NCG030513_2022 DMR_20220303

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DIVIR) Form for NCG030000
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DIVIRvia the 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 0513
Person Collecting Samples: Nicholas Fugitt
Facility Name: Goodyear Statesville
Laboratory Name: Pace Analytical
Facility County: Iredell
Laboratory Cert. No.: Charlotte 12/5342/37706 Ashville: 40/37712
Discharge during this period: LfjYes E] No (if no, skip to signoture ond date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceeclances? M, Yes r7vNo
A copy of this DIVIR has been uploaded electronically via httos://edocs.deci.nc.gov/Forms/SW-DMR E]Yes 1:1 No
Date Uploaded: 3/3/2022
Analytical Monitoring Requirements for Uutfa|bwith industrial Activities — Benchmarks in(Red)
Code
N/A
Receiving Stream Class
Class C
N/A
Date Sample Collected MM/DD/YYYY
02/03/2022
46529
24-Hour Rainfall in inches
1+ Inch
Zinc, total recoverable in mg/ L (0,126
Chemical Oxygen Demand (COD) in
00340
<25 mg/L
*OutfallsmOutstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TS5 limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L
nm(pe,hvater)um(Sabwater)
Notes (optional):
"| certify bymysignature below, under penalty oflaw, that this document and all attachments were prepared under mydirection nrsupervision m
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 offines and imprisonment for knowing vio|atiura/"
\
Signature ofP�nitteevrDelegated Authorized Individual
Email Address
704-301-7215
Phone Number