NCG130027_DMR_20240416

NC Department cf
Environmental Quality
Received
NCDEQ Division of Energy,Mineral and Land Resources APR 1 6 2024
Stormwater Discharge Monitoring Report (DMR) Form for NCG130000
Non-metal Waste and Scrap Winston-Salem
Regional Office
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. NCG13 0027 Person Collecting Samples:Bryan Kimball
Facility Name: Safety-Kleen Systems, Inc. Laboratory Name: Pace Analytical
Facility County: Randolph Laboratory Cert. No.: 37712
Discharge during this period:❑■ Yes ❑ No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances?❑Yes 0 No
If so,which Tier(I, II,or III)?
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class WS-III
N/A Date Sample Collected MM/DD/YYYY 3/15/2024
46529 24-Hour Rainfall in inches 0.25
00400 pH in standard units(6.0—9.0 FW, !+.Q
6.8-8.5 SW) p U
Chemical Oxygen Demand(COD)in 25
00340 mg/L(120)
00552 Non-Polar Oil&Grease in mg/L(15) NA
C0530 TSS in mg/L(100 or 50*) 10.3
NCOIL New Motor/Hydraulic Oil Usage in 0
gal/month
Notes(optional):SDO No.01
"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 information,including the possibility of fines and imprisonment for
knowing violations."
4/12/2024
Signa ure of Permittee o elegated Authorized Individual Date
[e-mail] 336-644-0332
Email Address Phone Number