NCG030152_2021 DMR_20211210

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG030000
Metal Fabrication
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 DMR to the appropriate DEMLR Regional Office,
Certificate of Coverage No. NCG03O1,Sa Person Collecting Samples:
Facility Name: C Laboratory Name: to�roV i
Facility County: €j- �, Laboratory Cert. No7 c'(
Discharge during this period: Yes No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? Yes M No
If so, which Tier (I, II, or lll)?
A copy of this DMR has been uploaded electronically via https://edocs.dn.nc.goy/Forms/SW-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
FW
N/A
Date Sample Collected MM/DD/YYYY
11 /aAla)
46529
24-Hour Rainfall in inches
,
530
0g/L
(100 or 50*)
F�2400
Fc--
ndard units (6.0-9.0 FW,
7
SW)
01119
Copper, total recoverable in mg/L
(0.010 FW, 0.0058 SW)
,VV
01051
Lead, total recoverable in mg/ L
, f�
(0,075 FW, 0.22 SW)
01094
Zinc, total recoverable in mg/ L (0.126
FW, 0,095 SW)
Chemical Oxygen Demand (COD) in
Zmg/L
(120)
v, l
Non-Polar Oil & Grease in mg/L (15)
/V
* 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 mg1L, All other water classifications have a benchmark of 100 mg/L
FW (Freshwater) SW (Saltwater)
Notes (optional)
"l 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`iinlu Athe possipikof fines and imprisonment for knowing violations."
Signature offPermittee or Delegated Authorized Individual
-
Ema' Address
Z to /?- 1
Date
Phone Number