NCG060410_2021 DMR_20211021

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCGO60000
Food and Kindred
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. NCG06 0410
Person Collecting Samples: Parker Cliatt
Facility Name: Amazon.com Services LLC - DLT6
Laboratory Name: Eurofins TestAmerica
Facility County: Guilford
Laboratory Cert. No.: 269
Discharge during this period:E1
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? QYes Fv� No
If so, which Tier (I, 11, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall001
Outfall002
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
WS-IV
WS-IV
N/A
Date Sample Collected MM/DD/YYYY
9/8/2021
9/8/2021
46529
24-Hour Rainfall in inches
0.5
0.5
C0530
TSS in mg/L 1,1000 or 50*
4.6
5
00400
pH in standard units (6.0- 9.0 FW,
6.64
7.25
6.8 — 8.5 SW)
00556
Oil & Grease in mg/L (30)
< 1.3
< 1.4
31616
Fecal Coliform per 100 ml of
freshwater (if required) (1(100)
N/A
N/A
61211
Enterococci per 100 ml of saltwater
N/A
N/A
(if required) (500)
Chemical Oxygen Demand in mg/L
00340
15
26
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
N/A
N/A
Usage in gal/month
00552
Non -Polar Oil & Grease in mg/L ,: ;
N/A
N/A
Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of All other water classifications have a benchmark of vv=y L
FW (Freshwater) ; !' (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, 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 1p%mation, including thi possibility of fines and imprisonment for knowing violations."
re of Permittee br Delegated Authorized Individual
[e-mail]
Email Address
) b Izl
Date
[phone]
Phone Number