NCG060014_2022 DMR_20220627 (2)

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(0I
Person Collecting Samples: K m ��r
Facility Name: CAAc N ' ahT
Laboratory Name: CA q -%' Cam.
Facility County: WG K2
Laboratory Cert. No.: (`� 3
Discharge during this period: M 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 CrNo
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR ffyes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
00 f
N/A
Date Sample Collected MM/DD/YYYY
6 j" g ap
46529
24-Hour Rainfall in inches
r$ / 1,
COS30
TSS in mg/L (100 or 50*)
51
00400
pH in standard units (6.0 — 9.0 FW,
%•
6.B-9.5SW)
c�
31616
Fecal Coliform per 100 ml of
0-A
freshwater (if required) !11000)
61211
Enterococci per 100 ml of saltwater
q
(if required) (500)
� V �A
00340
Chemical Oxygen Demand in mg/L
a
u
.q
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 1.7.Pi
1V1b
Outtaus to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of nE,, moo; / -. All other water classifications have a benchmark of
,'IN (Freshwater) 5VV (Saltwater)
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
false information, including the possibility of fines and imprisonment for knowing violations."
< ,
' 44 A
Signature oi Permittee or Delegated
rized Individual
61i71_2,2_
Date
! 4�;, L2 122 ;Z-)3 -,21,94
Email Address Phone Number