NCG160116_Monitoring Report_20220314

NCDEQ Division of Energy, Mineral and Land Resources
RECEIVED
Stormwater Discharge Monitoring Report (DMR) Form for NCG160000
Asphalt paving Mixtures and Blocks
Click here for instructions
MAR 14 2022
DENR-DEMLk
Land Quality Section
'll R IOf(ce
Complete, sign, scan and submit the DMR via the Starmwater NPDES Permit Data Monitoring
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate
esv e e Iona
Report (DMR) Upload form within
DEMLR Re eional Office.
Certificate of Coverage No.. NCG160 //I,
Person Collecting Samples:
ea
Facility Name: &A4whtl
Laboratory Name:
PAT? L4BS
Facility County: /01*4111 t/
Laboratory Cert. No.:
As ,10'
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)?
A copy of this DMR has been uploaded electronically via https:/Iedocs.deg.nc.gov/Forms/SW-DMR ® Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities —Benchmarks in (Red)
Parameter
Code
Parameter
Outfall /
Outfall ',t
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
�r
C0530
TSS in mg/L(100or 50')
N
7i L
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)
NICOIL
Estimated New Motor/Hydraulic Oil
Usage in gal/month
Outtalls to outstanding Resource Waters (ORW), High quality Wafers (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 1DD mg/L
Notes (optional):
"I certify by my signature below, under penalty of law, thatthis document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gatherand evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, orthose persons directly responsible forgathedngthe 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 possiblllty of fines and imprisonment for knowing violations."
Signarrure of Permitte or Delegated Authorized Individual - Date
Email Address Phone Number