HomeMy WebLinkAboutNCG160116_2021 DMR_20210830NCDEQ Division of Energy, Mineral and Land Resources
Roro; wa er Discharge MainifoOng Vieport (DWIR) Form for NUU60000
Asphalt Paving Mixtures and blocks
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Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data (Utn«itoring Repni,t {DMR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the a ro riate DE MLR Regional Office.
Coverage No.. NCG160//gyp
X,' /�. � �r
Person Collecting Samples::
Laboratory Name: A A
ty: �IltleelAl
r
Laboratory Cert, No.:ring
this period: ® Yes ❑ No (if no, skip to signature and date)
ility implemented mandatory Tier response actions this sample period for any benchmark exceedances7 ❑ Yes M No
If so, which Tier (1,11, or 111)7
A copy of this DMR has been uploaded electronically via htt )s: edocs.deg.nc.gov/Forms/Sytl-D[\AR [j] Yes F] No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall (
outfall
Out-fali
Outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
V11,
jr
C0530
TSS in mg/L(100 or 50'T)
xzoi4
SO
Additional parameters for outfails in drainage areas that use >55 gallons per month of new hydraulic oil on average
00552
Non -Polar Oil & Grease in mg/L(15)
NCOIL
Estimated New Motor/Hydraullcoil
Usage in gal/month
Gutraiis to Outstanding Resource Waters (ORW), High quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark T55 limit of 50 ing/t. All other crater classifications have a benchmark of 100 n)g/I_
Notes {opfiional):
N 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 bestof 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 or Delegated Authorized Individual
Date
Email Address Phone Number