HomeMy WebLinkAboutNCG060425_2022 DMR_20220425NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG060000
Food and Kindred
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 a ro riate DE MLR Re Tonal Office.
Certificate of Coverage No.
Facility Name:a �, qr.--w &
Facility County:
Person Collecting Sam le
,T- LaboratoryName: ,41c
Laboratory Cert. No.: -Z'3 i
Discharge during this period: E21t+es ❑ No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sam le Period for any benchmark exceedances? ❑ Yes ETNo
If so, which Tier (I, 11, or III)?
A copy of this DMR has been uploaded electronically via https:U-edocs.deo.nc.gov/rorms/SW-DMR ❑ Yes [-]No
Date Uploade Yr 20Z, Z
Analytical Monitoring
Requirements for Outfalls with
Industrial Activities
- Benchmarks
in
Parameter
Code
Parameter
Outfall
p n
O it
r
Outfatl
Outfaji �
Outfall
N/A
Receiving Stream Class
a�
r•
N/A
Date Sample Collected MM/DD/YYYY
- LG°Z
�: " C �_ 1
` _ G,
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L (100 or 50*)
I
I
o�id
00400
s8in$5W)standardunits (6.0- 9.0 FW,i
g
31616
Fecal Coliform per 100 ml of
'' 11
/A_
freshwater (if required) (1000)
N
/V
61211
Enterococci per 100 ml of saltwater
)�
(if required) il500)
l
,Q
Ch
00340 ( ern icat Oxygen Demand in mg/L � }
120 /0 /v ! V
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
Usage in gal/month
00552 Non -Polar Oil & Grease in mg/L
Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark T55 limit of ' . All other water classifications have a benchmark of 100 mg/L
(Freshwater) 5V! (Saltwater)
Notes (optional): tpZ2.,
"1 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 Delegated Authorized Individual Date
Email Address Phone Number