NCG140500_2022 DMR_20230217 (2)

NCDEQ Division of Energy,Mineral and Land Resources
Wastewater Discharge Monitoring import(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. NCG14 0500 Person Collecting Samples: James Higgins
Facility Name:C.W.Matthews Greensboro Ohenry Blvd.Concrete Batch Plant Laboratory Name: Pace Analytical
Facility County:Guilford Laboratory Cert.No.: 633
Discharge during this period:❑Yes ✓0 No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?❑Yes 0✓ No
If so,which Tier(I, II,or III)?
A copy of this DMR has been uploaded electronically via https://edoL,.deq.nc.gov/Forms/SW-DMR Q Yes ❑No
Date Uploaded:02/17/2023
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Effluent Limits in
Parameter Parameter Outfall 1 Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class NA
N/A Date Sample Collected MM/DD/YYYY NA
Daily Flow Rate in cfs(50%of 7Q10
82220 for HQW/OR4.1 NA
C0530 TSS in mg/L(30,20,or 10*) NA
00400 pH in standard units(6.0-9.0 NA
•hwater,6.8-8.5 saltwater) _
Settleable Solids in HQW,ORW,SA,
00545 SB,Tr&PNA(5 mL/L) NA
Non-Polar Oil&Grease in mg/L(N/A,
00552 bi samples above 15 requir -t NA
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 .All other water classifications have a benchmark of 30 mg/L.
Notes(optional): 2022 Quarter 4. There was no discharge from this facility during the quarter.
"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."
2-//2/ 12
Signsitltre of ermittee or Delegated Authorized Individual Date
Email Address [e-mail] cwmatthews.com Phone Number [phone]