NCG160034_2021 DMR_20220112

IMCDEQ Division of Enemy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCGI60000
Asphalt Paving Mixtures and Blocks
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 DE MLR Regional Office.
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter Cade 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 504)
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil an average
00552 Non -Polar 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 benchmarkTSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L
Nutes (optional):
"1 certify by my signature below, wider penalty of law, that this document and all attachments were prepared under my direction orsupervisian in
accordance with a system designed -to assure that qualified personnel properly gatherand evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, orthose persons directly responsible for gatheitng.the information, the information
submitted is, to the bestof 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."
Signature of Pertmittee or Del
Authorized Individual
Date
Email Address Phone NLIITl:)ei"