NCG030707_Monitorig Report_20211027

Stormwater NPDES Permit Data Monitoring Report
(DMR) Upload
Permit and Facility Information:
Please enter the permit number and other details for this
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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)
NCG030707
Must begin with NCS or NCG
Facility Name:*
Tube Specialties Compnay
County:*
Iredell
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.

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.
SDO 10.18.2021.pdf 108.67KB
Only PDFs are accepted.
Comments:
* 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 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');
a 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:* Bill Hoover
Name of person submitting this form
Email Address: * [e-mail]
Phone Number: * 17433332686
Signature:
Date: * 10/19/2021

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calendar Year 2 D 2 (
Individual NPDES Permit No. NCSULJLJUUU or
Certificate of Coverage (COC) No. NCG❑O ®❑O ❑? 777
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: -TO&C SQECIAt- %15 00MJ*AvJY
County: SR E b,r. L%-
Phone Number: 7( 4f 3 33.-26,96 Total no. of SDOs monitored
Outfall No.. I
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No fS
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No 54
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
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SW U-264 - Generic Annual DMR
Last revised 510212018

"I certify, 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 1/,AfA
Date k0-I'L—LI
For questions, contact your local Regional Office:
DWO Regional Office Contact Information:
r
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
(919) 791 A200
FAYETTEVILLE REG[ 0RF10E
225 Green Street
Systel Building Suite 714
Fayetteville. NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
WINSTON-SALEM REGIONAL OFFICE CENTRAL OFFICE
450 Hanes Mill Rd, Suite 300 1617 Mail Service Center
Winston-Salem, NC 27105 Raleigh, NC 27699-1617 L40Tgandenna oe
[phone] [phone] nbM Cetdmals 11-"
SW U-264 -Generic Annual DMR
Lest revised 6/02/2018

Analytical Results sTATESVILLE
ANALYTICAL
Tube Specialties Co., Inc.
1401 Industrial Drive
Statesville, NC 28677
Receive Date: 10/05/2021
Reported: 10/18/2021
For: Stormwater
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
211005-56-01
Copper
OF#1
0.002
mg/L
EPA200.7
10/18/2021
MD
211005-56-01
Lead
OF#1
<0.002
mg/L
SM31138-20M
10/08/2021
MD
211005-56-01
Oil and Grease
OF#1
<5.08
mg/L
EPA1661RevS
10107/2021
CE
211005-56-01
TSS
OF#1
<2.778
mg/L
SWUM-2011
10/07/2021
211005-56-01
Zinc
OF#1
0.026
mg/L
EPA200.7
10/15/2021
MD
Respectfully submitted,
Melissa Myers
NC Cart #440,
NCDW Cart #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 3

Condition of Receipt
Sample Number 211005-56-01 Temp on Arrival: 2.5
Parameter Schedule:
Nitric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: Copper
Nitric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: Lead
Nitric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: Oil and Grease
Hydrochloric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TSS
Received on Ice
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 3

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