NCG030447_2021 DMR_20210528

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 D M R to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG03 0447
Person Cot lecting Samples: Jason Haire
Facility Name: Caterpillar Inc.
Laboratory Name: Pace Analytical Services, LLC
Facility County: Lee
Laboratory Cert. No.: 12 , 40 , 633
Discharge during this period: El Yes ❑ No fif no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances7 ❑ Yes ❑ No
If so, which Tier (1, 11, or III)? II
A copy of this D M R has been uploaded electronically via httRs:dedocs.deg.nc.gov/Forms/SW-DMR ❑✓ Yes ✓❑ No
Date Uploaded: 05/28/2021
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Parameter
Outfall1
outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
WS IV
N/A
Date Sample Collected MM/DD/YYYY
05/03/2021
46529
24-Hour Rainfall In inches
0.24 in
C0530
TS5 in mg/L (100 or 50*1
66.3
00400
pH in standard units (6.0-9.0)
6.6
01119
Copper, total recoverable in mg/L
<0.005
(0.010)
01051
Lead, totai recoverable in mg/ L
c0 005
(0.075)
01094
Zinc, total recoverable in mg/ L
U41
(0.126)
78141
Total Toxic Organics (TTO) in mg/L(1)
N/A
(if required)
00552
Nan -Polar Oil & Grease in mg/L (15)
<5.00
Additional parameters for outfails in drainage areas that use >55 gallons per month of new hydraulic oil on average
NCOIL Estimated New Motor/Hydraulic Oil
Usage in gal/month
* OutfaIIs to outstanding Resource Waters (0RW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark T55 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 forgathering the information, the information
submitted i , t the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false infer ation, includinythe aossibility of fines and imprisonment for knowing violations."
S1gAture of Permitte4,orB'11egated Authorized Individual
01
Da
Email Address Phone Number

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 (TTO), 1 certifythat 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 discharge monitoring report. I further certify that this facility is implementing all the provisions of the Solvent
Management Plan included in the Stormwater Pollution Prevention Plan."
5ignatdre of Permittee or Delegated Authorized individual
Date
Email Address Phone Number