NCG060348_2021 DMR_20211008

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG060000
Food and Kindred
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report iDMR1 Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the al2propriate DEMLR Regional Office.
Certificate of Coverage No. NCG06 0348 Person Collecting Samples: N/A
Facility Name: American Skin Food Group, LLC Laboratory Name: N/A
Facility County: Pender Laboratory Cert. No.: N/A
Discharge during this period: ❑ Yes ❑� No (if no, skip to signature and date)
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:j/edocs.deg.nc.gov/Forms/SW-DMR ❑ Yes ❑jNo
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
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L (100 or 50*)
00400
pH in standard units (6.0-9.0)
00556
Oil & Grease in mg/L (30)
31616
Fecal Coliform per 100 ml of
freshwater (if required) (1000)
61211
_
Enterococci per 100 ml of saltwater
(if required) (500)
00340
Chemical Oxygen Demand in mg/L
(120)
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic
oil on average
Estimated New Motor/Hydraulic Oil
NCOIL
Usage in gal/month
00552 Non -Polar Oil & Grease in mg/L (15)
I Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark T55 limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L
Notes (optional): No applicable discharge during sampling hours in September 2021
"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 bett Jf edge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false formation di the possibi ' y of fines and imprisonment for knowing violations."
r ►► 10/07/2021
of Permittee or DelegateOAuthorized Individual Date
Email Address [e-mail] Phone Number 910-259-2232