NCG100197_2022 DMR_20221216

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 0197 Person Collecting Samples: SHANE BOND
Facility Name:PULL-A-PART OF WINSTON SALEM Laboratory Name: PACE ANALYTICAL SERVICES
Facility County:FORSYTH Laboratory Cert. No.:381
Discharge during this period: Yes ❑No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?EYes ❑No
If so,which Tier(I, II,or III)?Tier I and Tier III
A copy of this DMR has been uploaded electronically via https://edocs.deq.nc.gov/Forms/SW-DMR 0 Yes No
Date Uploaded: 12/16/2022
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall Soo 001 Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class
N/A Date Sample Collected MM/DD/YYYY 11/15/2022
46529 24-Hour Rainfall in inches 0.70
C0530 TSS in mg/L(100 or 50*) 9.8
pH in standard units(6.0-9.0 FW,
00400 7 6.8—8.5 SW) _
00340 Chemical Oxygen Demand in mg/L 144
(120)
01051 Lead,total recoverable(as Pb)in None Detected
mg/L(0.075 FW,0.22 SW)
Ethylene Glycol in mg/L(any amount
77023 detected Tier One;8,000 mg/L Tier 54.6
Two and Three)
00552 Non-Polar Oil&Grease in mg/L(15) None Detected
NCOIL Estimated New Motor/Hydraulic Oil 10
Usage in gal/month
* 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):
"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 fines and imprisonment for knowing violations."
12/16/2022
Signature of Permittee or Delegated Authorized Individual Date
[e-mail] [phone]
Email Address Phone Number