NCG030538_2022 DMR_20220407

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG030000
Metal Fabrication
Click here for instructions
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. NCG030538
Person Collecting Samples: Jessica Clark
Facility Name: CVG
Laboratory Name: PAR Labs
Facility County: Cleveland
Laboratory Cert. No.: 20
Discharge during this period:
El
Yes
0
No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? Lj Yes No
If so, which Tier (1, II, or III)?
A copy of this DMR has been uploaded electronically via htt s: edocs.de .nc. ov Forms SW-DMR QYes U No
Date Uploaded: 4/7/2022
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
1
N/A
Date Sample Collected MM/DD/YYYY
31612022
46529
24 Hour Rainfall in inches
1.2
C0530
TSS in mg/L (100 or 50*)
<5
00400
pH in standard units (6.0 — 9.0 FW,
5.69
6.8-8.5 SW)
Copper, total recoverable in mg/L
01119
(0.010 FW, 0.0058 SW)
O.D1 i
Lead, total recoverable in mg/ L
01051
(0.075 FW, 0.22 SW)
<.002
Zinc, total recoverable in mg/ L (0.126
01094
FW, 0.095 SW)
255
Chem'cal Oxygen Demand (COD) in
00340
mg/L (120)
17
00552
Non Polar Oil & Grease in mg/L (15)
<52
' 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/t
FW (Freshwater) sw (Saltwater)
Notes (optional):
"I certify by my signature brlDw, 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
in ry the person or persons who manage the system, or those persons directly responsible for gathering the information, the information
Pmittel is, to the best of my knowledge and belief, true, accurate, and complete. r am aware that there are significant penalties for submitting
false info mation, including thV0NjW lWf fines and imprisonment for knowing violations."
4/7/2022
of Permittee or Delegated Authorized Individual Date
[e-mail]
Email Address
704-937-4434
Phone Number

PAR
PROMPT•ACCURATE• RELIABLE
LABQRATORIES, INC
WWW.PARLABS.COM
REPORT OF ANALYSE;
Attn: JON TAYLOR
CVG MAYFLOWER VEHICLE SYSTEMS PROJECT NAME: MAR 22
PO Box 789 DATE: 04/06/22
KINGS MOUNTAIN, NC 28086-3607
SAM13LE NUMBER-
144055
SAMPLE ID- C:VG STOR14WATER
SAMPLE MATRIX- WW
DATE SAMPLED
03/16/22
TIME SAMPLED- 1350
DATE RECEIVED-
03/22/22
SAMPLER- JC
RECEIVED BY- DJ
TIME RECEIVED-
1400
DELIVERED BY- RE
TYPE SAMPLE- Grab
Page 1 of
ANALYSIS
ANALYSIS
METHOD DATE TIME BY
RESULT UNITS
FIELD TEMPERA='URF,
pH VALUE
CHEM.OXY.DEMAND
OIL S GREASE
TOTAL SUSPENDED SOLIDS
COPPER, TOTAL
LEAD, TOTAL
ZINC, TOTAL
Y'HERH, 03/16/22 1350 JC
SM 450OH-13 03/16/22 1350 JC
EPA 410.4 03/23/22 0620 CT
EPA 1664 04/01/22 1030 CT
SM 2540 D 03/23/22 0915 DJ
EPA 200.7 03/29/22 1653 EV
EPA 200.7 03/29/22 1653 EV
EPA 200.7 03/29/22 1653 EV
f,AIOPATORY DIRECTOR i.r
2217 Orahani Park Urine • Charlotte, INC 28273
Phone: [phone] • Fax: [phone]
11,7 degrees C
5.69 units
17 mg/L
< 5.2 mg/L
< 5 mg/L
0.011 mg/L
c 0-002 mg/L
0.255 mg/L

PRQMPT��CCUtiA 6 RSL149LE
CHAIN OF CUSTODY
Phone [phone]
Fax [phone]
LABORATORIES, INC
Shipping ti Mailing:
2217 Graham Park Drive
Charlotte, NC 28273
IS rs essential that ad information be recorded or, tn.s Cna-r+ ut Cosloay dacunre^[ for aeteptan[a t}, PAR L abowones Inc and the North
Caeolini lrnent of Environmental and Nalural Resources
Company Name (billing) Comments/ S cial Instructions
CVG MAYFLOWER
Address
PO BOX 789
City, Stale It zip code pH Y"�q
KING$ MOUNTAIN, NC 28086
Point of Contact 8 Telephone Nt-m}1?
+ C-Q C1cwk- '7Dq-437-qd2
Sample Taken By: SIGNATUR PRINTED NAME,Is.-Q( tV
om,
ARE SAMPLES FOR STATE cVEPA REPORTING? YES X NO
'Sample Type, ow ww X _ GwMw Kw Soil Other
Sample Tomp at time of sampling: �} �� • C Sample Temp upon receipt: ° C
"Field Preserved: Yes X No Teflon Liner/Zero Headspace: Yes No nla X
Residual Chlorine checked at time of sampling (Y/N): Dechlorination Necessary (YIN):
liant Sample I D.
Sample Location 1 Number)
Comp
Grab
Preswy
<4`C
Set Up
Date/Trme
3 u ! ��
Cohadlon
Oate/Tkne
sysea
ueated
SS
u Pb, Zn
OIL S GREASE
TORMWATER
X
Ili
X
X
HNo,
H'5a'
<46C
.alit, (;�
y/4
tf LL ! . �e
13/tU 1,
3/114
X
Unqulsneo Dy
uater r ime Ker e, ea u}
ualm 1 li'm
C
Relinquished by
atelTrma Race v
DatelTirne
Q,
--
C=Composite G-Grab DW-Dnntttng Wate• WW--Wastewater GWMW=groundwater Mon-tonng Well hW=Hazardous Waste
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