NCG060400_2023 DMR_20240123

NCDEQ Division of Energy,Mineral and Land Resources
.Stormwater Discharge Monitoring Report(DMR)Form for NCG060000
Food and Kindred
Click here for instructions
Complete,sign,scan and'Submit the DMR via the Stormwater NPDES Permit Data Monitoring Report(DMR)Unload form within
30 days of receiving sampling results. Mall the original,signed hard copy of the DMR to the aporonriae DEMLR Regional Office.
Certificate of Coverage No.NCGO6
Facility Name: Person Collecting Samples: ow i
Facility County: •
"' v Laboratory Name: tiJ - 4 • i
Laboratory Cert.No.:
Discharge during this riod: Yes No (f no,skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? Yes 121 No
If so,which Tier(I,II,or III)?
A copy of this DMR has been uploaded electronically via httos:Uedacs.deo.nc.Aov/Forms/SW-DMR
Date Uploaded: 4— 3- a 0 a Yes 0 No
Analytical Monitoring Requirements for Outfalls with industrial Activities—Benchmarks in ike6
Parameter
Code Parameter Outfall Outfall Outfall
N/A Receiving Stream Class Outfall Outfall
N/A Date Sample Collected MM/DD/YYYY
46529 24-Hour Rainfall in Inches 5
C0530 TSS in mg/L(100 or 50r)
00400 pH in standard units(6.0-8.0 FW,
r 6.8—tl.5SW q
31616 Fecal Coliform per 100 ml of
freshwater If re.uired 1000 .9-7
61211 Enterococci per 100 ml of saltwater
if re•uired 500)
00340 Chemical Oxygen Demand in mg/L
Additional parameters for outfalis in drainage areas that use>55 gallons
Estimated New Motor/Hydraulic Oil g per month of new hydraulic oil on average
NCOIL t A
U e in I/month
00552 Non-Polar OH&Grease in mg/L`L,d-p; 4 .0
Outfalls to Outstanding Resource Waters
haw a t°,toOut benchmark TSS nmR so - (ORW),High Quality Waters(HOW),Trout Waters(Tr)and Primary Nursery Areas(PNA)
.All other water classlficatlons have a benchmark of
,,v(Freshwater)Stt'(Saltwater)
Notes o tonal :
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,includi he possibility of fines and Imprisonment for knowing violations."
samba PermIttee or Delegated Authorized Individual J r 3 V 09 /
Date
+ r�vu viCe,-,
Email Address /D 9,(o fo3i
Phone Number