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NCDEQ Division of Energy,Mineral and Land Resources
IStormwater Discharge Monitoring Report(DMR)Form for NCG030000
Metal Fabrication
7Click here for instructions
Con`iplete,si�sc�n and subhiit 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.
CertificatePerson Collecting Samples: i Y- At4 •C
of Coverage No.NCG03011 5rr J
Facility Name: S eliAI Qrodti(- Te�(.1' otogt e5 Laboratory Name: l
Facility County: d Cr1 JJ Laboratory Cert.No.: NI C NW I`/1�'� W —1
Discharge during this period:aces ❑No (if no skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? Yes ❑No
If so,which Tier(I,II,or III . i rvqn{411 ,jrarwlohD te Co Pe(I-to-til I yr(0.1ovzi)b1-e
A copy of this DMR has been uploaded electronica via https://edocs.deq.nc.gov/Forms/SW-DMR Yes 0 No
Date Uploaded: 10 l ) / 1y02-1-1
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall.$I Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class F W
N/A Date Sample Collected MM/DD/YYYY q 12( /20Z
46529 24-Hour Rainfall in inches p,ZGJ i.
C0530 TSS in mg/L(100 or 50*) 10,i njll_
t pH in standard units(6.0-9.0 FW,
i 00400 6.8-8.5 SW) ?"—I
f
SU
01119 Copper,total recoverable in mg/L D`023�{
(0.010FW,0.0058 SW) 1 L
01051 Lead,total recoverable in mg/L J c
(0.075 W,0.22 SW)
Zinc,total recoverable in mg/L(0.126 0.0(031
o�3Q
01094 ! ,FW,0.095 SW) I L,
Chemical Oxygen Demand(COD)in 00340 20mg/L(120) 2 VI I.
00552 Non-Polar Oil&Grease in mg/L(15) N D
*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) -
I Notes(optional): pH iyu tv\-�U 1 c loie rj
- 'VY1e
"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' f Lion,including the pos'bitty of fines and imprisonment for knowing violations."
nd
op•
101s1 iw-29
Sign ture of Permittee or Delegated Authorized Individual Date
(t, -or.(3,)d'i-A�5T-`-ecIn- C 10 � Z - "1�52
Email Address hone umber