NCG030505_2021 DMR_20210917

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Dc-(� IYl�eS�{ �} o(�%DEQ Division of Energy, Mineral and Land Resources
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A-fPlwo—Storn-miter Discharge f ordtovin Repoa (I)i� R) Form for NC63030000
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring -Report (DMR Uplo-d fog f 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 05p 5
Person Collecting Samples: i K @C_k-4
Facility Name: Sta�%V--1'iv-ued
Laboratory Name: cJ q
Facility County: s1LlLaboratory
Cert. Na.:
Discharge during this period: ri
Yes
No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? 0Yes No
If so, which Tier (1, 11, or ill)?
A copy of this DMR has been uploaded electronically via 13tp s.:f/edocsy.de�cgov�ForsfSWDMR Yes _ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities - Benchmarks in (tied)
Parameter
Parameter
Outfall
Outfall
Outfall
outfall
Outfall
code
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 S0
00400
pH in standard units (6.0..-9,0 FW,
Copper, total recoverable in mg/L
01119
(0.010 FW, 0.00A1 SW)
Lead, total recoverable in mg/ L
01051
(0,€]75 FW, U2 5W)
Zinc, total recoverable in mg/ L (0.1.6
01094
FV1J, 0,095 SMI)
Chemical Oxygen Demand (COD) in
00340
mg/L (120)
00552
Nan -Polar Oil & Grease In mg/L (15)
" 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 Fog/L. All other water classifications have a benchmark of 100 mg;/I.
11h! (Freshwater) �;W (Saltwater)
Motes {optional): bNi�i�'�t c c�rra 1el c. Lt' loco �5 �'i r' 2
"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
submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
fa infor Lion, including the possibility of fines and Imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual
Email Address
Phone Number