NCG160223_2022 DMR_20220929

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 0223
Person Collecting Samples: James W. Willard II (INENCO, Inc.)
Facility Name; Fibrecrete Preservation Technologies, Inc.
Laboratory Name: Pace Analytical Services, LLC
Facility County: SURRY
Laboratory Cert. No.: 12, 40, 37706, & 37712
Discharge during this period: Q 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 Q No
If so, which Tier (l, II, or III)?
A copy of this DMR has been uploaded electronically via httos://edacs,deo.nc.gov/Forms/SW-DMR ✓❑ Yes ❑ No
Date Uploaded: 09/23/2022
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Code
Parameter
outfall I
Outfall
Outfall
Outfall
outfall
N/A
Receiving Stream Class
C
N/A
Date Sample Collected MM/DD/YYYY
09/10/2022
46529
24-Hour Rainfall in inches
0.82
C0530
TSS in mg/L (100 or 50')
87.9
Additfonal parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average
00552
Non •Polar Oil & Grease in mgfL (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 T55 limit of 50 mg/1. 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 wledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
false inforpiation,0nclydi mpossibility of fines and imprisonment for knowing violations."
jCY« E 64tir PH416w- 09/23/2022
Signature of Permittee or Delegated Authorized Individual Date
Email Address [e-mail] Phone Number 336-786-8244

September 23, 2022
DEQ Winston-Salem Regional Office
Attn: DEMLR Stormwater Program
450 West Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
Re: Stormwater Discharge Outfall Monitoring Reports (DMR)
Fibrecrete Preservation Technologies, Inc.
Surry County
General Permit NCG160000
Certificate of Coverage Number NCG160223
Dear Stormwater Program,
We respectfully submit the enclosed original copy of the Stormwater Discharge Outfall
Monitoring Report (DMR) for Fibrecrete Preservation Technologies Inc under General
Permit Number NCG160000, Certificate of Coverage NCG160223. This submission is
for stormwater discharge sampling for the following sampling period (Year 3, P2) as
outlined in Part II, Section B of our stormwater discharge permit.
If you have any questions or comments regarding this Stormwater Discharge Outfall
Monitoring Report (DMR), please contact us at your convenience.
Sincerely,
Bartholomew S. Pharr, President
Fibrecrete Preservation Technologies, Inc.
Enclosures: Stormwater Discharge Outfall Monitoring Report (DMR)