NCG140466_2022 DMR_20221206 (2)

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NCDEQ Division of Energy,Mineral and Land Resources
Stormwater 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 wet signature.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.NCG140466 Person Collecting Samples: i.gefefeo( AAA, /i .a
Facility Name: ThomasConcnt,ofCaroflms-Smlh}IeldPlant Laboratory Name: Pace Analytical -."'7
Facility County: Johnston Laboratory Cert.No.: ENV 375
Discharge during this period:❑Yes 0 No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances?❑Yes ❑■ No
If so,which Tier(I,II,or III)?
A copy of this DMR has been uploaded electronically via https.//edocs.deq.nc.gov/Forms/SW-DMR 1=1 Yes ❑ No
Date Uploaded:
Part A:Analytical Monitoring Requirements for Outfalls 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 50*)
00400 pH in standard units(6.0-9.0 FW,6.8-
8.5 SW)
Non-Polar Oil&Grease in
00552 mg/L(15)for drainage areas that use>55
gal/mo of new hydraulic oil on average
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 TSS limit of 50 mg/L 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 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."
4,41— /2— -
Signature of Permittee or Delegated Authorized Individual Date