NCG160117_Monitoring Report_20220314

RECEIVED
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
'111hR 14 21122
OENR-UEMLK
Land Quality Secuor,
Mooresville Regional Of lco
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (DMRI 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.. NCG160
Person Collecting Samples: / S
Facility Name: ep/✓QJ.RD
Laboratory Name: AR- WS
Facility County: eA S
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 R No
If so, which Tier (I, II, or 111)?
A copy of this DMR has been uploaded electronically via httos://edocs.deg.nc.gov/Forms/SW-DMR ® Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities— Benchmarks in (Red)
Parameter
Code I
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/OD/YYYY
VA g$ ;E2
46529
24-Hour Rainfall in inches
IZ&
C0530
TSS in mg/L(l000r5o')
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 (HOW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark T65 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 orsupervision in
accordance with a system designed to assure that qualified personnel properlygather and evaluate the information submitted. Based on my
inquiry of the person or persons who manage the system, orthose persons directly responsiblefor gathering the information, the information
submitted is, tothe 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."
of Permit'kee or Delegated Authorized individual
�av_GBwr �,/�zz
Date
Email Address Phone Number