NCG120107_2020 DMR_20200921 (7)

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG120000
Landfills
Click here for instructions
1 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. NCG12 0 1 0 7 Person Collecting Samples:
Facility Name: Great Oak Landfill Laboratory Name:
Facility County: Randolph Laboratory Cert. No.:
Discharge during this period: ❑ Yes ❑■ No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances? ❑ Yes K No
If so, which Tier (I, II, or III)? II
Part A: Analytical Monitoring Requirements for outfalls with Industrial Activities— Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
NIA
Receiving Stream Class
Due to COVID-19 and the safety of
NIA
Date Sample Collected MM/DD/YYYN
Great Oak employees and Contractors,
46529
24-Hour Rainfall in inches
the monthly Tier II sampling (S132W) has
COS30
TSS In mg/L (100 or 500)
pH In standard units (6.0--9.0)
Fecal Coliform per 100 ml of
been suspended through August 2020.
Beginning in September 2020,
Sampling will resume.
00400
31616
freshwater (1000
Chemical Oxygen Demand In mg/L
00340
f
Part B: Vehicle & Equipment Maintenance Areas — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
00552
Non -Polar Oil & Grease in mg/L Its)
New Motor/Hydraulic Oil Usage in
NCOIL
gal/month
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), 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.
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 significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations."
�_ P-r—
Signature of Permittee or Delegated
q l{ LOLa
Efate