NCG060326_2021 DMR_20210708

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCGO60000
Food and Kindred
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 jappropriate DEMLR Regional Office.
Certificate of Coverage No. NCG06 03 P-t, Person Collecting Samples: "A'I �r6or�
Facility Name: ]3,,,v �oar�► Irr►, y—cam Laboratory Name: Epj:tr7�wa6xTiY}{_ Cfla;�►ti3r 1NU
Facility County: p�py Laboratory Cert. No.: p,�,2 spq p!fs � 377a
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 (1, 11, or Ill)?
A copy of this DMR has been uploaded electronically via htt s: edocs.de .nc. ov Forms 5W DMR ®Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code Parameter Outfall - ( Outfall Outfall Outfall Outfall
N/A Receiving Stream Class
N/A Date Sample Collected MM/DD/YYYY {p �� ! t0 !4. f
46529 24-Hour Rainfall in inches
.3 .3
C0530 TSS in mg/L (100 or 50*) 1 3 133
00400 pH in standard units (6.0 — 9.01 G to L a
00556 oil & Grease in mg/L (30) C S.0 C S• o
31616 Fecal Coliform per 100 ml of
freshwater (if required) (1000)
61211 Enterococci per 100 ml of saltwater
(if required) (500)
00340 Chemical Oxygen Demand in mg/L ri
(120) l} S
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)
* 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)
"t certify by my signature below, under penalty of law, that this document and ail 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. f am aware that there are significant penalties for submitting
false irformazJop!,tncluding the possibility of fines and irnprisonmeni for knowing violzN-m.� "
S ature of Permittee or Authorized le ated
Ja Individual Date
Email Address Phone Number
5c,o ++ , rams z1 [� bong e . cc2t, 14) - (-)Q ZCo