NCG060114_2022 DMR_20220826

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG060000
Food and Kindred
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 a ppropriate DE MLR Regional Office.
Certificate of Coverage No. NCG06 0 11 '4
Person Collecting Samples:
Facility Name: l Njfy nl J h} 11 S
Laboratory Name:
Facility County: M
Laboratory Cert, No.: VC-7-7lcj -�{4 ' R 7
Discharge during this period: Yes ❑ No (if no, skip to signature and date)
Has your facility implemented mandatory Fier response actions this sample period for any benchmark exceedances? W Yes ❑ No
If so, which Tier (I, II, or III)? `7I C Y
A copy of this DMR has been uploaded electronically via https.//edocs.deg.nc.gov/Forms/SW-OMR ❑ Yes [—]No
Date Uploaded: � - .-) 11 • 2c)
Analytical Monitoring Requirements for ❑utfalls with Industrial Activities — Benchmarks in (Red)
Parameter
parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
CIA
N/A
Date Sample Collected MM/DD/YYYY
12 22
46529
24-Hour Rainfall in inches
. 2
C0530
TSS in mg/L (100 or 50*)
If2 _ rS
pH in standard units (6.0-9.0 FW,
00400
6.8-8.55W)
_
S
31616
Fecal Coliform per 100 ml of
freshwater (if required) (1000)
�•
61211
Enterococci per 100 ml of saltwater
(if required) (500)
Chemical Oxygen Demand in mg/L
00340
(120)
1i . 11 -
Additional parameters for outfa[is in drainage areas t at use >55 gallons per month of new hydraulic oil on average
NCOIL
Estimated New Motor/Hydraulic Oil
Usage in gal/month
00552
Non-Potar Oil & Grease in mg/L (15)
* OutfaIIs to Outstanding Resource Waters (oRW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of 50 mgJL. All other water classifications have a benchmark of 100 mg/L
FW (Freshwater) SW (Saltwater)
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 knowledge and belief, true, accurate, and complete. I am aware that there are signfficant penalties for submitting
false infor ation, including the possibility of fines and imprisonment for knowing violations."
i� 7 r 7 y
Permittee or
egated Authorized Individual
*1LL.i re vk-� cuo uvet. � (any
Email Address
Date
(C/!6)- V/) 2-
Phone Number