HomeMy WebLinkAboutNCG060351_2021 DMR_20220212NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DIVIR) For for NCGO60000
Food and Kindred
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Complete, sign, scan and submit the DIVIR via the Qrmwa e N D I �_erqj!LW a onl I n4e
—, "r t tl2r�
'a t 't forr within
30 days of receiving sampling results, Mail the original,
signed hard copy of
e DMR 0 the Regional Offjce.
Certificate of Coverage No. NCG06 Person Collecting..Sample
Facility Name- - I
Facility County: Laboratory Name:
Laboratory Cert. No.:
Discharge during this period, es [] No (if no, skip to signature and date)
Has your facility Implemented mandatory Tier response actions this, sam le Period for any benchmark exceeda
If so, which Tier (1, 11, or 111)7
A copy of this DIVIR has been uploaded electronically via hp.JLqdMdA.nc.oy -DM[_Yes0 No
Date Unloaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — apnehmnrim In 1120A1
Parameter
Code
Parameter
—Class
Outfall
Outfall
utfal
Outfall
Outfall
N/A
Receiving Stream
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall In Inches
C0530
TSS In mg/L (100 or SO*)
4-. Q
00400
pH In standard units (6.0 — %0 FW,
31616
Fecal Collform per 100 mi of
freshwater (if required ). (1000)
61211
Enterococci per 100 ml of saltwater
(if required) (500)
I"q
P IA
00340
Chemical Oxygen Demand In mg/L
Ad 11 ditional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic
oil on average
NCOIL
Estimated New Motor/Hydraulic oil
Usage in gal/month
00552
Non -Polar Oil & Grease in mg/L (15)
WUUQ %W WUL34111UIIQ; Rebource Waters 10RWI, High Quality Waters (HQ ), 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)
"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
fai Inl`MMMfy, Including the possibill"f fines and Imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual
— d �,
Email Address
® /&/0 -2-
Date
Z,
Phone Number