NCG050174_2024 DMR_20240718

1
NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG050000
Apparel, Printing, Rubber, Etc.
Click here for instructions
1
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 appropriate DEMLR Reg€onal Office.
Certificate of Coverage N9.NCc05 0 , Lt Person Collecting Samples: \ 1
Facility Name: �j _ ,Lon(/� LaboratoryName: (/(
cal
Facility County: } d' (�{} `J Laboratory Cert.No.: 1.2, 1
Discharge during this period: Yes ❑ No (if no,skip to signature and date)
Has your facility implemented mandatory Tier r sponse actions for an benchmark exceedances?❑Yes j4 No
If so,which Tier(I, II, or Ill)? h 0 -eve avvjesr �r� ..-�� s
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 OO CO OW)
)
N/A Date Sample Collected MM/DD/YYYY 1 O W)i!- ,D 4p y I ,D, J ' ONt /iOa
00400 pH in standard units(6.0—9.0 FW, r�/ I �1 e �!
6.8-8.5 SW) q l
46529 24-Hour Rainfall in inches O,03 Op 04 . a 03 O, We O_c(o
00552 Non-Polar Oil&Grease in mg/L(15)
C0530 TSS in mg/L(100 or 50*) a ,el d) ,q , ) eg.1 3?,1-
00340 Chemical Oxygen Demand (COD)in � ���I
mg/L(120) 39 % f (0
NCOIL gal/month New r/Hydraulic Oil Usage in 3d(
'P7 all
:),6' r] i .a . ix r ` 'i t7 -'
Notes(optional): Se, 4 ,ri lie./ot✓
"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."
— 7-a, .20 2 y
Signature o ermlttee or Delegated Authorized Individual Date
Note: Upon review, we have determined that both sampling events may have been conducted within 72-
hours of a previous stormwater event. For April's sampling, an offsite weather station indicates that
there may have been a measurable storm around 9:00am the day prior, but on-site personnel did
not observe any precipitation until the time of sample. For May's sampling, an offsite weather
station indicated that there was a period of potential precipitation and discharge in the middle of
the night. However, when sampling personnel arrived onsite at 6:30am that morning-there was no
indication that it had rained onsite or that outfalls had discharged.A weather station has been
purchased and is in the process of being installed at the facility.

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 Nq. NOS//0��,1 fl/�rr�� ,f Person Collecting Samples: � j ' t
Q O Y1 01 Y U!t^V i f( W Ot�-(d, w i i(���� t i I t/t,I
Facility Name: /� LaboratoryName:
Facility County: Q.qn OW V I U Laboratory Cert.No.: 1 Z / 4 p
Discharge during this period:LI 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 Ill)?
Analytical Monitoring Requirements for Outfal Is with Industrial Activities—Benchmarks in (Red)
Parameter Parameter Outfall Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class l (9 tj 0Q r 7 (v I 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."
Signature of Permittee or Delegated Authorized Individual Date