NCG100023_DMR_20220707 (2)

NCDEQ Division of Energy, Mineral and Land Resources NC Department of
Environmental Quality
Stormwater Discharge Monitoring Report (DMR) Form for NCG100000 Received
Used Motor Vehicles JUL 0 7 2022
Click here for instructions
Winston-Salem
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report(DM1 lloradd( i}.within
30 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the appropriate DEM �R E2egiotnnal office.
Certificate of Coverage No. NCG10 0023 Person Collecting Samples: N/A
Facility Name:M &M Motor Company, Inc Laboratory Name: N/A
Facility County:Randleman Laboratory Cert. No.: N/A
Discharge during this period: Yes El No (if no,skip to signature and date) _
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? Yes fl No
If so,which Tier(I, II, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deq.nc.gov/Forrns/SW-DMR riYes fl No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class
N/A Date Sample Collected MM/DD/YYYY
46529 24-Hour Rainfall in inches
C0530 TSS in mg/L(100 or 50*) —__H
00400 pH in standard units(6.0—9.0 FW,
6.8-8.5SW)
00340 Chemical Oxygen Demand in mg/L
(120) — —
01051 Lead,total recoverable (as Pb)in
mg/L(0.075 FW,0.22 SW) ---
Ethylene Glycol in mg/L(any amount
77023 detected Tier One;8,000 mg/L Tier
Two and Three) —
00552 Non-Polar Oil&Grease in mg/L(15)
NCOIL Estimated New Motor/Hydraulic Oil
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/1
FW(Freshwater)SW(Saltwater)
Notes(optional): —1
"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 info ati n,incl ing th ,pos ibility of fi es and imprisonment for knowing violations."
A . / 4/ .,7 -20 -,2,9
Signature of ermittee or Delegated Authorized Individual Date
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Email Address Phone Number