NCG190050_2020 DMR_20201208

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG190000
Marinas
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. NCG19 J�C',5-o
Facility Name: -S�'b
Person Collecting Samples: i2d -1-1 661E 4_777 �
Laboratory Name:,�'c
Facility County:['r
Laboratory Cert. No.:
Parameter Code: 46529 - 24-Hour Rainfall in inches C! f
Discharge during this period: Plyes ❑ No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances? ❑ Yes No N07 YE-7-
If so, which Tier (I, II, or III)? W j'ill j ,1 i; eS ti T G/ tc .�4Lr/�P[r ,� 4,. S Esvo � a�L
Monitoring Requirements - Benchmarks in (Red)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
SA; Aw
N/A
Date Sample Collected MM/DD/YYYY
I f oq aDaj)
NCOIL
Average Monthly Oil Usage at Facility (gals)
qj 6w
00552
Non -Polar Oil & Grease in mg/L (15)
<15*fA& L
C0530
TSS in mg/L (100 or 50*)
f� 5or,,,6 A
00340
Chemical Oxygen Demand in mg/L (120)
(apM(r
00400
pH (6-9)
9 ��
01105
Aluminum, total recoverable in mg/ L (0.75)
, 6�3rA
01033
Chromium III, total recoverable in mg/L at
certain facilities'(0.905 FW, none SW)
= t)1 p9E Ii
C0034
Chromium VI, total recoverable in mg/L at
++
<)
certain facilities'(0.016 FW, 1.1 SW)
1 )64
01119
Copper, total recoverable in mg/L (0.010 FW,
�)fP�L
0.005 SW)
01114
Lead, total recoverable in mg/ L (0.075 FW,
/
0.220 SW)
01067
Nickel, total recoverable in mg/ L (0.335 FW,
0.074 SW)
01094
Zinc, total recoverable in mg/ L (0.126 FW,
0.095 SW)
* 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. .
1 Only required for Ship and Boat building and Repairing [SIC 373] facilities that perform metal fabrication in areas that could
potentially be exposed to stormwater.
FW Freshwate , W Saltwater) Tfr-,
Notes (optional): V641—,1/9L1- $�; c�i?�» cV?':V% L'Yt ! r� T /�'Crtvy �'� L riTi ���.�/s J::i ii :'�i1 ?7 4f' J5
"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
0SC67. C>>Z 08 e 202-0
of Permittee or Delega ed Authorized Individual Date