NCG060139_2022 DMR_20220127

NCDEQ Division of Energy, Mineral and Land Resources
Complete, sign, scan and submit the DMR via the
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the
i� _ within
Certificate of Coverage No. NCG06 Q (3 I Person Collecting Samples:
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(a� e111 r,s_Gl;+u�on/` LaboratoryNames,.,; �ci9 .dJiro.�ni�.���d+cx'f��.x
Facility Name:S,a_ , � , e ��r���_.a_G�, , _.
Facility County;.Ss,r soi✓ Laboratory Cert. No.: W I t9Z p 1 l b cf
Discharge during this period: Yes ❑ No (if no, skip to signature and date)
Has your facility lmplemente mandatoryTier response actions this sample period for any benchmark exceedances? Yes ❑ No
if so, which Tier (I, II, or III)? -
A copy of this DMR has een upl aded electronically via ' _ ❑Yes ❑ No
Date Uploaded!
Analytical Monitoring
Requirements for Outfalis with
Parameter
Receiving Stream Class
Industrial Activities -Benchmarks in 1-di
Outfall Outfall -7 Outfall Outfall Outfall
- --
G S
7- Z ZD Z
Parameter
Code
N/A
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in Inches
C0530
TSS in mg/L(100 or 501
pH in standard units (6.0- 9.0 FW,
00400 6.8 _ 6.5 SW)
31616 Fecal Coliform per 100 ml of
freshwater (if required)
Enterococcl per 100 ml of saltwater
61211 -�
(if required) - ��-
00340 Chemical Oxygen Demand in mg/L�
(120) _L
Additional parameters for outfalls in drainage areas that use>5 per month of new hydraulic oil on average
NCOIL Estimated New Motor/Hydraulic Oil
Usage in gal/month _
00552 Non -Polar Oil & Grease in mg/L —
outfalls to outstanding Resource Waters (ORW), High Quality Waters (HQW}, Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of50 mg/L. All other water classifications have a benchmark of 30 mg/L
(Freshwater)sW (saltwater)
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 ledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false Informatio ossibility of fines and imprisonment for knowing violations."
-27 Zz
Signa%t�ure of permittee or Delegated Authorized individual Date ,
�11�
Email Address Phone Number