NCG060244_2024 DMR_20241017

NCDEQ Division of Energy,Mineral and Land Resources
Stormwater Discharge Monitoring Report(DMR)Form for NCGQ60000
Food and Kindred
Click here for instructions
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report(DMR)Upload form within 1
30 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the appropriate DEMLR Regional Of f ice.
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Certificate of Coverage No. NCG06 O \4 j ry Person Collecting Samples: i ay-ti_ - & __-.?
Facility____ Name t laboratory Name: 1O,C�.e..
Facility County: t'; >r �L- w�r 1.40t -d Laboratory Cert.No.: 1 j
Discharge during this period:�A Yes ❑No (if no,skip to signature and date) i
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? Yes ❑No
if so,which Tier(I,II,or Ill)? -t e-v' 1 _,
A copy of this DMR has been uploaded electronically via https:((edocs degsic.gov/Forms/SW-DMR XYes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in;Red)
'Parameter y 4 I
Code Parameter Outfall ` 1 Outfall a Outfall 3 Outfall Outfall f
N/A Receiving Stream Class !
j N/A Date Sample Collected MM/DD/YYYY
46529 24-Hour Rainfall in inches i.511 I 10 5 f f i,5"
CO530 TSS in mg/L(100 or SO') ( 2_ 2a 0 i 9 _
00400 pH in standard units(6.0—9.0 FW, i
6.6-6.5SW) 1,qg 5,ciLf 10 8
3 Fecal Coliform per 100 ml of
31616 f
freshwater(if required)(1000)
! 61211 i Enterococci per 100 ml of saltwater
(if required)(500) _
00340 Chemical Oxygen Demand in mg/L /v 'n + I
a (120) /� /-r /L( 1
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Additional parameters for outfalls in drainage areas that use>55 gallons per month of new hydraulic oil on average
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NCOIL Estimated New Motor/Hydraulic Oil !
Usage in gal/month
00552 f Non-Polar Oil&Grease in mg/L(15) 14, t I) 0 ND
*Outfalls to Outstanding Resource Waters(ORW),High Quality Waters(HOW),Trout Waters(Tr)and Primary Nursery Areas(PNA)
have a benchmark T55 limit of 50 mg/L.All other water classifications have a benchmark of 100 mg/L
FW(Freshwater)SW(Saltwater)
Notes(optional): -r1
, 4, e_ l-1 i. /v'i c o_vle_„ --!,,E- I attsv> cdl,,i Ay C t ti DVe Fe_ e-
"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 i risonment for knowing violations."
Signature of Permittee or ele edauthorized ndividual Date
w o/i/e.,/,4214 , 0 ; ,, 70 3-79 'D&
Email Address Phone Number