NCG060139_2022 DMR_20221122 (2)

NCDEQ Division of Energy,Mineral and Land Resources
1216 f._ �� -
Complete,sign,scan and submit the DMR via the
+� r within
30 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the Li.iir•__,
/
Certificate of Coverage No.NCGO6®(3 Person Collecting Samples: y//"1- /" •����
Facility Name:5m ; C;e( 4k lit„.L.,_(w.p_,G(;,,.4o., Laboratory NameSr,;444:41,1 //,JL/i(0,,n4 r-J�f C� s'%.�iz,,, 4j c.
Facility County: ,$,.„,, so,, - - - - Laboratory Cert. No.: W u7T P I(6 / Cf'i
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?VI,Yes ❑ No
If so,which Tier(I,II,or III)? - - -
A copy of this DMR has been uploaded electronically via 1 .e '— _ E3-Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities-Benchmarks in led)
Parameter Parameter ' Outfall ,. Outfall 2 Outfall Outfall Outfall
Code i
N/A Receiving Stream Class G,-Si� CiS If
N/A Date Sample Collected MM/DD/YYYY
-
a6529 24-Hour Rainfall in Inches
C0530 TSS in mg/L(100 or 50") Vjf — 0 — _
00400 pH in standard units(6.0-9.0 FW, ) )
6.8-8.5SW) r ,
31616 Fecal Coliforrn per 100 ml of
freshwater(if required)(1000) - I _.
61211 Enterococci per 100 ml of saltwater
(if required)(500) i - - —- -,--
Chemical Oxygen Demand in mg/L I
00340 (120) —-
Additional parameters for outfalls in drainage areas that use>S5 gallons per month of new hydraulic oil on average
NCOIL Estimated New Motor/Hydraulic Oil 1
Usage in gal/month 1
00552 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(PNA)
have a benchmark TSS limit of 50 mg/L.All other water classifications have a benchmark of 00 mg/L
(Freshwater) (Saltwater)
I Notes(optional): /V 2 A i" - ®
-
i
"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 informa'on includi the possibility of fines and imprisonment for knowing violations."
jam/ 3 1/202 2---
Signature Permittee or Delegated Authorized Indi ' ua Date
1'/ `6 if,- to 041 4/016_
3Fr v/,6 6'
Phone Number
Email Address