NCG130008_DMR_20250127

NC Department of
Environmental Quality
NCDEQ Division of Energy,Mineral and Land Resources Received
Stormwater Discharge Monitoring Report(DMR) Form for NCG130000 JAN 2 7 2025
Non-metal Waste and Scrap Winston-Salem
Click here for instructions Regional Office
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. NCG33 0008 Person Collecting Samples: A/-r"s
Facility Name: L✓'6shw-Sltw Ret)tl,'j Laboratory Name: I
Facility County: Fufsyiti Laboratory Cert. No.: Shl Lby
Discharge during this period: Yes ❑ No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances?Mes ❑ No If so,which Tier(I,II,or III)? T,`e,r A
Analytical Monitoring Requirements for Outfails with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class
N/A Date Sample Collected MM/DD/YYYY ( L It Ly
46529 24-Hour Rainfall in inches 0.8
00400 PH in standard units(6.0—9.0 F W, 6.7
6.8-8.5 SW)
00340 Chemical Oxygen Demand(COD)in
mg/L(120)
00552 Non-Polar Oil&Grease in mg/L(35) I.
- C0530 TSS in mg/L(100 or 50•) S
NCOIL New Motor/Hydraulic Oil Usage in LJc a(
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 f
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."
D 1164Zs-
Signnaature of Perm/ittee or Delegated Authorized Individual Date
ll ya�lcmFsF,�re'oa��i scihi�s�v 3af—s�3r
Email Address Phone Number

NCDEQ Division of Energy, Mineral and Land Resources NC Department of
Environmental Quality
Stormwater Discharge Monitoring Report (DMR) Form for NCG130000 Received
Non-metal Waste and Scrap JAN 2 7 2025
Click here for instructions
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report DMR d f r 7ithin30 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the Appropriate DEML Reziona
Certificate of Coverage No.NCG13aV3 Person Collecting Samples: Z( yV.k„er
Facility Name: Laboratory Name: F tii/'Ms
Facility County: F s rk Laboratory Cert. No.: -SS)
Discharge during this period: Yes ❑No (!f no,skip to signature and date)
Has your facility Implemented mandatory Tier response actions for any benchmark exceedances7 Yes [:] No
If so,which Tier(I, II,or III)? T yf I
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Code Parameter Outfall 2 Outfall Outfall Outfall Outfall
N/A Receiving Stream Class
N/A Date Sample CollectedMM/DD/YYYY 0r! 1-7 ZV
46529 24-Hour Rainfall in inches (, S
00400 PH in standard units(6.0—9.0 FW, 3
6.8-8.5 SW)
00340 Chemical Oxygen Demand(COD)in 3 1
mg/L(120)
00552 Non-Polar Oil&Grease in mg/L(15) �. y
C0530 TSS in mg/L(100 or s0•) 2 6
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 Prermittee or Delegated Authorized Individual Date
��h-[✓tEr r5�, � I^[f�ti�(k 52r�(cta.[G,._ ]��J —3//�"��
3s-
Email Address Phone Number

NCDEQ Division of Energy,Mineral and Land Resources NC Department of
Environmental Quality
Stormwater Discharge Monitoring Report (DMR) Form for NCG130006eceivPd
Non-metal Waste and Scrap JAN 21 2023"
Click here for instructions Winston-Salem
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report MMItihial®fffoan 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.NCG130007 Person Collecting Samples: I. ym,er
Facility Name: Laboratory Name: V&wa ,-s
Facility County: Fvrsl fl, Laboratory Cert. No.: S 9
Discharge during this period: Yes ❑ No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances?❑Yes ffNo
If so,which Tier(I,11,or III)?
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class 6
N/A Date Sample Collected MM/DD/YYYY Owi LN
46529 24-Hour Rainfall In inches 0.1
00400 PH in standard units(6.0—9.0 FW, 7 Z
6.8-8.5 SW)
00340 Chemical Oxygen Demand(COD)in 7 7
mg/L(120)
00552 Non-Polar Oil&Grease in mg/L(15) < I•,r
C0530 TSS in mg/L(100 or 50') 160
NCOIL New Motor/Hydraulic Oil Usage in L SS
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 ofPermittee or Delegated Authorized Individual Date
LC
!
Email Address Phone Number

NCDEQ Division of Energy, Mineral and Land Resources NC Department of
Environmental quality
Stormwater Discharge Monitoring Report (DMR) Form for NCG130000 Received
Non-metal Waste and Scrap JAN 2 7 2025
Click here for instructions
c
Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report(DMR)tialpad.fgrmm��iin
30 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the appropriate DEMLR Reeional O ice.
Certificate of Coverage No.NCG1300nd Person Collecting Samples: 1. *ews
Facility Name: lv 4 n-Salt, i2ecyda5 Laboratory Name: G�41j
Facility County: F.(stiA Laboratory Cert. No.; .5 5
Discharge during this period: Yes ❑ No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances?❑Yes aft
If so,which Tier(I,11,or III)?
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in (Red)
Parameter Parameter Outfall Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class L
N/A Date Sample Collected MM/DD/YYYY 03 zi mzy
46529 24-Hour Rainfall in inches 0.3 -
00400 pH in standard units(6.0-9.0 FW, 6•k
6.8-8.5 SW)
00340 Chemical Oxygen Demand(COD)in Lp
mg/L(120)
00552 Non-Polar Oil&Grease in mg/L(15) I.4
C0530 TSS in mg/L(100 or 50•)
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
hhu1 Al: e (51c, 308-s�3S
Email Address Phone Number