NCG030646_2022 DMR_20220718

NCDEQ Division of Energy, Mineral and Land Resources
5tormwater Discharge Monitoring Report (DMR) Form for NCGO30000
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the DMR via the Stor mwaler NPDES Permit Data Monitoring Report f DMR) Upload fo,rrn within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DFMLR Regional Office.
Certificate of Coverage No. NCG03646
Person Collecting Samples: NA
Facility Name: John Deere Kernersville
Laboratory Name: NA
Facility County: Forsyth
Laboratory Cert. No.: NA
Discharge during this period, L]Yes
El No (if no, skip to Signature and date)
Has your facility Implemented mandatory Tier response actions this sample period for any benchmark exceedances? Yes LjNo
If so, which Tier (1, II, or Ill)?
A copy of this DMR has been uploaded electronically via https!//vdocs,deg. nc. ov�Forms SW-DMR Yes No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
parameter
Gutfall
Outfall
ou#all
Outfall
Outfall
Code
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/Dd/YYYY
46529
24-Hour Rainfall in inches
C0530
T55 in mg/L (100 or 50*)
pH in standard units (6.0-9.0 FW,
00400
6.8-8.5 5W)
01119
Copper, total recoverable in mg/L
0.010 FW, 0.005E 5W)
Lead, total recoverable In mg/ L
01051
0.0i5 FW, 0.22 5W)
01094
zinc, total recoverable in mg/ L (0.126
FW, 0.095 5W)
Chemical Oxygen Demand (COD) In
00340
mg/L (120)
00552 1
Non -Polar Oil & Grease in mg/L (15)
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas JPNA)
have a benchmark T55 limit of 50 melt. All other water Classifications have a benchmark of 100 mg/4
rW (Freshwater) SW (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 forgathering 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."
Signature of Peri'nittee nr Delegated Authorized Individual
cmc.com
Email Address
July 18, 2022
Date
336-423-5552
Phone Number