NCG120118_DMR_20220818

NC Department of
NCDEQ Division of Energy, Mineral and Land Resources Environmental Quality
Received
Stormwater Discharge Monitoring Report(DMR) Form for NCG12OORG 1 8
Landfills2022
Click here for instructions Winston-Salem
RRQ
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report[ 9O lD e1 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. NCG12 0118 Person Collecting Samples:Andrew Smith
Facility Name:Gold Hill Road C&D Landfill Laboratory Name:ENCO
Facility County:Randolph Laboratory Cert. No.:NA
Discharge during this period:❑Yes 0 No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?❑Yes 0 No
If so,which Tier(I, II,or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deq.nc.gov/Forms/SW-DMR 0 Yes ❑ No
Date Uploaded:08/16/2022
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class
N/A Date Sample Collected MM/DD/YYYY
46529 24-Hour Rainfall in inches
C0530 TSS in mg/L(100 or 50*)
00400 pH in standard units(6.0-9.0)
00340 Chemical Oxygen Demand in mg/L
(120)
31616 Fecal Coliform in#per 100 ml(1000)
Additional parameters for outfalls in drainage areas that use>55 gallons per month of new hydraulic oil on average
00552 Non-Polar Oil&Grease in mg/L(15)
NCOIL Estimated New Motor/Hydraulic Oil
Usage in gal/month
*Outfalls to Outstanding Resource Waters(ORW),High Quality Waters(HQW),Trout Waters(Tr)and Primary Nursery Areas(PNA)
have a benchmark TSS limit of 50 mg/L.All other water classifications have a benchmark of 100 mg/L
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 p son or persons who manage the system,or those persons directly responsible for gathering the information,the information
submitted isi
best of m k w -.•e and belief,true,accurate,and complete.I am aware that there are significant penalties for submitting
false informshading t e os.?ity of fines and imprisonment for knowing violations."
c, /v,. 811
Signature of Permittee or Delegated Authorized Individual Date
Email Address [e-mail] Phone Number [phone]