NCG160223_2020 DMR_20210202

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Forrn for fgCG160000
Asphalt Paving
Click here far 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. NCG16 0 2 2 3 Person Collecting Samples: RYAN R OSBORNE (INENCO, INC.)
Facility Name: Fibrecrete Preservation Technologies Inc Laboratory Name: Pace Analytical Services, LLC
Facility County: Sorry Laboratory Cert. No.: 12, 40. 37706. & 37712
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, II, or III)?
Part A: Analytical Monitoring Requirements for outfalls with Industrial Activities- Benchmarks in (iced)
Parameter
Code
Parameter
outfall 1
outfall
outfall
outfall
outfall
N/A
Receiving Stream Class
C
N/A
Date Sample Collected MM/DD/YYYY
08/21/2020
46529
24-Hour Rainfall in inches
1.96
C0530
TS5 in mg/L (100 or 50*)
8.4
Part B: Vehicle & Equipment Maintenance Areas - Benchmarks in (Red)
Parameter
Code
parameter
Outfall
Outfall
outfall
outfall
outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
00552
Non -Polar oil & Grease in mg/L (15)
NCOIL
New Motor/Hydraulic Oil Usage in
gal/month
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TS5 limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L,
Notes (optional):
"1 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 " Z-
i% Uric-- C�"_
Signature of Permittee or Delegated
zed Individual
IZ-1z/
Da e

January 22, 2021
DEQ Winston-Salem Regional Office
Attn: DEMhR Stormwater Program
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Re: Stormwater Discharge Outfall Monitoring Report (DMR)
Year 1, Period 2, Sample 2 (Permit Term: July 1, 2020 to December 31, 2020)
Fibrecrete Preservation Technologies Inc (Surry County)
General Permit NCG160000; Certificate of Coverage Number NCG160223
Dear Stormwater Permitting Unit;
We respectfully submitthe enclosed original and one copy of the Stormwater Discharge
Outfall Monitoring Report (DMR) for Fibrecrete Preservation Technologies Inc under
General Permit NumberNCG160000, Certificate of Coverage NCG160223. This
submission is for stormwater discharge sampling for Year 1, Period 2, Sample 2 (Permit
Term: July 1, 2020 to December3l, 2020) as outlined in Partll, Section B of our
stormwater discharge permit.
If you have any questions or comments regarding this Stormwater Discharge Outfall
Monitoring Report (DMR), please contact us at your convenience,
Sincerely,
Bart Pharr, Vice President
Fibrecrete Preservation Technologies Inc
Enclosures: Stormwater Discharge Outfall Monitoring Report (DMR), 1 signed original