NCG100008_2022 DMR_20220502

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG100000
Used Motor Vehicles
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. NCG10 008
Person Collecting Samples: Justin Myers
Facility Name: Lewisville Motor Company Inc.
Laboratory Name: Pace
Facility County: Forsyth
Laboratory Cert. No.: 12
Discharge during this period:
Yes
ID
No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?F—] Yes No
If so, which Tier (I, Il, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR 11 Yes EINo
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L (100 or 50*)
pH in standard units (6.0 — 9.0 FW,
00400
6.8 — 8.5 SW)
Chemical Oxygen Demand in mg/L
00340
(120)
Lead, total recoverable (as Pb) in
01051
mg/ L (0.075 FW, 0.22 SW)
Ethylene Glycol in mg/ L (any amount
77023
detected Tier One; 8,000 mg/L Tier
Two and Three)
00552
Non -Polar Oil & Grease in mg/L (15)
Estimated New Motor/Hydraulic Oil
NCOIL
Usage in gal/month
* Outfalls 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
FW (Freshwater) SW (Saltwater)
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 mnowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false information, inAluding e ossibility of fines and imprisonment for knowing violations."
Sign%u're of Ffermittee or Delegated Authorized Individual
Email Address
Date
33�- 7G�"�357
Phone Number