NCG030240_2021 DMR_20211001

NCDEa Division of Energy, 11141neraI and land Resources
Stormsivater Discharge ManitGring Repot (Delp,) Form for NCG03 000
Met -al Fabrication
Click here for instructi❑ns
Complete, sign, scan and submit the DIMR via the Starmwater NPDES Permit Data Monitori Report DIVI RI Upload farm within
30 days of receiving sampling results. Mail the original, signed hard copy of the D149R to the appraoriate DEMLR Repko nal 0(fice,
Certificate of Coverage No. NCG030240 Person CollectingSamples, David Heath
Facility Name;Mere-Hitachi Laboratory Name, Pace Analytical
Facility County: Forsyth Laboratory Cert. No,:12, 49, 633
Discharge during this period: Dyes D No (if,ro, star to signature and date)
Has your facility implemented m a nda tort' Tier response actions this sample oeriad for any benchmark exceedances Yes H No
If so, which Tier (f,11, or I11)?
A copy of this DMR has been uploaded electronically via htt s= edocs.de _nc, ov Forrns SW-DMR es El No
Date Uploaded:
Analytical Monitoring Requirements forOutfalls with Industrial Activities— Benchmarks in (Red)
Parameter
Code
Parameter
Dutfan 01
S-111
outfall
Outfall
outfall
outfaM
NIA
Receilvirrg Stream class
NIA
bate Sample Collected MM/aD/YM
91112D 4
46529
24-Hour Rainfall in inches
87
C053D
TS5 In rng/L (100 or Soo l601
04400
pH in standard units (6-0 — 9.0 FW,
6.91
5."_5 SVV
01119
Copper, total recarerable in mglL
0094
0,0 0 FW, 0.0058 5W
01051
Lead, total recoverable in mg j L
<Xx Mq&
(0.075 FW, 0,22 5W)
01094
Zinc, total recoverable in nV/ L (01-26
FW, 0.095 SWI
U.U9
00340
Chemiral Oxygen Demand (COD) in
<XX L
ma L(120)
<XX r L
0055Z
Eton -Polar Oil & Grease in mglL (IS)
4utralrst0 Outstanding Resour€e Waters (URvw), High QualitV Waters (HQW),Trout Waters(Trj and Pfimary Nursery Areas (pNA)
have a benchmark T55 limit of 50 mg/ L AR other water clas$ificatio% hav12 a benchmark of 100 rngfL
FVU (Freshwater) S'01(Saltwateri
Notes (optional):
"I €ertify by my signature below, under penak-Y of 13w, that this document and all attachments were prepared under my direction or Supervision In
accordance with a system deslgned to assure that qualified personnel properly gather and evaluate the information submitted. Rased On My
inquiry of the person or persons who manage the system or those person9 dire Wy 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 irrformatlorb including the possibility of fines and imprlsonment for knowing %fj eAatiorrs."
Gt- L-VJi
Signature gFPermittee or Delegated AtOorixed lndividuaI
[e-mail]
Email Address
913012021
Date
[phone]
Phone Number