NCG050169_DMR_20250113_003

NCDEQ Division of Energy,Mineral and Land Resources
Stormwater Discharge Monitoring Report(DMR)Form for NCGO50000 °���< �/��
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Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report(DMRI U01oad fornl,°othin
30 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the aoorooriate DEMLR Regional&five.
Certificate of Coverage No.NCG05 0169 Person Collecting Samples:Gerald Runkles
Facility Name:International Paper-Charlotte Container Plant Laboratory Name: Statesville Analytical
Facility County: Mecklenburg Laboratory Cart.No.: 440
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 ®No
If so,which Tier(I,It,or III)?
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Code Parameter Outfall 001 Outfall 002 Outfall Outfall Outfall
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 7.3
46529 24•Hour Rainfall in Inches 0.3"
00552 Non-Polar Oil&Grease in mg/L(15) See notes
C0530 TSS in mg/L(100 or 50•) 19.87
00340 Chemical Oxygen Demand(COD)in
m h NMI 30
NCOIL New Motor/Hydraulic Oil Usage in
gal/month
Notes(optional): Outfall 001 sampled 7/19/2024.Less than 55 gallons of motor/hydraulic oil used each month for vehicle or equipment maintenance.
"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.eased 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."
Signat I
of Permittee or Delegated Authorized Individual Date 13