NCG030056_2020 DMR_20201221 (4)

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. NCG03 0 0 5 6 Person Collecting Samples: John Burke
Facility Name: Gilbarco inc Laboratory Name: Pace
Facility County: Guilford 0 Laboratory Cert. No.: 12, 40, 633
Discharge during this period: U Yes U No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances? U Yes U No
If so, which Tier (I, II, or III)? 1 0
Analytical Monitoring Requirements for Outfalls with Industrial Activities - Benchmarks in (Red)
Parameter
Code
Parameter
Outfall)01
Outfall02
Outfall03
Outfall
Outfall
N/A
Receiving Stream Class
5
5
5
N/A
Date Sample Collected MM/DD/YYYY
11/26/2020
11/26/2020
01/26/2020
46529
24-Hour Rainfall in inches
0.3
0.3
0.3
00552
Non -Polar Oil & Grease in mg/L (15)
<5.00
<5.00
<5.00
C0530
TSS in mg/L (100 or 50*)
136
8.4
17.7
00400
pH in standard units (6.0-9.0)
7.33
6.20
5.84
NCOIL
New Motor/Hydraulic Oil Usage in
< 1�-
S.
gal/month
01119
Copper, total recoverable in mg/L
0.013
0.006
0.012
(0.010 FW, 0.005 SW)
01051
Lead, total recoverable in mg/ L
0.005
�0.005
�0.005
(0.075 FW, 0.220 SW)
01094
Zinc, total recoverable in mg/ L (0.126
0.077
0.075
0.120
FW, 0.095 SW)
78141
Total Toxic Organics (TTO) in mg/L(1)
SMP
SMP
SMP
* 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
/ V/, //.�-
Date