NCG030061_2021 DMR_20211014

NCDEQ Division of Energy, Mineral and land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCGO30000
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DMR via the St rmwater NPDES Permit pata Monitorfn Report (DMK Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DEMLR Re ions( Office_
Certificate of Coverage No. NCG,03 0061
Person Collecting Samples: Jack Taylor
Facility Name: Moen
Laboratory Name: Environment 1 inc
Facility County:Craven
Laboratory Cert. No.:10
Discharge during this period: 0 Yes ❑ No (if no, slip to signature and dote)
Has your facility implemented mandatory Tier response actions this sawwle Reriod for any benchmark exceedances? ❑ Yes JD No
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via httpsaledocs.dN.nc.gov/Forms/SW-DMR
0 Yes [:]No
Date Uploaded: 9/8/21
Analytical Monitoring Requirements for Outfalls with Industrial
Activities — Benchmarks in (Red)
Parameter
Code Parameter OutfaR 001
Outfal1002 outfall outfall Outfaff
N/A Receiving Stream Class other
other
N/A Date Sample Collected MM/DD/YYYY 814/21
8/4/21
46529 24-Hour Rainfall in inches 1.30
1.30
C0530 TSS in mg/L (100 or 50*) 11.0
45.0
00400 pH in standard units (6.0 — 9.0) 5.2
9.3
01119 Copper, total recoverable in mg/L 0.018
0.007
0.010)
01051 Lead, total recoverable in mg/ L
<0.002
< 0.002
(0.075)
01094 Zinc, total recoverable in mg/ L 0.027
0.036
(0.1.26)
78141 Total Toxic Organics (TTO) in mg/L(1) N/A
N/A
(if required)
00552 Non -Polar Oil & Grease in mg/L (15) <5.0
<5 0
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
NCOIL Estimated New Motor/Hydraulic Oil NIA
N/A
usage in gal/month
* Outfalls to Outstanding Resource Waters (ORW), High Quali y Waters (Hoorn, Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark755 limit of 50 mg/L All other water dassificaWns have a benchmark of 100 mg/L
Notes (optional):
"I certify by my signature below, under penalty of law, thatthis document and all attachments were prepared under my direction or supervision in
accordance with a system des ned to assure that qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the person or per; who manage the system, orthose persons directly responsible for gatheringthe information, the information
submitted is, to the bestIt
knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false1nfarrj.90n�nCludrr pos�sibilityoffinesandimprisonmentforknowingviolations."
918121
Sign rKabe.Fi
or elegated Authorized Individual — Date
Email Address er@moen Phone Number [phone] ext. 6341

Total Toidc Organics Certification:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring
requirement for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no leak, spill, or dumping of
concentrated toxic organics in the stormwater or onto areas which are exposed to rainfall or stormwater runoff has occurred since
filing the last discharge moni ng report_ I further certify that this facility is implementing all the provisions of the solvent
Managemeno!jp-intlude}E ii e Stormwater Pollution Prevention Plan "
5ignatuie of Vidhxiit w r4*l�-gated Authorized Individual
WWII
Date - —
Email Address Katie_Flitrj"rrioen.com Phone Number [phone] ext. 6341