NCG210099_2020 DMR_20210118

NCDEQ Division of Energy, Mineral and Land Resources
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Complete, sign, scan and submit the DMR via the Stormwator NPDFS Permit Da+a Mr.,,nitori wort (0„�RLUpload Form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the a rapriat nEMLR Regional Office.
Certificate of Coverage No. NCG21 9 Person Collecting Samples: arc_�_ (_*Zlr_ 1
Facility Name: Laboratory Name:..Fmcle ftv �'
Facility County: WDO Laboratory Cert. No, tA1-9-M02g
Discharge during this period: GXes ❑ 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: Vehicle & Equipment Maintenance Areas - Benchmarks in (Red)
Parameter
Code
parameter
Outfall
Outfall 2
Outfall
Outfall
Outfall
N/A
Receiving Stream ClassS��
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
.
00552
Non -Polar Oil & Grease in mg/L (15)
(�]�
C0530
TSS in mg/L (100 or 50*)
00400
pH in standard units (6.0 -- 9.0)
NCOIL
New Motor/Hydraulic Oil Usage in
gal/month
Part B: Analytical Monitoring Requirements - Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Uutfall 2.
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
` Tr
w( IT-; C
N/A
Date Sample Collected MM/DD/YYYY
lie 7024
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L (100 or 50*)
L�JGJ
003A0
Chemical Oxygen Demand in mg/L
toto ✓� j L
/L
njj
(120)
J
* 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. Ad 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 an 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 penaltie for submitting false information, including the possibility of fines and imprisonment for
knowing vio)ation,S.° „ _ /7 4
Signature of Permittee or Delegated Authorized Individual
Date