NCG050393_2024 DMR_20240813

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. NCG05O3ci3 Person Collecting Samples:
Facility Name:Ve$CWTI Laboratory Name:
Facility County:Vance. Laboratory Cert. No.:
Discharge during this period: ❑ Yes is 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)?
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in (Red)
Parameter Parameter Outfall 1 Outfall 2, Outfall Outfall Outfall
Code
N/A Receiving Stream Class
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): NO Pious observed a} eiTer oaFci \ For Q1 202L1.
"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 violation
Signature o Permittee or Delegated Authorized Individual Date