NCG080919_DMR_20230104 (1)

Semi-annual Stormwater L.,,%charge Monitoring Report
for North Carolina Division of Energy, Mineral and Land Resources General Permit No. NCG080000
Date submitted -,2 3
CERTIFICATE OF COVERAGE NO. NCG08 0 R I q SAMPLE COLLECTION YEAR
FACILITY NAME p SAMPLE PERIOD ❑Jan-June [�July-Dec
/�c7 U s �'�� Tro.As }c+.`;,�i ,Y�t c
COUNTY A,�-c 4.,11 or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES DISCHARGING TO CLASS ❑ORW ❑HQW Egtrout ❑PNA
LABORATORY Lab Cert.# RE t,,r NED ❑Zero-flow ❑Water Supply ❑SA
Comments on sample collection or analysis: 20� [:]Other
JAN
_ENfRAL FtLE:5 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
C)WR SECTION
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new oil per month? ❑yes [j?/no (if yes, complete Part A)
Part A:Vehicle& Equipment Maintenance Areas Monitoring Requirements(If applicable) �No discharge this period'
Outfal! No. Date Sample Collected' 24-hou:rainfall amount, Non-Po!ar Oil&Grease Total Suspended Solids, New Motor or Hydraulic Oil Usage,
(mo/dd/yr) Inches3 mg/L mg/L gal/mon
Benchmarks _ - 15 I 100 or 504 Parameter Code - I 46529 00552 � C0530 NCOIL
Qv 1 1. 1 og N j IL 30 mslt Nto
0001 1.1 04 A[ 30 r+ /L Li G
0b.3 04 /42 %c 30 r, 4 �1
i Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfali.
'For sampling periods with no discharge at any single outfali,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 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 SWU-248, last revised 11/1/2018
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Part B: 6 _ /ater Separators and Secondary Containment Areas at Petrole6, sulk Stations and Terminals (If applicable) ❑ No discharge thL _ !riod'
Outfall Date Sample 24=hour rainfall. Sample.Collected, Total Susperided` pH; Non Polar;0i1&
No: Collected - amount, mo/dd/yr Solids, Standard units Grease,
Inches nig/�.' mg/l- .
Permit Lrmrt'
" 100 or
Parameter Code'- - 46529 - C0530 00400 00552
Footnotes from Part A also apply to this Part B
Note: If your report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier?responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS: .
0 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 ANY ONE OUTFALL? YES ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO❑
REGIONAL OFFICE CONTACT NAME:
lifarl are original copy of this DMA': including all "No Discharge"reports, o+fithin 30 days of receipt of the lab resents(or at end of monitoring period in the
case of"Alo 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 significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
,L ,l a- /�' 1-4 -,73
Signature of Permittee Date
Permit Date: 11/1/2018-5/31/2021 SWU-248, last revised 11/1/2018
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