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HomeMy WebLinkAboutNCG180194_2020 DMR_20201216NCDEQ Division of Energy, Mineral and Land Resources Stormwater Discharge Monitoring Report (DMR) Form for NCG180000 Furniture Manufacture 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. NCG18 0 1 9 4 Person Collecting Samples: AZIMUTH TECH SVCS Facility Name: KLAUSSNER FURNITURE INDUSTRIES Laboratory Name: MERITECH, INC. Facility County: Randolph 0 Laboratory Cert. No.: 165 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 ❑■ No If so, which Tier (I, II, or III)? Part A: Vehicle & Equipment Maintenance Areas — Benchmarks in (Red) Parameter Code Parameter Outfa I I Outfa I I Outfa I I Outfa I I O utfa I I N/A Receiving Stream Class C N/A Date Sample Collected MM/DD/YYYY 11/11/2020 46529 24-Hour Rainfall in inches 0.19 00552 Non -Polar Oil & Grease in mg/L (15) <5 C0530 TSS in mg/L (100 or 50*) - NCOIL New Motor/Hydraulic Oil Usage in gal/month * Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA) have a benchmark TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L. 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 information, including the possibility of fines and imprisonment for knowing violations." Signature of Permittee or Delegated Authorized Individual Date