NCG030712_2021 DMR_20210608

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 the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG03 0712
Person Collecting Samples: Jeff Gedock
Facility Name: Intertractor America Corp
Laboratory Name: Meritech, Inc.
Facility County: Forsyth
Laboratory Cert. No.: 165
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, II, or III)?
A copy of this DMR has been uploaded electronically via https:l/edocs.deg.nc.izovIForms/SW-DMR_ ❑✓ Yes ❑ No
Date Uploaded: June 2021
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Parameter
Outfall OF-1
Outfall
Outfall
0utfall
Outfall
Code
N/A
Receiving Stream Class
C
N/A
Date Sample Collected MM/DD/YYYY
4-24-2021
46529
24-Hour Rainfall in inches
0.76
C0530
TSS in mg/L (100 or 50*)
4
00400
pH in standard units (6.0-9.0)
7.24
01119
Copper, total recoverable in mg/L
0.004
(0.010)
01051
Lead, total recoverable in mg/ L
<0.010
(0.075
01094
Zinc, total recoverable in mg/ L
0.059
(0.126)
Total Toxic Organics (TTO) in mg/L(1)
NA
78141
(if required)
00552
Non -Polar Oil & Grease in mg/L (15)
<5
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
Estimated New Motor/Hydraulic Oil
NCOIL
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 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 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 submitting
false information, including the possibility of fines and imprisonment for knowing violations."
ature of Permittee or Delegated Authorized Individual
Email Address
-TSC(4,-) o7X97/14eGi %/nF!C_evl, 4 0 M
G 7/-2
Date
Phone Number