NCG160017_2022 DMR_20220721

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 U load farm within
30 days of receiving sampling results, Mail the original, signed hard copy of the DMR to the appropriate DEMLR Regional CFffice.
Certificate of Coverage No. NCG160017
Person Collecting Samples: Arnette
Facility Name: Rutherfordton Asphalt
Laboratory Name: Pace
Facility County: Rutherford
Laboratory Cert. No.:40
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, ll, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR ❑✓ Yes ❑ No
Date Uploaded:07/21/22
Analytical Monitoring Requirements for outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall LAB
Outfall RAP
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
W5-IV
WS-IV
N/A
Date Sample Collected MM/DD/YYYY
05/23/22
05/23/22
46529
24-Hour Rainfall in inches
1.6
1.6
C0530
TSS in mg/L tigWor 501
145.8
154.2
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 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 forgathering 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 possibilityof fines and imprisonment for knowing violations."
SiggyK/1Permittee or Delegated Authorized Individual
Email Address [e-mail]
07121 122
Date
Phone Number 865-279-6374