NCG050398_2024 DMR_20240426

NCDEQ Division of Energy,Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG050000
Apparel, Printing, Rubber, Etc.
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.
Certificate of Coverage No.NCG0503°V3 Person Collecting Samples:\)i j\-( May.)
Facility Name: ►<-V-Vt '\.) 5 k Laboratory Name: Ev eoFAN5 Rv b'"\
Facility County: Laboratory Cert.No.:
Discharge during this period:[f]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)?
Part A:Vehicle&Equipment Maintenance Areas-Benchmarks in(Red)
Parameter Parameter Outfall 00 a Outfall 003 Outfall Qa\ Outfall Outfall
Code
N/A Receiving Stream Class
N/A Date Sample Collected MM/DD/YYYY 31 W?)( 31 aa` (a a 1 apt
pH in standard units(6.0-9.0 FW,
00400 7a^ -7i .7 1.7
6.8-8.5 SW) r
46529 24-Hour Rainfall in inches 0. 1 �p e u -I 0 e1 1
00552 Non-Polar Oil&Grease in mg/L(15) 1j/j:� (V/A N f 1\
C0530 TSS in mg/L(100 or 50*) 4-a,sj 'j
00340 Chemical Oxygen Demand(COD)in
mg/L(120) < 1 3
NCOIL New Motor/Hydraulic Oil Usage in I : S I 'gal/month
J ,
Notes(optional): �'�c,r:t\t„,,c �t`ath n,A -. \\ 00 J�fGS �ao`! tN\Yn prA\p,t\3 P4,76ti(1'-) 4A^(,
\(\,tvjst. t1\l`c`Ov^S ot` - 15 Go\-)
"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 i formation,the information submitted is,to the best of my knowledge and belief,true,accurate,and complete. I am
aware that the are significant pen 'ties for submitting false information,including the possibility of fines and imprisonment for
knowing i atlo s."
\ 1 4La
Signature of Perm ttee ele at uthorized Individual Date