECTION
I YI' At. rlicrhnme tiic nenPnil7a
Outfall No.
Date Sample
Collected1
(mo/.dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
H
P '
Standard units
Total Copper
Total Lead
Total Zinc
Non-Polar-O&G/
Total Petroleum Hydrocarbons
Total Toxic
Organics
Benchmarks
_
-
100 mg/L or 50 mg/L4
6.0 —9.0
0.010 mg/L
6.075 mg/L
0.126 mg/1
1S mg/L
1 mg/L
Parameter Code
-
46529
C0530
00400
01119
01051
01094
00552
78141
t.
- rviontnry sampnng imsteab of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outrall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
'The 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, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies.
5Total Toxic Organics sampling Is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12, for electronic crystal manufacture use the definition as found In 40 CFR 469.22, and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date:11/l/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 1 of 3

Facilities &. % incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement forTlO monitoring
may be waived. 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 electing to employ the 170 monitoring waiver, the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(ITO), 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 the all the provisions of the
solvent management plan included in the 5tormwater Pollution Prevention Plan."
Name (Print name)
Title (Print title)
Signature
Date
Note: Results must be reported in numerical format. 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/I.". where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Ver2, or Tler 3 responses See General Permit text
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No discharge this oeriod?2
Outfall No.
Date Sample Collected'
(mo/dd/yr)
244hour rainfall amount,
lnches3
New Motor Oil or
Hydraulic Oil Usage
Non -Polar O&G/ Total
Petroleum Hydrocarbons
Total Suspended
- Solids
Benchmarks
-
-
-
9S mg/L
100 mg/L or 50 mg/0
Parameter Code
-
46529
NCOIL
00552
C0530
Footnotes from Part A also apply to 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.
Permit Date: 1.1/1/201.8-05/31/2021 SWU-245, last revised 11./1/2038'
Page 2 of 3

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