NCG030646_DMR for NO FLOW_20230428

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG030000
Metal Fabrication
Click here for instructions
Complete, sign, scan and submit the 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. NCG030646
Person Collecting Samples:
Facility Name:John Deere Kernersville
Facility County: Forsyth
Laboratory Name:
Laboratory Cert. No.:
Discharge during this period: E]Yes
0
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 https://edocs.deg.nc.gov/Forms/SW-DMR ✓ Yes U No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L (100 or 50*)
00400
pH in standard units (6.0-9.0 FW,
6.8-8.5 SW)
01119
Copper, total recoverable in mg/L
(0.010 FW, 0.0058 SW)
Lead, total recoverable in mg/ L
01051
(0.075 FW, 0.22 SW)
01094
Zinc, total recoverable in mg/ L (0.126
FW, 0.095 SW)
Chemical Oxygen Demand (COD) in
00340
mg/L (120)
00552
Non -Polar Oil & Grease in mg/L (15)
uutraus to Outstanaing Kesource 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
FW (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 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."
/l / i --1 C�
4/26/2023
atureWf Permittee of Delegated Authorized Individual Date
[e-mail]
Email Address
336-414-2601
Phone Number