NCG030011_2021 DMR_20211203

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 DIVIR via the Stcrm%vater NPIDES Permit Data Monitoring Report (DMR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DIVIR to the aopropriate DEMLR Regional Office.
Certificate of Coverage No. NCG03 00
Person Collecting Samples:
Facility Name: 0, tr tL tf V
Laboratory Name:
Facility County: e, V-1 ct C vp S C) 1-,>
Laboratory Cert. No.:
Discharge during this period: 0 Yes [TNo
(if no, skip to signature and date)
Has your facility implemented manclatoryTier response actions this sample period for any benchmark exceeclances? n Yes E]No
If so, which Tier (1, 11, or 111)?
A copy of this DIVIR has been uploaded electronically via htti3s://Pdocs.deG.iic.gov/Foi,i-n-s/SW-DilvlR E]Yes ONo
Date Uploaded: -02-1
_ I ?,. 1312
Analytical Monitoring Requirements for Outfalls with Industrial Activities - Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L (100 or 501
00400
pH in standard units (6.0 - 9.0 FW,
6.8-8.5 SW)
01119
Copper, total recoverable in mg/L
(0.010 FW, 0.0058 SW)
01051
Lead, total recoverable in mg/ L
(0.075 FW, 0.22 SW)
01094
Zinc, total recoverable in mg/ L (0.126
W, 0.095 SW)
Chemical Oxygen Demand (COD) in
00340
mg/L (120)
00552
Non -Polar Oil & Grease in mg1L (15)
* 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
FW (Freshwater) SW (Saltwater)
Notes (optional): /V,9 q 6,-t 2 i V\
_C, 4 CC p.- i / ( e �,- (.,/ C —t-D t-7 if
"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
fals ation, including the possibility of fines and imprisonment for knowing violations."
(2-1
Signa k ture of Per1rA4ee-oNDzjejpted Authorized Individual Date
7 -
r) � e .0 V, V\ e (D vv'-- Y/
Email Address Phoi iber