NCG030240_2022 DMR_20220303

NCDEQ Division of Energy, Mineral and Land Resources
,Storrrrwater Discharge Monitoring Repoft (DNiR) Form for NCG030000
Metal Fabrication
Click here far instructions
Complete, sign, scan and submit the DM via the Stormwater €+tPVE5 Permit Data Monitorin Re ort DMli I La PIoad form within
30 days of receiving sampling results. Mall the original, signed hard copy of the DMR to the approtpriate DEMLR Sgional_Oflice,
Certificate of Coverage No. NOG030240
Person Collecting Samples- Aaron Paschal
Facility Name -Deere -Hitachi Const Mach Corp
Laboratory Name, Pace Analytical
Facility County; Forsyth Laboratory Cert. No_: 12, 40, 633
Discharge during this period-ElYes EFNo (,f nip, skip to signature and dote)
Has your faculty imp•lernerl#ed rnandatory Tier response actions
If so, which Tier �1, 11, or 11Q?
this sample ner€od for any benchmark exceedances? Yes UNo
A copy of this DMR has been uploaded electronitally via htt2s.jjedPCs_
Date Uploaded-
deg. nc_goy/corms/S -DMii ✓ Yes LjNo
Anaiytical Monitor€ng Requirements for Dutfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Pararnater
0utfall01
Outfall
ou"all
Outfall
Outfall
Cade
NIA
Receiving Stream Class
1 -;11
NIA
Date Sa mple Col lected MMjDDjYYYY
2171202
4GS29
24-Huur Rainfall in inOes
_5$
C0530
T5S in mg/L 1100 or 50*j
11.0
0U40D
pH in standard units (6.11-9,0 FW,
7.29
6.8-. S 5 W
01119
Copper, total recoverable in mg,JL
<XX mgIL
(0.010 fw, G} DU50 SW
Lead, total recoverable in mgl L
01051
(0.075 FW, 0.22 S
}()( t71glL
lint, total recovi mahle in mg/ L (C.12fi
01094
FW, 0.095 5W)
0485
Chemical Oxygen Demand [COD} in
ODMO
m L(120)
<XX mg1L
D0552
Nair -Polar Oil & Grease in mg/L (15)
<XX rng1L
" Outfalls to Outstanding Resource Waters (ORWI, Hagh Quality Waters {HQW), Trout Waters jr) and Primary Nursery Areas (RNA)
have a benchmark T5S rimit of 50 mg/L_ All other water classlflratl0ns hove a benchmark of 1DO mgf L
FW {Freshwater} SW ISaltwaterj
Dotes (n onal)- � I
'I certify by my signature below, under penalty of law. that thls document and all attachments were prepared under my direction or Supie rvis�an in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based an my
inquiry of the person or pemans who manage the system, or those persons directly responsible for gathering the information, the information
submitted 'Sr 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 knowlno violat€ons."
Signature of
r Delegated Authorized Individual
A�a x�
Date
ohasej dhomc.xrn 336-423-5552
Email Address Phone Number