NCG030251_2021 DMR_20220126

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCGO30000
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Repart DMR Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG03.DaS- Person Collecting Sagin, ey
Facility Name �_/-E k.•1Laboratory Name. 2j
Facility County: VIV b , Laboratory Cert. No.:
Discharge during this period: Yes No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? Yes o
If so, which Tier (1,11, or III)?
A copy of this DMR ,}as bElen uploaded electronically via https:/ledoa.dech.nc.i ov/forms/SW-DMR es No
Date Uploaded: j! Z(sl?,pZ'L
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfait
Outfaii
Outfall
N/A
Receiving Stream Gass
N/A
Date Sample Collected MM/DD/YYYY
L211 PkrW/Z
D2
2 l Zc`
2 7f+
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L ju or 50-)
00400
pH in standard units (6.0 — 9.0 FW,
6.8-8.5 SW)�
�'
r✓ •7 Q
01119
Copper, total recoverable in mg/L
(0.010 FIN, 0.0058 SW)
Q���
L�• C)
�r
C.;,f`��l �'
01051
Lead, total recoverable in mg/ L
(0.075 FIN, 0.22 SUir1
• CJ��
C� �t�� j
' CScJ�
(�� L'L'��S
01094
Zinc, total recoverable in mg/ L (0.126
FW, 0.095 SW)
�• E�
Chemical Oxygen Demand (COD) in
mg/L (120)
(�
00552
Non -Polar oil & Grease in mg/L
AJO
AJ n
Aj jJ
" Outfalls to Outstanding Resource Waters (ORW), 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) : (Saltwater)
AJQ = t� t� rYc ✓F r
"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, inclu ing the possibility of fines and imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual
&a - &Ali 9,11 A 4.2 e r. Cony
Email Address
Date
Phone Number