NCG160012_2021 DMR_20220125

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG160000
Asphalt Paving Mixtures and Blocks
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 DEMLR Regional Office.
Certificate of Coverage No. NCG16 0012
Person Collecting Samples: Austin Pote
Facility Name: Fred Smith Company - Wake Forest Asphalt Plant
Laboratory Name: ENCO
Facility County: Wake
Laboratory Cert. No.: C317045
Discharge during this period: 0 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 III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR ❑✓ Yes ❑ No
Date Uploaded: 01/25/2022
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall 001
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
WS-IV; NSW
N/A
Date Sample Collected MM/DD/YYYY
12/08/2021
46529
24-Hour Rainfall in inches
0.14
C0530
TSS in mg/L (100 or 50*)
59
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)
N/A
NCOIL
Estimated New Motor/Hydraulic Oil
Usage in gal/month
N/A
* 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): N/A
"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 information, including the possibility of fines and imprisonment for knowing violations."
!� 01 /25/2022
Signature of Permittee or Delegated Authorized Individual Date
Email Address [e-mail] Phone Number 919-535-5229