NCG030061_2021 DMR_20210809

NCDEQ Division of Energy, Mineral and land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG030000
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (DMR) Unload farm 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 0061
Person Collecting Samples: Jack Ta or
Facility Name: Moen
Laboratory Name: Environment 1 Inc
Facility County: Craven
Laboratory Cert. No.:10
Discharge during this period: 0 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 (I, II, or 111)?
A copy of this DMR has been uploaded electronically via https1fedocs.deg.nc.goy/Form_ SLSW-AMR ❑✓ Yes ❑ No
Date Uploaded: 7/7121
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
parameter
Outfall001
Outfall002
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
other
other
N/A
Date Sample Collected MM/DD/YYYY
6/3/21
6/3/21
46529
24-Hour Rainfall in inches
1.55
1.55
C0530
TSS in mg/L (100 or 50*)
11.0
45.0
00400
pH in standard units (6.0-9.0) 1
7.2
7.3
01119
Copper, total recoverable in mg/L
0.054
0.028
(0.010)
01051
Lead, total recoverable in mg/ L
<0.002
0.006
(0.075)
01094
Zinc, total recoverable in mg/ L
0-044
0.215
(0.126)
78141
Total Toxic Organics (TTO) in mg/L(1)
NIA
N/A
(if required)
00552
Non -Polar Oil & Grease in mg/L(15)
<5.0
<5.0
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
N/A
N/A
Usage in ellmonth
_L____
* Outfalls to Outstanding Resource Waters (OR", 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, thatthis document and all attachments were prepared under my direction or supervision in
accordance with a system design o assure that qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or pe ho manage the system, or those persons directly responsible for gathering the information, the information
submitted ' , to the b knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
falseinfoghaggFIV i epossibiliityoffines and imprisonment for knowing violations."
Delegated Authorized Individual
7/7/21 _
Date T
Email Address Kaf3e["er@moen Phone Number [phone] ext. 6341

Total To)dc Organics Certification:
"Based upon my inquiry of the person or persons directly re�pppnsible for managing compliance with the permit monitoring
requirement for total toxic organics (1TO), I certify thh Mahe best of my knowledge and belief, no leak, spill, or dumping of
concentrated toxic organidg into a sto vfonto areas which are exposed to rainfall or stormwater runoff has occurred since
filing the last di harge nj o i g report. I further certify that this facility is implementing all the provisions of the Solvent
Manag n u d ie Stormwater Pollution Prevention Plan:"
7R121
5ignatur of P e 1 gated Authorized Individual Date
Email Address Katle.Fritzlc rornoen_com Phone Number [phone] ext. 6341