NCG140354_2023 DMR_20231031

BENCHMARK EXCEEDANCE or TIER 2 DISCHARGE MONITORING REPORT (DMR) — STORMWATER
SUBMIT TO REGIONAL OFFICE*
General Permit No. NCG140000
*Use this form if any stormwater samples have EXCEEDED A BENCHMARK or if the facility is in TIER 2 MONITORING for any parameter.
Send sample results to the DEMLR Regional Office within 30 days of receipt from the laboratory.
Certificate of Coverage No. NCG14
Facility Nape: t„��,�� �t eAf],. f\At. TAc • Sample Collection Period: Period 1 O' Period 2 U Calendar Year 2023
County: ckgrSon For Monthly Monitoring: Month c
Phone Number: ( cock'1-SQj(o to Person Collecting Samples: Ju,,:41s„
Certified Laboratory: .e.S .L.ol ( € .Ak.1. Lab #
Lab #
Has this facility had 4 or more benchmark exceedances for any single parameter, at any one SW discharge outfall (SDO)? Yes n No
Have you contacted the Regional Office? Yes No
Whom at the Region did you speak with?
Stormwater Monitoring Requirements
Does this SDO Total Non-polar O&G
include Vehicle Suspended pH, (EPA Method 1664 New Motor Oil
Outfall Date Sample Total Is this SDO in Maintenance Solids (TSS), SU (SGT-HEM)), mg/I Usage (gal/mo.)
Collected Rainfall Tier 2?
No. Activities (VMA)? mg/I (VMA)
If applicable
If applicable
55
mo/dd/yr inches Y/N Y/N 100 6.0-9.0 15 >re gaUmo.a.average
Non-polar
requires TSS and Non•polar
or "NO FLOW" 50 (ORW,HOW,Tr,PNA) O&G monitoring
(o\Z2 ?02 3 0.2� N tJ �Oo G0•38
Permit Date 8/1/2017 —6/30/2022 Last Revised 8-22-2017
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Certificate of Coverage No. NCG14
CERTIFICATION
"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." [Required by 40 CFR§122.221
Signature cJ(,tcs(jJliL—
Date tol3► l20 23
Mail Benchmark Exceedance/Tier 2 DMR to Your DEMLR Regional Office Land Quality Section:
ASHEVILLE REGIONAL OFFICE FAYETTEVILLE REGIONAL OFFICE MOORESVILLE REGIONAL OFFICE
2090 US Highway 70 225 Green Street 610 East Center Avenue/Suite 301
Swannanoa, NC 28778 Systel Building Suite 714 Mooresville, NC 28115
[phone] Fayetteville, NC 28301-5043 [phone]
[phone]
RALEIGH REGIONAL OFFICE WASHINGTON REGIONAL OFFICE WILMINGTON REGIONAL OFFICE
3800 Barrett Drive 943 Washington Square Mall 127 Cardinal Drive Extension
Raleigh, NC 27609 Washington, NC 27889 Wilmington, NC 28405-2845
[phone] [phone] [phone]
WINSTON-SALEIII REGIONAL CENTRAL OFFICE
OFFICE Win, • I ale e
450 Hanes Mill Road, Suite 300 Questions for The Central Officeti
Winston-Salem. NC 27103 Stormwater Permitting Program? ,✓` i t, , � 9ti tiff " . •r?
[phone]
[phone] �� 1 '�'s— �
CI r.>97
F• ettd�ville S `s
( i:Y/
\JrWilrn'ingron
Permit Date 8/1/2017—6/30/2022 Last Revised 8-22-2017
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