NCG060139_2022 DMR_20220712

111CDEQ Division of Energy, Mineral and Land Resources
Complete, sign, scan and submit the DMR via the- V__-_: within
i 30 days of receiving sampling results. Mall the original, signed hard copy of the DMR to the pp
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Certificate of Coverage No. NCG06 ®( 3 q 1 Person Collecting Samples:_
FacilityName.'6A4,;e(pi? hesk ea� ' Laboratory Name�r.,; V:eI�Q aldiro,✓ue.��j fcie: ,,,�;�..�
Facility County:.�a.r psoN _ Laboratory Cert. No W w-T P I (b
Discharge during this period: RrYes ❑ No (if no, skip to signature and date)
Has your facility Implemented mandatory Tier 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 _ Yes [:]No
LDate Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in i R -::?
Parameter Outfall—outfall IOual llParameter Outf
Code
N/A Receiving Stream Class G y_J
N/A Date Sample Collected MM/DD/YYYY
46529 24-Hour Rainfall in Inches
C0530 i TSSinmg/Li1G0or50*1
00400 i pH in standard units .0-9J! FW, I — ��7 q
Fecal Coliform per 100 ml of —I
31616 freshwater (if required} (1000) i ;P7 (] P v
61211 Enterococcl per 100 ml of saltwater
00340 Chemical Oxygen Demand in mg/L 7 i
(12°
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 j
Usage in gal/month�-
00552 Non -Polar Oil & Grease in mg/L i;35'
Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Trl and Primary Nursery Areas (PNA)
have a benchmark T55 limit of 5o E,/ . All other water classifications have a benchmark of i
(Freshwater) sr. (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 knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false infor cl a possibility of fines and imprisonment for knowing violations."
/z z 2
a`ture of Permittee or Delegated Authorl ed Individual Date
Phone Number
Email Address