NCG140507_2022 DMR_20230117

NCDEQ Division of Energy,Mineral and Land Resources
Wastewater Discharge Monitoring Report(DMR) Form for NCG140000
Ready-Mix 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. NCG14057,7 Person Collecting Samples:iC/,(.4 .7_, jjo i c c'12
- Facility Name:/a4cLEcti cayjsjoicrThA 2 , Laboratory Name: pp c
Facility County: co p -w6A Laboratory Cert. No.:
Discharge during this period:0 Yes No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?❑Yes ❑ No
If so,which Tier(I,II,or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deq.nc.gov/Forms/SW-DMR ❑Yes ❑No
Date Uploaded:
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
N/A Date Sample Collected MM/DD/YYYY
82220 Daily Flow Rate in cfs(S0° of 7Q10
for HQW/ORW)
C0530 TSS in mg/L(30,20,or 10*)
00400 pH in standard units(6.0-9.0
freshwater,6.8-8.5 saltwater)
00545 Settleable Solids in HQW,ORW,SA,
SB,Tr&PNA(5 mL/L)
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(HQW)have a TSS limit of 20 mg/L,outfalls to Trout Waters(Tr)and
Primary Nursery Areas(PNA)have a TS5 limit of 10 mg/L.All other water classifications have a benchmark of 30 mg/L.
Notes(optional): pbeirjr O&C/ AA IS Zp�-�, !h) Sii711.►U8Y 1W J UA)LY LLSGsA1/H27i/
°UMF -J OF UaDE SDJ CiNia-0�-E; /1.ViSTRAFLGO FlatThvtr, yy
I certify by my signature below,under penalty of law,that this document and all attachments were prepared ur(ddr 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 imp iso ment for knowing violations."
MAA to i0 COok) EucT&o-1 rkk b, /(4,e,40/L_ 13/7/2043
Signature of Permittee or Delegated Authoriz I ividual Date
Email Address Phone Number