NCG080053_DMR_20211221

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG080000
Date submitted 121 -Z I -z 1
CERTIFICATE OF COVERAGE NO. N0008 00 S3 SAMPLE COLLECTION YEAR ZOZ I
FACILITY NA E SAMPLE PERIOD ❑ Jan -June K July -Dec
COUNTY - REl t. I or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES n n I —I \ r' �6Gp�RGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Watersupply ❑SA
LABORATORY (i Lab Cert. p DEC 2 8 2021Other GI[�5.5
Cori (�e is on sa ple collection or analysis: CENT
�Tr �gYFc� 0)')Ji IC Gturl /l q GDIlaG+'dYl RAL FILES
01AIR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month?,yes ❑ no (if yes• complete Part A)
Part A: Vehicle & Equipment Maintenance Areas Monitoring Requirements (If applicable) ❑ No discharge this period'
Outfall No.
Date Sample
Collected' (mo/dd/yr)
24-hour rainfall
amount, Inches'
Non -Polar Oil &
Grease mg/L
Total Suspended
Solids (TSS), mg/L
pH,
Standard units
New Motor or
Hydraulic Oil Usage,
gal/mon
Benchmarks
_
_
15
100 or SW
6.0 — 9.0
_
Parameter Code
46529
00552
C0530
00400
NCOIL
SD© AA
WD
$,
7, b a
1000 gotl
,
o -
-) --z I
. $
r- m riA
-, o- D
f -)-z
: 8
7,65
- Do - E-)
)•-z I
a
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
' 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 text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, 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. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX".
Permit Date: 11/1/2018-5/31/2021 last revised 1/14/2020
Page 1 of 2

Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals(If applicable) ❑ No discharge this periodz
Outfall
No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Notes (Optional)
Total Suspended
Solids,
mg/L
pH,
Standard units
Non -Polar Oil &
Grease,
mg/L
Permit Limit
-
-
-
100orSW
6.0-9.0
15
Parameter Code
-
46529
-
C0530
00400
00552
Footnotes from Part A also apply to this Part B
Note: if you reporta sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. see General Permit text.
FOR PARTA AND PART B MONITORING RESULTS:
• 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 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONEOUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMUR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal copv 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
case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
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 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
there are sign' ' ant penalties for submitting false information, including the possi"finesandnment for knowing violations."
Signature of Permittee Date
Permit Date: 11/1/2018-5/31/2021 last revised 1/14/2020
Page 2 of 2

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCGO80000
Date submitted 12. - -2 1 - 2 1
CERTIFICATE OF COVERAGE NO. N0008 0653
FACILITY NAME Ins )j 16r f -i3 f nr
COUNTY U r7 ,nMhC` J
PERSON COLLECTING SAMPLES °�rf (A r) 1711-nGp+
LABORATORY Face Lab Cert. # YO
Corn ents on sample collect'on or analysis:
~I -e�� te() "",S) "Iu ri n a r, )1
SAMPLE COLLECTION YEAR ZbZ f
SAMPLE PERIOD ❑ Jan -June 0 July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow Water Supply ❑SA
Other C,1055 G
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ayes ❑ no (if yes, complete Part A)
Part A: Vehicle & Equipment Maintenance Areas Monitoring Requirements (If applicable) ❑ No discharge this period2
Outfall No.
Date Sample
Collected' (mo/dd/yr)
24-hour rainfall
amount, Inches3
Non -Polar Oil &
Grease mg/L
Total Suspended
Solids (TSS), mg/L
pH,
Standard units
New Motor or
Hydraulic Oil Usage,
gal/mon
Benchmarks
_
-
15
100 or SW
6.0 — 9.0
_
Parameter Code
-
46529
00552
C0530
00400
---~NC
SVDO—
Z—I1—Z
d
ND
10
7'8 Z
a
15.&
e r ,n
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z 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 rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 1, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, 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. Conversely, where fecal coliform results exceed the dilution upper limit, report the result as ">XX".
Permit Date: 11/1/2018-5/31/2021 last revised 1/14/2020
Page 1 of 2

Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (if applicable) ❑ No discharge this period'
Outfall
No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Notes (Optional)
Total Suspended
Solids,
mg/L
pH,
Standard units
Non -Polar oil &
Grease,
mg/L
Permit Limit
-
-
-
100 or 504
6.0 — 9.0
15
Parameter Code
-
46529
-
C0530
00400
00552
Footnotes from Part A also apply to this 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.
FOR PART A AND PART B MONITORING RESULTS:
• 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 OUTFALLTRIGGER TIER 2 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 ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal covv 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
case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
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 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 pg=ns directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
are tha there are si ' ' ant penalties for submitting false information, including the possibility of fine and i prisonment for knowing violations."
l�
Cinn�furo of Pnr i Yaa Date
Permit Date: 11/1/2018-5/31/2021 last revised 1/14/2020
Page 2 of 2