NCG140390_2022 DMR_20220427

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater 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 DEMLR Regional Office.
Certificate of Coverage No. NCG1403q
Facility Name:
Person Collecting Samples:
Laboratory Name:
Facility County: Y 0 N
Laboratory Cert. No.:
Discharge during this period: ❑ Yes RrNo (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 https:ZZedocs.deg.nc.g_ov/Forms/SW-DMR Yes []No
Date Uploaded: 4-OLLp-
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outtall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L (100 or 50*)
00400
pH in standard units (6.0-9.0)
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 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 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."
Q
Signature of Permittee or Delegated Authorized Individual
Email Address
w ► r,635 Y-Qp, 1.
a,.
Phone Number
�CAA) Ugq-_ )3q

NCDEQ Division of Energy, Mineral and Land Resources
Wastewater Discharge Monitoring Report (DMR) Form for NCGI40000
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 DEMLR Regional Office.
Certificate of Coverage No. CG14,9.3q
Facility Name: Y u
Facility County:
Person Collecting Samples: '
Laboratory Name:
Laboratory Cert. No.:
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 ❑ No
If so, which Tier (I, II, or III)?
❑ Yes ❑ No
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/­`SW-DMR
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Effluent Limits in (Red)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
Daily Flow Rate in cfs (50% of 7Q10
82220
for HQW/ORW)
C0530
TSS in mg/L (30, 20, or 10*)
00400
pH in standard units (6.0-9.0
freshwater, 6.8-8.5 saltwater)
00545
Settleable Solids in HQW, ORW, SA,
SB, Tr & PNA (5 mL/L)
Non -Polar Oil & Grease in mg/L (NIA,
00552
but samples above 15 require tiered
responses)
" Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW) have a TSS 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 responsrbie for gathering the information, the information
submitted is, to the best of my knowledge and belief, true, aoauate, and complete. I am aware that there are significant penalties for submitting
false information, including the possibility of fines and imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual
Email Address
Phone Number
-10(1) CogtA- ,3Lc)34