NCG030537_DMR_20210504

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Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG030000
Date submitted 05.104.110' A
CERTIFICATE OF COVERAGE NO. NCG03Q 5 3
FACILITY NAME i In t Vill&�at{-
COUNTY Irl! d
PERSON COLLECTING SAMPLES 144 k0A-�
LABORATORY Lab Cart.N
Comments on sample collection or analysis:
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR �L011
SAMPLE PERIOD ❑ Jan -June © July -Dec
or 'Monthly' .412 f l 1 (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
RECEIVE[` JROtherloO to Sate�r Suppiy ❑SA
MAY 11 2021 PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
CENTRAL FILES
DWR SECTION
No discharge this period?z
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
Organics s
Benchmarks
-
-
100 mg/L or So 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
0055Z
78141
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance forthe same parameter at the same outfall.
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.
° See General Permit, Section B, Table 1 to identify the especially sensitive receiving water classifications where the more protective benchmark applies.
s 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: 11/1/2018-05/31/2021
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 for TTO monitoring
maybe 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 a
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."
Tn l,n cro�,:wi1
Name (Print name)
ozet. Pres�c�ercE
Title (Pri t title)
r
Date
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non -detect, NO, or other similar non -numerical
format. When results are below the applicable 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 Tier 1, Tier 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 No discharge this period?'
Outfail No.
Date Sample Collected'
(mo/dd/yr)
24-hour rainfall amount,
Inchess
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
CO530
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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y ' FOR PART A AND PART B MONITORING RESULTS:
ic- A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
? �j.t • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YESONO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE7 YES�'NO ❑
C y REGIONAL OFFICE CONTACT NAME: �4tild khan g( James Moore,
so 1771
cn Mail an original copy of this Di including all "No Discharge" reports within 30 days of receipt of the lab results (or at end of monitoring period in the
case of "No Discharge" reports) to:
y' Division of Water Quality
0. Attn: DWQ Central files
Z 1617 Mail Service Center
O 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 orsupervision 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
are aware that there ara significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
?Sign, of Permittee Date
Permit Date: 11/1/2018-05/31/2021
SWU-245, last revised 11/1/2018
Page 3 of 3

EF-238
704 253 6542
Nov 2 2007 02:25pm •P001/002
EF-238
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Permit No.: N1Cl I l,_J- j I I I or Certificate of Coverage No.:
Facility Name: 0�15 n ��Jt t•L.
County: Phone No. -4-044 �.ji
Inspector:
Date of Inspection: _ QU s . I z
ti
By this signature, I certify, that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Oatfall Description
1�
Outfall No. 01 Structure (pipe, ditch, etc.)•
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color ;
Describe the color of the discharge using basic cold (re bmwn. tint (light, medium, '
dark) as descriptors: W o
3. Odor "
Describe any distinct odors that the discharge may have (Le., smells strongly of oil, weak chlorine odor,
etc.)
4. Clarity
Choose the number which best describes the clarity of the discharge where 1 is clear and 10 is very
cloudy:
1 C2 3 4 5 6 7 8 9 10
r
Page 1
SwL-242-020705
Sampler.---4E.H.S.---4EMS Ree.
1? o�siotin,� TI'AtA• 1'711,711M 4 T?,a,.;..;.- _ AT, nA

EF-238
704 253 6542 Nov 2 2007 02:25pm P002/002
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:
1"l 2 3 4 5 6 7 8 9 10
6. Suspended Solids
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J
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:
1 2 3 4 5 6 7 8 9 10
7. Fomn
Is there any foam in the stormwater discharge? Yes
60
• 'r
8. Oil Sheen
Is there an oil sheen in the stormwater discharge? Yes N
9. Deposition at Outfall
Is there deposition of material (sediments etc.) at or immediately below the outfall? Yes 60)
10. Erosion at OutfaU
Is there erosion at or immediately below the outfali? Yes
11. Other Obvious Indicators of Siormwater Follntion
List and describe l t �1Q•J Loc,c�cs� bV�, 5 ��j� �C ��tg• 1
LrAS oL ticJ 8�1 Io L c
r- z tlo S ?o CjIE-- Vri bWVEJ0z>
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
svU-242-020705
Sampler.- 4E.H.S.---4EMS Rec.
Revision Date: 12/23/2015- Revision No: 04 Retention Period: 5 years

EF-238
Permit No.: N/C�„
Facility Name: j
County:
Inspector:
Date of Inspection:
By this signature, I
704 253 6342
�.
R
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Nov 2 2007 82:25pm P001/002
EF-238
certify tho this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description
Outfall No. 0 �' Structure (pipe, ditch, etc.) W W
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
2. Color
Describe the color of the discharge using basic__ol� fed, brown, blue, etc.) and tint (light, medium,
dark) as descriptors: EVE- �,,
3. Odor
Describe any distinct odors that the disc ema hyve (i.e., smells strongly of oil, weak chlorine odor,
�
etc.)
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 6 7 8 9 10
Page l
SWU-242-020705
Sampler.---->E.H.S.----GEMS Rec.
Revision Date: 12/23/2015- Revision No: 04 Retention Period: 5 years

EF-238
704 253 6542
Nov 2 2007 02:25pm P002/002
S. 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:
i 2 3 4 5 6 7 8 9 10
6. Suspended Solids
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 (14o
8. On 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 oNo
10. Erosion at Outfall
Is there erosion at or immediately below the outfail? Yes No
11. Other Obvious Indicators of Storarwater Pollution
List and describe 3 �rt(LM1•S 5 Gv�Z &1tZow w,t
a4sS 0 VS9. Gn (Zo µ+ Vqq-
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
Sampler.---4E.H.S.---4EMS Rec.
Revision Date: 12/23/2015- Revision No: 04 Retention Period: 5 years