NCG030511_2022 DMR_20230113

NCDEQ Division of Energy,Mineral and Land Resources
Stormwater Discharge Monitoring Report(DMR)Form for
NCG030000-Metal Fabrication
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. NCG030511 Person Collecting Samples: Johnson,Mark
Facility Name: Scott Safety Laboratory Name: Waypoint Analytical
Facility County: Union Laboratory Cert.No. 402
Discharge during this period: 0 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? p Yes ❑ No
If so,which Tier(I, II, or III)? Tier I
A copy of this DMR has been uploaded electronically via https://edocs.deq.nc.gov/Forms/SW-DMR 0 Yes ❑ No
Date Uploaded: PPnriir'-
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Rau/
Parameter Outfall Outfall Outfall Outfall Outfall
Code Parameter SDO-1 SDO-2 SDO-3 SDO-4 NA
NA Receiving Stream Class C C C C NA
NA Date Sample Collected MM/DD/YYYY 12/15/2022 12/15/2022 12/15/2022 12/15/2022 NA
46529 24-Hour Rainfall in inches 0.54 in. 0.54 in. 0.54 in. 0.54 in. NA in.
C0530 TSS in mgiL i 00 or 50 , < 2.5 mg/L < 3.6 mg/L < 2.5 mgiL 4.6 mg/L < mg/L
0400 pH in standard units `'.0—9.0) < 5.10 *"* < 5.80 --'- < 6.60 *** < 6.70 *** <
01119 Copper,total recoverable in mg/L(0.010) < 0.006 mg/L < 0.002 mg/L < 0.006 mg/L < 0.004 mg/L < mg/L
01051 Lead,total recoverable in mg/L(0.075) < 0.001 mg/L < 0.001 mgiL < 0.001 mgiL < 0.001 mg/L < mg/L
01094 Zinc,total recoverable in mg/L(0.126) < 0.076 mg/L < 0.010 mgiL < 0.010 mg/L < 0.011 mgiL < mgiL
00340 Chemical Oxygen Demand(COD)in mg/L(126 < 30 mg/L < 57 mg/L < 30 mg/L < 31 mg/L < mg/L
00552 Non-Polar Oil&Grease in mg/L(15) < 5.5 mg/L < 5.6 mg/L < 5.5 mg/L < 5.7 mg/L < mg/L
78141 Total Toxic Organics(TTO)in mg/L ''' < 0.00 mg/L < 0.00 mg/L < 0.00 mg/L < 0.00 mg/L < mg/L
*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 100 mg1L
Notes
"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 n>wyl.9t viol Ins."
Paul Doron i iit I?_,i-, 3
Signature of Permittee or Delegated Authorized Individual Date
Email Address [e-mail] Phone Number [phone]

NGC030000 F-8 Qualitative Monitoring Reports:If no discharge occurs during the sampling period,the permittee must record within 30 days of the end of the sampling
period in the facility's monitoring records. 'No Finw'^r'No Discharge'shall be reported on the Discharge Monitoring Report(DMR).
Stormwater Discharge Outfall(SDO)
Qualitative Monitoring Report
For guidance on filling out this form,please visit https:lldeq.nc.gov/aboutldivisions/energy-mineral-land-resources/npdes-stormwater-gps
Permit No. NGG030000 Certificate of Coverage No. NCG030511
Facility County: Union Inspector: Johnson, Mark
Date of Inspection: Thursday 12/15/22 Phone Number [phone]
Total Event Precipitation (inches): 0.54 in.
All permits require qualitative monitoring to be performed during a'measurable storm event."
A"measurable storm event"is a storm event that results in an actual discharge from the permitted site outfall.The previous measurable storm event must
have been at least 72 hours prior.The 72-hour storm interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period,and the permittee obtains approval from the local DEMLR Regional Office.
By this signatures certifyththat this report is accurate and complete to the best of my knowledge:
Paul Doron 11 G .---(1t/�
Signature of Perm ittee or Designee
1. Outfall Description:
Outfall No. SDO-1 Structure(pipe,ditch,etc.): Pipe
Receiving Stream: SWP3§2.1:°Stormwater discharge on the east side of the facility is directed towards the East Fork of Twelve Mile Creek.°
Describe the industrial activities that occur within the outfall drainage area: Roof, parking areas and driveways runoff.
2.Color-Describe the color of the discharge using basic colors(red, brown, blue,etc.)as descriptors: clear
Describe the color of the discharge using tint(light,medium,dark)as descriptors: none
3.Odor:Describe any distinct odors that the discharge may have(i.e., smells strongly of oil,weak chlorine odor,etc.): none
4.Clarity:Choose the number which best describes the clarity of the discharge,where 1 is clear and 5 is very cloudy: 1
5. Floating Solids-Choose the number which best describes the amount of floating solids in the stormwater discharge,where 1 is
no solids and 5 is the surface covered with floating solids: 1
6. Suspended Solids-Choose the number which best describes the amount of suspended solids in the stormwater discharge,
where 1 is no solids and 5 is extremely muddy: 1
7. Is there any foam in the stormwater discharge? none
8. Is there an oil sheen in the stormwater discharge? none
9. Is there evidence of erosion or deposition at the outfall? none
10.Other Obvious Indicators of Stormwater Pollution: not applicable
List indicators,or"Not Applicable"
1.Outfall Description:
Outfall No. SDO-2 Structure(pipe,ditch,etc.): Pipe
Receiving Stream: SWP3§2.1:"Stormwater discharges on the N and W sides are directed towards the City POTW(discharging into Bearskin Creek)."
Describe the industrial activities that occur within the outfall drainage area: Roof, parking areas and driveways runoff.
2.Color-Describe the color of the discharge using basic colors(red, brown,blue,etc.)as descriptors: light brown
Describe the color of the discharge using tint(light, medium,dark)as descriptors: none
3.Odor: Describe any distinct odors that the discharge may have(i.e.,smells strongly of oil,weak chlorine odor,etc.): none
4.Clarity:Choose the number which best describes the clarity of the discharge,where 1 is clear and 5 is very cloudy: 2
5.Floating Solids-Choose the number which best describes the amount of floating solids in the stormwater discharge,where 1 is
no solids and 5 is the surface covered with floating solids: 2
6.Suspended Solids-Choose the number which best describes the amount of suspended solids in the stormwater discharge,
where 1 is no solids and 5 is extremely muddy: 2
7.Is there any foam in the stormwater discharge? none
8. Is there an oil sheen in the stormwater discharge? none
9.Is there evidence of erosion or deposition at the outfall? none
10.Other Obvious Indicators of Stormwater Pollution: not applicable
List indicators, or"Not Applicable"

1.Outfall Description:
Outfall No. SDO-3 Structure(pipe,ditch,etc.): Pipe
Receiving Stream: SWP3§2.1:"Stormwater discharges on the N and W sides are directed towards the City POTW(discharging into Bearskin Creek)."
Describe the industrial activities that occur within the outfall drainage area: Roof, parking areas and driveways runoff.
2.Color-Describe the color of the discharge using basic colors(red,brown,blue,etc.)as descriptors: clear
Describe the color of the discharge using tint(light, medium,dark)as descriptors: none
3.Odor: Describe any distinct odors that the discharge may have(i.e.,smells strongly of oil,weak chlorine odor,etc.): none
4. Clarity:Choose the number which best describes the clarity of the discharge, where 1 is clear and 5 is very cloudy: 1
5.Floating Solids-Choose the number which best describes the amount of floating solids in the stormwater discharge,where 1 is
no solids and 5 is the surface covered with floating solids: 1
6.Suspended Solids-Choose the number which best describes the amount of suspended solids in the stormwater discharge,
where 1 is no solids and 5 is extremely muddy: 1
7. Is there any foam in the stormwater discharge? none
8. Is there an oil sheen in the stormwater discharge? none
9. Is there evidence of erosion or deposition at the outfall? none
10.Other Obvious Indicators of Stormwater Pollution: not applicable
List indicators, or"Not Applicable"
1.Outfall Description:
Outfall No. SDO-4 Structure(pipe,ditch,etc.): Pipe
Receiving Stream: SWP3§2.1:"Stormwater discharge on the east side of the facility is directed towards the East Fork of Twelve Mile Creek."
Describe the industrial activities that occur within the outfall drainage area: Roof, parking areas and driveways runoff.
2.Color-Describe the color of the discharge using basic colors(red,brown,blue,etc.)as descriptors: brown
Describe the color of the discharge using tint(light, medium,dark)as descriptors: light
3.Odor:Describe any distinct odors that the discharge may have(i.e.,smells strongly of oil,weak chlorine odor, etc.): none
4.Clarity:Choose the number which best describes the clarity of the discharge,where 1 is clear and 5 is very cloudy: 2
5.Floating Solids-Choose the number which best describes the amount of floating solids in the stormwater discharge,where 1 is 1
no solids and 5 is the surface covered with floating solids:
6.Suspended Solids-Choose the number which best describes the amount of suspended solids in the stormwater discharge, 2
where 1 is no solids and 5 is extremely muddy:
7.Is there any foam in the stormwater discharge? none
8. Is there an oil sheen in the stormwater discharge? none
9. Is there evidence of erosion or deposition at the outfall? none
10.Other Obvious Indicators of Stormwater Pollution: not applicable
List indicators,or"Not Applicable"
Proposed Corrective and/or Preventive Actions
List action items here(EHS will record in the 3M Worldwide Incident Management System,WIMS)or"Not Applicable."

Stormwater Grab Sampling Field Sheet
General Information
Permit No. NGG030000 Certificate of Coverage No. NCG030511
Facility County: Union GPS Coordinates: Latitude 35.01,Longitude-80.64
City: Monroe Sampler Johnson, Mark
State: North Carolina,US Phone Number [phone]
Sample Date: Thursday 12/15/22 Weather Conditions: Rainy
Total Event Precipitation(inches): 0.54 in. Nature of Discharge: Rainfall
Sampling Equipment
Method: Collect directly into sample bottle Transfer container: Not Applicable
Sample Collection Information
Sample Collection Time: 1130 am Weather Conditions:
Sample Observations:
Color
List indicators, or"Not Applicable"
Odor
List indicators,or"Not Applicable"
Clarity
List indicators,or"Not Applicable"
Foam
List indicators,or"Not Applicable"
Solids
List indicators,or"Not Applicable"
Others
List indicators,or"Not Applicable"
Previous Storm Ended>72 hours Before Start of This Storm
The 72-hour interval can be waived when the previous storm did not yield a measurable discharge or if you are able to document that less than a 72-hour
interval is representative of local storm events during the sampling period.
Notes
Please list additional notes or observations here or"Not Applicable"
Sample Date: Thursday 12/15/22 Sampler Signature: Johnson, Mark