NCG140350_MONITORING INFO_20190430

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v I LI 3 S O
DOC TYPE.
❑ HISTORICAL FILE
MMONITORING REPORTS
DOC DATE
❑ I O 2J
YYYYM M DD

BENCHMARK EXCEEDANCE or TIER 2 DISCHARGE MONITORING REPORT (DMR) — STORMWATER
SUBMIT TO REGIONAL OFFICE*
General Permit No. NCG140000
`Use this form if any stormwater samples have EXCEEDED A BENCHMARK or if the facility is in TIER 2 MONITORING for any parameter.
Send sample results to the DEMLR Regional Office within 30 days of receipt from the laboratory.
Certificate of Coverage No. NCG140350
Facility Name: Thomas Concrete of Carolina — Wake Forest Plant Sample Collection Period: Period 1 ® Period 2 ❑ Calendar Year 2019
County: Wake For Monthly Monitoring: Month: Aoril
Phone Number: 919-562-1909 Person Collecting Samples: Duncklee & Dunham, Lily Walker
Certified Laboratory: ESC Lab # ENV 375
Lab #
Has this facility had 4 or more benchmark exceedances for any single parameter, at any one SW discharge outfall (SDO)? Yes ® No ❑
Have you contacted the Regional Office? Yes ® No ❑
Whom at the Region did you speak with? Thad Valentine
Stormwater Monitorina Reauirements
Outfall
No.
Date Sample
Collected
Total
Rainfall
Is this SDO in
Tier 2?
Does this SDO
include Vehicle
Maintenance
Activities (VMA)?
Total
Suspended
Solids (TSS),
mg/I
pH,
SU
Non -polar O&G
(EPA Method 1664
(SGT-HEM)), mg/I
(VMA)
fl.ppft,bl.
New Motor Oil
Usage (gal/mo.)
ff ePP icabh
a
�dr„NOFLOW"
mo/dd/yr
-inches -
+^'fl'
1
Y/N
Y/N
100
50 (ORW, HOW, h,PNA)
6.0-9.0
15
>SS BaVmo. average
aaa1,ae.SsawNo"olal
08G moMWd�g
001
04/30/19
Y
N
NO DISCHARGE
N/A
N/A
Permit Date 8/1/2017 — 6/30/2022 Last Revised 8-22-2017
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Certificate of Coverage No. NCG140350
CERTIFICATION
"I certify, 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." (Required by 40 CFR §122.22]
Signature
Date 5-
Mail Benchmark Exceedance/Tier 2 DMR to Your DEMLR Regional Office Land Quality Section:
ASHEVILLE REGIONAL OFFICE I FAYETTEVILLE REGIONAL
2090 US Highway 70
Swannanoa, NC 28778
[phone]
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
VIOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WASHINGTON REGIONAL OFFICE I WILMINGTON REGIONAL OFFICE
3800 Barrett Drive I
943 Washington Square Mall
Raleigh, NC 27609
Washington, NC 27889
[phone]
[phone]
WINSTON-SALEM REGIONAL
CENTRAL OFFICE
OFFICE
450 Hanes Mill Road, Suite 300
Questions for The Central Office
Winston-Salem, NC 27103
Stormwater Permitting Program?
[phone]
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
Permit Date 8/1/2017 — 6/30/2022 Last Revised 8-22-2017
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