NCG140398_2021 DMR_20210405 (2)

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG140000
Ready -Mixed Concrete
Click here for instructions
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. NCG14 0 3 9 8 Person Collecting Samples: Gary Kilker
Facility Name: Carolina Ready Mix and Builders Supply, LLC Laboratory Name: Pace Analytical
Facility County: Madison I Laboratory Cert. No.: 40
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, ll, or III)?
Part A: Analytical Monitoring Requirements for Outfalls with Industrial Activities— Benchmarks in (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
Trout
N/A
Date Sample Collected MM/DD/YYYY
03/16/21
46529
24-Hour Rainfall in inches
.75 in
C0530
TSS in mg/L (100 or 50*)
5.9
00400
pH in standard units (6.0 — 9.0)
6.6
00552
Non -Polar Oil & Grease in
mg/L (15) for drainage areas that use > 55
gal/mo of new hydraulic oil on average
0
NCOIL
Estimated New Motor/Hydraulic Oil
Usage in gal/month
None
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HOW), 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,
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 Frermiitee or Delegated Authorized Individual
04/05/21
Date