NCG060352_Monitoring Report_20220113

NCDEQ Division of Energy, Mineral and Land Resources
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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 appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG06 0352
Person Collecting Samples: James Barbaric,
Facility Name: S&D Coffee, Inc
LaboratoryName: pace Analytical
Facility County: Cabarrus
Laboratory Cert. NO.: NC Field service Cert #5342 Waste water#12 and 40
Discharge during this period: © Yes ❑ No (if no, skip to signature and dote)
Has your facility implemented mandatory Ter 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 httos://edoa.deg.nc.gov/Forms/SW-DMR 0 Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
c
N/A
Date Sample Collected MM/DD/YYYY
121a 2021
46529
24-Hour Rainfall in inches
.63
C0530
TSS in mg/L (100 or 50•)
10.8
pH in standard units (6.0-9.0 FW,
00400
6.8-8.5 SW)
6.8
Fecal Coliform per 100 ml of
31616
freshwater (if required) (1000)
Enterococci per 100 ml of saltwater
61211
(if required) (500)
Chemical Oxygen Demand in mg/L
00340
(120)
No
Additional parameters for outfalls in drainage areas that use>55 gallons per month of new hydraulic oil on average
Estimated New Motor/Hydraulic Oil
NCOIL
Usage in gal/month
00552
Non -Polar Oil & Grease in mg/L (15)
No
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (How), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L
FW (Freshwater) SW (Saltwater)
Notes (optional):
"I certify by my signature below, under penalty of law, thatthis 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, orthose 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 thatthere are significant penalties for submitting
false information, including the possibility of fines and Imprisonment for knowing violations."
Fo,r. T ai.,U dd
Signature of Permittee or Delegated AutHl6nzed Individual
Barberioj@snd caffee.com
Email Address
1/7/2022
Date
704-782-3121
Phone Number