NCG030596_Monitoring Report_20211206

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (DMR) UplAWm Tftin
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate OEM RiAnal Office.
Certificate of Coverage No. NCG03 0596
Person Collecting Samples: K. Rhinehart
Facility Name: Controls Southeast Inc
Laboratory Name: Par Labs
Facility County: Mecklenburg
Laboratory Cart. No.: 20
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, II, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR ❑✓ Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities— Benchmarks in (Red)
Parameter
Parameter
Outfall1
Outfall2
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
C
C
N/A
Date Sample CollectedMM/DD/YYYY
11/12/2021
11/12/2021
46529
24-Hour Rainfall in inches
1.74
1.74
C0530
TSS in mg/L(100 or 50*)
5
12
00400
pH in standard units (6.0-9.0)
7.37
7.43
01119
Copper, total recoverable in mg/L
0.003
0.015
(0.010)
01051
Lead, total recoverable in mg/ L
0.002
0.002
(0.075)
01094
Zinc, total recoverable in mg/ L
0.666
0.087
(0.126)
78141
Total Toxic Organics (TTO) in mg/L(1)
N/A
N/A
(if required)
00552
Non -Polar Oil & Grease in mg/L (15)
6.0
15.8
Additional parameters for outfalls in drainage areas that use>55 gallons per month of new hydraulic oil on average
NCOIL
Estimated New Motor/Hydraulic oil
N/A
N/A
Usage in gal/month
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HOW), Trout Waters (Tr) and Primary NurseryAreas (PNA)
have a benchmark TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L
Notes (optional): Elevated zinc levels previously reported to Mr. Zahid Khan
"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."
of Permitlleeidr Delegated Authorized Individual
12/01/2021
Date
Email Address [e-mail] Phone Number (704)-644-5002

Total Toxic Organics Certification:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring
requirement for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no leak, spill, or dumping of
concentrated toxic organics into the stormwater or onto areas which are exposed to rainfall or stormwater runoff has occurred since
filing the last discharge monitoring report. I further certify that this facility is implementing all the provisions of the Solvent
Management Plan included in the Stormwater Pollution Prevention Plan"
12/01/2021
Delegated Authorized Individual Date
Email Address [e-mail] Phone Number 704-644-5002

1211/21. 4:24 PM
Submission Completed
I* Stormwater NPDES Permit Data Monitoring Report
fflRiOORTH bR LINA (DMR) Upload
Permit and Facility Information:
Please enter the permit number and other details for this upload.
...........................................................................................................................................................................................................................................................................................................................................................................................
IMPORTANT.- Until the eDMR system is implemented for DEMLR Stormwater Program permits, an original
signed hardcopy of the DMR MUST be mailed to the address in your permit, in addition to this electronic
upload.
Fields marked with a red asterisk are required.
Permit Number* Enter COC or Individual Permit Number (NOT General Permit number with all 0's)
NCG030596
Must begin with NCS or NCG
Facility Name: * Controls Southeast, Inc.
County: * Mecklenburg
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/regional-offices/mooresville
Monitoring Period Information:
Monitoring Period What is the YEAR of the sample date(s)?
Year:* 2021
Multiple DMRs from sampling periods within the same year can be uploaded together, but please upload different
years with a new submittal form.
https://edocs.deq.nc.gov/Forms/Form/Submit 1/2

12/1 /21, 4:24 PM
Submission Completed
Also, copies of the lab results and qualitative (visual) monitoring should NOT be submitted unless specifically
requested by DEQ staff. Only upload the completed and signed DMR forms.
DMR Upload * Click the upload button or drag and drop files here to attach document.
20211112 Stormwater Discharge Monitoring Rep... 2AMB
Only PDFs are accepted.
Comments:
* By checking the box and signing box below, I certify that:
a I have given true, accurate, and complete information on this form;
o I agree that submission of this Data Monitoring Report (DMR) upload form is a "transaction" subject to Chapter 66,
Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
o 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.
Full Name: * Kate Rhinehart
Name of person submitting this form
Email Address: * [e-mail]
Phone Number: * 7045781872
Signature: *
AALc f RAGufatt
Date: * 12/01 /2021
https://edocs.deq.nc.gov/Forms/Form/Submit 2/2

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PFZ CHAIN OF CUSTODY
Phone[phone]
oU pAT6•g6L1ABL6 Fax [phone]
LABORATORIES, INC
Shipping:
2217 Graham Park Drive
Charlotte, NC 28273
it Is essentlal that all information be recorded on this Chain of Custody document for acceptance by PAR laboratories, Inc. and the North
V tll VlllgY
nC
e(billing) Comments/ S ecial Instructions
ONTROLSSOUTHEA5T,INC
Address
12201 NATIONS FORD ROAD
City, State & zip code
PINEVILLE, NC 28134
Point of Contact & Telephone Number O 4- S -7 $- I %7 2
SAM H9ktFf a*478-13Si ICATE iF H t rJ 6 41- tOr R-T
Sample , _
Taken By: SIGNATURE,-10t) tt-( n V-U- LOt - t f RIN I tU NAMt r- 4P�i r. W Ol ni a "r T
ARE SAMPLES FOR STATE or EPA REPORTING? YES _NO
'Sample Type: DW WW GWMW HW Soil Other
Sample Temp at time of sampling: ° C Sample Temp upon receipt: ° C
"Field Preserved: Yes _No _Teflon Liner/Zero Headspace: Yes No _ n/a
Residual Chlorine checked at time of sampling (YIN): Dechlorination Necessary(YIN):
Client Sample I.D. -
Sample Location r Number)
Comp,
Grab
Preserv.
Set Up
Daterrime
Collection
DateTme
Anualysas
Requested"
STORM WATER RUNOFF #1
X
< 4° c
I t tz 7-1
PH, TSS
X
H2SOn
O&G
X
HNo,
Pb, Cu, Zn
STORM WATER RUNOFF #2
X
< 4° c
it I Z zl
PH TSS
X
HZSO,
t
O&G
X
HNO,
b, Cu, Zn
RBI gmsned Dy uaren mre nomrvcu
�.:.. (�Lowr 9 50 1� t il- ra a/�i9S7�
Relinquished by: Daterrime Received by: Date rime
'C-Composge G=Grab DW=Drinking Water WW=Wastewater
Monitoring Well HW=Hazardous Waste