NCG140494_2022 DMR_20220928

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG140000
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.
Mailed in DMRs must contain an original wetsignature. Electronic signatures will not be accepted for mailed in DMRs. This is a
requirement until the permittee has registered for eDMR for reporting.
Certificate of Coverage No. NCG14 0494
Person Collecting Samples:
Facility Name: Carolina Sunrock- Burlington North Concrete
Laboratory Name:
Facility County:
Laboratory Cert. No.:
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 (I, II, or III)?
A copy of this DMR has been uploaded electronically via https:/Iedocs.deg.nc.gov/FormsjsW-DMR 1■❑ Yes ❑ No
Date Uploaded:
Part A: Analytical Monitoring Requirements for Outfalls with Industrial Activities— Benchmarks in (Red)
Parameter
Parameter
C utfa ll
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
46529
24-Hour Rainfall in inches
C0530
TSS in mg/L (100 or 50*)
pH in standard units (6.0-9.0 FW, 6.8-
00400
8.5 SW)
Non -Polar Oil & Grease in
00552
mg/L (25) for drainage areas that use > 55
gal/mo of new hydraulic oil on average
Estimated New Motor/Hydraulic Oil
NCOIL
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 TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L.
Notes (optional):This proposed concrete plant is permitted but has not started yet
"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."
Tracy E. Davis PE Digitally signed by Tracy Davis, PE 9/27/2022
� Date: 2022.09.27 16:51:08 -04'00' 7
Signature of Permittee or Delgipted Authorized Individual Date