NCG140001_2023 DMR_20230601

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.NCG140001 Person Collecting Samples:SynTerra,Sophie Backhouse
Facility Name: Thorns Concrete waWO.na.Raee.p,Plant Laboratory Name: Pace Analytical, SynTerra
Facility County: Wake Laboratory Cert.No.: 375,5591
Discharge during this period:❑Yes ❑■ No (if no,skip to signature and dote)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances?❑Yes El 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 ■❑Yes 0 No
Date Uploaded:
Part A:Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall 002 Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class C;NSW
N/A Date Sample Collected MM/DD/YYYY N/A
46529 24-Hour Rainfall in inches
C0530 T55 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 TS5 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." ��
oti.�.t b/l '2 3
Signature of P rst ee or De gate Authorized Individual Date