NCG140031_2021 DMR_20211018

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 DEM LR Regional Office.
Certificate of Coverage No. NCG14 6
Person Collecting Samples: D01A �, �dc a 1
Facility Name: }�; ,�� e >N .
Laboratory Name:
Facility County: �.
Laboratory Cert. No.: �3
Discharge during this period: 21es ❑ No fif 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 Ili)?
A copy of this DMR has been uploaded electronically via https://edocs.dec[.nc.gov/Forms/SW-DMR ❑ Yes [_-]No
Date Uploaded:
Analytical Monitoring Requirements for outfalls with Industrial Activities - Effluent Limits in (Red)
Parameter
Code
Parameter
Outfall
Outfall
0utfall
outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
y-B202 f
82220
Daily Flow Rate in cis (50% of 7Q10
for HQW/ORW)
'133
C0530
TSS in mg/L (30, 20, or 10*)
, ,-
00400
pH in standard units (6.0-4.0
// p
freshwater, 6.8-8.5 saltwater)
00545
Settleable Solids in HQW, ORW, 5A,
S6, Tr & PNA (5 mL/L)
Non -Polar Oil & Grease in mg/L (N/A,
00552
but samples above 15 require tiered
/�
responses)
I
* Outfalls to Outstanding Resource Waters (011W), High Quality Waters (HQW) have a TS5 limit of 20 mg/L, outfalls to Trout Waters (Tr) and
Primary Nursery Areas (PNA) have a TSS limit of 10 mg/L. All other water classifications have a benchmark of 30 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 that there are significant penalties for submitting
false informati , inc the possibility of fines and imprisonment for knowing violations."
Signature of Permittee legated Authorized Individual
Email Address AC- n n 7 � is �! e I l a.,~� s~E_e_1 , c o ^
/o -- I
-f
Date
Phone Number 336 - G72, a 9 s 7