NCG030240_2022 DMR_20220824

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG030000
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (DMR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG030240
Person Collecting Samples: David Heath
Facility Name: John Deere Kernersville
Facility County: Forsyth
Laboratory Name: Pace Analytical
Laboratory Cert. No.: 12, 40, 633
Discharge during this period:
[]Yes
❑ No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? Yes No
If so, which Tier (I, 11, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR 0 Yes No
Date Uploaded:8/24/2022
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall 01
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
WS-111
N/A
Date Sample Collected MM/DD/YYYY
8/9/2022
46529
24-Hour Rainfall in inches
.33
C0530
TSS in mg/L (100 or 50*)
19.1
00400
pH in standard units (6.0 — 9.0 FW,
6.58
6.8-8.5 SW)
01119
Copper, total recoverable in mg/L
< XXmg/L
(0.010 FW, 0.0058 SW)
01051
Lead, total recoverable in mg/ L
< XXmg/L
(0.075 FW, 0.22 SW)
01094
Zinc, total recoverable in mg/ L (0.126
FW, 0.095 SW)
m
<XX/L
g
Chemical Oxygen Demand (COD) in
00340
mg/L (120)
32.6
00552
Non -Polar Oil & Grease in mg/L (15)
<XXmg/L
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of So mg/L. All other water classifications have a benchmark of 100 mg/L
FW (Freshwater) SW (Saltwater)
Notes (optional):
"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 informat�ncluding the possibility cf figgs and imprisonment for knowing violations."
Email Address
8/24/2022
Date
336-423-5552
Phone Number