NCG070115_2024 DMR_20240328

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG070000
Stone, Clay, Glass, & Concrete Products
Click here for instructions
Complete,sign,scan and submit the DMR via the S'c}rr;_ Ater N!, > '.r;nit f) --r 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. NCGO7 Person Collecting Samples: HI C 114� ( Pb`Gets
Facility Name: 4 d 4 ms 0/c9(G f 1!t Laboratory Name: Pa(-( / G hi
Facility County: U t I -(o/d Laboratory Cert. No.: ¢V(v p )ry//4
Discharge during this period:IN Yes ❑No (if no,skip to signature and date)
Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances?❑Yes ❑ No
If so,which Tier(I, II,or III)?
A copy of this DMR has been uploaded electronically via httns://edocs.dec.nc. ,o Forms/SW--DMR ❑Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Vehicle&Equipment Areas—Benchmarks in (Red)
Parameter Parameter Outfall2- Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class i//19-
N/A Date Sample Collected MM/DD/YYYY 2-/- 2-9
46529 24-Hour Rainfall in inches a 7
C0530 TSS in mg/L(100 or 501 1S
00552 Non-Polar Oil&Grease in mg/L(15) N j;
NCOIL Estimated New Motor/Hydraulic Oil 0
'—i 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 mat.All other water classifications have a benchmark of 7,10 rr;g/t_
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
in• iry of the person or persons who manage the system,or those persons directly responsible for gathering the information,the information
ted is,to the best of my knowledge and belief,true,accurate,and complete.I am aware that there are significant penalties for submitting
for ation,in ing the possibility of fines and imprisonment for knowing violations."
4 an1 1 `
V Z ti ,
Sig .ture of Permittee or Delegated Authorized Individual Da ((ff
Email Address Phone Number