NCG070104_2024 DMR_20240328

NCDEQ Division of Energy,Mineral and land Resources
Stormwater Discha:Ile IVIOilitr ring Report(DfViii) Form Tor NE1.070000
Stone, Clay, Gins!'? & Concrete Products
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Complete,sign, scan and submit the©MR via the 51urmw1v ti Rtpfxa ,errs,#,latty,;,„tir,:rrr ,0 days of receiving sampling results. Mail the original,signed hard copy of the DMR to the pc prig{t{tf r Dt M P Reg}rhO IAA thin
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CerttFrc;tte of Coverage Ho 'Nt"G47Q f0
Facility Name / �r �"
Person Collecting Samples �'
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tl _J. .„,. . GI,CT.S' co . Laboratory Name ,t
Facility County 5
• Laboratory Cert. Na
Discharge during this pert•od: Yes si r
.._._» (r1 nv, skip to signature Qnd dote/ —.._..__ __
Has your facility implemented mandatory Tier response actions this sample
1 If so,which Tier(I, tl,or ill)? period for any benchmark exceedances?+[]Ye; 0 No
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A copy of this OMR has been uploaded electronically via rlttos./;enc�,cs Jc i � t
lic ay For:ins/SW DMIR
t Yes �Na
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Gate Uploaded:
• —__. •.,......»_ __.
Analytical Monitoring Requirements for Vehicle&Equipment Areas—Benchmarks hi (Red)
Parameter _.......... ____..
Code Parameter Outfarl Outfall Outfall Qutfall Outfall
N/A Receiving Stream Class .»...»w —........,...,...._. .._ ._
Date Sample Collected MM/t16/YYYY __..,-..,...._ .w ;_
N A _..__.._.,. m __.m_
46529 24Hour Rainfall in inches —
C0530 TS5 in mg/L(100 or 5€4
40552 i Non-Polar Oil&Grease in trig/!(f5)
NCOIL I Estimated New Motor/Hydraulic Oil ' 0 .q4...
Usage in gal/month c'.e-.
..1 /•,„r.. ... a..., „44,7--0-"c4-- i. i
* outfatis to Outstanding Resource Waters(ORW),High Quality Waters(HQW),Trout Waters(Tr)and Primary Nursery Areas(PNA)
have a benchmark TSS limit of St1 mg/L.All other water classifications have a benchmark of 100 mf;/t
Notes(optional). ci w� r { �/.. Si 6 f '.5 14,)e. /+ f Q 1 c!' �Ci% G1444. 7
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,t - cu •te,and complete.I am aware that there are significant penalties for submitting
false information,including the possibility of fines a'.'imprison r .nt for knowing violations."
S' n re of Premuittee or Delegated Sign a egated Autho zed tn.ivl. al Date
7
Email Address , r!`1 ! ;L
Phone Number