NCG060069_2022 DMR_20220726

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
Lertincate or coverage ivo. ivWUbU-JW-11
Facility Name.
r
Facility County -
Discharge during this period: ® Yes ❑ No (if no, slop to signature and date)
Person Collecting Samples:
Laboratory Name
Laboratory Cert No : 40
within
HCAA -t
Has your facility implemented mandatory Tier response act ons this sample period for any benchmark exceedances? ❑ Yes ® No
if so, which Tier (I. it, or Illy
A copy of this DMR has been uploaded electron tally via Yes ❑ No #
Date Uploaded
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in
i Parameter
Code Parameter Outfall (1�1� Outfall (S� Outfall
N/A
Receiving Stream Class
\(-5 • V
W — v
>N/A
Y
Date Sample Collected MM/t7D/Ywe
040 •'S9
(NY-w-aoa�
46529
i 24-Hour Rainfall in inches
0 . as
Q ► (D-3
C0530
i TS5 in mg/L . i. is
_
I
Outfall Outfall
f
00400 I pH in standard units
31616 Fecal Coliform per 100 ml of
I
freshwater (if required)
61211 Enterococci per 100 ml of saltwater
!�
f A
I
(if required) :.
N
i W A
00340 I Chemical Oxygen Demand in mg/L
_
o
Additional parameters for outfalls in drainage
areas that use >55 gallons per month of ne�u h� draulic oil on average
NCOI L Estimated NOw Nlotor/Hydraulic Oil
_ Usage in gat/months
f 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 of All other water
classifications have
a benchmark of
(Freshwater) (Saltwater)
Notes loot onall:
.I certify oy my >ionaiure below urje- p2nalt/ of la'.v, that this document and all au3criments :vere prepared' Under m1 ciire�ticr. or sUoer-I-lion i;,
accordance With a s`jstem designeo to assure that qualified personnel properly gather and evaluate the inforrnatiOn $Upmlt:ed Based on my
,no,iry of the person or oerrors who manage t?:e s /item, cr those persons directly respons ble f 7r gather ng the irfcr-na-ion, the nformat on
suorri tied s, cc) the best of my know -edge and belle', true acrurate, and complete I am a,v3re that there are s aniflcant Oenalnes for submitting
to se,)formation, including the posy 611 ty of fines and imprisonment for knowing viz atipr,s
Signature of Permittee or Delegated Authorized Individual
1 W�L
Date
Um - M V Coves 1!�3 � q3 � (0 6
Email Address Phone Number _