HomeMy WebLinkAboutNCG060217_2022 DMR_20220407INCDEQ Division of Energy, Mineral and Land Resources
Stormwatet Uischarge Monitoring Report (DMR) Form for NCG060000
Food and Kindred
Click here far instruction
Complete, Sign, scan and su#tmit the DMR via file S[orntwdter NPDfS Permit Data Momtorlrg, Rc oil DMR) Uo10a0 form within
30 days of receiving sampling results. Mail the o0ginsal, signed hard copy of the DMR to the ippi opi i ,tt DF Mt k Rrr=,�or:dr Oft,ct-.
Certificate of Coverage No. NCG06
Facility Name: A}>A _ l t_
Facility County: t 1 t _ .
Pelson Collecting Samples:
Laboratory Name M cc r
Laboratory Cert. No.: I I
Discharge during this period: Lj Yes Do No tij no, skip to signature and date)
Has your facility irttplerriented mandatory Tier response actions this s,a nple period for any 0enchrnark crxceedances? RI Yes ❑ No
if so, which Tier (I, li, or Ill)?
A copy of this RMR has heen uploaded electronically via https !/FdorS tleq nc govjForm%,rSW DMR
Rate Jplpacled.
Analytical Monitoring Requirements for Outfalis with Industrial Activities - Oenchmarks in (Red)
Yes I I No
Parameter
Cpde
--PararTaetar
putfall Outfall - —
Qcrtfall
ptitfall
Outfali -- -
N/A
Rereiving Stream Class
N/A
pate sample Collected MM/Dp/yYYY
46529
24-hour Rainfall in inches
C0530
TSS tri MOL 1100 or SO'
00400
PH ill 5141100rd uniIS i6-0-9 n Ew.
- -
-----
--- -
3161E
Fecal Coliform per 100 ml of
freshwater (if required)
Enterococci per 100 nil of saltwater
6 211
(if required) 1500)
Chernical Oxygen Demand in ing/L -
nU34Q
Aclditional parameters for outfalls in drainage areas that use >55 gEjllar7s per ntorith of flew hydraulic oil on average
Fstimated New Motor/Hydraulic Oil
NCQit
Usage in galtlrionth
00552
_
Non -Polar Qil & Grease in MIRA. 15
. Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HOW), Trout Wager; (Tr) and R1i, ary Nwrsery Areas (RNA)
have a benchmark TSS limit of 70 mg/t- All other water classifications have a benchmark Of tot) mg/t
FW (Freshwater.) SW (Saltwater)
Notes [aptionak)=
' l certify by my signature below, under penalty of law, that this docur:tent and oll attachments were prepared under my direction at supervisior: in
accoroafire with a system desigiri d to assuri: that qualified personnel property ttather and evaluate the intorrnation submitted. Based on my
inclory of the person w perso;is who manage the sysrenn, or these persons directly respunssttle fjr gathering the information, the information
sulsmltfed' , to the hest of my knowledge and beiirt, t ,ie, accurate, an,i coniplete. I am aware that there are significant penalties for stibmstting
false info tion. including the possibility of fines and ir,iprisonment for knowing violations "
1
i �14- as
Signature of Permittee or Delegated Authorized Individual [late
_._19
Entail Address Phone Number