NCG060382_MONTINORING REPORT_20201204

NCDEQ Division of Energy, Mineral and Land Resources
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Stormwater Discharge Monitoring Report (DMR) Form for NCG060000 _ vC L )
Food and Kindred
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Click here for instructions r
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Reoort(DMR) Upload form a��rthin
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. NCG06 I Person Collecting Samples: John Jambs
Facility Name: Mountalre Farms Inc. -Statesville Breeder Feed Mill Laboratory Name: Statesville Analytical
Facility County: Iredea Laboratory Cert. No.: 44o
Discharge during this period: ❑ Yes M No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances? V Yes ❑ No
If so, which Tier (I, II, or III)? III
Part A. Analytical Monitoring Requirements for Outfalls with industrial Activities— Benchmarks In (Red)
Parameter
Code
Parameter
Outfall 02
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
C
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
00556
Oil & Grease in mg/L (30)
COS30
TSSin mg/L (100 or50•)
00400
pH in standard units (6.0-9.0)
31616
Fecal Coliform per 100 ml of
freshwater(1000)
61211
Enterococci per 100 ml of saltwater
(500
00340
Chemical Oxygen Demand in mg/L
(120
Part B: Vehicle & Equipment Maintenance Areas— Benchmarks in (Red)
Parameter
Code
Parameter
Quit ll
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
- —00552 _.
Nan -Polar Oil & Grease in mg/L (15)
New Motor/Hydraulic Oil Usage in
NCOIL
al/month
• Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HOW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of 50 mil All other water classifications have a benchmark of 100 mg/L.
Notes (optional): October 2020
" 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.'; .
Signature of Permlttee or Delegated Authorized Individual
ai aaa
Date