NCG140138 DMR SW 20210811

N
STORMWATER DISCHARGE OUTFALL (SDO) - MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140138
FACILITY NAME: Gre stone Concrete Products Inc.
SAMPLE COLLECTOR: 1� L7�//�[ iX
CERTIFIED LABORATORY � � � Lab #
l��R�i�i Lab#�
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLING PERIOD: ❑ July -December January -June cat
SAMPLING FREQUENCY: Quarterly: ❑ Semi-annually 17�
COUNTY Vance 7�
PHONE NO. 252-438-5144
ADD TO LISTSERVE? [—]YES ONO EMAIL
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other SQc,I)
Outfall No.
Date Sample
Collected
(mm/dd/yr OR
NO FLOW)
P H
(Standard Units)
TSS
(mg/L)
Total
(in)
In Tier 2
Monthly Monitoring?
(y/n)
of Months iTier 2
ItRainfall°
Samplingg
-
-
6-92
1002,3
-
-
-
c,
i
I If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE' for each outfall here. Please make sure to mark the sample period above.
' If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HOW, Trout, and PNA waters where they are 50 mg/l.
° For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 8/1/2017-6/30/2022 Last Revised 8/09/17
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr)l
pH
(Standard
Units)
Non -Polar
Oil &Grease using
method 1664
SGT-HEM
(mg/L)
Total
Suspended
Solids
(mg/L)
Total
Rainfall a
(in)
New Motor Oil Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier 2
Sampling 2
6-92
152
1002,3SIR
,
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring period
in case of "No Flow") to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, 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 r eying the infor ation, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware t t there are—tignific t p, es for submi ing false information, including the possibility of fine and imprisonment for knowing violations."
(Sig ermit ee
( te)
Permit Date: 8/1/2017-6/30/2022 Last Revised 8/09/17
Page 2 of 2