NCG060295_2021 DMR_20210319

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG06000v
Food and Kindred
Click here for instructions
Complete, sign, scan and submitthe 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 9 5
Person Collecting Samples: Robert Jackson
Facility Name: Mountaim Farms Inc. -Lumber Bridge Processing Plant Laboratory Name: Cameron Testing Services, Inc.
Facility County: Robeson I Laboratory Cert, No.: 645
Discharge during this period: Q Yes ❑ No (if no, skip to signature and date)
Has your facility implemented mandatoryTier response actions for any benchmark exceedances? 0 Yes ❑ No
If so, which Tier (I, 11, or III)? 111
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Part B: Vehicle &Equipment Maintenance Areas— Benchmarks in (Rep)
Parameter
parameter
Outfall2
Outfall
Outfall
Outfall
OutFall
Code
N/A
Receiving Stream Class
C;Sw
N/A
Date Sample Collected MM/DD/YYYY
03/03/2021
00552
Non -Polar Oil &Grease in mg/L(15)
<5.00
NCOIL
New Motor/Hydraulic Oil Usage in
440
gal/month
* Outfalls to outstanding Resource
Waters (ORW), High Quality Waters
(HOW), 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): March 2021
"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 pegalties for sub mni .ng false information, including the possibility of fines and imprisonment for
knowing violati9ns� / /
Signature of'�ermittee or Delegated Authorized Individual
Date