NCG050169_DMR_20250113_001

NCDEQ Division of Energy,Mineral and Land Resources �F 1
Stormwater Discharge Monitoring Report(DMR) Form for NCGOS0000
Apparel,Printing,Rubber, Etc.
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Complete,sign,scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report IDMRI Uoloa �6IArd�fhin
30 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the a ro riate OE MLR Re Iona
r:
Certificate of Coverage No.NCG05 0169 Person Collecting Samples:William Lovelady
Facility Name:International Paper-Charlotte Container Plant Laboratory Name: Statesville Analytical
Facility County: Mecklenburg Laboratory Cert.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,II,or III)?
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall 001 Outfall002 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) 7.29
46529 24-Hour Rainfall in inches OA6"
00552 Non-Polar Oil&Grease in mg/L(151 See notes
C0530 TSS in mg/L(100 or 50•) 28.5
00340 Chemical Oxygen Demand(COD)in
mg1L 11201 <20
NCOIL New Motor/Hydraulic Oil Usage in
gal/month
Notes(optional): Outfall 001 sampled 12282024.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.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." I
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Signature Permittee or Dglegato Authorized Individual Date