NCG030061_2021 DMR_20220104

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. NCG03 0061
Person Collecting Samples: Jack Taylor
Facility Name: Moen
Laboratory Name: Environment 1 Inc
Facility County: Craven
Laboratory Cert. No.: 10
Discharge during this period:[] Yes Q✓ 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 III)?
A copy of this DMR has been uploaded electronically via htt s: edocs.deg.nc.goy/Forms/SW-DMR ✓❑ Yes ❑ No
Date Uploaded: 12/1/21
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall001
Outfall002
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
other
Other
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-n—q n►
01119
Copper, total recoverable in mg/L
(0.010)
01051
Lead, total recoverable in mg/ L
(0.075)
01094
Zinc, total recoverable in mg/ L
(0.126)
Total Toxic Organics (TTO) in mg/L(1)
78141
(if required)
00552
Non -Polar Oil & Grease in mg/L (15)
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
NCOIL Estimated New Motor/Hydraulic Oil
N/A
N/A
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
Notes joptional):
"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 my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false in€orrrq4tion, includi�the possibility of fines and imprisonment for knowing violations."
12/ 1 /21
or Delegated Authorized Individual Date
Email Address Katie f ritzler@moen Phone Number [phone] ext. 6341

Total Toxic Organics Certification:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring
requirement for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no leak, spill, or dumping of
concentrated toxic organics into the stormwater or onto areas which are exposed to rainfall or stormwater runoff has occurred since
filing the last disch ge monitoreport. I further certify that this facility is implementing all the provisions of the Solvent
2t{y
Management PI�included r inAtl eStormwater Pollution Prevention Plan."
Signature of Pew D&eted Authorized Individual
12/1121
Date
Email Address Katie.Fritzier@; oen.com Phone Number [phone] ext. 6341