NCG030450_2021 DMR_20210924

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 NPOES 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.NCG03 CD
Person Collecting Samples: /i7,42rrC tARtss
Facility Name: �_ Q �,� o ,yt �� ��
Laboratory Name: M) e /Lo 6qe
Facility County:
Laboratory Cert. No.: f
Discharge during this period:
Eyes
No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?11Yes _ No
If so, which Tier (1, 11, or III)?
A copy of this DMR has been uploaded electronically via https:J/edocs.deg.nc.gov/Forms/SW-DMR l Yes r7l No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities -- Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class(
N/A
Date Sample Collected MM/DD/YYYY
C 'Z(
46529
24-Hour Rainfall in inches
t) , Z
C0530
TSS in mg/L 1100 or 50*)
-4• t 1 �]
00400
pH in standard units (6.0-9.0 FW,
6.8-8.5 SW)
Copper, total recoverable in mg/L
01119
(0.010 FW, 0.0058 SW)
Z_ Vj Uo goo
01051
Lead, total recoverable in mg/ L
L a, O Z a
(0.075 FW, 0.22 SW)
01094
Zinc, total recoverable in mg/ L (0.126
FW, 0.095SW)
®� Oc�
00340
Chemical Oxygen Demand (COD) in
mg/L (120)
D
00552
Non -Polar Oil & Grease in mg/L (15)
L $ f o o
* 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
FW (Freshwater)SW (Saltwater)
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 qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, orthose 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
false information. includinethe oossibilitv of fines and imprisonment for knowine violations."
f��ti %�-
Signature ofPermittee/or Delegated Authorized
�Individual
A*( L . G(i �c�lnllZ ( i iw�tCX< GtS�a t
Email Address
Date
Phone Number