NCG030061_2021 DMR_20210519

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 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 theappropriate DEMLR Regional Office.
Certificate of Coverage No. NCG03 0061 Person Collecting Samples: Jack Taylor
Facility Name: Moen Laboratory Name: Environment 1 Inc
Facility County: Craven Laboratory Cert. No.: 10
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? ❑ Yes ❑ No
If so, which Tier (I, ll, or III)?
A copy of this DMR has been uploaded electronically via htt s: edocs.de .nc. ov Forms SW-DMR 0 Yes ❑ No
Date Uploaded: 5/2/21 J
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter Code Parameter Outfall001 Outfall002 Outfall Outfall Outfall
N/A Receiving Stream Class Other Other
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)
01119 Copper, total recoverable in mg/L
(0.010)
01051 Lead, total recoverable in mg/ L
(0.075)
01094 Zinc, total recoverable in mg/ L
(0.126)
78141 Total Toxic Organics (TTO) in mg/L(1)
(if required)
00552 Non -Polar Oil & Grease in mg/L (15)
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
NCOIL Estimated New Motor/Hydraulic Oil N/A N/A
Usage in 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, jo�th q(}my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false inform on; n di He possibility of fines and imprisonment for knowingviolations."
Signature of Permi
or Delegated Authorized Individual
_5A_1 ' �,(
Date
Email Address Kati6,F ritzier@moen Phone Number [phone] ext. 6341

Total Toxic Organics Certification:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring
requirement for total toxic organics (70), 1 certify that to the best of my knowledge and belief, no leak, spill, or dumping of
concentrated toxic organics into the stormwater or onto areas which are exposed to rainfall or stormwater runoff has occurred since
filing the last disc�ge monitoring report. I further certify that this facility is implementing all the provisions of the Solvent
Mana emcn Plan i cluded in the Stormwater Pollution Prevention Plan."
A
of Pe rmi tee or Delegated Authorized Individual Date
Email Address Kat [e-mail] Phone Number [phone] ext. 6341