NCG060379_2021 DMR_20210217

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG060000
Food and Kindred
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 approeriate DEMLR Regional Office.
Certificate of Coverage No. NCG06® Person Collecting Samples: A\ovey fanez
Facility Name: fi Snncs Laboratory Name: e0mv v.'C'eS41,%y, ?i Iyi na.d 17c Rd 14 b
Facility County: Qj,4oj h Laboratory Cert. No.: (eS4 NO
Discharge during this period: 5C] 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, li, or III)? I
Part A: Analytical Monitoring Requirements for Outfalls with Industrial Activities- Benchmarks in (Red)
Parameter
Parameter
Outfall i
(joN/A
Outfall 60 1-Outfall
Oo
Outfall
Outfall
Receiving Stream Class
WakS
N/A
Date Sample Collected MM/DD/YYYY
p zi
dt �t (
et ref (UTA
46529
24-Hour Rainfall in inches
6.q 3C),
q -3
00556
Oil & Grease in mg/L (30)
-e S
< 5,e
S
C0530
TSS in mg/L (100 or 50*1
aSq
a c(b
l31
00400
pH in standard units (6.0- 9.0)
'] , y
(� ,[1 L1
, Z
31616
Fecal Coliform per 100 ml of
freshwater (1000)
61211
Enterococci per 100 ml of saltwater
{500)
00340
Chemical Oxygen Demand in mg/L
(120)
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 (15)
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 sub Ise information, including the possibility of fines and imprisonment for
knowing violations."
Signature o ermittee or Delegated Authorized Individual Date '
x