NCG060161_2022 DMR_20221026

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG060000
Food and Kindred
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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. NCG06 0161 Person Collecting Samples: Katie Bernal
Facility Name:Clement Pappas NC LLC Laboratory Name: Pace Analytical
Facility County: Henderson Laboratory Cert. No.:40
Discharge during this period:©Yes El No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?EYes p No
If so,which Tier(I, II,or Ill)?
A copy of this DMR has been uploaded electronically via https://edocs-deq.nc gee!/Fornts/SW•DMR ElYes Q No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall 001 Outfall 002 Outfall 003 Outfall Outfall
Code
N/A Receiving Stream Class C C IC
N/A Date Sample Collected MM/DD/YYYY n/a n/a n/a
46529 24-Hour Rainfall in inches n/a I n/a n/a
C0530 TSS in mg/L(100 or 501 n/a n/a n/a
00400 pH in standard units(6.0—9.0 FW, n/a n/a n/a
6.8-8.5SW) _
00556 Oil&Grease in mg/L(30) n/a n/a n/a
Fecal Coliform per 100 ml of
31616 freshwater(if required)(1000) n/a n/a n/a
61211 Enterococci per 100 ml of saltwater n/a n/a n/a
(if required)(500) _
00340 Chemical Oxygen Demand in mg/L n/a n/a n/a
(120)
Additional parameters for outfalls in drainage areas that use>55 gallons per month of new hydraulic oil on average
Estimated New Motor/Hydraulic Oil
NCOIL n/a n/a n/a
Usage in gal/month
00552 Non-Polar Oil&Grease in mg/L(15) n/a n/a n/a
*Outfalls to Outstanding Resource Waters(ORW),High Quality Waters(HOW),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
FW(Freshwater)SW(Saltwater)
Notes(optional): Q3 2022 monitoring period;no discharge
"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 significant penalties for submitting
false information,i ding the possibility of fines and imprisonment for knowing violations,"
� l /60 /D -—21 .zx
Signature of Permittee or Delegated Authorized Individual Date
[e-mail] 828-693-0711 ext1707
Email Address Phone Number