NCG060230_2021 DMR_20210730

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG060000
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 appropriate DEIV1LR Regional Office.
Certificate of Coverage No. NCG06 0230
Person Collecting Samples: R Fincher
Facility Name: Innospec Active Chemicals LLC
Laboratory Name: Statesville Analytical; Innospec Performance Chemicals
Facility County: Rowan
Laboratory Cert. No.: NC #440; NC #5173
Discharge during this period: ✓0 Yes ❑ No (if no, skip to signature and date)
Has your facility implemented mandatary Tier response actions this sample period for any benchmark exceedances? 0 Yes 0 No
If so, which Tier (I, II, or III)? Tier
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.goy/Forms/SW-DMR ✓❑ Yes ❑ No
Date Uploaded: 07/30/2021
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Parameter
Outfall 001
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
WS-V
n1a
N/A
Date Sample Collected MM/DD/YYYY
06/03/2021
46529
24-Hour Rainfall in inches
0.9
C0530
TSS in mg/L (100 or 50*)
212.8
00400
pH in standard units (6.0-9.0)
7.3
00556
Oil & Grease in mg/L (10)
<5.43
31616
Fecal Coliform per 100 ml of
nIa
freshwater (if required) (1000)
61211
Enterococci per 100 ml of saltwater
nla
(if required) (500)
Chemical Oxygen Demand in mg/L
OD340
(120)
29
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
Na
00552
Non -Polar Oil & Grease in mg/L (15)
n/a
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TS5 limit of 50 mg/L. All other water classifications have a benchmark of 200 mg/L
Notes (optional): Site is under a E&SC Plan/Construction Stormwater Permit NCG010000; all site drains to this outfall.
"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 an niy
inquiry of.the person or persons who manage the system, or those persons directly responsible forgathering 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 Permittee orDelega&d Authorized Individual
Email Address [e-mail]
,;7 %�
Date
Phone Number 336-.847-5061