NCG120108_2022 DMR_20220518 (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 0108 Person Collecting Samples:
Facility Name: Edgecombe County Landfill Laboratory Name:
Facility County: Edgecombe Laboratory Cert. No.:
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 I11)? 11
A copy of this DMR has been uploaded electronically via https://edocs.dtg.nc.gov/Forms/SW-DMR ✓❑ Yes ❑ No
Date Uploaded: May 18, 2022
Analytical Monitoring Requirements for Outfalis with Industrial Activities — Renchmarkc in %Rsaell
--- -- -- --•�--•--•,. • Sig .4U011Ly vvacers jrl%4W), i rout waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of SO m,fie°'.` . All other water classifications have a benchmark of 100 mg/L
Notes (optional): Tier 2: no rainfall sampling opportunities during April 2022
"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."
n m r• A
Signature of Permittee or
Individual
Dat
Email Address [e-mail] Phone Number 252-813-3947