NCG030308_2021 DMR_20210729

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG030000
Meta( 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.
Analytical Monitoring Requirements for Outfalls with Industrial Activities —Benchmarks in (Red)
Parameter
Code I Parameter Outfall Outfall Outfall Outfall Outfali
146529124-Hour
eceiving Stream Class
ate Sample Collected MM/DD/YYYY
Rainfall in inchesSS in mg/L (100 or 50*)H in standard units (6.0 — 9.0)opper, total recoverable in mg/L.010)
01051 Lead, total recoverable in mg/ L
(0.075)
01094 zinc, total recoverable in mg/ L
0.126)
78141 Total Toxic Organics (TTO) in mg/L(1)
(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
NCOIL Estimated New Motor/Hydraulic Oil
Usage in gal/month
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary NurseryAreas (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
submit
is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false ffifo ration, including the possibility of fines and imprisonment for knowing violations."
Of
or Delegated Authorized Individual
Email Address ' Phone Number

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 (Tf0), 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 a ast discharge monitoring report. I further certify that this facility is implementing all the provisions of the Solvent
M a ent Plan included in the Stormwater Pollution Prevention Plan."
Signature of Pe ttee or Delegated Authorized Individual Dad
Email Address Phone Number