NCG050222_2024 DMR_20240506

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. NCG05027.1 Person Collecting Samples: gEN.. JI M i N M 1 i-K1 N5
Facility Name:('CA 5ALISI3uRY Laboratory Name:STfTE5vILte ANAL Y-ricq�
Facility County: 1?OwRN Laboratory Cert. No.: ''Igo
Discharge during this period:ts 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)?
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in (Red)
Parameter Parameter Outfall I Outfall Z. Outfall 3 Outfall 4-4 Outfall
Code
N/A Receiving Stream Class
N/A Date Sample Collected MM/DD/YYYY 03115/202.4 03/15/202.4 0 3/IS/202,1 0.3/15/?o2N
00400 pH in standard units(6.0—9.0 FW, 7 -7
LI
6.8-8.5SW) � 6 1 . �. Z 7,
46529 24-Hour Rainfall in inches 0.61" 0.6 I " 0, 6I " ©, 6 I"
00552 Non-Polar Oil&Grease in mg/L(15)
C0530 TSS in mg/L(100 or 50*) 7 9.N 16 1 o. 2. 3 ?-0 , '71
00340 Chemical Oxygen Demand(COD)in Z -77 `
ms/L(120) J10 ,� Zo G20
New
NCOIL gal/month r/Hydraulic Oil Usage in I 41 . 11, ZS 11. 15 I q .2S
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." -,
',-- -/ . �L L
Signature of Permittee or Delegated Authorized Individual Date