NCG050418_2024 DMR_20240802

NCDEQ Division of Energy,Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG050000
Apparel, Printing, Rubber, Etc.
Click here for instructions
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. NCGO5 0418 Person Collecting Samples:Thomas Haynes
Facility Name: Lydech, Inc.-Yadkinville Laboratory Name: Pace Analytical
Facility County: Yadkin Laboratory Cert. No.: 37738
Discharge during this period:0 Yes 0 No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances?❑Yes ❑■ No
If so,which Tier(I, II,or Ill)?
Part A:Vehicle&Equipment Maintenance Areas—Benchmarks in(Red)
Parameter Parameter Outfall Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class 001 002
N/A Date Sample Collected MM/DD/YYYY No Flow No Flow
00400 pH in standard units(6.0-9.0 FW,
6.8-8.5 SW)
46529 24-Hour Rainfall in inches
00552 Non-Polar Oil&Grease in mg/L(15)
C0530 TSS in mg/L(100 or 50*)
00340 Chemical Oxygen Demand(COD)in
mg/L(120)
NCOIL New Motor/Hydraulic Oil Usage in
gal/month
Notes(optional):110 Gallons Used per Month for the entire facility
"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,including the possibility of fines and imprisonment for
known g violations."6(_,-,,e,97....,_B„,oe- K
Signature of Permittee or Delegated Authorized Individual Date