NCG050428_2024 DMR_20240611

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. Mall the original,signed hard copy of the DMR to the rnropriate DEMLR Regional Office.
Certificate of Coverage No.NCG05 - ZS Person Collecting Samples: ?kit i-12-tit-`l
Facility Name: "Try Ey="rt..-I0f- "Pls..; 2- Laboratory Name: 02(.t.. 11..-.1ty-4- 2t Ss.-v:r.s, U.4.
Facility County: ;t.a1,.►gr-, Laboratory Cert.No.: A0
Discharge during this period:RYes ❑ No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances?❑Yes Q-No
I If so,which Tier(I,II,or Ill)?
Analytical Monitoring Requirements for Outfalis with Industrial Activities-Benchmarks in
Parameter ! Parameter Outfall Outfall o t - Outfall tia 3 Outten eon►- Outfall
Code
N/A Receiving Stream Class C C. C_ C
N/A Date Sample Collected MM/DD/YYYY 03'V 1 I tLoi rvo A.:50,+.5, a 31 Z,1 Hirt- 03. .1 2a' 4-
r
00400 pH In standard units ry 1.y.,,�,� g.zo Y to
$,3Y
46529 24-Hour Rainfall in inches Q,(p rn _ 0,(o" CA,`4 C C.(pN
00552 Non-Polar Oil&Grease in mg/L I —
C0530 TSS in mg/L IS on r+ d:co.k-v.- '`I'D 44' IS .9
Chemical Oxygen Demand(COD)in j��
00340 mg/L i {f� rw4:trLa2v r.f iD
New Motor/Hydraulic Oil Usage in 4 ��C Z. S S' L. S5-
NCOIL gal/month S 1
Notes(optional):Ic rsj 0 r.p dc.,lreck -Fyvr.. 12b
"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,"
• .' -ii,./.•&, / ,74 /7 61/0/?V
Signature of Permittee or Delegated Authorized Individual Date