NCG190103_2021 DMR_20220118

OV t) 262Z, NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG1 0 00 11eC 2�2.Z
Marinas and Shipbuilding
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (DMR) ( load 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. NCG19
Facility Name()
Person Collecting Samples:
Facility County: [oratory Name:Wi
Laboratory Cert. No.:
Discharge during this period: ❑Yes No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via https://edocs deg nc gov/Forms/SW DMR
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
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
00552
Non -Polar Oil & Grease in mg/L (15)
00340
Chemical Oxygen Demand in mg/L (120)
00400
pH in standard units (6.0-9.o)
01105
Aluminum, total recoverable in mg/ L
(0.75 FW, 0.24 SW)
Chromium III, total recoverable in mg/L
01027
at certain facilities** (0.905 FW, none
SW)
Chromium VI, total recoverable in mg/L
C0034
at certain facilities** (0.016 FW, 1.1
Outfall I Outfall I I Outfall I Outfall
J Yes U No
!Yes [:]No
Outfall
01042 Copper, total recoverable in mg/L
(0.010 FW, 0.006 SW)
ZFW,0.095SW)
Lead, total recoverable (as Pb) in mg/ L
0.075 FW, 0.22 SW)
Nickel, total recoverable in mg/L (0.335
W, 0.074 SW)
inc, total recoverable in mg/L (0.126
NCOIL Estimated 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
* *Only required for Ship and Boat Building and Repairing [SIC 3731 facilities that perform metal fabrication in areas that could potentially be
exposed to stormwater
FW (Freshwater) SW (Saltwater)

"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
fall@ jnformation, including the possibility of fines and imprisonment for knowing violations."
of Permittee or
Email Address
WAAa(p<-Ze-11
Authorized Individual
H� Cl�,�v�q _
Dat
Phone Number
q)O q52-4&4��