NCG060081_2021 DMR_20211203

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCGO60000
Food and Kindred
Click here for instructions
Com pi ete, sign, scan and subm it the DM R via the Stormwater NPDES Perm it Data Monitoring Report fDMR) U pload form within
30 days of receivi ng sam pl ing resu Its. Ma il the original, signed hard copy of the D M R to the appropriate DE M LR Regional Off ice.
Certificate of Coverage No. NCG06,0013
Person Collecting Samples: I I A4 MCC-Ca-il-LE
Facility Name: UBCC OpffRATI tw - 5�-C'
Laboratory Name: WArg P 0 i)�T MALVT1 CAL
FacilityCounty: AAC--CJLLt5�JMLAtL0
Laboratory Cert. No.: L4 61-
Discharge during this period: M Yes 0 No (if no, skip to signature and date)
Has your facility implemented mandatoryTier response actions this sample Period for any benchmark exceedances? El Yes 0 No
If so, which Tier (1, 11, or 111)?
A copy of this D MR has been uploaded electro nica Ily via https://edocs.deg.nc.gov/Fc)rm s/SW- DIVI E] Yes E] No
Date Uploaded:
Analytical Monitoring Requirements f or Outfa IN with Industria I Activities - Bench ma rks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
oo 1
002-
t) D 3
004
uos-
N/A
Date Sample Collected MM/DD/YYYY
jj10LJj7-Qj
ljj0jZ6-Lj
I I 1L)LIJUU
11 LtX41ZO-Zt.
/7-021
46529
24-Hour Rainfali in inches
C0530
TSS in mg/L (100 or 50*)
St,.t4/ACj )L
&IA5/L-
A451L
25--[Mq /I-
-�'41LMjld
OG400
pH in standard units (6.0 - 9.0 FW,
G,4
4
te't�Ll
�,Iyt
6.8 - 8.S SW)
31616
Fecal Coliform per 100 MI. of
freshwater (if required) (1000)
61211
Enterococci per 100 ml. of saltwater
(if required) (SOO)
00340
Chemical Oxygen Demand in mg/L
a,
M 5 IL
A41 IL
51S A-
(120)
Additional para meters for outfa lis in d rai nage areas that use >55 ga lions per month of new hydraulic oil on average
NCOIL
sti mated New Motor/Hydraulic Oi I
Usage in gallmonth
00552
Non-Pofar Oi I & Grease in mg/L (15)
* 0 utfa I I s to out sta n di ng Resource Wat e rs (0 RW), H igh Qua lity Wa ters (H QW), Trout Wa ters (Tr) a nd Pri M"a ry N urs ery Are a s (P NA)
h awe a ben chm ark T55 I Im It of 50 mg/L. Al I other water c I ass ifi catl ons h awe a be nc hm ar k of 100 mg/ L
FW (Freshwater) SW (Saltwater)
I 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
accorda nce with a system designed to assu re that qual ified personnel properly gather and evaluate the information su bm[tted. 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 arn aware that there are significant penalties for submitting
false infoq3�ation, including the possibility of fines and imprisonment for knowing violat[ons."
5 ign atu r e' of 0 r—m i ttee o r oe le gat ed Au t h o rized Ind ivi du a I
rAv. P0
4ke -Ij 1-454 b
Email Address
/ 2LD 3 4Z�W
Date
�qn - �3t/-7
Phone Number