NCG080923_Monitoring Report_20220120

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Permit and Facility Information:
Please enter the permit number and other details for this upload.
IMPORTANT., Until the eDMR system is implemented for DEMLR Stormwater Program permits, an original signed
hardcopy of the OUR 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 COO or Individual Permit Number (NOT General Permit numberwith all e's)
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NCG080923
Must begin With NCS of NCG
Facility Name:* Safety-Kleen Systems, Inc.
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County:* Mecklenburg
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After uploading here, the original signed hardcopy, must be mailed to:�
DEQ Mooresville Regional Office
Attn: DEMLR Stormwater Program
610 East Center Avenue
Suite 301
Mooresville, NC 28115
Further contact details at https://deq.nc.gov/contact/regional-offices/inooresville
Monitoring Period Information:
Monitoring Period What Is the YEAR of me 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.
Also. copies of the lab results and qualitative (visual) monitoring should NOT be submitted unless specifically
requested by DEQ staf, Only upload the completed and signed DMR forms.
DMR Upload* Click the upload button or drag and drop files here to attach document.
NC080923_Q4 2021 DMR.pdf 180.44KB
Only Port; 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;
• 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");
• 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

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NCDEQ Division of Energy, Mineral and Land Resources
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Stormwater Discharge Monitoring Report (DMR) Form for NCGO80000
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Click here for instructions
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Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monit ring Report (DMR) I ad fdr-A wil!to
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DEAR Regional Office.
This DMR form is only applicable to stormwater discharges from the following areas that have been specifically designated by the
Division as subject to the requirements of Part F-1 and brought under NCG080000: (1) oil water separators (2) containment
structures at petroleum bulk stations and terminals with a total petroleum storage capacity of less than 1 million gallons (3) other
stormwater discharges specifically designated. For stormwater discharges associated with vehicle maintenance areas at
categorically captured facilities under NCG080000, please use the standard NCGO80000 DMR form.
Certificate of Coverage No. NC308 0923
Person Collecting Samples: Nick Cash
Facility Name: Safety-Kleen Systems, Inc.
Laboratory Name: Way Point Analytical
Facility County: Mecklenburg
Laboratory Cert. No.:
Discharge during this period:
0
Yes
No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? QYes No
If so, which Tier (l, ll, or III)? Tier I
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR ----aYes rJNo
Date Uploaded: 1/17/21
Analytical Monitoring Requirements for Oil/Water Separators and Secondary Containments Areas at Bulk Stations & Terminals
(Those Designated and Brought Under NCG080000) — Effluent Limits in (Red)
Parameter
Code
- Parameter
Outfall01
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
C
N/A
Date Sample Collected MM/DD/YYYY
12/08/2021
46529
24-Hour Rainfall in inches
0.57
C0530
TSS in mg/L (100 or 50*)
167
00552
Non -Polar Oil & Grease in mg/L (15)
16.1
00400
pH in standard units (6.0-9.0 FW,
6.8 — 8.5)
6 8 FW
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), 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): TSS Benchmark result exceeded. Corrective BMP measures being implemented to reduce TSS.
"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 flnes and imprisonment for knowing violations."
of Permittee or ffeleaated Authorized Individual
[e-mail]
Email Address
1/17/22
Date
336-644-0332
Phone Number