HomeMy WebLinkAboutNCG060257_Monitoring Info_20201124IBC Department c'
Environmental Quaii' �,y
Received
NCDEQ Division of Energy, Mineral and Land Resources NOV 2 4 2020
Stormwater Discharge Monitoring Report (DMR) Form for NCG06000(winston-Salet;'I
Food and Kindred Regional C1-'
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. NCG06 0 2 5 7 Person Collecting Samples: Allen Spencer
Facility Name: MOM Brands Laboratory Name: Pace Analytical
Facility County: Randolph Laboratory Cert. No.: 37706, 5342, 12, 37712, 40, 37738, 633
Discharge during this period: Q Yes ® No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances? ® Yes H No
If so, which Tier (I, II, or III)?
Part A: Analytical Monitoring Requirements for Outfalls with Industrial Activities® Benchmarks in (ked)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
C
N/A
Date Sample Collected MM/DD/YYYY
10/29/2020
46529
24-Hour Rainfall in inches
.25
00556
Oil & Grease in mg/L (30)
<5
C0530
TSS in mg/L (100 or 50*)
5.5
00400
pH in standard units (6.0 = 9.0)
6.0
31616
Fecal Coliform per 100 ml of
freshwater () 00i))
61211
Enterococci per 100 ml of saltwater
(5w,1)
00340
Chemical Oxygen Demand in mg/L
28.2
(120)
Part tso venicie & tquipment Maintenance Areas ® Benchmarks in (fte0)
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 (I)
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 Y, wgll . All other water classifications have a benchmark of 100 mg/t.
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
knowin4iolations."
Signafur4 of Pe flee or Delegated Authorized Individual
I �C� O
Date
NC Department of
Environmental Quality
Received
NCDEQ Division of Energy, Mineral and Land Resources NOV 2 4 2020
Stormwater Discharge Monitoring Report (DMR) Form for NCG0600PAnston-Salem
Food and Kindred R
eglonal 0mce
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. NCG061 0 12 15 171 Person Collecting Samples: Allen Spencer
Facility Name: MOM Brands Laboratory Name: Pace Analytical
Facility County: Randolph 0 Laboratory Cert. No.: 37706, 5342, 12, 37712, 40, 37738, 633
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 ❑■ No
If so, which Tier (I, II, or III)?
Part A: Analytical Monitoring Requirements for Outfalls with Industrial Activities— Benchmarks in (iced)
Parameter
Code
Parameter
Outfall
Outfall�
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
C
N/A
Date Sample Collected MM/DD/YYYY
10/29/2020
46529
24-Hour Rainfall in inches
.25
00556
Oil & Grease in mg/L (30)
<5
C0530
TSS in mg/L (100 or 50*)
5.5
00400
pH in standard units (6.0 — 9.0)
6.0
Fecal Coliform per 100 ml of
31616
freshwater (1000)
61211
Enterococci per 100 ml of saltwater
(500)
00340
Chemical Oxygen Demand in mg/L
^� L
L
(1,20)
.
Part B: Vehicle & Equipment Maintenance Areas — Benchmarks in (Red)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
00552
Non -Polar Oil & Grease in mg/L (15)
„�
Iv�01'
New Motor/Hydraulic Oil Usage in
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
knowinW�iolations."
Signafur� of Pe it a or Delegated Authorized Ind ivi d au I
I -�C) O
Date