NCG140453_2021 DMR_20210708 (2)

NCDEQ Division of Energy, Mineral and Land Resources
Wastewater 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
Person Collecting Samples: Gary Kilker
Facility Name: Carolina Ready Mix and Builders Supply, LLC Laboratory Name: Pace
Facility County: Henderson Laboratory Cert. No.: #4o
Discharge during this period: ❑■ Yes ❑ No (if no, skip to signature and date)
ro
your facility implemented mandatory Tier response actions for any benchmark exceedances?❑ Yes ❑■No
, which Tier (I, 11, or III)?
Part A: Analytical Monitoring Requirements for Outfalls with Industrial Activities— Effluent Limits in (Red)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
Class C
N/A
Date Sample Collected MM/DD/YYYY
06/22/21
82220
Daily Flow Rate in cfs (50% of 7Q10
N/A
for HQW/ORW)
C0530
TSS in mg/L (30, 20, or 10*)
38.9
00545
Settlleable Solids in HOW, ORW, SA,
N/A
SB, Tr & PNA (5 mL/L)
00400
pH in standard units (6.0-9.0
7
freshwater, 6.8-8.5 saltwater)
Non -Polar Oil & Grease in mg/L (N/A,
00552
but samples above 15 require tiered
responses)
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HOW) have a TSS limit of 20 mg/L, outfalls to Trout Waters (Tr) and
Primary Nursery Areas (PNA) have a TSS limit of 10 mg/L. All other water classifications have a benchmark of 30 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
knowirfk violations."
Signature oLermittee or Delegated Authorized Individual
-2 / 0-q)
Date