NCG140141_2021 DMR_20220228 (3)

NCDEQ Division of Energy, Mineral and Land Resources
Wastewater 111scharge Monitoring Report (DMR) Farm for NCG14000€1
Ready -Mix Concrete
Click here for instructions
Complete, sign, scan and submit the DMR via the 5tormwater NPDES Permit DGaa Monitorin Re ort (DMR Li >oad for within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the napr:xriate_DEMLR Region
Certificate of Coverage No. NCG14014
Facility Name: I
Person Collecting Samples: 7r,;,,j ft4 ( f
Laboratory Name: ' e r
Facility County: , ` L ,: 1 Laboratory Cert. No.: q
Discharge during this period: ❑ Yes Q No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? ❑ Yes Q, No
If so, which Ter (I, II, or Ili)?
A copy of this DMR has been uploaded electronically via hzrpz f eLacs.dp .nc. ovl,=o ms/SV4f-Df�
Date Uploaded:
Analytical Monitoring Requirements for Clutfalls with Industrial Activities— Effluent Limits in %.
Parameter
Code Parameter Outfall Outfall Outfall Outfall Outfall
N/A Receiving Stream Class 'y r
N/A Date Sample Collected MM/DD/YYYY 4/111-
82220 Daily Flow Rate in cfs
C0530 TSS in mg/L ' ° ;, �
00400 pH in standard units 6..U;
00545 Settleable Solids in HQW, ORW, SA,
SB, Tr & PNA ,� i.:u-_i�
Non -Polar Oil & Grease in mg/L (N/A,
00552 but samples above 15 require tiered
Outfails to Outstanding Resource Waters (ORW), High Quality Waters (HQW) have a TSS limit of outfalls to Trout Waters (Tr) and
Primary Nursery Areas (PNA) have a TSS limit of r•ra, W. All other water classifications have a benchmark of a:. !y'1.
me
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, orthose 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."
Jcl
ature of Permittee or Delegated Authorized Individual Date
Email Address ?� a � I y, ` ,1, e
- o v€ Phone Number