HomeMy WebLinkAboutNCG120019_2022 DMR_20220411NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG120000
Landfills
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (I)MR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR: to the appropriate DEMLR Regional Office.
Analytical Monitoring Requirements for Outfalls with Industrial: Activities -.Benchmarks in (Red): '
Par et r Parameter Oud84 Outer • .Outfan : Outfan DutfaH ,
lode
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
0 3jxjj
46529
24-Hour Rainfall in inches
feel
C0530
TSS in nWL (100 or Sd-)
pH in standard units(6:,6.8-8.5 SW)
40
r31626
Chemlcaf.Oxygen Demand in mg/L
120)
Fecal Coliform in # per 106 Ml (1000)
Additional parameters for outfalis in`dtainaae areas that use >55' eallons Der -month of new hvdraulic all ori-avera¢e
00552
Non -Polar Oil & Grease in mg/L (15)
NCOIL
Estimated New Motor/Hydraulic Oil'
Usage in gal/month
Outfalls to Outstanding Resource Waters (ORW), High Quality -Waters (HQW), Trout Waters (Tr) and Primarytilursery.Areas (PNA)
have a benchmark TSS Rmft of 50 mg/L: All other water classifications have a benchmark of•100 mg/L.
FW (Freshwater) SW (Sakwated
Notes (optional):
"I certify by my signature below, under penalty of law, that this document and ail attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel -properly gather andevaluate 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."
LG• /. Z Z
Signature of Permittee or Delegated Authorized Individual Date
Email Address Phone Number