NCG160055_2022 DMR_20220822

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCGI60000
Asphalt Raving Mixtures and Blocks
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDFS Permit Data MonitoriM Resort (DMR) Unload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the apprv.priatc L7EMLft_i�gp a[ Office..
Certificate of Coverage No. NCG160055
Person Collecting Samples: Dan Carmicheal
Facility Name: S.T. Wooten Sanford Asphalt
Laboratory Name: Cameron Testing
Facility County: Lee
Laboratory Cert. No.: 654
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 0 No
If so, which Tier (I, 11, or II1)?
A copy of this DMR has been uploaded electronically via https://edocs.dcg.nc.gov/1 ormslSV�l-DMR ❑✓ Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
parameter
Outfall1
Outfall
outfall
Outfall
Outfall
N/A
Receiving Stream Class
C
N/A
Date Sample Collected MM/DD/YYYY
04-18-2022
46529
24-Hour Rainfall in inches
1
cc
TSS in mg/L (100 or 50*)
14.63mgfl
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)
NA
NCOIL
Estimated New Motor/Hydraulic Oil
Usage in gal/month
NA
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmarkT55 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, orthose 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 inform , me ing the possibXity of fineyand imprisonment for knowing violations."
08-22-2022
Signature ofP,4Vmittee or Delegated Authorized Individual Date
EmailXd'dress [e-mail] Phone Number 252-290-5912