NCG100197_DMR_20200628

Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG100000
Date submitted 6/28/2021
CERTIFICATE OF COVERAGE NO. NCG10 O 1 9 7 SAMPLE COLLECTION YEAR 2021
FACILITYNAME Pull-A-Partofydinslon-Salem pr r+�lVEDSAMPLE PERIOD ❑■ Jan -June [:1 July -Dec
COUNTY Forsyth or ❑ Monthly° (month)
PERSON COLLECTING SAMPLES Shane Bond AUG 0 2 2021 DISCHARGING TO CLASS ❑ORW ❑HQW [—]Trout ❑PNA
LABORATORY Pace Analyitcal Services, Inc. Lab Cert. # 381 ❑Zero -flow ❑Water Supply ❑SA
Comments on sample collection or analysis: pWR ;iECT101`I Mother C
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 4
Total event rainfalls 0.21 or ❑ No discharge this period?'
Outfall
No.
Date
Sample
p
Collected,
mo/dd/year
PH,
Standard
Units
Total Suspended
Solids SS),
mg/L
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), mg/L
Ethylene Glycol,
y y
mg/L
Lead, Total
Recoverable,
mg/L
Total Toxic
3
Organics ,
mg/L
New Motor or
Hydraulic Oil
Usage,
gal/mo
Benchmark
-
6.0 — 9.01
100 or 502
15
8,000
(Tiers 2 and 3)
0.075
1.0
Parameter Code
-
00400
C0530
00552
77023
01051
78241
NCOIL
1
6/10/2021
7.16
7.5
<4.9
<5.0
<0.025
N/A
5
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.
'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.
'See General Permit Table 1, identifying the especially sensitive receiving waters classifications where the more protective benchmark applies.
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.
°Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
5Total 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.
6For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
Permit Date:11/1/2018-05/31/2021
Form SWU-251, Last Revised 11/1/2018
Page 1 of 2

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DEMLR waive monitoring of total toxic organics. The solvent
management plan shall include a list of the total toxic organic compounds used along with other requirements 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
"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."
Joe Bistes
Name (Print name)
Vice President
Title (Print title)
gna ure
Mail Original to:
Division of Water Quality
Attn: Central Files
1617 Mail Service
Center
Raleigh, North Carolina 27699-1617
7/27/2021
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 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.
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
,� e -
Signature of Permittee
Date
7/27/2021
Permit Date: 11/1/2018-05/31/2021 Form 5WU-251, Last Revised 11/1/2018
Page 2 of 2