NCG140500_2022 DMR_20221010

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG140000
Ready -Mix 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. NCG 14 0500
Person Collecting Samples: Josh Nelson
Facility Name: CW Matthews Greensboro Ohenry Blvd Concrete Batch Plant
Laboratory Name: NA
Facility County: Guilford
Laboratory Cert. No.: NA
Discharge during this period: ❑ Yes ❑,r 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, 11, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/5W-DMR []Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfafls with Industrial Activities — Benchmarks In (Red)
Parameter
Code
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
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 501)
00400
pH in standard units 1,6.0 - 9.0)
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 17.,'.
NCOIL
Estimated New Motor/Hydraulic oil
Usage in al/month
Outfalls to
have a bencf
Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
TSS Knit of , . All other water classifications have a benchmark of
"I certify by my s natur below, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance with sy m designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of theXpeor persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, st of knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting
falseinformatgin th possibility of fines and imprisonment for knowing violations."
Signature of Perjnittee or Delegated Authorized Individual
10 /6 20 2 Z
Date
Email Address [e-mail] Phone Number 404-317-9618