NCG140138_DMR_20220411

I { 1
STORMWATER DISCHARGE OUTFALL (SDO) - MONITORING FORM RECFIVED
GENERAL PERMIT NO. NCG140000 APR 19 2022
CERTIFICATE OF COVERAGE NO. NCG140138 SAMPLE COLLECTION YEAR:' i'EIV'I RAIL FILER
FACILITY NAME: Gre stone Concrete Products Inc. SAMPLING PERIOD: ❑ I
July -December January -June DWR SECTION
SAMPLE COLLECTOR: �M r g1VN %/% SAMPLING FREQUENCY: Quarterly: ❑ Semi-annually
CERTIFIED LABORATORY Lab # COUNTY Vance
IA4e NA V 2ZT .A/_ Lab # 1�26. PHONE NO.252-438-5144
OPTIONAL INFO: ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
Part A: Stormwater Monitoring Requirements
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout ❑Other n :ji'
Outfall No.
Date Sample
Collected
(mm/d '
NO FLOW)'
PH
(Standard Units)
TSS
(mg/L)
Total
Rainfall'
(in)
In Tier 2
Monthly Monitoring?
�y/n) g'
# of Months in Tier 2
Sampling2
-
-
6-9z
1001,3
//
' 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/I.
°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
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Part R- Vphirlp Maintannnra Ar_tivity Mnnitnrina Renuirements fnr farilities using > SS 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'
6-92
152
1002,3-
% /IJZ
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 for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that th�ze-eignifigat pena
(Signature
Permit Date: 8/1/2017-6/30/2022
r submitting false information, including the possibility of fines and imprisonment for knowing violations."
(D te)
Last Revised 8/09/17
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