NCG150048_2023 DMR_20231207 (2)

NCDEQ Division of Energy,Mineral and Land Resources
Stormwater Discharge Monitoring Report(DMR)Form for NCG150000
Airports
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.
Mailed in DMRs must contain an original wet signature.Electronic signatures will not be accepted for mailed in DMRs.This is a
requirement until the permittee has registered for eDMR for reporting.
1 Certificate of Coverage No.NCG15 0048 Person Collecting Samples: Jack Poole
Facility Name: Shelby-Cleveland County Regional Laboratory Name: Pace Analytical Services
Cleveland NCDEQ#329
Facility County: Laboratory Cert. No.:
Discharge during this period:❑✓ Yes ❑No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions 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 El No
Date Uploaded:
Part A:Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall al OutfalD.S_A Outfall ak Outfall Outfall
Code
N/A Receiving Stream Class Freshwater Freshwater Freshwater
N/A Date Sample Collected MM/DD/YYYY 11/20/2023 11/20/2023 11/20/2023
46529 24-Hour Rainfall in inches .86 .86 .86
00400 pH(Freshwater:6-9,Saltwater:6.8- 6.86 G.7 G.
8.5) V / V 05
C0530 TSS in mg/L(100 or 50*) 14 ND 17
01027 Conductivity in µohms/cm 6.62 5.77 4.1
C0034 Chemical Oxygen Demand(COD)in 26 ND 53
mg/L(120)
Non-Polar Oil&Grease in mg/L(15) N D N ID N D
00552 for drainage areas that use>55
gal/mo of new hydraulic oil on avg.
NCOIL Estimated New Motor/Hydraulic Oil 20 20 20
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 50 mg/L.All other water classifications have a benchmark of 100 mg/L.
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 information,including the possibility of fines and imprisonment for
knowing violations."
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Signature of ermittee or Delegated Authorized Individual Date