NCG060326_2022 DMR_20220623

NCDEQ 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 appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG06 tJ 3 (0
Person Collecting Samples:
Facility Name: EvN(A7 r JOP- i rt- ftmL.Md
Laboratory Name: Ev �2cnJra�Nr►9� C l{t✓,,,, 5�
Facility County: boptTiJ
Laboratory Cert. No.: Qia C,, 4tq -
Discharge during this period: ❑ Yes jgNo (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? ❑ Yes R No
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.de-g.nc.gov/Forms/SW-DMR Yes []No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Receiving Stream Class
Date Sample Collected MM/DD/YYYY
24-Hour Rainfall in inches
I
TSS in mg/L (100 or 50*)
pH in standard units (6.0 — 9.0)
Oil & Grease in mg/L (30)
Fecal Coliform per 100 ml of
freshwater (if required) (1000)
61211
Enterococci per 100 ml of saltwater
(if required) (500)
00340
Chemical Oxygen Demand in mg/L
(120)
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 (15)
• Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TS5 limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L
Notes (optional):
" 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
f7Lc inform on ir,f ilid;np the possibility of fines and irnpr Isnnmer t fo, kncr+ g violations "
-- - 1�-d3--,)a.
Signature of F'erniittee of U gated Authorized Individual Date
Email Address
sc-at+ . ; umc'ej a b"fie , CBr,%
Phone Number
9to-Ssa--6C)