NCG060139_2023 DMR_20231201

NCDEQ Division of Energy,Mineral and Land Resources
I-_ ._._ •
I Complete,sign,scan and submit the DMR via the : •- within
I 30 days of receiving sampling results. Mall the original,signed hard copy of the DMR to the-pp
1 Certificate of Coverage No.NCG06 Q(,3 G(
Person Collecting Samples:
Facility Name:$Ai , ,Q;',GC_i?GSh ri e,g,14cori,..c,i,,,., , Laboratory NameSr.,', 4:e,I,A /1--Amj/rD���..Fo1 L-,,,,o;/,� l�
Facility County: SA.ry pso,J _ _ - _ Laboratory Cert. No.: r,,v WZ i i(6 / Cl�
, I
Discharge during this period:IDYes ❑No (if no,skip to signature and date) _ __
Has your facility Implemented mandatory Tier response actions this sample period for any benchmark exceedances? (,Yes El No
If so,which Tier(I,II,or III)? _.
A copy of this DMR has been uploaded electronically via ) _ _ _ [N Yes ❑ No
Date Uploaded: -° ---------
Analytical Monitoring Requirements for Outfalls with Industrial Activities-Benchmarks in' :_:r`)
Parameter Parameter I Outfall Outfall o� ? Outfall Outfall j Outfall
r
Code __. __.., .
N/A I Receiving Stream Class I G.S yJ _ G� _ ___ - -- ---
N/A Date Sample Collected MM/DD/YYYY ...- _- ____
I 46529 24-Hour Rainfall in Inches
it. 1
1 C0530 TSS in mg/L .1 .r :=`s
pH in standard units 1 s..a-:,..r"_`',
00400 6.8-8.5 SW) _ —
Fecal Coliform per 100 nil of
31616 I freshwater(if required)'.".:"°'' I - — -----
61211 Enterococcl per 100 ml of saltwater
(if required) . _ _._
Chemical OxygennDDemand in mg/L 1
Additional parameters for outfalls in drainage areas that use>55 gallons per month of new hydraulic oil on average
NCOIL Estimated New Motor/Hydraulic Oil i I
Usage in gal/month - —_i-...
00552 Non-Polar Oil&Grease in mg/LI 5! 1 I - _ . ____ _ 1
Outfalls to Outstanding Resource Waters(ORW),High Quality Waters(HQW),Trout Waters(Tr)and Primary Nursery Areas(PNA)
have a benchmark TSS limit of 5:1 t. .All other water classifications have a benchmark of
a=
sa;=(Freshwater)Sc.(Saltwater)
r
Notes(optional): R i J� �' _✓ ..-_____f
"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,in g th ossibility of fines and imprisonment for knowing violations."
it-I-z3
Signature of P mittee or Delegated Authorized Individual Date
awJm 'Zad'1'MiV10b, 9/a-99 —O71/
Email Address Phone Number