NCG060139_2021 DMR_20220127

NCDEQ Division of Energy, Mineral and Land Resources
Complete, sign, scan and submit the DMR via the
C days of receiving sampling results. Mail the original, signed hard copy of the DMR to the
within
Certificate of Coverage No. NCG06 Q (3 c1 Person Collecting Samples:
Facility Name:$ LaboratoryNamesm ; P:e1�Q ,�wJdiro�ns�,�FaL [�,�"o //' {1;,.`
Facility County ,5,�.,., so,, Laboratory Cert, No.: W Wi to116
Discharge during this period: es ❑ No (if no, skip to signature and date)
Has your facility Impie-mented mandatory Tier response actions this sample period for any benchmark exceedances? [ Yes ❑ No
If so, which Tier (1, II, or III)?
A copy of this DMR has been uploaded electronically via ' ❑ Yes ❑ No
Date uploaded: _ _r/27 Z _ - -
Analytical Monitoring Requirements for Outfalls with Industrial Activities - Benchmarks in
Parameter
Parameter
Outfall Outfall Outfall Outfall Outfall
Code
N/A
Receiving Stream Class
-
V) S I
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in Inches
_%
5530
TSS in mg/L(100 or 501
00400
PH in standard units'6.0- 9.0 FW,
6.8-8.5SW)
--
31616
Fecal Coliform per 100 ml of
freshwater (if required)- J00]
Oav
61211
Enterococcl per 100 ml of saltwater
(if required) (500)-
Chemical Oxygen Demand in mg/L
00340
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
Estimated New Motor/Hydraulic Oil
NCOIL
Usage in gal/month
00552
Non -Polar Oil & Grease 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 ms All other water
classifications have a benchmark of 30 mg/
FW (Freshwater)SW (Saltwater)
Notes (optional):
"1 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 y knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false into g the possibility of fines and Imprisonment for knowing violations."
�-
Signature of Permittee or Delegated Authorized Individual Date
Email Address Phone Number