NCG030088_2020 DMR_20210125

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG030000
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DM 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. NCG03 0 D 8 8 Person Collecting Samples: Charles Dickerson
Facility Name: BSH home Appliances Carp. Laboratory !Name:
Facility County: Craven Laboratory Cert. No.:
Discharge during this period: ❑ Yes ■ No (if no, skip to signature and dote)
Has your facility implemented mandatory Tier response actions for any benchmark exceed antes? ❑ Yes ❑■ No
If so, which Tier (1,11, or lll)?
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall 1
Outfall 2
Outfall 3
Outfall4
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
1 24-Hour Rainfall in inches
00552
Non -Polar Oil & Grease in mg/L (15)
C0530
T55 in mg/L (100 or 50*)
00400
pH in standard units (6.0 — 9.0)
New Motor/Hydraulic Oil Usage in
NCOIL
gal/month
Copper, total recoverable in mg/L
01119
(0.010 FW, 0.005 SW)
Lead, total recoverable in mg/ L
01051
(0.075 FW, 0.220 SW)
01094
Zinc, total recoverable in mg/ L (0.126
FW, 0.095 5W)
78141
Total Toxic Organics (TTO) in mg/L(1)
* ❑utfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TS5 limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L.
Notes (optional): Due to multiple shutdowns. quarantines, and other Cavid related issues, a measurable event was not recorded. Period 7-20 thru. 12-20
"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 property 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." /--\
ignature of Permittee or Delegated Authorized Individual
1 /25/2021
Date