NCG030436_DMR_20200929 (2)

for North Carolina Division .of Energy,. Min ral and Land Resources General Permit No. NCGO30000
Date submi ed
CERTIFICATE OF -COVERAGE NO. NCG031_A_1.(,_. SAMPLE.COLLECTION YEAR
. FACILITY.'NAME SAMPLE PERIOD ❑Jon -June: ❑ July -Dec
COUNTY (l) a (CE - or 10 Monthly' f .5f. (month)•
PERSON.COLLECTING sAMPLES 5h DISCHARGING TO CLASS ❑O . W ❑ QW ❑Trout ❑PNA
LABORATORY. i ab Cert. h t ero-flow ❑Water Supply ES
A
Comments on,sample colleefio or'analysis:
F�FC IiVr Other
OCT 12 ZOZO PLEASE REMEMBERTO.51GN ON PAGES 2.AND/OR 3 3
CEN FILES
Part A: Stormw.ater Benchmarks and Monitoring Results DWR SECT'ICN
5.f Nn dierhnrnp Chic nprind7?
Outfall No.
Dote.Sample
Collected'
(mo/dd/yr)
24-h'ou.r.rainfall
amouht,
Inches;
Total Suspended Sol
ds
PH
Standard units
Total Copper
Total Lead
Total Zinc
Nan-PolarO&G/
Total Petroleum
Hydrocarbons
Total Toxic
Organics
s
Benchmarks"
_
100 mg/I. or 50 mgi
6.0-9.0
0.010 mmg/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
1.Monthly sampling (instead of semi-annual) must begin with the sec
a For sampling periods with no.discharge,at. any single outfall, you.mi
'The total precipitation must be recorded using data from an on-sitE
° See General Permit, Section B, Table 1 to `identify the especially ser
S Total Toxic Organicssaniplingls applicable drily for those. facllitie5, N
electronic crystalsor. manufacture -cathode ray tubes. For purposes
Effluent -Guidelines for the facility.subject to the regUirement to'sam
manufacture use the definition as found in 40 CFR'469.12; forelectn
tube. manufacture usethe definition' found in 40 CFR 469.31),
d consecutive benchmark exceedance for the same parameter at-the'same.outfall.
still subrn1t.this'discha%a monitoring report with a ch'eckmark. here.
in gauge. Unattended sites: may be eligible for a Waiver:of the. rain gauge requirement,
ive receiving water cla'ssificatl'ons wherefhe more protective. benchmark.applies.
ch perform metal finishing -operations, manufacture semiconductors, ranufacture
this permit the definitiomof Total Toxic Organics is that definition contained.1n.the'EPA
(for metal finishing use the definition as found in 40 CFR 433.111, forsemiconductor'
c,crystai manufacture use the46flnition as found in 40 CFR 469,22;. and.for cathode ray
Permit Date: 11/1/2018.05/31/2021
SW..U.245, last revised 11/1/2018
Page 1 of 3

Facilities that incorporate a solvent management plan intol.be Storm ater Pollution Prevention Plan may. so certify; and the.requirement•for TTO monitoring
may be waived.. The-solvent.managemeht plan shail include a list of ti a total toxic organic -compounds used and the otiher'elements listed in the General
Permit. For those facilities electing .to employ.-the.TTO monitoring Wai Lier, the dischairger`shall sign the following certification statement:
%ased.-upoA my inquiry of the person or per$gns directly responsibl for -managing compliance with the:permit•rrionitoring requirement for total.tgxic organics.
certify that.to the best of myRnoWledge and belief, no dum ing•of concentrated toxlc orgardesfrito the stormwater or areas which are*expo�ed to tainFall or
stermwater.runoff has gccurred.sirice f+ling.the-last discharge monit ring report. I further certify. that this -facility is implementing. the- all the .provisions.of the
solvent management plan included -.in the: StorrriWater Pollution Pte ntlon Plan."
Name (PrihtIrY`ame)
Title (Print title)' 1
Signature Date
Note,: Results imust be -reported in numerical format. Do not repori elow Detectiorr Limit, BDL, <POL., Non -deflect, ND, or.othersiMilair non=nurimerical
;format: When results are belowthe applicable limits, they must -be 6 orted inihe format "<XX m ' U :where XX 1s the numerical value -of the detection
limit, eepor'ting limit, •etc. iri mg/L
Note; • lfyou report-a•sample value M excess of -the henchMdrk, you +stimplement T♦er 3, Tier. 2,.-or-7ier. 3 responses. See General Permit text.
Part B: ••Vehicle Maintenance Area Monitoring Results:•only for acilities averaging > 55.gal of new oil -per- month.
_ n No- dischaecie-this period?z
Outfall•No: Date Sdffiple Coliddedi 24-hour rain 11 amci unt; New Motor. Oil or, Non -Polar P&G/ Tofal Total Suspended
(mo%dd/yr) 'Inch e. Hydraulic Oil Usage Petroleum Hydrotarbont Solids
Benchmarks - - - IS mg/L 100 mg/L or 50 mg/O
Paratne'ter Code - 46S 9 MOIL 06552 C0536
Fodtfiotes from Part A also:apply to Part B
Note: If you report o.sample value in.excess of the benchmark; you: ust4rnp1em'edt•TMr•1, Ver 2, or-*71er 3 responses: See Genera! Perrrrit text:
Permit Date: 11/1%2Q'18LQ5/31/2021 5.1NU-245, last revised 11/1/2018
Page 2.0•3

F R PART 6 AND PAR 8-MONITORING RESULTS:
• A BENCHMARK*EXCEED'ANCE TRIGGERS TIER'1 kEQUIREMENTS. SE
• 2 EXCEEDANCES IN -.A AOW FOR THE
SAMEPARAMETER ATTHE gAh
• TIEFZ'3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEED
IF YES, HAVE YOU. CQNTACM E DW.qL REGIONAL -OFFICE? YkS
REGIONAL OFFICE CONTACT NAME. aA
case of "No Discharge" reports) to:
Division -of Water Quality.
Attri: OWQ Central Files:.
16V Mail Service Center
Raleigh, North Carolina 27.699-1617
PERMIT PART II SECTION B.
QUTFALL TRIGGER'TIER'2 REQUIREMENTS. SEE PEOMITT-PART 11 SE ION B.
SC S FOR•TNE'SAMt PARAMETER.ATANY ONE'OUTFALL? YES W NO ❑
I NO ❑
re
YOU MUST SIGN'THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty -of -law., -.that this doclrmenk and all attpchments were repared under•my direction or sypervision in accordance�with a system' designed to
a'ss6te that qualified persdrinel properly gather and evaluate th-e1pformation submitted. Based on my inquiry of the person oe persons who manage the system, .or
those persons directly responsible for.gatheting-the information, the informa ton submitted is, to -the best of rimy kndwledge a.tid belief,:true, accurate, .and complete:. I
am-aware'that-there are significant penaltie for submitting false information including the possibllity-offines and imprisonment for.*knowing vfalations!'
Signature of*Perm
r) �2-v
Datet &_
Permit bate: 11:/1/2018-0V31/2021
SW9-2451 Iast•revlsed'11/1/2018:
Page 3 of-3