NCG140031_2023 DMR_20230920

NCDEQ Division of Energy,Mineral and Land Resources
Wastewater Discharge Monitoring Report(DMR)Form for hiCG140000
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 ,) Person Collecting Samples:
Facility Name:NWly el opals* ift 3100,, Pi l pu
Laboratory Name: t moll-kcal 6th&�s
Facility County: i`anao1 i�sc Laboratory Cert.No.: (p 3 moll
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 QrNo
If so,which Tier(I,II,or Ill)?
A copy of this DMR has been uploaded electronically via https://edocs.deq.nc.gov/Forms/5W-DMR laYes ❑No
Date Uploaded: 4! Zo j Z3
Analytical Monitoring Requirements for Outfalls with Industrial Activities—Effluent Limits In(Red)
Parameter Parameter Outfali Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class
N/A Date Sample Collected MM/DD/YYYY • /!zf 23
82220 Daily Flow Rate in cfs(50%of7QL0 1!.
for HQW/ORW)
CO530 TSS in mg/L(30,20,or 101 Z.Cp
00400 pH in standard units(6.0-9.0
freshwater,6.8-8.5 saltwater) -61 1
00545 Settleable Solids in HQW,ORW,SA,
SB,Tr&PNA(5 rnL/L) , )a
Non-Polar Oil&Grease in mg/L(N/A,
00552 but samples above:!5 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.Ail other water classifications have a benchmark of 30 mg/L.
Notes(optional):
"l 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."
Lkit , � 9-A0-a3
Signature ofiPermittee`br Delegated Authorized Individual Date
Email Address Phone Number 33(, -L7a -09

Pace Analytical Services,LLC
ace 1377 South Park Drive
Kern:rsvdle,NC 27284
[phone]
Page 1 of 1
Laboratory Report
Patty Perry Report Date: 09/19/2023
Piedmont Ready Mix Date Received 09/12/2023
524 W. Bailey St.
Asheboro, NC 27203
Project. Piedmont Ready Mix
Pace Project No. 92687159
Sample: OF 1 Lab ID: 92687159001 Collected: 09/12/23 09.37 Matrix: Water
Method Parameters Results Units Report Limit Analyzed Qualifiers
SM 2540D-2015 Total Suspended Solids ND mg/L 2.6 09/15/23 12:41
SM 2540E-2015 Total Settleable Solids ND mUUhr 0.10 09/12/23 16:03
Reviewed by
��
Stephanie Knott
704-977-0981
[e-mail]
Pace Analytical Services Eden
205 East Meadow Road Suite A,Eden,NC 27288 North Carolina Wastewater Certification#:633
North Carolina Dunking Water Certification#. 37738 VirginiaNELAP Certification#:460025
Page 1 of 3

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