NCG120058_2022 DMR_20220411

NCDEQ Division of Energy, Mineral and Land Resources
Starry water Discharge Monitoring Depart (DEM ) Form for NCG 20000
Landfills
Click here for instructions
Complete, sign, scan and submit the DMR via the 5tormwater 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 Ronal Office.
Analytical Monitoring Requirements for Outfalls with Industrial Activities-- Benchmarks in died!
�—I=111 to W U LO Ld tIUIF IV, nubuurce vvaters AuKvv), Hlgn QUallty 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.
FVV (Freshwater) SW (Saltwater)
Notes (optional):
"l 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 properiy gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, orthose persons directly responsible for gathering the information, the information
submitted is, to the best oNny knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false infoyflaVon, includinkthe possipiJity of fines and imprisonment for knowing violations."
of P ' ee or Delegated Authorized Individual Date
Email Address
Phone Number
G