NCG120054_2021 DMR_20211203

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG120000
Landfills
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 DIVIR to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG12 0054
Person Collecting Samples: Tim Kersesy
Facility Name: Sampson County Disposal, LLC
Laboratory Name: N/A
Facility County: Sampson
Laboratory Cert. No.: 16
Discharge during this period: [] Yes [a No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceeclances? 13 Yes E] No
If so, which Tier (1, 11, or 111)?
A copy of this DIVIR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR El Yes E] No
Date Uploaded: 12/3/21
Analytical Monitoring Requirements for Outfalls with industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall 1/2
Outfall 6
Outfall 10
Outfall
Outfall
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)
00340
Chemical Oxygen Demand in mg/L
(120)
31616
Fecal Coliform in #per 100 ml (1000)
Additional parameters for outfalls in drainage areas that use >SS gallons per month of new hydraulic oil on average
00552
Non-P lar Oil & Grease in mg/L (15)
NCOIL
Estimated New Motor/Hydraulic Oil
Usage in gal/month
* 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 mg/L
.1 Notes (optional): November 2021—DMR submitted by Matthew Jones on Behalf of Sampson County Disposal, L.L.C.
"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 ttp systern, or those persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge pnJA64f, true, accurate, and complete. I am aware that there are significant penalties for submitting
false information, including the possib' '
)fi6(X&q"+mprisonment for knowing violations."
Signature of Permittee or Del
Au6orized Individual
Date
Email Address joseph.srn1th9gflenv.com Phone Number [phone]