NCG060030_2022 DMR_20220401 (2)

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCGO60000
Food and Kindred
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report iDMR] 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. NCG060030
Person Collecting Samples: Stephen Gouge
Facility Name: Baxter Heltht.are Corporation
Laboratory Name: Baxter WWTP Lab, Environmental Testing Solutions
Facility County: McDowell
Laboratory Cert. No.: 935, 600
Discharge during this period: El Yes []No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period, for any benchmark exceedances? ❑ Yes 0 No
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via httos://edocs.deg.nc.gov/FormsISW-DMR ❑✓ Yes [--]No
Date Uploaded:04/01/2022
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks In (Red)
Parameter
Code
Parameter
Outfall ST01
Outfall ST02
Outfall ST04
Outfall NA
Outfa11 NA
N/A
Receiving Stream Class
r
Tr
Tr
NA
NA
N/A
Date Sample Collected MM/DD/YYYY
03/07/2022
03/07/2022
03/07/2022
NA
NA
46529
24-Hour Rainfall in inches
0.2
0.2
0.2
NA
NA
C0530
TSS in mg/L (100 or SO*)
13.6
3.4
1.0
NA
NA
00400
pH in standard units (6.0 — 9.0)
6.76
6.45
6.37
NA
NA
00556
Oil & Grease in mg/L (30)
<5
<5
<5
NA
NA
31616
Fecal Coliform per 100 ml of
NA
NA
NA
NA
NA
freshwater if required) (1000)
61211
Enterococci per 100 ml of saltwater
NA
NA
NA
NA
NA
(if required) (500)
00340
` 0) ical Oxygen Demand in mg/L
19
6
29
NA
NA
Additional parameters for outfalls in drainage areas that use >SS gallons per month of new hydraulic oil on average
NCOIL
Estimated New Motor/Hydraulic Oil
NA
NA
NA
NA
NA
Usage in gal/month
00552
Non -Polar Oil & Grease in mg/L (15)
NA
NA
NA
NA
NA
+ Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of sn moil. All other water classifications have a benchmark of 100 mg/L
Notes (optional):
"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
false infi"ation, includ)nS t1M possibility of fines and imprisonment for knowing violations."
Of
Authorized individual
04/01 /2022
Date
Email Address stephen—[e-mail] Phone Number 828-756-6608