NCG060114_2021 DMR_20220201

NCDEQ Division of Energy, Mineral and Land Resources
11 ::: N71",L
Food and Kindred
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Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (DMR) Upload 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. NCG060114
Person Collecting Samples: KL-L ert V1 f— LZUVV,
Facility Name: LJYIJ kW JW, ,�kS)
Laboratory Name. lalCrubaL, W.Lt4rLtz; ((e�, r1C.
Facility County: H U<L N
Laboratory Cert. No.: ►+IG If ##37714 LA -0A 41, 3 7 e
Discharge during this period: Y Yes El No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceeclances? M Yes R]No
If so, which Tier (1, It, or 111)? ri Z to
Aopy of thisDMR has been uploaded electronically via httgs:L/edocs,deg,nc.gov/E] FormszSW-DMR Yes E] Nolte Uploaded: + e�T -1 3t z Z-
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Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks In fRed)
Parameter
Code
Parameter
Outfall
Outfall
oudall
Outfall
Outfall
N/A
Receiving Stream Class
Utl
N/A
Date Sample Collected MM/DD/YYYY
12 /1()/ 2,02.1
46529
24-Hour Rainfall in inches
2 . & q I'"
C0530
TSS in mg/L (100 or S0*)
6.9 4) rl'91,-
1
00400
PH in standard units (6.0 ­ 9.0 FW,
61 — 8.5 SW)
31616
Fecal Collform per 100 ml of
freshwater (if required) (IM)
61211
Enterococci per 100 ml of saltwater
(if required) (SW)
00340
Chemical Oxygen Demand in mg/L
(120)
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
Usage in gal/month
00552
Non -Polar Oil & Grease In mg/L (IS)
* 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 rn2jL
Fed (Freshwater) SW (Saltwater)
I 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 kAowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false Information,
of fines and imprisonment for knowing violations."
Signature of Permit' 4 or belegated Authorized Individual
U0 I
Email Address
Date
cq:m) a � -I
Phone Number