NCG060139_2022 DMR_20221013

NCDEQ Division of Energy, Mineral and Land Resources
Complete, sign, scan and submit the DMR via the
30 days of receiving sampling results. Mall the original, signed hard copy of the DMR to the
within
Person Collecting Samples: r,•c 1FI&A1 ,/..IS,�a. I
Certificate of Coverage No. NCG06 ®l 3 R - i
Facility Namev$,ri r1,; e(o� },ts�.._r?r^�Gi� "'�O''�'' Laboratory Namer., ;t7elcQ �nJdiro�+cc _�,x%, j';.•�
Facility County .5'a� soa _ Laboratory Cert. No W i,�T A I l6 Cf —
Discharge during this period. Yes ❑ No (if no, skip to signature and date) _
Has your facility Implements mandatory Tier response actions this sample period for any benchmark exceedances? [� Yes ❑ No
If so, which Tier (I, II, or 111)? _
A copy of this DMR has been uploaded electronically via
Date Uploaded: /0/j12 Z
Analytical Monitoring Requirements for Outfalls with Industrial Activities-
Parameter Parameter outfall
Code
N/A ~ Receiving Stream Class en S Pd
N/A Date Sample Collected MM/DD/YYYY Z ZZZZ2
Benchmarks in
outfall outfall
46529
24-Hour Rainfall in inches
` • 6
�;L_
C0530
TSS in mg/L(100 or 50*)
Yes [:]No
outfall Outfall
I pH in standard units 16.0 - 9.0 FW,
00400
8.5 SN'
,
-
_
�
-
Fecal Coliforrn per 100 ml of
31616
O v D
freshwater (if required) 1000)
-
Enterococcl per 100 ml of saltwater +
61211
00340
(if required) (500)
Chemical Oxygen Demand in mg/L
— -
�—
(120)40—
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
Estimated New Motor/Hydraulic Oil I
NCOIL
Usage in gal/month
Ti--
00552 Non -Polar Oil & Grease in mg/1-11si
• 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 )0 mg/L
FW (Freshwater)SW (Saltwater)
I 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, includin possibility of fines and imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual Date
Email Address Phone Number