NCG140031_2022 DMR_20221005

NCDEQ Division of Energy, Mineral and Land Resources
Wastewater Discharge Monitoring Report (DMR) Form for NCG140000
Ready -Mix Concrete
Click here for instructions
Complete, sign, scan and submit the DMR via the 5torm_water NPDE5 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. NCG14CD 3 I Person Collecting Samples: E )1744e,
Facility Name: T i edwont `Aea ro r X Laboratory Name: _NaCQ
Facility Countyr.:TGnd4h Laboratory Cert. No.:
Discharge during this period: ZYes ❑ No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? ❑ Yes CglNo
If so, which Tier (I, 11, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR EKes [:]No
Date Uploaded: I C I's, ) ax
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Effluent Limits in (Red)
Parameter Parameter Outfall Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class
N/A Date Sample Collected MM/DD/YYYY
82220 Daily Flow Rate in cis (50% of 7Q30
for HQW/ORW)
C0530 TSS in mg/L (30, 20, or 10*)
00400 pH in standard units (6.0-9.0
freshwater, 6.8-8.5 saltwater) S ,
00545 Settleable Solids in HQW, ORW, 5A, j
SB, Tr & PNA (5 mL/L) ,
Non -Polar Oil & Grease in mg/L (N/A,
00552 but samples above 15 require tiered
responses)
Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW) have a TSS limit of 20 mg/L, outfalls to Trout Waters (Tr) and
Primary Nursery Areas (PNA) have a TSS limit of 10 mg/L All other water classifications have a benchmark of 30 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, i cluding the possibility of fines and imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual
Email Address b;1 N 6dir0,1+re ac7 M l)C, C {jam
Date
Phone Number