NCG160223_2021 DMR_20220322

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 0223
Person Collecting Samples: Ryan R. Osborne (INENCO, Inc.)
Facility Name: FIBRECRETE PRESERVATION TECHNOLOGIES, INC.
Laboratory Name: Pace Analytical Services, LLC
Facility County: SURRY
Laboratory Cert. No.: 12, 40, 37706, & 37712
Discharge during this period: ❑J 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 ❑✓ No
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via -: s: edocs.de .nc, ov For s SW-DMR ❑✓ Yes []No
Date Uploaded: 03/14/2022
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
ParameCodeter
I Parameter Outfall 1
Outfall
Outfall
Outfall Outfall
N/A
Receiving Stream Class
C
N/A
Date Sample Collected MM/DD/YYYY
09/21/2021
46529
24-Hour Rainfall in inches
2.90
COS30
TSS in mg/L (100 or 50*)
< 2.5
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
NCOIL
Estimated 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 TSS limit of . All other water classifications have a benchmark of 100 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 to best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false Inf ma ' , i ding the possibiI f fines and imprisonment for knowing violations."
03/14/2022
Signature of Permittee or Delegated Authorized Individual Date
Email Address [e-mail] Phone Number 336-786-8244

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 DEM LR Regional Office.
Certificate of Coverage No. NCG16 0223
Person Collecting Samples: Ryan R. Osborne (INENCO, Inc.)
Facility Name: FIBRECRETE PRESERVATION TECHNOLOGIES, INC.
Laboratory Name: Pace Analytical Services, LLC
Facility County: SURRY
Laboratory Cert. No.: 12, 40, 37706, & 37712
Discharge during this period: ❑I 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 ❑I No
If so, which Tier (I, II, or III)? _
A copy of this DMR has been uploaded electronically via http.s.//edocs.deg.nc.gQ_VlEorms/SW-DMR ❑✓ Yes [:]No
Date Uploaded: 03/14/2022
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in ,)
Parameter
Code
Parameter
I
Outfall 1
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
C
N/A
! Date Sample Collected MM/DD/YYYY
04/24/2021
46
24-Hour Rainfall in inches
0.66
C0530
I TSS in mg/L (100 or 50*)
54.2
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)
NCOIL
Estimated 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 TSS limit of *-0 mg/L. All other water classifications have a benchmark of
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 information, irpcE,qeiir}9ie possibility of fipes aukf�prlsonment for knowing violations."
e
re of Permittee or Delegated Authorized Individual
03/14/2022
Date
Email Address [e-mail] Phone Number 336-786-8244