NCG140500_2022 DMR_20221010 (2)

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 water NP-1-S Permit Daft 7itoring Report (DMR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the ipprropriate DEMLR Regional Office.
Certificate of Coverage No. NCG140500
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 Q No (if no, skip to signature and dote)
Has your facility implemented mandatory Tier response actions this sampfe period for any benchmark exceedances? ❑ Yes ❑ No
If so, which Tier (I, Il, or ill)?
A copy of this DMR has been uploaded electronically via
Date Uploaded:
dieo nc gov ❑ Yes ❑ No
Analytical Monitoring Requirements for Outfalls with Industrial Activities - Effluent Limits in
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
Daily Flow Rate in cfs
82220
I or HQW/ORW)
C0530
TSS in mg/L 20,
pH in standard units
00400
1lo_
Settleable Solids in HQW, ORW, 5A,
00545
SB, Tr & PNA •-nL/L)
Non -Polar Oil & Grease in mg/L (N/A
00552
:)ut samples above 15 require tiere
responses)
Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW) have a T55 limit of , outfalls to Trout Waters (Tr) and
Primary Nursg"reas (PNA) have a T55 limit of . All other water ciassifications have a benchmark of
"I certify by y sign ture below, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance th a stem designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my
inquiry of the persnor persons who manage the system, or those persons directly responsible for gathering the information, the information
submitted is, 4o t best of my knowledge and belief, true, accurate, and complete. f am aware that there are significant penalties for submitting
false informal , iinnc1ludping the possibility of fines and imprisonment for knowing violations."
Signature of ermittee or Delegated Authorized Individual Date
Email Addres� [e-mail] Phone Number 404-317-9618