NCG060351_2021 DMR_20210616

NCDEQ Division of Energy, Mineral and Land Resources
Storrriwater Discharge Monitoring Report (DMR) Fora for NCGO6000O
Food and Kindred
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report DMR Unload 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. N G06 p
J
Person Collecting Sample , r .. '
Facility Name;
44Laboratory
Laboratory Name/
Facility County:
Cert, No.:
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 o
If so, which Tier (I, II, or III)?
FA opy of this DMR has been uploaded electronically via htt s: edocs.decncov Farms SW aMR ❑Yes ®No
te Uploaded:
Analytical Monitoring Requirements for Outfails with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class`
r
N/A
Date Sample Collected MM/DD/YYYY
�
> -22
46529
24-Hour Rainfall in inches„
CO530
TSS in mg/L (100 or 50*)
j3
Gp_
00400
pH in standard units (6.0-- 9.0)
00556
Oil & Grease in mg/L (30)
31616
Fecal Coliform per 100 mi of
AJ Iv,4
&1KA
/U
freshwater (if required) (1000)
/A
61211
Enterococci per 100 ml of saltwater
, Li
rt✓ I
%4
(if required) 500)
00340
Chemical Oxygen Demand in mg/L
4
Wit'
�jj
(120)�'
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
Usage in gal/month
00552
Non -Polar Oil & Grease in mg/L (15)
* Outfalis 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, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
,fefs nation, Including the possj ty of fines and imprisonment for knowing violations."
Signature of Permittee or Deleg'dted Authorized individual
Email Address
Da e
Phone Number
704/-86,9-37i2-