NCG030505_2021 DMR_20211123

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report ( R) Forn-i for NCG030 00
Meta( Fabrication
Click here for instrucVons
Complete, sign, scan and submit the DMR via the Stormwater NPDES PerFnit Data Mgnitorin.V Lepari DMaP .load for€n within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the �p_p gprea�e.DEMLR R2FignaL C�ffirg.
Certificate of Coverage No. NCG03 050
Person Collecting Samples:
Facility Name: A
Laboratory Name:
Facility County: &14Laboratory
Cert. No.:
Discharge during this ped
Yes
fgNo
(if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?13Yes WNo
If so, which Tier (I, II, or IIl)?
A copy of this DMR has been uploaded electronically via hops..)/ c 2c s.deg.nc. ov Far 15Ell i iViR Yes No
Date Uploaded: rtm
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Reel)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L (100 or 50*)
00400
pH in standard units (6,0 -- 9.0 f ,
6.8-m Sid)
01119
Copper, total recoverable in mg/L
(0010 Fw, 0,00se SW)
Lead, total recoverable in mg/ L
01051
(0.075 Fier, 0.22 SW)
01094
Zinc, total recoverable in mg/ L (0.125
Fein oms S)
Chemical Oxygen Demand (COD) in
[:03410
mg/L (120)
00552
Non -Polar Oil & Grease in mg/L (15)
* 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 rig/I_
FVV (Freshwater) SW (Saltwater)
"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 forgathering 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,kT o6matiQn, including the possibility of fines and imorlsonment for knowine violations."
Signature of Permittee or Delegated Authorized Individual
Email Address
Date
-)nLi-S$% 57b93
Phone Number