NCG030011_2021 DMR_20211203 (2)

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DIVIR) Form for NCG030000
Metal Fabrication
Click here for inStrUctions
Complete, sign, scan and submit the DIVIR via the Storm��vater NPIDES Permit DQta rvloniLorinp Report (DltAR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DIVIR to the appropriate DEMLR Regional Office.
Certificate of Coverage No, NCG03 c� (--?I
Person Colle ting Samples: �10LJCJ- Pe ffc--(- -t--
Facility Name: I,Je,, v, vt e v-
Laboratory Name: Fe'l c5 e__
Facility County: ffif j/0, e-,,(--50 L-Al-
Laboratory Cert. No.: Z
Discharge during this period:
Elyes
[] No (if no, skip to signature ond date)
Has your facility implemented mandatory Tier response actions this s@mple period for any benchmark exceedances? EYes F]No
If so, which Tier (1, 11, or 111)?
A copy of this DMIR has been uploaded electronically via https:/./�f---docs. deg. nc.yov/Forms/SW- D MR No
Date Uploaded: 1 2- KYes
Analytical Monitoring Requirements for Outfalls with Industrial Activities - Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
-J�j- O"L-�
N/A
Date Sample Collected MM/DD/YYYY
J/ 1i 202 1
46529
24-Hour Rainfall in inches
di I /
C0530
TSS in mg/L (100 or 50*)
61
00400
pH in standard units (6-0 - 9.0 FW,
6.8-8.5 SW)
`7,
01119
Copper, total recoverable in mg/L
(0.010 FW, 0.0058 SW)
0, o06
01051
Lead, total recoverable in mg/ L
(0.075 FW, 0.22 SW)
/_1 0 0
01094
Zinc, total recoverable in mgl L (0.126
FW, 0.095 SW)
00340
Chemical Oxygen Demand (COD)'in
mg/L (120)
00552
Non -Polar Oil & Grease in mg/L (15)
q, 5
* 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)
lei
Notes (optional): P0 7,/4?Vd
"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."
e---? — - .
re of
Authorized Individual
V, V k
Email Address
(2/1 2-
Date
q- (- 0 vv%-__ 0218 - 6841- 3 50 1
Phone Number