NCG020895 SW TIER 2 to RO

BENCHMARK EXCEEDANCE or TIER 2 DISCHARGE MONITORING REPORT (DMR) STORMWATER
—
SUBMIT TO REGIONAL OFFICE*
General Permit No. NCG020000
*Use this form if any stormwater samples have EXCEEDED A BENCHMARK or if the facility is in TIER 2 MONITORING for any parameter
(including TIER 2 for Turbidity). Send sample results to the DEMLR Regional Office within 30 days of receipt from the laboratory.
Certificate of Coverage No. NCG020895
Facility Name: Sample Collection Period: Period 1 ❑ Period 2 ❑ Calendar Year
County: For Monthly Monitoring: Month
Phone Number: () Person Collecting Samples:
Certified Laboratory: Lab #
Lab #
Has this facility had 4 or more benchmark exceedances for any single parameter, at any one SW discharge outfall (SDO)? Yes ❑ No ❑
Have you contacted the Regional Office? Yes ❑ No ❑
Whom at the Region did you speak with?
Part A: Stormwater Monitoring Requirements (no VMA, see page 3 for outfalls with VMA)
Outfall
No.
Date Sample
Collected
Total
Rainfall
Is this SDO
in Tier 2?
Total
Suspended
Solids (TSS),
mg/I
Settleable
Solids,
ml/I
Turbidity, NTU
Upstream (U)
Turbidity,
NTU
Downstream (D)
Turbidity,
NTU
rlffi
Y/N
100
50 (ORW, HQW, Tr, PNA)
0.1
50
25 (lakes, reservoirs, salt waters)
10 (freshwater Tr designated
streams, lakes, and reservoirs
N/A
Water Quality
Standard apples
N/A
Water Quality
Standard apples
Permit Date 5/31/2017 — 9/30/2020 Revised 5/31/17 for Supplemental Monitoring Specific to this COC
Page 1 of 5

Certificate of Coverage No. NCG020895
Part A: Stormwater Monitoring Requirements (no VMA), cont.
Outfall
No.
Date Sample
Collected
Total
Rainfall
Is this SDO
in Tier 2?
Total
Suspended
Solids (TSS),
mg/I
Settleable
Solids,
ml/I
Turbidity, NTU
Upstream (U)
Turbidity,
NTU
Downstream (D)
Turbidity,
NTU
Total Cu,
mg/I
rlffi
Y/N
100
50 (ORW, HQW, Tr, PNA)
0.1
50
25 (lakes, reservoirs, salt waters)
10 (freshwater Tr designated
streams, lakes, and reservoirs
N/A
Water Quality
Standard apples
N/A
Water Quality
Standard apples
0.010
Part A: Stormwater Monitoring Requirements (no VMA), Supplemental Parameters
Outfall
No.
Date Sample
Collected
Iron,
mg/I
Total Ni,
mg/I
Total Zn,
mg/I
Total Sb,
mg/I
Total As,
mg/I
Total Be,
mg/I
Total Cd,
mg/I
Total Cu,
mg/I
N/A
0.335
0.126
0.09
0.34
0.065
0.003
0.010
Permit Date 5/31/2017 — 9/30/2020 Revised 5/31/17 for Supplemental Monitoring Specific to this COC
Page 2 of 5

Certificate of Coverage No. NCG020895
Part A: Stormwater Monitorina Reauirements (no VMA). Sunolemental Parameters (continued)
Outfall
No.
Date Sample
Collected
Total Pb,
mg/l
Total Hg,
mg/l
Total Se,
mg/l
Total Ag,
mg/l
Total
Hardness,
mg/l
MW
19
Still,
100/50
15
55
0.1 _F50/25/1
0
N/A
0.075
0.000012
0.056
0.0003
N/A
Part B: Stormwater Monitoring Requirements for SDOs with Vehicle Maintenance Activities (VMA) where facilities use > 55 gallons of new
motor oil a month if averaged over the calendar year. NOTE: Other parameters only for outfalls that include both mining activities and VMA.
VMA VMA only VMA only If applicable If applicable If applicable If applicable
Date Sample Total TSS, Non -polar New Motor SS, Turbidity, Upstream (U) Downstream (D)
Outfall Collected Rainfall mg/l O&G, mg/l Oil Use ml/l NTU Turbidity, Turbidity,
No. I I I (gal/mo.) NTU NTU
Permit Date 5/31/2017 — 9/30/2020 Revised 5131117 for Supplemental Monitoring Specific to this COC
Page 3 of 5
I
MW
19
Still,
100/50
15
55
0.1 _F50/25/1
0
N/A
N/A
Permit Date 5/31/2017 — 9/30/2020 Revised 5131117 for Supplemental Monitoring Specific to this COC
Page 3 of 5

Part B: Stormwater Monitoring Requirements for SDOs with Vehicle Maintenance Activities (VMA) where facilities use > 55 gallons of new
motor oil a month if averaged over the calendar year, Supplemental Parameters
Outfall
No.
Date Sample
Collected
Iron,
mg/I
Total Ni,
mg/I
Total Zn,
mg/I
Total Sb,
mg/I
Total As,
mg/I
Total Be,
mg/I
Total Cd,
mg/I
Total Cu,
mg/I
I
r
r
N/A
0.335
0.126
0.09
0.34
0.065
0.003
0.010
Part B: Stormwater Monitoring Requirements for SDOs with Vehicle Maintenance Activities (VMA) where facilities use > 55 gallons of new
motor oil a month if averaged over the calendar year, Supplemental Parameters (continued)
Outfall
No.
Date Sample
Collected
Total Pb,
mg/I
Total Hg,
mg/I
Total Se,
mg/I
Total Ag,
mg/I
Total
Hardness,
mg/I
I
r
0.075
0.000012
0.056
0.0003
N/A
Permit Date 5/31/2017 — 9/30/2020 Revised 5/31/17 for Supplemental Monitoring Specific to this COC
Page 4 of 5

Certificate of Coverage No. NCG020895
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 §122.22]
Signature
Date
Mail Benchmark Exceedance/Tier 2 DMR to Your DEMLR Regional Office Land Quality Section:
ASHEVILLE REGIONAL OFFICE I FAYETTEVILLE REGIONAL OFFICE I MOORESVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
(919) 791-42.00
WINSTON-SALEM REGIONAL
OFFICE
450 Hanes Mill Road, Suite 300
Winston-Salem, NC 27103
[phone]
Permit Date 5/31/2017 - 9/30/2020
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
(2r52r) 946-6481
CENTRAL OFFICE
Questions for The Central Office
Stormwater Permitting Program?
[phone]
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
Revised 5/31/17 for Supplemental Monitoring Specific to this COC
Page 5 of 5