HomeMy WebLinkAboutNCG060007_2022 DMR_20220712NCDEQ 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 Monitorin Re ort DMR U load form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DEMLR Re Tonal Office.
Certificate of Coverage No. NCGi
Facility Name:
Person Collecting Samples:
Laboratory Name:
Facility County: �� ;. ��� Laboratory Cert. No.:
Discharge during this period: ❑Yes o (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via Lt s: edocs_de .nc. ov Forms SW-DMR
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
ParameterASampleCollecteLd��
Outfall.# Outfall ,t� Outfall Outfall
Code
N/A Rece
N/A Date�
Yes [elo
❑ No
Outfall
46529
24-Hour Rainfall in inches
IVU t—
N'V LUG
C0530
TSS in mg/L (100 or SO*)
IRO',
00400
pH in standard units (6.0-9.0 FW,
IW
6.8 — 8.5 SW)
31616
Fecal Coliform per 100 ml of
freshwater (if required) (1000)
i
Enterococci per 100 ml of saltwater
61211
(if required) (500)
00340
Chemical Oxygen Demand in mg/L
���
i
(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
hh
Usage in gal/month
00552
Non -Polar Oil & Grease in mg/L (15)
nni05- N/✓AA_
Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), 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
(Freshwater) (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 ssibility of fines and imprisonment for knowing violations."
- � _ D7-f Z-ZoZZ
Signature of Permittee or legated Authorized Individual Date
r
Email Address Phone Number