NCG190103_2022 DMR_20230104

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG190000
Marinas and Shipbuilding
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. NCG19 Person Collecting Samples:
Facility Named ,\ —ICN %.0441.._ `fiery Name:
Facility County: (j ' t l C Laboratory Cert. No.:
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 ❑ 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:
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall Outfall Outfall Outfall Outfall
Code
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*)
00552 Non-Polar Oil&Grease in mg/L(15)
00340 Chemical Oxygen Demand in mg/L(120)
00400 pH in standard units(6.0-9.0)
01105 Aluminum,total recoverable in mg/L
(0.75 FW,0.24 SW)
Chromium III,total recoverable in mg/L
01027 at certain facilities*`(0.905 FW,none
SW)
Chromium VI,total recoverable in mg/L
C0034 at certain facilities**(0.016 FW,1.1
SW)
0 01042 Copper,total recoverable in mg/L
(0.010 FW,0.006 SW)
01051 Lead,total recoverable(as Pb)in mg/L
(0.075 FW,0.22 SW)
C0034 Nickel,total recoverable in mg/L(0.335
FW,0.074 SW)
01092 Zinc,total recoverable in mg/L(0.126
FW,0.095 SW) _
NCOIL Estimated New Motor/Hydraulic Oil
Usage in gal/month I J
*Outfalls to Outstanding Resource Waters(ORW),High Quality Waters(HQW),Trout Waters(Tr)and Primary Nursery Areas(PNA)
have a benchmark T55 limit of 50 mg/L.All other water classifications have a benchmark of 100 mg/L
**Only required for Ship and Boat Building and Repairing[SIC 373]facilities that perform metal fabrication in areas that could potentially be
exposed to stormwater
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 in a ' ,inc ossibilit of fine wing violations."
Signature of Permittee or Delegated
Authorized Individualy /yQ ���(a:te
Email Address�� 3 L \VC3J c \,t`Ji o3,,�J .Q ea 'r'hone Number C110 146` RtIrr
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