NCG030703_2021 DMR_20220111

NCDEQ Division of Energy, Mineral and Land Resources
5tormwater Discharge Monitoring Report (DMR) Form for NCG030000
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DM via the 5tormwater NPDES Permit Data Monitoring Report (DMR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DM to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG03 0703
Person Collecting Samples: Tom Wilson
Facility Name: Dtj Bose National Energy Services, inc.- 900 1 nd ustriai Drive Facility
Laboratory Name: Waypoint Analytical
Facility County. Sampson
Laboratory Cert. No.: 402
Discharge during this period:
0
Yes
No (if no, skip to signature and dote)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? Lj Yes r No
If so, which Tier (I, II, or III)?
A copy of this D M R has been uploaded electronically via https://edocs.deg-nc„gov/Forms/5W-DMR U Yes Lj 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*)
00400
pH in standard units (6.0 —9.0 FW,
6.8-8.5 SW)
01119
Copper, total recoverable in mg/L
(0.010 FW, 0,0058 SW)
01051
Lead, total recoverable in mg/ L
(0.075 FW, 0.22 SW)
01094
Zinc, total recoverable in mg/ L (0.126
FW, 0.095 5W)
00340
Chemical Oxygen Demand (COD) in
mg/L (120)
00552
*
Non -Polar Oil & Grease in mg/L(15)
0utfaIIs to Outstanding Resource Waters IORW), 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) 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 supervlsion 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 passibility of fines and imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual Date
Email Address
//4?L:4e2
Phone Number