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Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted 01 /0 0-09-1
CERTIFICATE OF COVERAGE NO. N0003 0 E; SAMPLE COLLECTION YEAR S01-0
FACILITY NAME'DeNso Mfa NGI Inc,--S'{'RfiQSV111L p1Rfli_ SAMPLE PERIOD []Jan -June []July -Dec
COUNTY Ired P�{�l —H or Monthly' 9#.Cth L-4Y (month)
PERSON COLLECTING SAMPLES O i K-a. 11-kttxW r� pCJSCCrrH��ARGING TO LASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY Lab Cert.# �E I`/f= ❑Zero -Row ❑Water Supply []SA
Comments on sample collection or analysis: Other CARif G
JAN 0 6 2021
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
CEN4 i�AL FILES
Part A: Stormwater Benchmarks and Monitoring Results DWR SECTION
krNo discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Total Suspended Solids
PH,
Standard units
Total Copper
Total Lead
Total Zinc
Non -Polar O&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organic$
Benchmarks
-
-
100 mg/L or 50 mg/O
6.0 -9.0
0.010 mg/L
0.075 mg/L
0.126 mg/L
15 mg/L
1 mg/L
Parameter Code
46529
C0530
00400
01119
01051
01094
00552
78141
I Monthly sampling (instead of semi-annual) must begin with thesecond consecutive benchmark exceedance for the same parameter at the same outfall.
I 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 rein gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total 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: I1/1/2018-05/31/2021 SWU-245, last revised 11/1/2018
Page 1 of 3
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Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may, so certify, and the requirement forTTO 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 TTO 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
(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 the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
Ton Brown
Name (Print name) 1
Vice e5 cien't-
Title (Print title) _
(1LiIZ,
Date
Note: Results must be reported in numerical mat. Do not report Below Detection Limit, BDL, <POL, Non -detect, ND, or other similar non -numerical
format. When results are below the applicab a limits, they must be reported in the format. "<XX mg/L". 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 Tler 1, Ter 2, or Tier 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 Nn dicrhnrnp Chic nprindR
Outfall No.
Date Sample Collected'
(mo/dd/yr)
24-hour rainfall amount,
Inches3
New Motor Oil or
Hydraulic Oil Usage
Non -Polar O&G/ Total
Petroleum Hydrocarbons
Total Suspended
Solids
Benchmarks
-
-
-
15 mg/L
100 mg/L or 50 mg/O
Parameter Code
46529
NCOIL
00552
COS30
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: 11/l/2018.05/31/2021 SWU-245, last revised 11/1/2018
Page 2 of 3
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FOR PARTA AND PARTS MONITORING RESULTS:
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• 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 REQUIREMENTS. SEE PERMIT PART II SECTION B-
?
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
tN '�
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
o y
REGIONAL OFFICE CONTACT NAME:
b It
7y
Mafl an original copy of this DMR including all "No Discharge" reports within 30 days of receipt of the lab results (or at end of monitoring period in the
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case of No Discharge" reports) to:
y'
Division of Water Quality
Attn: DWQ Central Files
P.
,:,
1617 Mail Service Center
p
Raleigh, North Carolina 27699-1617
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to
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"1 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."
%-
Signatur f Permittee
:5
Permit Date: 11/1/2018-05/31/2021
T
Dotn
SWU-245, last revised 11/1/2018
Page 3 of 3
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CHANGE OF RECORD
#
Date
Description
1
11/6/2007
New document
2
01/27/2011
3 Year Review — No changes needed to form at this time.
3
02/10/2014
Updated form
4
02/23/2017
3 Year Review — No changes needed to form at this time.
5
04/23/2019
Updated forms to 11/1/2018 updated revised forms.
Sampler.---4 S.H.E.---4EMS Rec.
Revision Date: 04/23/2019 - Revision No: 05 Retention Period: 5 years
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Nov 2 2007 02:25Fm P081/662
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Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
F ili Permit N .: NIC/ 1 1c S'_ f_1 AklU
r Certificate of Coverage No.: NLC G1J__/� 1�
ty
County: Li Phone No.
Inspector: liriS
Date of Inspection: 1 / 10 17-020
r
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
4WALto VU
(Si Lure of Perlittee or Designee)
1. Oatfall Description
Outfall No. Structure (pipe, ditch, etc.) � u
Receiving Stream: '
Describe the industrial activities that occur within the outfall drainage area:
e
2. Color
Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, '
dark) as descriptors: C, wy
3. Odor
Describe any Isnact odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor, {
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 2 3 4 5 b 7 8 9 10
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SWU-242-020705
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5. Floating Solids
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 10 is the surface covered with floating solids: ;
2 3 4 5 6 7 8 9 1
1 00
r�
6. Suspended Solids
Y
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
2 3 4 5 6 7 8 9 10
7. Foam
Is there any foam in the stormwater discharge? Yes Na
8. Oil Sheen
Is there an oil sheen in the stonmvater discharge? Yes ON6
9. Deposition at Ontfall
Is there deposition of material (sediments etc.) at or immediately below the outfall? Yes No
10. Erosion at Outfall
Is there erosion at or immediately below the outfali? Yes S
.`
r
11. Other Obvious Indicators of Siormwater PoUntion
List and describe C
M
1
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion maybe
indicative of conditions that wan -ant further investigation and corrective action.
.1
Page 2
swv 242•020705
Sampler.-- >E.H.S.---4EMS Rec.
Revision Date: 12/23/2015- Revision No: 04 Retention Period: 5 years
A-
704 253 6542 Nov 2 2087 02:25Fm A81/002
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0''NA��'�'�j
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Stormater Discharge Outfall (SDO) •�
Qualitative Monitoring Report r
Permit No.: NICI ! 1,��/ l,� or Certificate of Coverage No.: N/CLCV J_!_ __ !_j
Facility Name: DM146i112
County: l Phone No. -101A
Inspector: !' h M,S
Date of Inspection: W I Z 02-0
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
-0
aiAurn
(Si a of Perlittee or Designee)
1. Outfall Description
Outfall No. Structure (pipe, ditch, etc.)
Receiving Stream: '
Describe the Industrial activities that occur within the outfall drainage area:
a
2. Color
Describe the color of the ' chare lug basic colors (red, brown, blue, etc) and tint (light, medium, '
dark) as descriptors:
3. Odor
Describe any tint odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor,
etc.)
4. Clarity
Choose the number which best describes the clarity of the discharge where l is clear and 10 is very
cloudy- .
1 2 3 4 5 6 7 8 9 10
i
Page 1
SWLI-242-020703
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704 253 6542 Nov 2 2007 02:25pm P202/002
5. Floating Solids s
Choose the number which best describes the amount of floating solids in the stormwater discharge where
1 is no solids and 1 b is the surface covered with floating solids: ;
1 2 3 4 5 6 7 8 9 1.0
r,
6. Suspended Solids t
Choose the number which best describes the amount of suspended solids in the stormwater discharge
where 1 is no solids and 10 is extremely muddy:
.j
1 3 4 5 6 7 8 9 10 '•
7. Foam
Is there any foam in the stormwater discharge? Yes Vo
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes No
9. Deposition at Outfall
Is there deposition of material (sediment, etc.) at or immediately below the outfall? Yes No
10. Erosion at Outfall
Is there erosion at or immediately below the outfall? Yes No
11. Other Obvious Indicators of S�iorm• water Pollution
List and describe
by�i1 a -un CAM W4 a7AW)
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, deposition or erosion may be
indicative of conditions that warrant further investigation and corrective action.
Page 2
SWU•242.020705
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Sampler.---4E.H.S.---4EMS Rec.
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