NCG030505_2021 DMR_20211029

M0.11 b � �� �EM 1,1�5 1(-f-prrv►wl � ��
R
ovLo
fie_ 3Q l Co1 f AN
Suu t k. DE=Q Division of Energy, Mineral and Land Resources
''rr11
irt0D(6,Sg1f(er j(Stormwater Discharge Monitoring Deport (DMR) Form for NCGO30000
2-qf 11 Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES hermit Data Monitoring Report (©MR) 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. NCO03 05
Person Collecting Samples: (~tiCj t
Facillty Name: ,a
Laboratory Name; N)
Facility County:
Laboratory Cert. No,; (JJ f\
Discharge during this perio : E1yes
_
No (if no, skrp to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark excendances? E]Yes MNo
If so, which Tier (I, 11, or 111)?
A copy of this DMR has been uploaded electronically via https://edocs,deg.nc,gov/Forms/SW-DMR M Yes nNo
Date Uploaded;
Analytical Monitoring Requirements for Outfalls with Industrial Activltles — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Out{all
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall In Inches
C0530
TS3 in mg/L (100 or 50*)
00400
pH In standard units (6.0 — 9.0 FW,
6.8-8,5 SW)
Copper, total recoverable in mg/L
01119
(0.010 FW 0.0058 5W)
01051
Lead, total recoverable In mg/ L
(0,075 FW, 0.22 SW
01094
zinc, total recoverable in mg/ L (0.126
FW, 0.095 SW)
00340
Chemical Oxygen Demand (COD) in
mg/L (120)
00552
Non -Polar Oil & Grease In mg/L (15)
* Outfalls to Outstanding Resource Waters (ORW), High Qualitywaters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmarkTSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L
FW (Freshwater) SW (Saltwater)
Notes (optional): hM2 OMtx PH bt, trtr Sr, T[)rSl Q_-1
"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 Informa)ion, Including the possibility of fines and imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual
C�dl corA
Email Address
l o ,29i 2)
Date
:1 N -99 � - -70 F3
Phone Number
4