NCG030513_2021 DMR_20210712

The Goodyear Tire & Robber Company ---- Statesville Mold Plant
108 Business Park Drive
Statesville, NC 28677
July 12, 2021
DEQ Mooresville Regional Office
Attn: DEMLR Stormwater Program
610 East Center Avenue
Suite 301
Mooresville, NC 28115
RE: Storm Water DMR, General Permit NCG030000, COG NCG030513
Dear Mr. or Ms.,
The Goodyear Tire & Rubber Company — Statesville Mold Plant is covered under North Carolina General Storm
Water Permit NCG030000. The permit requires submission of a discharge monitoring report within 30-days of
receiving analytical results.
No events occurred during the months of January through June, so no sample was collected from outfall 91.
If further information is required please do not hesitate to contact me at 704-928-4505.
Sincerely,
Nick Fugitt
Quality Manager
The Goodyear Tire & Rubber Company

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report ([AMR) Form for NC6030000
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 0513
Person Collecting Samples: Nicholas Fugitt
Facility Name: Goodyear Statesville
laboratory Name: NA
Facility County: Iredell
Laboratory Cert, No.: NA
Discharge during this period: ❑ Yes ❑J No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions
If so, which Tier (l, II, or Ill)?
this sample period for any benchmark exceedances? ❑ Yes ❑ No
A copy of this DMR has been uploaded electronically via htt s:
Date Uploaded:
edocs.de .nc, ov Forms SW-DMR ❑ Yes ❑ No
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
code
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L (100 or 50*)
00400
pH in standard units (6.0 9.0)
01119
Copper, total recoverable in mg/L
(0.010)
01051
Lead, total recoverable in rng/ L
(0.075)
Zinc, total recoverable in mg/ L
01094
(0.126)
Total Toxic Organics (TTO) in mg/L(1)
78141
(if required)
00552
Non -Polar Oil & Grease in mg/L (15)
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 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
false information, including the possibility of fines and Imprisonment for knowing violations,"
Signature ©f PermittecAr Delegated Authorized Individual
-7ZaZZcr 1
Da e
Email Address )[e-mail] Phone Number 704 928 4503

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), I certify that 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."
Signature of`permittee or D�iegated Authorized Individual
Email Address [e-mail]
-7,9,2 C�
Oa e
Phone Number 704 928 4503