NCG160199_2022 DMR_20220904

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) 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. NCG16 0199
Person Collecting Samples: Mark Fortner
Facility Name: Fortner Contracting Inc.
Laboratory Name: Environmental NC 858-586-5588
Facility County: Swain
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)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR ❑✓ Yes ❑ No
Date Uploaded: 9-4-2022
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
Outfall 01 &02
Outfall
Outfall
Outfall
Outfall
N/A
Receiving Stream Class
C jr)
N/A
Date Sample Collected MM/DD/YYYY
05/26/2022
46529
24-Hour Rainfall in inches
0.72
C0530
TSS in mg/L (100 or 50*)
18.4
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."
for Mark Fortner
9/4/2022
Signature of 1? tee or Delegated Authorized Individual Date
Email Address
[e-mail]
919-980-1512
Phone Number

iiE.,&...
ENVIRONMENTAL
—Inc.... Aw..R_M_ .
P.O. Box 954 Cullowhee, NC 28723
50 West Sylva Shopping Center Sylva, NC 28779
Phone [phone] [phone]
FAX [phone]
E-mail [e-mail]
(Certificate of Rnatpoio
Client Name: HMC Paving
Address: 450 Industial Park Boulevard
Bryson City, NC 28713
Sample Identification: Gate (arab)
Collection Date: 5/26/2022
Date Received: 5/26/2022
RESULTS
Date
Foot -
Parameters
Result
MDL
Units
Analyzed
Method
notes
Solids, Total
Suspended
18.4
5.0
m /L
5/30/2022
SM 2540 D-1997
An ony Tlirofia, Laboratory Supervisor
fo 1 l (C I'Q_
Date
Report prepared: 6/16/2022 5:21 PM page 1 of 1