NCG120095_2021 DMR_20210315

NCDEQ Division of Energy, Mineral and Land Resources
Discharge Monitoring Report (DMR) Instructions
Completing the DMR Form:
1. The total precipitation shall be recorded using data from an on -site rain gauge.
Unattended sites may be eligible for a waiver of the rain gauge requirement if
approved in writing by the applicable DEMLR Regional Office.
2. Sampling results for each parameter shall be compared to the benchmark values for
the appropriate receiving stream classification (listed in parentheses).
3. Monitoring results shall be in numerical format; below detection limit (BDL), non -
detect (ND) or other non -numerical formats are not acceptable. When results are
below detection limits, they must be reported in the format "<XX mg/L," where "XX" is
the numerical detection limit in mg/L. Where fecal coliform results (if applicable)
exceed the dilution upper limit, the result should be reported as ">XX".
4. For sampling periods with no discharge at any single outfall, the DMR report is still
required to be completed and submitted.
If the sampled storm event coincides with a known non-stormwater discharge that is
deemed permitted under 15A NCAC 02H .0106, then this shall be noted on the DMR in
the notes section.
6. If any pollutant is sampled more frequently than required by the general permit and at
a sampling location covered under the general permit, then per permitting
requirements, those sampling results must be submitted on a DMR.
Submitting the DMR Form:
Do not send paper DMRs to the Central Files.
1. 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.
2. Mail the original, signed hard copy of the DMR to the appropriate DEMLR Regional Office.

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG120000
Landfills
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. NCG12 0095
Person Collecting Samples: David Reedy
Facility Name: Old Salisbury Road Landfill
Laboratory Name: Pace Analytical
Facility County: Forsyth
Laboratory Cert. No.: NC633
Discharge during this period: ❑ Yes ✓❑ No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? ElYes [] No
If so, which Tier (I, II, or III)?
❑✓ Yes ❑ No
A copy of this DMR has been uploaded electronically via https•//edocs deg.nc.gov/Forms/SW-DMR
Date Uploaded: 03/15/21
,�i..+a 1 Mnni+nrino RpnuiremPnts for Outfalls with Industrial Activities — Benchmarks in
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L (100 or 50*)
00400
pH in standard units (6.0 — 9.0)
00340
Chemical Oxygen Demand in mg/L
31616
Fecal Coliform in # per 100 ml .�
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
00552
Non -Polar Oil & Grease in mg/L 15)
NCOIL
Estimated New Motor/Hydraulic Oil
Usage in gal/month
Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQw), Trout Waters tI r) and PrInlaly IVUI=1y rlcam,u-1
have a benchmark TSS limit of , . All other water classifications have a benchmark of 1U0 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 knowle ge.aa elief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false information, inck d' y of fines and impriso ent for
or DelegateTAuthorized
Email Address [e-mail]
03/ 15/21
Date
Phone Number 336-734-1565