NCG060114_2022 DMR_20220627

NCDEQ Division of Energy, Mineral and Land Resources
mwater Discharge Monitoring Report (DMR) Form for NCG060000
Food and Kindred
Click here for instructions
Complete, sign, scan t
submit the DMR via the 5tormwater NPDES Permlt Data MonitoringRe ort DMR Upload form within
30 days of receiving spling results. Mail the original, signed hard copy of the DM to the appropriate DEMLR Regional Office.
Certificate of Coverage No.
NCG06 } }
Person Collecting Samples: (0
Facility Name; Y{ f �,(
Y Ci1�L� l h / jVL [�
Laboratory Name: M j pyi f
Facility County: •
Laboratory Cert. No.: 1,4( r 7 3 77 7
Discharge during this pe
lad: Yes ❑ No (if no, skip to signature and date)
Has your facility implemented
If so, which Tier (1, 11, or I
mandatory7ier response actions this sample period for any benchmark exceedances? Z Yes ❑ No
11)? i icy -I
A copy of this DMR has been
Date Uploaded:
uploaded electronically via httilocs.deg. nc.gov/Form sSW-DMR Yes U No
Analytical Monitoring Requirements for Outfalls with Industrial Activities - Benchmarks in pied)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream
Class
f
N/A
Date Sample
Collected MM/DD/YYYY
7 Z
46S29
24-Hour Rainfall
in inches
, I �<
CO530
TSS in mg/
(100 or So`)
C71 . —7
004GO
pH in standard
units ll - 9.0 FW,
,1 2-
6.8 - 8.5 5
)
Fecal Coiif
rm per 100 ml of
31616
freshwater
(if required) (1000)-
61211
Enterococ
per 100 ml of saltwater
(if require
) (500)
C',
00340
Chemical C
xygen Demand in mg/L
r� L
(120)
7 Vm
Additional p
rameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
NCOIL
Estimated
ew Motor/Hydraulic Oil
N
Usage in g
1/month
1 I
00552
Non -Polar
it & Grease in mg/L (15)
ou
outfalls to Outstanding esource Waters (011 High Quality Waters (HQW), Trout Waters l and Primary Nursery Areas (PNA)
have a benchmark TS5 Il t of 50 mg/L. All other water classifications have a benchmark of 100 mil
FW (Freshwater) 5w
Motes
"I certify by my signature b low, 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."
Sig.je of Permittee 61 Delegated Authorized Individual
Email Address
(i-/G-7.2.
Date
(Ilo) 6 eU - -?S� 2-
Phone Number