NCG100136_DMR_20240718

NCDEQ Division of Energy, Mineral and Land Resources ,
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Stor water Discharge Monitoring Report (D Form for NCGIO0000 "��� ��'�`�:%O�`
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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. NCG10 0136 Person Collecting Samples: Christian Burd
Facility Name:Foss Recycling, Inc.-Winston-Salem Facility Laboratory Name: Waypoint Analytical
Facility County:Forsyth Laboratory Cert. No.:402
Discharge during this period: Yes L01 No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?E]Yes No
If so,which Tier(I, Il, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forrris;1SW-DMR Yes E]No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall 001 Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class C
N/A Date Sample Collected MM/DD/YYYY 06/27/2024
46529 24-Hour Rainfall in inches 0.30
C0530 TSS in mg/L(100 or 50*) <5.0
00400 pH in standard units(6.0—9.0 FW, 7.13
6.8—8.5 SW)
00340 Chemical Oxygen Demand in mg/L <30
(120)
01051 Lead,total recoverable(as Pb)in <0.0060
mg/L(0.075 FW,0.22 SW)
Ethylene Glycol in mg/L(any amount
77023 detected Tier One;8,000 mg/L Tier <5.00
Two and Three)
00552 Non-Polar Oil&Grease in mg/L(15) <6.0
NCOIL Estimated New Motor/Hydraulic Oil N/A
Usage in al/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
FW(Freshwater)SW(Saltwater)
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
su 'tted is,to the best of my knowledge and belief,true,accurate,and complete.I am aware that there are significant penalties for submitting
f se' formation,inc n the possibility of fines and imprisonment for knowing violations."
_4l S/
' nat a of Permittee or Delegated Authorized Individual Date
[e-mail] 910-990-4891
Email Address Phone Number