NCG060089_2021 DMR_20211215

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG060000
Food and Kindred
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit pa.a Monitoring Report (DMR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the approp_,-late DEMLR Regional Office.
Certificate of Coverage No. NCG06 O O ?q
Person Collecting Samples:
Facility Name: bu or pds Coc-Porck4ion
Laboratory Name:
Facility County: H a irh e
Laboratory Cert. No.:
Discharge during this period: ElYes No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? ❑ Yes ❑ No
If so, which Tier (1,11, or Ill)?
A copy of this DMR has been uploaded electronically via https://edocs.dea.nc.gov/Forms/S�V-DMR ❑ Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
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*)
pH in standard units (6.0— 3.0 FW,
00400
6.8--8.5SW)
Fecal Coliform per 100 ml of
31616
freshwater (if required) (1000)
Enterococci per 100 ml of saltwater
61211
(if required) (500)
Chemical Oxygen Demand in mg/L
00340
(l2p)
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
Estimated New Motor/Hydraulic Oil
NCOIL
Usage in gal/month
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 TS5 limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L
F (Freshwater) SW (Saltwater)
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
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 information, inl ing the possibility of fins and imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual
kre_� �. oodu,K Gi-r. c0tt1
Email Address
1a-15-a)
Date
-910-305-677A
Phone Number

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG060000
Food and Kindred
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report #DMR) Upload farm within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DI iVILR Regional Office.
Certificate of Coverage No. NCG06 O O g
Person Collecting Samples:
Facility Name: D iA a I' FooJ57 CccApraliuri
Laboratory Name:
Facility County: H r �) e I
Laboratory Cert. No.:
Discharge during this period: ❑ Yes Vj No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? ❑ Yes ❑ No
If so, which Tier (I, II, or 111)?
A copy of this DMR has been uploaded electronically via htt s: /edocs,de .nc. ov Forms SW-Dt�4R ❑ Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
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*)
pH in standard units (6.0 —9.0 FW,
00400
6.8 — 8.5 SW)
Fecal Coliform per 100 ml of
31516
freshwater (if required) (1000)
Enterococci per 100 ml of saltwater
61211
(if required) (SOO)
Chemical Oxygen Demand in mg/L
00340
(120)
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
Estimated New Motor/Hydraulic Oil
NCOIL
Usage in gal/month
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 mg/L
FW (Freshwater) 5W (Saltwater)
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
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 information, inclLkding the possibility of fines and imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual
bra
Email Address
Date
9 1077�
Phone Number