NCG050305_2023 DMR_20231024

NCDEQ Division of Energy,Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCGO5OOOO
Apparel, Printing, Rubber, Etc.
Click here for instructions
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report(DN1R) 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. NCG05O O5— Person Collecting Samples:
Facility Name: e.cw4j Laboratory Name: •
Facility County: 'p, Laboratory Cert. No.: Q
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 0 Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Vehicle&Equipment Areas—Benchmarks in (Red)
ParameterCode Parameter j Outfall ( Outfall Outfall 3 Outfall Outfall
N/A Receiving Stream Class
N/A Date Sample Collected MM/DD/YYYY O / IAa9 /31/ats � /.9I/44 ,3
46529 24-Hour Rainfall in inches aj/i $4, 3 1
CO530 TSS in mg/L(100 or 50*) 1,/41 a. " •s
00552 Non-Polar Oil&Grease in mg/L(15)
NCOIL Estimated New Motor/Hydraulic Oil
Usage in gal/month
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
Notes(optional): M , ; ; I. . .,fflir...NMIWW,WI PPW Q.
wao rI .' !l7mr,Ori
"I certify by my signature below,un•er penalty o 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,incl ing the p sibility of fines and imprisonment for knowing violations."
C, _ -/d-/ -a3
Signature of Permittee or Delegated Authorized Individual Date
Email Address Phone Number