NCG060409_2022 DMR_20220718

I ICDEQ Division of Energy, Mineral and Land Resources
Stor at Discharge Monitoring Report (DMR) Form for NCG060000
Food and Kindred
Click here for instructions
Complete, sign, scan and sub ;.e 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 0409 Person Collecting Samples: John Haffner
Facility Name:Amazon.com Services LLC - GSO1 Laboratory Name:Eurofins Test America Savannah
Facility County: Forsyth Laboratory Cert. No.: 269
Discharge during this period: ✓❑ 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 0 No
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via https://edocs deq nc gov/Forms/SW-DMR ❑ Yes ❑ No
Date Uploaded: l 7 WZo , -
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter Parameter Outfall 001 Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class WS-IV
N/A Date Sample Collected MM/DD/YYYY 06/27/2022
46529 24-Hour Rainfall in inches 0.1
C0530 TSS in mg/L (200 or 50*) <5.0
00400 pH in standard units (6.0 — 9.0 FW, 7.84
6.8 — 8.5 SW)
31616 Fecal Coliform per 100 ml of N/A
freshwater (if required) (1000)
61211 Enter cocci per 100 ml of saltwater N/A
(if required) (500)
Chemical Oxygen Demand in mg/L 5.7
00340
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 N/A
Usage in gal/month
00552 Non -Polar Oil & Grease in mg/L N/A
Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of All other water classifications have a benchmark of 100 mg/L
i - I (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 possibility of fines and imprisonment for knowing violations."
Delegated Authorized Individual
Sign atu:re)�rmlt�teeo r
[e-mail]
Email Address
Date
[phone]
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