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HomeMy WebLinkAboutNCG100215_MONITORING INFO_20180213STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /V C� � pD DOC TYPE ❑HISTORICAL FILE U-MONITORING REPORTS DOC DATE ❑ a Ole D a 13 YYYYMMDD STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT rt CERTIFICATE OF COVERAGE NO. NCG100215 SAMPLES COLLECTED DURING CALENDAR YEAR: 20/ (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) FACILITY NAME Matlock's Used Cars and Parts COUNTY Alexander PERSON COLLECTING SAMPLE(S) Jeff Matlock PHONE NO. 828 j 632-6158 CERTIFIED LABORATORY(S) Lab # EC ftVED Lab # PLEASE REMEMBER TO SIGN ON THE REVERSE FEB 13 2018 Part A: Stormwater Benchmarks and Monitoring Results CENTRAL FILES For sampling periods with no discharge, you must submit this discharge monitoring DWR SECTION p g p g , y g g form noting "No Flow" or "No Discharge" wlthN 30 days of the end of that period to comply with permit reporting requirements. Outfall No. Date 'Sample Collected, mo/dd/year Total Rainfall, inches 00400 00530 - - - - 77023 01051 78141 pH, Standard Units Total Suspended Solids (TSS), mg/L Non -polar O&G/TPH (Method 1664 SGT-HEM), mg/L Ethylene Glycol, mg/L Lead, Total Recoverable,- mg/L Total Toxic Organics3, mg/L Benchmark - - 6.0 — 9.01 100/502 15 8,000 (Tiers 2 d 3) 0.03 1.0 Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General Permit. 1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. 2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table 11 of Chapter 40 Code of Federal Regulations (CFR) Part 122. Form SWU-251, lost revised October25, 2012 Page 1 of 2 r .A a �4001 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan 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 all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Name (Print name) Title (Print titl �&- �*z& Zlw� Si r Date /1/7 Mail Original and one copy to: Division of water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 "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 dir re;gn"�rilcanyognaltie7oi�subrrjitting ble for gathethe information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that JK e are false information, including the possibility of fines and imprisonment for knowing violations." or 12-z9-/ 7 _ (Date) Form SW U-251, last revised October 25, 2012 Page 2 of 2 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT L CERTIFICATE OF COVERAGE NO. NCGl00215 SAMPLES COLLECTED DURING CALENDAR YEAR: Z�I (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) FACILITY NAME Matlocles Used Cars and Parts COUNTY Alexander PERSON COLLECTING SAMPLE(S) Jeff Matlock_ _ PHONE NO. 828 632-6158 CERTIFIED LABORATORY(S) Lab # RECEIVED - Lab # • PLEASE REMEMBER TO SIGN ON THE REVERSE 4 JUL 27 [Uil Part A: Stormwater Benchmarks and Monitoring Results CENTRAL 1=1LEF For sampling periods with no discharge, you must submit t�iisvdi chC�rge'monitoring form noting "No Flow" or "No Discharge". within 30 days of the end of that period to comply with permit reporting requirements. Outfall :: No: Date Sample.`[ollected; mo/dd/year . Total. Rainfall, :. inches 00400 �00530. - - - - 77023 01051 •78141 pH; Standard Units Total Suspended, Solids (TSS), mg/L ; Non -polar WTPH (Method 1664 .SGT-HEM), mg/L Ethylene Glycol, mg/L Lead; Total Recoverable, mg/L Total Toxic Organics3, mg/L Benchmark - - 6.0-9.0� 100/502 15 8,000 (Tiers 2 and 3) 0.03 1.0 /yW U T=t Note: If you report a sampled value in excess of the benchmark value. or outside the benchmark ranee for oH. you must implement Tier 1 or Tier 2 responses in the General Permit. 1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U.- Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. 2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122. Form SWU-251, last revised October25, 2012 Page 1 of 2 a- �� �!~ w ® � . �� � �3 � �� �f' �� � �' + \ � � ® �y ©} \ f �# : � ~� �-\ STORMWATER DISCHARGE OUTFALL (SOO) MONITORING REPORT Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan 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 all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." M LOi' Name (Print name) Title (Print ti I Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 �1 7 Date "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 th9rehe sigpificant penAes for submitting false information, including the possibility of fines and imprisonment for knowing violations." &5// -7 (Date) Form SWU-251, lost revised October 25, 2012 Page 2 of 2 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT CERTIFICATE OF COVERAGE NO. NCG100215 SAMPLES COLLECTED DURING CALENDAR YEAR: tic (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) FACILITY NAME Matlock's Used Cars and Parts COUNTY Alexander PERSON COLLECTING SAMPLE(S) Jeff Matlock _' %E D PHONE NO. 828 632-6158 CERTIFIED LABORATORY(S) Lab # Lab # JA r1 4 �'' r PLEASE REMEMBER TO SIGN ON THE REVERSE 4 CENTRAL FILES Part A: Stormwater Benchmarks and Monitoring Results DWR SECTION For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within 30 days of the end of that period to comply with permit reporting requirements. Outfall No Date Sample Collected,< mo/dd/year Total ,' Rainfall;- inches :: 00400. 00530,; , . - - - - 77023 01051 78141 pH,'. Standard Units _ Total Suspended. Solids.(TSS), mdL: y Non -polar, O&G/TPH (Method 1664. SGT-HEM}, mg/L Ethylene Gtycal, mg/l. Lead, Total Recoverable, mg/L Total Toxic gan wYOrics3,, mg/L Benchmark - - 6.0—:9.0i 100/502 15 8,000 (Tiers 2 and 3) 0.03 1.0 AL IF Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General Permit. iSee If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. 25ee General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122. Form SWU-251, last revised October25, 2012 Page 1 of 2 oil STORMWATER DISCHARGE QUTFALL (SDO) MONITORING REPORT Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement. Solvent Management Plan 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 all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Name (Print name t ate-/47 Date Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 N 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." VON of Pe mittee or Designee) (Date) Form SW U-251, last revised October 25, 2012 Page 2 of 2 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT CERTIFICATE OF COVERAGE NO. NCG100215 SAMPLES COLLECTED DURING CALENDAR YEAR: (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) FACILITY NAME Matlock's Used Cars and Parts COUNTY Alexander PERSON COLLECTING SAMPLE(S) Jeff Matlock PHONE NO. 828 632-6158 CERTIFIED LABORATORY(S) Lab # Lab # PLEASE REMEMBER TO SIGN ON THE REVERSE Part A: Stormwater Benchmarks and Monitoring Results For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within 30 days of the end of that period to comply with permit reporting requirements_ Outfall ' No Date Sample Collected, mo/dd/year Total Rainfall,. inches 00400 00530 `` - - ; : 77023 ,01051 -;& 78141 pH; Standard Units' Total Suspended Solids (TSS), mg/L Non -polar S O&G/TPH .(Method 1664 SGT-HEM), mg/L EthyleneGlycol, mg%L;-. Lead, Total Recoverable, mg/L Total Toxic, Organics3, mg/L .. Benchmark - - 6A — 9.01 100/502 15 : 8 000 (Tiers Zand 3) 0 03-1 1.0 AJU Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General Permit. 1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. 2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table 11 of Chapter 40 Code of Federal Regulations (CFR) Part 122. Form SWU-251, lost revised October25, 2012 Page 1 of 2 44 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan 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 all the provisions of the solvent management plan included in the Stormwatei' Pollution Prevention Plan." Name (Print name Date Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 "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 therAre significant pgnalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." or (Date) Form SWU-251, last revised October 25, 2012 Page 2 of 2 C. STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT CERTIFICATE OF COVERAGE NO. NCG100215 SAMPLES COLLECTED DURING CALENDAR YEAR: (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) FACILITY NAME Matlock's Used Cars and Parts COUNTY Alexander PERSON COLLECTING SAMPLE(S) Jeff Matlock PHONE NO. 828 632-6158 CERTIFIED LABORATORY(S) Lab # Lab # RECE I VIU REMEMBER TO SIGN ON THE REVERSE 4 Part A: Stormwater Benchmarks and Monitoring Results JUL 0 5 2016 For sum lin periods with no discharge, you must submit this dischar C N noting"No Flow" or "No Dis k' within sumpling p 9. Y 9'�(�t� g 30 days of the end of that period to comply with perm! re arcing requirements. OutFall' Date00400 00530-�' ;_ �:77Q23'0105i; „Z8141 �. No. Sample Collette"d,Total� -pH, Total5usperided °Non -polar Ethylene Glycol, Lead, Total Total Toxic mo/dd/year Rainfall Standard Solids (TSSj O&G/TPH nEg/L Recoverable 3 ' ` Organics , .' inches Units mg/L (Method 1664 mg/L mg%L SGT-HEM), mg/L 8'000'.= B'erichinark - - 6.0--9 01 100/50 iS (Tiers 2 and 3j 0,03,1A Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General Permit. 1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy) instead of 6 S_U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. 2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122. Form SW U-251, lost revised October 25, 2012 Page 1 of 2 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan 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 all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Name (print e) e do Title rint title) Date Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 "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. 1 am aware that there are significar3t penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." Permittee or & — � I� (Date) Form SWU-251, lost revised October 25, 2012 Page 2 of 2 STORMWATER DISCHARGE OUTFALL (SDO} MONITORING REPORT CERTIFICATE OF COVERAGE NO. NCG100215 SAMPLES COLLECTENDUR�NG CA4kLfENDAR YEAR: (This monitoring report shailLtre received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) FACILITY NAME Matlock's Used Cars and Parts COUNTY Alexander PERSON COLLECTING SAMPLE(S) Jeff Matlock PHONE NO. 828 632-6158 CERTIFIED LABORATORY(S) Lab #RECEIVED Lab # PLEASE REMEMBER TO SIGN ON THE REVERSE 4 FEB 0 t � 016 Part A: Stormwater Benchmarks and Monitoring Results CENTRAL FILES For sampling periods with no discharge, you must submit t ©s �discha ge(m onitoring form noting "No Flow" or "No Discharge" within 30 days of the end of that period to comply with permit reporting requirements. Ouifall Nb:, . Date Sample Collected,' Total 00400 00530 _ _ _ _. 77023 , 01051 7814T- w pH, Total Suspended Tlon=polar Ethylene Glycol, lead, Total Total.Toxic .. - mo/dd/year Rainfall, Standard Solids(TSS}, ``O&G/TPH mg/L Recoverable, Organ�cs3, f inches Units mg/L (Method 1664 mg/L mg/L _ ..,. SGT-HEM), mg/L . s Benchmark - - .. 6.0 — 9.0 100/50 15 _ b ; . (Tiers 2 and 3) 0.03 i 0 Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General Permit. iSee If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold ofthis benchmark range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. iSee General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122. Form SWU-251, last revised October 25, 2012 Page 1 of 2 i STORMWATER DISCHARGE Ot)TFALL (SDO) MONITORING REPORT Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan 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 all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." 11,Vdr&a Ini fiZTLbG k Name (Print name) H S A611nade Title (Print title) Signature Date Mail Original and one copy to: Division of water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 "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." Permittee or Designee) (Date) Form SW U-251, last revised October 25, 2012 Page 2 of 2 STORMWATER DISCHARGWUTFALL (SDO) MONITORINGAEPORT CiRTIFIC:ATE OF COVERAGE NO. NCG100215 'SAMPLES COLLECTED DURING CALENDAR YEAR: (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) FACILITY NAME Matlock's Used Cars and Parts COUNTY Alexander PERSON COLLECTING SAMPLE(S) Jeff Matlock PHONE NO. 828 632-6158 CERTIFIED LABORATORY(S) Lab # RECEIVED Lab # FEB 0 2 2010 PLEASE REMEMBER TO SIGN ON THE REVERSE Part A: Stormwater Benchmarks and Monitoring Results. CENTRAL FILES DWR SECTION For sampling periods with no discharge, you must submit this discharge monitoring form noting 'No Flow" or 'No Discharge" within 30 days of the end of that period to comply with permit reporting requirements. Outfall _ No. Date" Sample Collected, mo/dd/year Total.- Rainfall, : v inches 00400 00530 - - - - 77023 01051 78141 pH, .:.Standard. Units f:Total Suspended Solids (TSS), .Mg/l. -Non-polar;= : O&G/TPH (Method 1664 _ SGT:HEM), mg/L Ethylene Glycol, mg/L Lead,Total. Recoverable, mg/l Total Toxic 3 Organics ,. mg[L Benchmark' - 1 6.0 — 9,0 2 100/50 15 8,000 (Tiers 2 and'3) 0.03 1.0 i� Ism Nor' J0001F . - Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General Permit. 1See If pH values outside.this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. . 2See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table 11 of Chapter 40 Code of Federal Regulations (CFR) Part 122. Form SW U-251, last revised October 25, 2012 Page 1 of 2 4% NP kf STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Faj,ilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan 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 all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." Ama..M4 &AGv— Name (Print name) 14fanctf Title rint title] lr I2-31 ��S ignature Date Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 "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." or 12-:1-f .5— [Date] Form SWU-251,105t revised October25, 2012 Page 2 of 2 ` STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT RECEIVED CERTIFICATE OF COVERAGE NO. NCG100215 SAMPLES COLLECTED DURING CALENDAR YEAR: 9/-5 AUG 0 3 2M (This monitoring report shall be received by the Division no later than 30 days CENTRAL FILES from the date the facility receives the sampling results from the laboratory.) DWR SECTION FAE ';TY NAME Matlock's Used Car:: _md-Parts - COUNTY _ A!Z;;-Lnder = PERSON COLLECTING SAMPLE(S) Jeff Matlock PHONE NO. 828 j 632-6158 CERTIFIED LABORATORY(S) Lab # Lab # PLEASE REMEMBER TO SIGN ON THE REVERSE 4 Part A: Stormwater Benchmarks and Monitoring Results For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flow" or "No Discharge" within 30 days of the end of that period to comply with permit reporting requirements. Outfall No. Date Sample Collected, mo/dd/year Total Rainfall, inches 00400 00530 - - - - 77023 01051 78141- pH, . Standard . Units Total Suspended!- Salids (TSS}, mg/L Non -polar O&G/TPH (Method 1664 SGT-HEM), mg/L Ethylene Glycol, mg/L Lead, Total Recoverable;' mg/L Total Toxic 3 Organics mg/L Benchmark - 6.0 - 9.01 100/502 15 8,000 (Tiers 2 and 3) 0.03 1.0 Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses in the General Permit. 1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9. 2 See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table 11 of Chapter 40 Code of Federal Regulations (CFR) Part 122. Form SWU-251, last revised October25, 2012 Page 1 of 2 �* w •r.-r: -:- STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan 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 all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." t 4jx— Name (Print name) Date Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." or 7-�-o - 6- T ( Date) Form SWU-2S1, last revised October25, 2012 Page 2 of 2 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT CERTIFICATE OF COVERAGE NO. NCG100215 SAMPLES COLLECTED DURING CALENDAR YEAR: FACILITY NAME Matlock's Used Cars and Parts PERSON COLLECTING SAMPLE(S) Jeff Matlock CERTIFIED LABORATORY(S) Lab # Lab # Part A: Stormwater Benchmarks and Monitoring Results (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) COUNTY Alexander PHONE NO. 828 632-6158 PLEASE REMEMBER TO SIGN ON THE REVERSE 4 For sampling periods with no discharge, you must submit this discharge monitoring form noting "No Flaw" or "No Discharge" within 30 days of the end of that period to comply with permit reporting requirements. Outfal l No. ,, Date Sample Collected, mo/dd/year Total Rainfall, inches 00400 00530 - - - - 74023 01051 79141 pH, Standard Units Total Suspended Solids (TSS), mg/L Non -polar O&G/TPH (Method 1664 SGT-HEM), mg/L' Ethylene Glycol, mg/L Lead, Total Recoverable, mg/L Total Toxic organics3, mg/1_ Benchmark _ = - - � 6.0 — 9.0 2 l0a/50 15 8,000 (Tiers 2 and 3) 0.03 1.0 ?L mono INV Now' Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Ter 2 responses in the General Permit. 1See If pH values outside this range are recorded in sampled stormwater discharges, but ambient precipitation pH levels are lower, then the lower threshold of this benchmark range is the pH of the precipitation (within instrument accuracy) instead of 6 S.U. Readings from an on -site or local rain gauge (or local precipitation data) must be documented to demonstrate background concentrations were below the benchmark pH range of 6-9- 2 See General Permit text to identify whether the more protective benchmark applies for especially sensitive receiving waters. 3For purposes of this permit the definition of Total Toxic Organics is that list as stated in Appendix D, Table II of Chapter 40 Code of Federal Regulations (CFR) Part 122. Form SWU-251, last revised October25, 2012 Page 1 of 2 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may request that DWQ waive monitoring of total toxic organics. 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 allowed such a waiver, the discharger shall sign the following certification statement: Solvent Management Plan 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 all the provisions of the solvent management plan included in the Stormwater Pollution Prevention Plan." i Name (Print name) Title (Print title) 77--= -A- Date Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 "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 forjubmitting false information, including the possibility of fines and imprisonment for knowing violations." ittee or (Date) Form SWU-251, last revised October25, 2012 Page 2 of 2