NCG080683_DMR_20210607

N C Department of
Environmental Quality
Received
NCDEQ Division of Energy, Mineral and Land Resources JUN U 7 2321
Stormwater Discharge Monitoring Report (DMR) Form for NCGO80000 Winston-Salem
Transit and Transportation Regional Office
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (DMR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG08
Person Collecting Samples:
Facility Name: High Point Fleet Maintenance/Environmental Services Laboratory Name: City of High Point Water Quality
Facility County: Guilford I Laboratory Cert. No.: 55
Discharge during this period: ❑ Yes M No (if no, skip to signature and date)
Has your facility implemented mandatoryTier response actions for any benchmark exceedances? 0 Yes ❑ No
If so, which Tier (I, II, or III)? II
Part A: Vehicle & Equipment Maintenance Areas— Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
00552
Non -Polar Oil & Grease in mg/L (15)
C0530
I TSS in mg/L (100 or 50•)
00400
pH in standard units (6.0-9.0)
NCOIL
New Motor/Hydraulic Oil Usage in
gal/month
Part B: Oil/Water Separators & Secondary Containment Areas at Bulk Stations & Terminals — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/OD/YYYY
46529
24-Hour Rainfall in inches
00552
Non -Polar Oil & Grease in mg/L (15)
C0530
TSS in mg/L (100 or 50•)
00400
pH in standard units (6.0-9.0)
• Outfalis to Outstanding Resource Waters (ORW), High Quality Waters (HOW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L.
Notes (optional):
"I certify by my signature below, 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."
Signature of Permittee or Delegated Authorized Individual
6-z—z)
Date

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Submission Completed
Stormwater NPDES Permit Data Monitoring Report
i
NORTH CAROL �' (DMR) Upload
Permit and Facility Information:
Please enter the permit number and other details for this
IMPORTANT. Until the eDMR system is implemented for DEMLR Stormwater Program permits, an original
signed hardcopy of the DMR MUST be mailed to the address in your permit, in addition to this electronic
upload.
Fields marked with a red asterisk are required.
Permit Number* Enter COC or Individual Permit Number (NOT General Permit number with all 0's)
NCGO90683
Must begin with NCS or NCG
Facility Name: * City of High Point, NC - Fleet Services
County: * Guilford
After uploading here, the original signed hardcopy must be mailed to:
DEQ Winston-Salem Regional Office
Attn: DEMLR Stormwater Program
450 West Hanes Mill Road
Suite 300
Winston-Salem, NC 27105
Further contact details at https://deq.nc.gov/contact/regional-offices/winston-
Salem
Monitoring Period Information:
Monitoring Period What is the YEAR of the sample date(s)?
Year:* 2021
Multiple DMRs from sampling periods within the same year can be uploaded together, but please upload different
years with a new submittal form.
https://edocs.deq.nc.gov/Forms/Form/Submit 1/2

s 03/06/2021
Submission Completed
Also, copies of the lab results and qualitative (visual) monitoring should NOT be submitted unless specifically
requested by DEQ staff. Only upload the completed and signed DMR forms.
DIVIR Upload * Click the upload button or drag and drop files here to attach document.
6-3-21 Fleet Services.pdf 474.71 KB
Only PDFs are accepted.
Comments:
* By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o I agree that submission of this Data Monitoring Report (DMR) upload form is a "transaction" subject to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act");
o I understand that an electronic signature on this upload form has the same legal effect and can be enforced in the
same way as a written signature; AND
a I intend to electronically sign and submit this DMR upload form.
Full Name:* Robby Stone
Name of person submitting this form
Email Address: * [e-mail]
Phone Number: * 3368833217
Signature: *
0-�0. '0.ev
Date: * 06/03/2021
https://edocs.deq.nc.gov/Forms/Form/Submit 2/2