NCG030560_2021 DMR_20211209

NCDEQ Division of Energy, Mineral and Land Resources
water Discharge Monitoring Report (DMR) Form for NCG030000
Metal Fabrication
Click here for instructions
Complete, sign, scan a d submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (DMR) Upload form within
30 days of receiving sa pling results. Mail the original, signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Coverage No.
NCG03 0560
Person Collecting Samples: David Gosselin
Facility Name: Engine S
stems Inc.
Laboratory Name: Microbac (Fayetteville)
Facility County: Nash
Laboratory Cert. No.: 11
Discharge during this period:
0 Yes ❑ No (if no, skip to signature and date)
ted mandatory Tier response actions this sample Period for any benchmark exceedances? ❑[Z]NO
No
Has your facility implemei
If so, which Tier (I, II, or III
?
A copy of this DMR has be
an uploaded electronically via https://edocs.deg.nc,.gov/Forms/SW-DMR ❑✓ Yes ❑ No
Date Uploaded: 12/9/202
Analytical Monitoring Ra
juirements for Outfalls with Industrial Activities — Benchmarks In (Red)
Parameter
Code
Parameter Outfall Outfall Outfall Outfall Outfall
N/A Receiving Stream
Class NSW CLASS C
N/A
Date Sample
ollected MM/DD/YYYY
11/22/2021
46529
24-Hour Rain
all in inches
2.00
C0530
TSS in mg/L (
00 or 50*)
4.86
00400
pH in standar
J units (6.0-9.0)
6.6
01119
Copper, total
recoverable in mg/L
(0.010)
.00309
01051
Lead, total re
overable in mg/ L
008
(0.075)
01094
zinc, total recoverable
in mg/ L
(0.126)
.0233
78141
Total Toxic Organics
(TTO) in mg/L(1)
N/A
(if required)
00552
Non -Polar Oil
& Grease in mg/L (15)
5.00
Additional parameters
for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
NCOIL Estimated New
Motor/Hydraulic Oil N/A
Usage in gal/
onth
Outfalls to Outstanding Ro
ource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit a
P 50 mg/L. All other water classifications have a benchmark of 100 mg/L
Notes (optional):
"I certify by my signature belo w, 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 mi knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false information, including th possibility of fines and imprisonment for knowing violations."
-i Lam.
Signature of Perm ittee or elegated Authorized Individual
Email Address
rnichae.(#-Wz,,f t
k IrbyCorp-cart
/Z-9- 2oz1
Date
Phone Number
252^qo7-8278

Total Toxic Organics Cert. cation:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring
requirement for total toxic organics (-Fro), I certify that to the best of my knowledge and belief, no leak, spill, or dumping of
concentrated toxic organics into the stormwater or onto areas which are exposed to rainfall or stormwater runoff has occurred since
filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the Solvent
Management Plan includedl in the Stormwater Pollution Prevention Plan."
I2-
Date
Phone Number
2-52--Yo7-82Z8