NCG140453_2022 DMR_20220908 (2)

NCDEQ Division of Energy, Mineral and Land Resources
Wastewater Discharge Monitoring Report (DMR) Form for NCGI40000
Ready -Mixed Concrete
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. NCG14 0 4 5 3 I Person Collecting Samples: Gary Kicker
Facility Name: Carolina Ready Mix and Guilders Supply, LLC Laboratory Name: Pace Analytical
Facility County: Henderson I 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 for any benchmark exceedances? ❑ Yes ■❑ No
If so, which Tier (1, 11, or Ill)?
Part A: Analytical Monitoring Requirements for autfalls with Industrial Activities— Effluent Limits in (Red)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
Class C.
N/A
Date Sample Collected MM/DD/YYYY
08/30/22
Daily Flow Rate in cfs (50% of 7Q10
82220
for HQW/ORW)
C0530
T55 in mg/L (30, 20, or 10*)
17.8
5ettlleable Solids in HQW, ORW, SA,
00545
SB, Tr & PNA (5 mL/L)
00400
pH in standard units (6.0-9.0
7.9
freshwater, 6.8-8.5 saltwater)
Non -Polar Oil & Grease in mg/L (N/A,
00552
but samples above 15 require tiered
N/A
responses)
Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW) have a TS5 limit of 20 mg/L, autfalls to Trout Waters (Tr) and
Primary Nursery Areas (PNAy have a TSS limit of 10 mg/L. All other water classifications have a benchmark of 30 mg/L.
Notes (optional); No shop. no oil usage at this location
"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."
Signa ure of P ttee or Delegated Authorized Individual
09.07.2022
Date