NCG160050_2020 DMR_20201222

NCDEQ Division of Energy, Mineral and Land Resources
5tormwater Discharge Monitoring Report (DIVI ) Forms for NCG160000
Asphalt Paving
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Dadra Monitorir� tie�e�rt�C7MR1l} Imo d farm within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate opriate DEMLR Regional Office.
Certificate of Coverage No. NCG16 0 0 5 0 Person Collecting Samples; Kevin Poole
Facility Name: S. T. Wooten Clayton Asphalt Laboratory Name: Cameron Testing
Facility County: Johnston H1 Laboratory Cert. No.: 654
Discharge during this period: ■❑ Yes ❑ No (if no, skip to signature and date)
rs
your facility implemented mandatory Tier response actions for any benchmark exceedances? Yes ■ No
o, 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
1
N/A
Date Sample Collected MM/DD/YYYY
11/30/2020
46529
24-Hour Rainfall in inches
.75
C0530
TSS in mg/L (100 or 50*)
<5.00 rngl
Part B: Vehicle & Equipment Maintenance Areas — Benchmarks in (Red)
Parameter
Parameter
Outfall
outfall
outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
00552
Non -Polar Oil & Grease in mg/L (15)
New Motor/Hydraulic Oil Usage in
NCOIL
gal/month
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of So 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 thattlher"re significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowinR,v olations," /
Sign atur�1_0'+-rmKee or Delegated Authorized Individual
1 2-22-2020
Date