HomeMy WebLinkAboutNCG060081_2022 DMR_20220331NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG060000
Food and Kindred
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Complete, sign, scan and submit the DM via the Stormwater NPDES Permit Data Monitoring Report [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. NCG06 /
Person Collecting Samples: 72164
Facility Name: O7 C QIt-I r 0,04 5 — S PC—
LaboratoryName: WAY fop Ill.] / A A-V�LYT) 69L
Facility County:
Laboratory Cert. No.: g02-
Discharge during this period: Yes ❑ No (if no, skip to signature and dote)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? -]Yes [a !moo
If so, which Tier (l, II, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for outfalls with Industrial Activities - Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
outfail
Outfall
N/A
Receiving Stream Class
007 1
00 -
Q 0_4
005-
N/A
Date Sample Collected MM/DD/YYYY
23/�VN
Z 3120ZZ-
Z Z
13/Z O -ZZ,
� z a%2cii
46529
24-Hour Rainfall in inches
: 5 3
; S
, 5"�,
r 5 3
I S 'a
C0530
TSS in mg/L (100 or 50*)
2Afa
11.1 AAg t--
f , 3 1►R 1-
l L
Z 2 • / my/..
00400
pH in standard units (6.0 - 9.0 FW,
%ter
6.07
[r,T7
7Dtj
10,1L4
6.8 - 8.5 SW)
31616
Fecal Coliform per 100 ml of
freshwater (if required) (1000)
61211
Enterococci per 100 ml of saltwater
(if required) (500)
00340
Chemical Oxygen Demand in mg/L
52 M�1�
��� it��IL
-�, rvtcj 1L
< 50Mi'i-
<50M3
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
NCOIL
Estimated New Motor/Hydraulic Oil
�II4t
Usage in gal/month
00552
Non -Polar Oil & Grease in mg/L (15)
r]. 3 n1 j r_
C rj•--1 m9 c
C 5 q Ali L
< 5 , 5 M j
NL5 L
* outfalls to outstanding 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
FW (Freshwater) SW (Saltwater)
Notes (optional):
"t 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, including the possibility of fines and imprisonment for knowing violations."
GcLl•cb_�
Signature oFPermittee or Delegated Authorized Individual
tug, Puke�Aes Co, ot--)ke- eoo5oilcirlded, eonx
Email Address
3 1 31 2'L
Date
WID --921- `3,2&D
Phone Number