NCG120054_2022 DMR_20220412 (2)

NCDEQ 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 (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. NCG12 0054 Person Collecting Samples: Tim Ke
Facility Name: Sampson Count Disposal, LLC Laboratory Name: N/A
Facility County: Sampson Laboratory Cert. No.: 16
Discharge during this period: ❑ 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 ✓❑ No
If so, which Tier (I, ll, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR ❑✓ Yes ❑ No
Date Uploaded: H / 12 / -1 Z
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall 11
outfall12
outfall
Outfall
outfall
N/A
Receiving Stream Class
C, SW
C, SW
N/A
Date Sample Collected MM/DD/YYYY
No Discharge
No Discharge
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L (100 or 50*)
00400
pH in standard units (6.0 — 9.0)
00340
Chemical Oxygen Demand in mg/L
(120)
31616
Fecal Coliform in # per 100 ml (1000)
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
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 Primary Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L
Notes (optional): First Quarter 2022 DMR. Outfalls subject to quarterly monitoring. No discharge within the monitoring eriod.
"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, o hose persons directly responsible for gathering the information, the information
submitted is, to the best of my knowledge and beii ru accurate, and complete. I am aware that there are significant penalties for submitting
false information, including the possibility of fin nd ' 4sonment for knowing violations."
Signature of Permittee or Delegated
Individual
Date
Email Address [e-mail] Phone Number [phone]