NCG140138_2022 DMR_20221228

NCDEQ Division of Energy, Mineral and Land Resources
Wastewater 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. NCGlwl fk Person Collecting Samples:(5%W
Facility Name: 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?El Yes �No
If so,which Tier(I, II,or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR'MYes El No
Date Uploaded:
Part A:Analytical Monitoring Requirements for Outfalls with Industrial Activities—Effluent Limits in(Red)
Parameter parameter Outfall o� Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class
N/A Date Sample Collected MM/DD/YYYY -
82220 Daily Flow Rate in cfs(50%of 7Q10
for HQW/ORW) Q
C0530 TSS in mg/L(30,20,or 10*)
00545 Settleable Solids in HQW, ORW,SA,
SB,Tr&PNA(5 mL/L) !{
PH in standard units(6.0-9.0
00400 freshwater,6.8-8.5 saltwater)
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, including the possibility of fines and imprisonment for
knowing violations."
_7/� -
Signature o rmittee or De egated uthor' ed Individual Da e
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