NCG060139_2022 DMR_20220603

NCDEQ Division of Energy, Mineral and Land Resources
Complete, sign, scan and submit the DMR via the . -,-_ _ -.:_ within
30 days of receiving sampling results. Mall the original, signed hard copy of the DMR to the .
j Certificate of Coverage No. NCG06 ® (.3 q Person Collecting Samples:
Facility Name_s,yi ; t, ; e(� 4�, cal [ � �Gl; ti�a•� Laboratory NameSm ; � l ,�✓iro�n6� bj t' asr g�, �i.•�
Facility County: 5'4„.�so, Laboratory Cert. No.: W u� C F 116 1 Cl
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ddtJ
Discharge during this period: Yes ❑ No (rf no, skip to signature on
Has your faciiity implemented mandatory Tier response actions this samLle veriod for any benchmark exceedances? [4 Yes ❑ No
If so, which Tier (1, II, or 111)?
_-
'
❑Yes ❑ No
A copy of this DMR h n be uploaded electronically via
Date Uploaded:
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Analytical Monitoring Requirements for Outfalls
with Industrial Activities - Benchmarks in "at;,')
Parameter i
Parameter
? I
Outfall I Outfall Outfall Outfall
+ Outfall
Code
N/A Receiving Stream Class
N/A Date sample Collected MM/DD/YYYY
5�� t�yi--
46529 24-How Rainfall in lnches
Q.
C0530 i TSS In mg/L(W)sir,150*I
L 14 2 - ---.
1._ 00400
' pH in standard units jc. ` - 9.0 :°VJ"
O p
i 5.8 - 8.5 SW)-
-
-
31616 Fecal Coliform per 100 ml of
I freshwater Of required) t1000)
.� 7 41 Lv
%'Zy2fv M'400
61211 Enterococcl per 100 mi of saltwater
(if required) -
Chemical Oxygen Demand in mg/L
00340 _ I
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
NC01L Estimated New Motor/Hydraulic Oil
Usage in gal/month-
_ 00552 Non -Polar Oil & Grease in mg/L S; - _ _,,
f Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of ru r.i /L. All other water classifications have a benchmark of ;;1 ? m c;'
W (Freshwater) Sf:; (Saltwater)
I Notes(optional):
111 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 wledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false i=,udinillty of fines and Imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual Date
Email Address Phone Number