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Home My WebLink AboutNCG050174_2024 DMR_20240430 • 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.N GO5�q. 1. Person Collecting Sample: F(/� _ 11E� Facility Name: Zo r i "' -F c Gory tedl,LL.L Laboratory Name: �A�,V�Ui/��' "J Facility County: a t O( (/( Laboratory Cert.No.: H U V)i-T,vrV I Ile #% 12 f�S�l(V(l(e &io Discharge during this period:[ Yes ❑No (if no,skip to signature and date) Has your facility implemented mandatory Tier re ponse actions for any le jcch�mark excenediicces? Yes ❑No If so,which Tier(I,II,or III)? N O eXeee o w/6 'f or V V 1 V i 1e O1 l I f(/i It Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red) Parameter Parameter Outfall Outfall Outfall Outfall Outfall Code N/A Receiving Stream Class O 1 N/A Date Sample Collected MM/DD/YYYY 3?a 1 011 3 � 91(4 3 31 ) A L 4F 00400 PH in standard units(6.0—9.0 FW, �` I �� 1, � ^ �Q 6.8-8.5 SW) ` D 46529 24-Hour Rainfall in inches 04 4 te 0, 14) 0. b10 0120 00552 Non-Polar Oil&Grease in mg/L(15) N C0530 TSS in mg/L(100 or 501 n.ri o,?j i51), 0 3.ii- 00340 mg/m(1a21 Oxygen Demand(COD)in l,2, 3 ND 31, 32, NCOIL New Motor/Hydraulic Oil Usage in r 210.1)10 (� �j Jiro' gal/month (� AO (/',O•�VJ Q� V �l O Notes(optional):yiVA Y C(il tik0 f t.O1 _, peyvym to J6V V p Le r 01 1 oyegi,ce, "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." ai, 1//Z`',/Zoz J Sign e of Permittee or Delegated Authorized Individual Date NCDEQ Division of Energy,Mineral and Land Resources Stormwater Discharge Monitoring Report(DMR) Form for NCGO50000 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.NCGO5 Person Collecting Samples: C-4I� Cj( Y vA Facility Name:GieO e(Uf1(r(,OVVW4?tfjd,(AA, Laboratory Name: Vet Ce ) Facility County: (kotlf t Laboratory Cert.No.:ff uvltt'i/}U 4F"12-/AsinBt t 1 k:t-)D 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)? TI V I Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red) Parameter Parameter Outfall Outfall Outfall Outfall Outfall Code N/A Receiving Stream Class �O l ' N/A Date Sample Collected MM/DD/YYYY 1 aL_ 5 V O 1 a,(4 3 10'A 00400 pH in standard units(6.0-9.0 FW, ( �^ 6.8-8.5 SW) 7• 1 {��• �'7 �, Lj 46529 24-Hour Rainfall in inches 0.43 0.gg 00552 Non-Polar Oil&Grease in mg/L(15) vN; N I� Iv fp C0530 TSS in mg/L(100 or 501 1 L F V 14771 PD9,0 00340 Chemical Oxygen Demand(COD)in rn ` mg/L(120) 1,J(9 NCOIL New Motor/Hydraulic Oil Usage in 1 I I (� A O•A rV� a O,�(.--. gal/month �J 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." Signature of Permittee or Delegated Authorized Individual Date 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.NCG05 Person Collecting Samples: ix( V OO- , Facility Name:Gye�O��'Jn inP'i4GINC COrVl4 tteoi, LU Laboratory Name: 19&GR � n(� Facility County: r�U1y�V60ipk Laboratory Cert.No.:J-i # III/As4einii,e:40 Discharge during this period:❑Yes ( No (if no,skip to signature and date) Has your facility implemented mandatory Tierresponse actions for an benchmark exxceedanc�s?''Yes ❑No If so,which Tier(I,II,or III)? A`S(M Av/� P_ 1 wit cr Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red) Parameter Parameter Outfall Outfall Outfall Outfall Outfall Code N/A Receiving Stream Class 0014 oo* O D q O l 0 N/A Date Sample Collected MM/DD/YYYY 00400 pH in standard units(6.0—9.0 FW, 6.8-8.5 SW) 46529 24-Hour Rainfall in inches 00552 Non-Polar Oil&Grease in mg/L(15) C0530 TSS in mg/L(100 or 50") 00340 Chemical Oxygen Demand(COD)in mg/L(120) NCOIL New Motor/Hydraulic Oil Usage in gal/month 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." ', ,,. y/z-9/2,o 41z Signafure of Permittee or Delegated Authorized Individual Date