NCG080919_DMR_20220705

r
aerrni-annual jtormwater &..,charge iyionitorin� Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. N00080000
Date submitted -7 - 5- 2 4
CERTIFICATE OF COVERAGE NO. NCG08 Q q SAMPLE COLLECTION YEAR p?0. �
FACILITY NAME 14oy�+v^ SAMPLE PERIOD [VJan-June ❑July-Dec
COON T Y i_+ c_L e (t or ❑ Monthly' (month)
PERSON COLLECTING, SAMPLES DISCHARGING TO CLASS ❑ORW ❑HQW rout ❑PNA
LABORATORY Lab Cert.# ❑Zero-flow ❑water Supply []SA
Comments on sample collection or analysis: ❑Other
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 Vo (if yes, complete Part A)
Part A:Vehicle&Equipment Maintenance Areas Monitoring Requirements(If applicable) M11vo discharge this period'
Outfall No- Date Sample Collected' 24-hour rainfall amount, Non-Polar Oil&Grease Total Suspended Solids, New Motor or Hydraulic Gil Usage,
(mo/dd/yr) €nches3 m L
gf rr:g/L gal/mon
Benchmarks _ - 15 100 or 504 -
Parameter code - 46529 00552 C0530 NCOIL
doa 0- 9 0(c IL 4&
003 v. 9 [7& M 1L ac, t (L qG
' 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.
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.
'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 resorted 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 SWU-248, last revised 11/1/2018
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Part B: O, rater Separators and Secondary Centair!rne!?t Areas at Pp±role��. ;alk Stations and Ter.�.irals 111111'applica"le) r Alo discharge «i_ --;--112
`Outfall Date Sample 24-hou:r rainfall; Sample Collected) Tota6 uspended pN, Non-Polar Oii &`
No: Collected) amount, mo/dd/yr Sol►& pfidlard;units Grease, -
(mo/,dd/yr) inches' mg/L mg/k
Permrt Lrmt _ - 100 or-304 6.0
Para`M`eter.code - 46529 - C0530 00400 00552
Footnotes frorn 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 Kermit text.
FOR PART A AND PART B MONITORING RESULTS:
o A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
0 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
0 TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO L
iF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES NO
REGIONAL OFFICE CONTACT NAME:
Mail an original copy of this DlaJll, includin all"No Discharge"reports within 30 daVs of receipt of the rala 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
am aware that there are significan enalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signature of Permittee Date
Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018
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