NCG060139_2023 DMR_20240103

NCDEQ Division of Energy,Mineral and Land Resources
_.— .. __.
Complete,sign,scan and submit the DMR via the within
L30 days of receiving sampling results. Mall the original,signed hard copy of the DMR to—the
Certificate of Coverage No.NCG06®13 G1 -.Person Collecting Samples: _a _
Facility Name.6A, V,e( �s�, ea� r?rs!'��%l,iu>{onr Laboratory NameSr, :.�
Facility County: Laboratory Cert. No.: Lv w-T p 1 i 6
_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 — _ ❑Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities-Benchmarks in(Red)
Parameter } i
1 Parameter Outfall Outfall i Outfall Outfall Outfall
N/A Receiving Stream Class G S 1")
N/A Date Sample Collected MM/DD/YYYY _
46529 m� 24-Hour Rainfall in Inches
C0530 ; TSS in mg/L(10 O —
00400 pH in standard units
6.8—6.5 SW)
Fecal Coliform per 100 ml of J F
31616 freshwater(if required)�j1000)
Enterococcl per 100 ml of saltwater
61211 if required) �4 --- -
( q )(:-=}
00340 Chemical Oxygen Demand in mg/L
(12G)
Additional parameters for outfalls in drainage areas that use>55 gallons per month of new hydraulic oil on average
Estimated New Motor/Hydraulic Oil I i
NCOIL Usage in al/month
00552 Non-Polar Oil&Grease in mg/L;
outfalls to Outstanding Resource Waters(ORW),High Quality Waters(HC1W),Trout Waters(Tr)and Primary Nursery Areas(PNA)
have a benchmark TSS limit of 5:0 rnr('..All other water classifications have a benchmark of
V(Freshwater)r ;(Saltwater)
f
Notes(optional): T Q
"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,Ir W'rlg the possibility of fines and Imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual Date
6-mr—fi j'1r;Vd4" �M 4-1 47V
Email Address Phone Number