NCG120054_2021 DMR_20210910

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG120000
Landfills
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. NCG12 0054
Person Collecting Samples: Tim KerseS
Facility Name: Sampson County Disposal, LLC
Laboratory Name: N/A
Facility County: Sampson
Laboratory Cert. No.: 16
Discharge during this period: ❑ Yes 0 No (if no, skip to signature and date j
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? ❑ Yes ❑ No
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR E4 Yes []No
Date Uploaded: I / to / Z j
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall 1 /2
Outfall 6
Outfall 10
Outfall
Outfall
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)
00340
Chemical Oxygen Demand in mg/L
(120)
31616
Fecal Coliform in # per 100 ml (1000)
Additional parameters for outfalls 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/Hydraulic Oil
Usage in gal/month
s 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 quali/rmnr
ersonnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage th those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge b ef, trccurate, and complete. I am aware that there are significant penalties for submitting
false information, including the pass! bil' of es a m wing violations."
Signature of Permittee or Dele,�Oed Authorized Individual
Email Address [e-mail]
9.7 i
Date
Phone Number [phone]