NCG060139_2022 DMR_20220327

NCDEQ Division of Energy, Mineral and Land Resources
J i. L
Complete, sign, scan and submit the DMR via the _ =. _ + within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the
Certificate of Coverage No. NCG06 ®(� person Collecting Samples: or+G /1�✓rG 1++.gam
Facility Name�$,yr ;; c( ��, ca� G�., e,on/; Laboratory NameSr, ; i�.�tel�Q LwJI/iro.✓nc�.a�.��,x:�>✓,, :•�
Facility County: S',,,,v _Laboratory Cert. No.: W wZ P I
Discharge during this period: JRrYes ❑ No (if no, skip to sign_oture_and date)
Has your facility implemented mandatory Tier response actions this sample Reriod for any benchmark exceedances? CA Yes ❑ No
If so, which Tier (I, II, or 111)? _
A copy of this DMR has been uploaded electronically via _ _ _ ❑ Yes ❑ No
LDate Uploaded: 3%L 7 'Z2 _ - -- —--- -
Analytical Monitoring Requirements for Outfalls with Industrial Activities - Benchmarks in {Red)
_
Parameter parameter outfall Outfall Outfall
I
�Outfall
Outfa[I #
Code _ —
N/A Receiving Stream Class_
—
N/A Date Sample Collected MM/DD/YYYY
46529 24-Hour Rainfall in inches Q, r� • S�"j _
C0530 TSS in mg/L(.100 ar 501
pH in standard units 16.0-- 9.G
00400
Fecal Coliform per 100 ml of
I
31616
I freshwater (if required) (10.00) I
Enterococcl per 100 ml of saltwater
61211 (if required) (301
00340
I Chemical.2 Oxygen Demand in mg/L
�• D d
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/Ls:.S)
Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of MU g/L. All other water classifications have a benchmark
(Freshwater)Sk, (Saltwater)
`Notes(optional):
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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, includin the possibility of fines and Imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual Date
Signature
�1` � � 4r�'���1+ :��� . ��� _r.�je.• � ter_
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Phone Number
Email Address