NCG030195_Monitoring Report_20220418

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG03000
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report�trj..Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the ��r�riate'IE.MIR Regional Office.
Certificate of Coverage No. NCG030195 Person Collecting Samples: J. Thurman Horhe, P.E.
Facility Name: Imperial Brown, Inc. Laboratory Name: K & W Laboratories
Facility County: Rowan Laboratory Cert. No.: 559
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? Eyes DNo
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR Eyes No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall 001
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
C
N/A
Date Sample Collected MM/DD/YYYY
03/07/2022
46529
24-Hour Rainfall in inches
0.3
C0530
TSS in mg/L (100 or lio:`)
< 2.6
00400
pH in standard units ,,o I�Arv,
6.39
01119
Copper, total recoverable in mg/L
< 0.005
(€.)..+f.}�1,o i"'v, i)oif('rx tiyvO
01051
Lead, total recoverable in mg/ L
< 0.005
9,+:,:➢%`._ ! VV, t'?.;,Y , kr,t)
Zinc, total recoverable in mg/ L ;, '
01094
0.013
Chemical Oxygen Demand (COD) in
00340
mg/L (;.; ; i)
<10
00552
Non -Polar Oil & Grease in mg/L (:U'l-)
< 5.9
Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of t�l '? . All other water classifications have a benchmark of
E 1VV (Freshwater) 'V (Saltwater)
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 information, including the possibility of fines and imprisonment for knowing violations."
Signature of Permittee or
krhoads a@imperial-brown.00n i
Email Address
4/7/2022
Date
503- 706-6060
Phone Number

Permit and Facility Information:
Please enter the pennit number and other details for this
......................... ....._
IMPORTANT. Until your stormwater permit is registered in the eDMR system, an original signed (D-QJ digitally
signed) hardcopy of the DMR must be mailed to the address in your permit, in addition to this electronic upload.
Permit Number* Enter COG or Individual Permit Number (NOT General Permit number with all O's)
NCG030195
Must begin with NCS or NCG
Facility Name:* Imperial Brown, Inc.
County:* Rowan
After uploading here, the original signed hardcopy must be mailed to:
DEQ Mooresville Regional Office
Attn: DEMLR Stormwater Program
610 East Center Avenue
Suite 301
Mooresville, NC 28115
Further contact details at https://deq.nc.gov/contact/regionaI-offices/mooresviIle
k4k )nitoring Period Information:
Multiple DMRs from sampling periods within the same year can be uploaded together, but please upload different
years with a new submittal form.
Monitoring Period What is the YEAR of the sample date(s)?
Year:* 2022
Copies of the lab results and/or qualitative (visual) monitoring should NOT be submitted unless specifically
requested by DEQ staff. Only upload completed and signed DMR forms.
"*DMR forms should have original signature (not digital) to comply with requirements in 40 CFR 122.22**
DMR Upload* Click the upload button or drag and drop files here to attach document.
Imperial BrownNCG03-DMR-030722-DEMLR-SW IB
277.04KB
March 2022.pdf
Only PDFs are accepted.
Comments:
* ,e By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o I agree that submission of this Discharge Monitoring Report (DMR) Upload form is a "transaction" subject to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act");
o I understand that an electronic signature on this upload form has the same legal effect and can be enforced in the same
way as a written signature; AND

o I intend to electronically sign and submit this DMR Upload form.
Pauli name;;Ken Rhoads
Name of person submitting this form
Email Address:* [e-mail]
Phone Number:* 15037066060
Signature:*
04/07/2022