NCG030703_2021 DMR_20211014 (2)

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 NPDES 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 0703
Person Collecting Samples: Tom Wilson
Facility Name: DuBose National Energy Services, Inc.- 900 Industrial Drive Facility
Laboratory Name: Waypoint Analytical
Facility County: Sampson
Laboratory Cert. No.: 402
Discharge during this period:0 Yes 0 No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?[]Yes 0 No
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR Q Yes 0 No
Date Uploaded: 10/13/21
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Parameter
Outfall 1
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
C; Sw
N/A
Date Sample Collected MM/DD/YYYY
9/27/21
46529
24-Hour Rainfall in inches
0.1
C0530
TSS in mg/L (100 or 50*)
<2.9
pH in standard units (6.0-9.0 FW,
00400
6.8-8.5 SW)
3.88
Copper, total recoverable in mg/L
01119
0.010 FW, 0.0058 SW)
<0.0020
Lead, total recoverable in mg/ L
01051
(0.075 FW, 0.22 SW)
<0.0010
Zinc, total recoverable in mg/ L (0.126
01094
FW, 0.095 SW)
<0.020
Chemical Oxygen Demand (COD) in
00340
mg/L (120)
<50
00552
Non -Polar Oil & Grease in mg/L (15)
1<5.8
* 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): Stormwater will be re -sampled for pH. Laboratory or sampling error is suspected.
"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
false information, including the possibility of fines and imprisonment for knowing violations."
Signature of PermittWor Delegated Authorized Individual
Email Address
/D A/-2�
Date
910 _574 Zis�t
Phone Number