NCG160050_2021 DMR_20210504

NCDEQ Division of Energy, Mineral and Land Resources
StormWater Discharge Monitoring Report (DMRj Form for NCG1.60000
Asphalt Paving Mixtures and Blocks
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report fDMR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the 2p_prot?riate DEMLR Regional Office.
Certificate of Coverage No. NCG160050
Person Collecting Samples: Kevin Poole
Facility Name: S.T. Wooten Clayton Asphalt
Laboratory Name: Cameron Testing
Facility County: Johnston
Laboratory Cert. No.: 654
Discharge during this period:❑✓ 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 0 No
If so, which Tier (I, II, or Ill)?
A copy of this DMR has been uploaded electronically via htt s: edocs.de .nc. ov Forms SW DMR 21 Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall 1
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
WS-III;NCW,CA
N/A
Date Sample Collected MM/DD/YYYY
3/2512021
46529
24--Hour Rainfall in inches
2
C0530
TSS in mg/L (100 or 50*)
<6.25mg1
Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
00552
Non -Polar Oil & Grease in mg/L (15)
NA
NCOIL
Estimated New Motor/Hydraulic Oil
Usage in gal/month
NA
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L
Notes (optional):
"I certify by my signature below, under penalty of taw, 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, inyludigg the possibility of fined ayfd imprisonment for knowing violations."
Signature of PeyrfjWee or Delega`(ed Authorized Individual
5-4-2021
Date
Email Address [e-mail] Phone Number 252-290-5912

Cameron Testing Services, Inc Laboratory Report
S. T. Wooten Corporation
a
-9
Clayton Asphalt
NC DEEalR 4654
NC PHHS 037799
US EPA #NCO1915
2103.214
Yes
J, Cameron 03)25121
2103-21'4 01 Clayton OFA vkw i3_ ors .56,25 Mait En 0312&21 2549 D W TSS
Review / r (/ Aaov
Project DaCa
219 S. sipela Sir.
Smiford NC 27330
919-24)qA240
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