NCG030710_2021 DMR_20220120

NCDEQ Division of (energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form ;.,r NCG030000
Metal Fabrication
-lick i .,, instructions
Complete, sign, scan and submit the DMR via the "S Permit Data Monitoring Report (DMR) Upload torm within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the c,ropriate DEMLR Regional C
Certificate of Coverage No. N0003F
Facility Name: Trivium Cable Facility
Person Collecting Samples:
Laboratory Name:
Facility County: Catawba Laboratory Cert. No.:
Discharge during this period: ❑ Yes Q No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances? ❑ Yes ❑ No
If so, which Tier (I, 11, or III)?
Analytical Monitoring Requirements for Ourtfalls with lndustriai Activities - Benchmarks in
Parameter
Code
Parameter
®utffall
outfall
outffall
outffali
outffall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
00552
Non -Polar Oil & Grease in mg/L 11
C0530
TSS in mg/L !u ur SO')
00400
pH in standard units (6.0 — 9.0)
New Motor/Hydraulic Oil Usage in
NCOIL
gal/month
01119
Copper, total recoverable in mg/L
,1U Fw, o.uos �i.
01051
Lead, total recoverable in mg/ L
In n7'
01094
Zinc, total recoverable in mg/ L
, 0.095 SW,
78141
Total Toxic Organics (TTO) in mg/L
Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of I mg/I. All other water classifications have a benchmark of
Notes (optional):
"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."
Signature of Permittee or Delegated Authorized Individual Dat