NCG030646_2021 DMR_20211029

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (D IR) Form for NCGG30000
}Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DMR via the Storm water NPDES Permit Bata M0ni3Orilig Report (DN1R)Upload form within
30 days of receiving sampling results_ Mail the original, signed hard copy of the DMEt to the aT)propriate l]f<fv LR Regional Office.
Certificate of Coverage No. NCG030646 Person Collecting Samples;
Facility Name. Deere -Hitachi Laboratory Name;
Facility County, Forsyth Laboratory Cert. No..
DIscharge during this period; Lj Yes U No (if no, skip to Signature and date)
Has your facility implemented mandatnryTier response actions this sample period far any benchmark exceedances?1:1 Yes LJ No
If so, which Ter (I, II, or IiI)?
A Copy of this DMR has been uploaded electronically via htt s; ed ocs. decl.nC_ ov Forms S -DMR LjYes LjNo
Date Uploaded_ II b \
Analytical Monitoring Requirements for OutfalIs with Industrial Activities — Benchmarks in 3 Red)
Parameter
cod e
Parameter
Outfall
outfall
Outfall
Outfall
Dutfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MVI/dd/YYYY
-
46529
24-Hour Rainfall in Inches
C0530
T55 in mg/L (100 or So*
00400
pH in standard units (6,0— 9.0 FW,
6.8-8.5 SVV
Copper, total recoverable in mg/L
01119
0.010 FW, 0.D0585W
Lead, total recoverable in r%/ L
01051
0.075 FW, G.22 SWJ
01094
Zinc, total recoverable in mg/ L lID. 176
RN, 0.095 SW
Chemical Oxygen Dernand (COD) in
00340
ntg/L (1m)
04552
felon -Polar Oil & Grease in mUlL (15)
' 0utfaIIs to Outstandirpg Resource Waters f0fft High Quality Waters (HQVV), Trout waters tTrj acid Prbmry Nursery Areas (PNA)
bavi} a benchmark T55 limit of 50 mg/L. AIi other water classifications have a bienchmark of 100 rng/L
fW jFreshwater) SW (5aItwater)
Dates (optional).
1 certify by my signature below, u nder pen alty of law, that this docu ment and al I attach merits were prepared under my direoun or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the Iriformation submitted_ Based on my
inquiry of the person or persons who manage the system, ar those persons directly responsible for gathering the information, the information
subm Itted is, to t he best of my knowledge and belief, true, accurate, and complete. I am aware that there are sign ifica nt pe riWtles for su bmi tting
false information, includ ing the possi bi I Ity of fines a rid imprisonment For knowing violations_"
Signature of Porn ttee or Delegated Authorized Individual
[e-mail]
Email Address
10129/2021
Date
(336) 4 3-5552
Phone Number