NCG030589_2021 DMR_20220117

.46
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 _ _ iter 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 .313propriate DEMLR Regional Office.
Certificate of Coverage No. NCG0305set Person Collecting Samples:
Facility Name: Laboratory Name:mlc
Facility County: Laboratory Cert. No.: "i'
Discharge during this period: 11 Yes No (if no, skip to signature and date) beNt: er
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via lit s; gdocs.de .nc. ov Forms 5W-DMR
Date Uploaded: 1 f"7/42a
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in
')DaI
Yes 1fNo
QYes [7]No
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 — 9.0 FW,
00400
6.8-8.5 SW)
Copper, total recoverable in mg/L
01119
0.010 FW 0.0058 SW
Lead, total recoverable in mg/ L
01051
0.075 FW, 0.22 SW)
01094
Zinc, total recoverable in mg/ L (0.126
FW, 0.095 SW)
Chemical Oxygen Demand (COD) in
00340
mg/L (120)
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 . All other water classifications have a benchmark of 100 mg/L
(Freshwater) SW (Saltwater)
"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, including the possibility of fines and imprisonment for knowing violations."
f'tTG C i-lhItA
Signature of Permittee or Delegated Authorized Individual
401/ /S / z0 2 z
Date
MC 9K) -1?11-'
Email Address U Phone Number