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Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Datesubmittede '21' !G�
CERTIFICATE OF COVERAGE NO,/NGG03 " 6 SAMPLE COLLECTION YEAR 2�(L
FACILITY NAME .j4 4 L=X7'/Lacten- SAMPLE PERIODZ-Jan-June 0 July-Dec
,�I or ❑Monthly' (month)
PERSON AjAfc.N SAMPLES DISCHARGING TO CLASS ❑ORW ❑HQW QTrout ❑PNA
PERSON COLLE ING �jl.®n` I.t',n�� Zero-flow QWater Supply EISA
LABORATORY race p,.'a�y le4L Lab Cert.# (,,33
Comments on sample collection or analysis: QOther
PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -3,
Part A:Stormwater Benchmarks and Monitoring Results
❑No discharge this period?2
Date Sample 24-hour rainfall Non-Polar O&G/
p pH, Total Toxic
Outfall No. Collected' amount, Total Suspended Solids Standard units Copper Lead Zinc Total Petroleum Organicss
(mo/dd/yr) Inches3 Hydrocarbons
Benchmarks==_> - - 100 mg/L or 50 mg/L4 6.0—9.0 0.007 mg/L 0.033 mg/L 0.067 mg/L 15 mg/L 1 mg/L
WI OD 06fr /. ! 6.3 o.o?it o.o/y- 0,730 0 0
1 Monthly sampling(instead of semi-annual)must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 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.
4 See General Permit,Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations,manufacture semiconductors,manufacture
electronic crystals,or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample(for metal finishing use the definition as found in 40 CFR 433.11;for semiconductor
manufacture use the definition as found in 40 CFR 469.12;for electronic crystal manufacture use the definition as found in 40 CFR 469 22;and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date:11/1/2012-10/31/2017 SWU-245,last revised 10/25/2012
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Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify,and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver,the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO),I certify that to the best of my knowledge and belief,no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Pla "
�i`/f�� /Oral Z
Name(Print name)
ehls piiip_.
Title it ) 4t)
rifo. 20/) L
(Signature) (Date
Note:Results must be reported in numerical format. 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 ma/L",where XX is the numerical value of the detection
limit,reporting limit,etc.in mg/L
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 Permit text.
Part B: Vehicle Maintenance Area Monitoring Results:only for facilities averaging>55 gal of new oil per month.
❑No discharge this period?2
Date Sample 24-hour rainfall
Outfall No. Collected) amount, Non-polar O&G/TPH by
(mo/dd/yr) Inches3 EPA 1664(SGT-HEM) Total Suspended Solids pH
Benchmarks=__> - - 15 mg/L 100 mg/L or 50 mg/L* 6.0—9.0 SU
Footnotes from Part A also apply to this Part B
*See General Permit text,Table 5,identifying the especially sensitive receiving water classifications where the more protective benchmark applies
Permit Date:11/1/2012-10/31/2017 SWU-245,last revised 10/25/2012
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