NCG140339_MONITORING INFO_20190305

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IVC& )y-o 33�
DOC TYPE
❑HISTORICAL FILE
DCMONITORING REPORTS
DOC DATE
YYYYMMDD

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No NCG140000
Calendar Year 2018
*Report ALL WASTEWATER monitoring data on this form (include "No Flow"/ No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH i of each year
Certificate of Coverage No NCG14 ®3❑ 3❑ 9❑
Facility Name Lowery St
County Forsyth
Phone Number (336 ) 226-517
Certified Laboratory Prism Lab
Lab # 402
Lab #
Total no of outfalls monitored 3
Wastewater (WW) Discharge Outfall No 001
Does this outfall discharge WW to SA waters? Yes ❑ No ❑✓
Does this outfall discharge WW to SIB or PNA waters? Yes ❑ No ❑✓
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ❑✓
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ✓❑
Were there any limit violations in the calendar year? Yes ❑ No 0
Outfall No
Daily Flow Rate,
pH,
TSS,
SS,
Non -Polar O&G (EPA Method 1664
cfs
SU
mgll
mill
(SGT-HEM)), mgll
001
d a pphcabfe
Standard
Effluent
HOW or ORIN
50% of 7Q10
freshwater
6 0-9 0
Qw
P ARo
No Limit
Limitations
20
SB any
Trot
Indicate NO FLOW if
saltwater
5
Samples above benchmark
applicable
6 8-8 5
HQW ! ORW and Tr or
subject to Tiered Responses
Dally Maximum
PNA
15
10
Date
Sample
Collected,
`r
!
E
, t j
f i fj f7 C;'
e
ra P f kf
f
Hs F fF+ f++wit a�"I t s� did lS t+ s n !t
i
molddlyr
1
3/2/2018
NO FLOW
MAR 0 5 2019
6/3012018
NO FLOW
_.
U I'mAu
9/27/2018
NO FLOW
12/21/2018
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No NCG14 0❑00®
Additional Outfall Attachment (make copies as needed for additional outfalls)
Wastewater (WW) Discharge Outfall No 3
Does this outfall discharge WW to SA waters? Yes ❑ No ❑
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ❑
Were there any limit violations in the calendar year? Yes ❑ No ❑
Outfall No
Daily Flow Rate,
cfs
pH,
SU
TSS,
mgll
SS,
mlll
if applicable
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mgll
Effluent
Limitations
Daily Maximum
HOW orORW
50% of 7Q10
Indicate NO FLOW it
applicable
ra tshwater
6 0-9 0
saltwator
6 8-8 5
Standard
30
Ow
20
HOW ! ORW rrLd Tr or
PNA
10
HOW SA
se PNAorany
TrotA
5
No Limit
Samples ahoas Benchmark
subject W Tiered Responses
15
Date
Sample
Collected,
mo/dd! r
�
�a
i
;x : ,l
,1��
ir,r 1'� k to
3/212018
003
82
BRL
6/3012018
NO FLOW
912V2018
NO FLOW
12121/2018
NO FLOW
Permit Date 8/112017 -- 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No NCG14 ©0 3❑®
Additional Outfall Attachment (make copies as needed for additional outfalls)
Wastewater (WW) Discharge Outfall No 2
Does this outfall discharge WW to SA waters? Yes ❑ No ❑
Does this outfall discharge WW to SIB or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ❑
Were there any limit violations in the calendar year? Yes ❑ No ❑
Outfall No
3
Daily Flow Rate,
cfs
pH,
SU
TSS,
mgll
SS,
mill
if oppfica6fe
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mg/l
Effluent
Limitations
Daily Maximum
HQW or DRlN
50% of 7Q10
indicate NO ble
applicable
freshwater
6 0-9 0
aatptwepterL
6 $-8 5
Standard
Qa
0
HOW ! O W an Tr or
�
PHA
10
Hss P ARo SA
Trout
5
No Limit
s abo o Benchmark
Subjecteto Tiered Responses
15
Date
Sample
Collected,
molddl r
I; fa
V 3 ! I �
f y hft�� ,a
." 4 '� ✓R t'° Q "sF`
f�_�"r
fi #9`�'�3 r
- `- 11,E
t ws I
'� '
r a{y x ,�y+e
t�' t._
i° M £ a
�!. 1,
i
��� rb4
� d` i �� { d
, ��
s s4 n u d
if ih F}
3
�r '3` a�E e ,;�r,a�
�dk� i�'r � " R„'7 � f �z�M 4T L ; a �"1
�� i , , z " I
3i �Ifd f S i
'1�f� t'y��`
f VIV
R Y I f7 f Y L Y
a'd 'Ee
3/2/2018
NO FLOW
6/30/2018
NO FLOW
9/27/2018
NO FLOW
12/21/2018
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No NCG 14 ❑oU,C[T
CERTIFICATION
"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 I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations "
[Required by 40 CFR §122 22]
Signature
Date
Mail Annual Summary Wastewater DMR to the NCDEQ Central Office
Note the address is correct — Central Fries is housed in DWR (not DEMLR)
N C Department of Environmental Quality (DEQ)
Division of Water Resources
Attn DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at
[phone]
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
II SUBMIT TO CENTRAL OFFICE* II
General Permit No NCG140000
Calendar Year 2018
'Report ALL STORMWATER monitoring data on this form (include No Flow 1 No Discharge and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year
Certificate of Coverage No NCG14 ®3❑ 3�®
Facility Name Lowery St
County Forsyth
Phone Number ( 336 ) 996 2841 Total no of SDOs monitored 3
Certified Laboratory Research and Analy Lab Lab #
Lab #
Stormwater Discharge Outfall (SDO) No 001 VMA Outfall? Yes ❑
Is this outfall currently in Tier 2 for any parameter? Yes ❑
Was this outfall ever in Tier 2 during the past year? Yes ❑
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes enough consecutive samples below benchmarks to decrease frequency ❑
Yes received approval from DEMLR to reduce monitoring frequency ❑
Other ❑
No ❑✓
No a
No []
ECE VED
MAR 0 4 2019
-NTRAL FIL3=S
VVR ,';E.rC Ti0'j
Outfall No
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
m li
pH,
SU
Non -polar O&G
(EPA Method
1664 SGT-HEM
{ )),
mgll (VMA)
lfapptrcabte
New Motor Oil
Usage (gallmo )
lfapplicable
Stormwater
Benchmarks
lrrtlrcata NO FLOW if
applicable
Circle Benchmark
1 001 i�o
6 0-9 �
'� �
�65 gallmo average requires 7S5 and
Non polar 0&G monitoring
Date Sample
Collected,
molddlyr
r ��,
et
h $
r �rr
c r a a ? t
r
,
>A a s S
3/2/2018
NO FLOW
6/30/2018
NO FLOW
9/27/2018
NO FLOW
121211201E
NO FLOW
Permit Date 8/1l2017 — 6/3012022
Last Revised 8-22-2015

Certificate of Coverage No NCG14 0❑ 3� 3n®
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No 2 VMA Outfall? Yes ❑ No ❑
Is this outfall currently in Tier 2 for any parameters Yes ❑ No ❑
Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes enough consecutive samples below benchmarks to decrease frequency ❑
Yes received approval from DEMLR to reduce monitoring frequency ❑
Other ❑
Outfall No
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
m 11
pH,
SU
Non -polar O&G
(EPA Method
1664 (SGT-HEM
rng/l (VMA) )}�
Happhca6fa
New Motor Oil
Usage (gallmo )
trapp0canla
Stormwater
Benchmarks
lndreat0 NO FLOW d
applrcabla
Circle Benchmark
� OOI5a
6 0-9 0
15
�66 gallmo average requires T55 and
Non potar OdG monitoring
Date Sample
Collected,
molddl r
r t
�� r
H.r 6
r r�
o I
4 ' 'CA ¢
i4r =' Q ��
b i
L P °Y
r,
,pi t4 f> � �'
a�° r��� ,,
, x ui
3/2/2018
NO FLOW
6/3012018
NO FLOW
8/27/2018
NO FLOW
12121/2018
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No NCG94 ®3❑F31R
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No 3 VMA Outfall? Yes ❑ No ❑
Is this outfall currently in "tier 2 for any parameter? Yes ❑ No ❑
Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes enough consecutive samples below benchmarks to decrease frequency ❑
Yes received approval from DEMLR to reduce monitoring frequency ❑
Other ❑
Outfall No
3
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
m Il
pH,
SU
Non -polar O&G
(EPA Method
1664 (SGT-HEM)),
mg/l (VMA)
New Motor Oil
Usage (gallmo )
Stormwater
Benchmarks
Indicate NO FLOW if
applicable
Circle Berle hma rk
� aar5a
fi 0-9 0
1 �
>55 gallmo average requires T55 and
Non polar OSG monitoring
Date Sample
Collected,'ii
molddl r
�
T l - 4, j �
0 � � "i' �f , , ,ii���
0
4� fb '� ' '1r
3/2/2018
003
6RL
82
6/30/2018
NO FLOW
9/2V2018
NO FLOW
12/21/2018
NO FLOW
Permit Date 8/1/2017 — 6130/2022
Last Revised 8-22-2015

Certificate of Coverage No NCG14 &
UCQ
CERTIFICATION
"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 I am aware that there are significant penalties for
submitting false information), including the possibility of fines and imprisonment for knowing violations "
(Required by 40 C1wR §122
Signature
Date
15
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office
Note the address is correct — Central Files is housed in DWR (not DEMLR)
N C Department of Environmental Quality (DEQ)
Division of Water Resources
Attn DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEME_R Stormwater Permitting Staff in the Central Office at
[phone]
Permit Date 811/2017 — 6/30/2022
Last Revised 8-22-2015

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE`
General Permit No NCG140000
Calendar Year 2017
*Report ALL WASTEWATER monitoring data on this form (Include No Flovd'1`No Discharge and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each r__ � � F n
Certificate of Coverage No NCG14 K]J 3❑ 9❑ APR 13 2016
Facility Name Lowery Street Plant r &„ , IA0 C-„
County Forsyth D NR SECTION
Phone Number (704 ) 607-4456 Total no of outfalls monitored 2
Certified Laboratory Research & Analytical Lab Lab # 34
Lab #
Wastewater (WW) Discharge Outfall No 001 & 002
Does this outfall discharge WW to SA waters?
Yes ❑
No ❑✓
r�
Does this outfall discharge WW to SB or PNA waters?
Yes ❑
No 0
�.��u1Q_e
Does this outfall discharge WW to HQW or ORW waters?
Yes ❑
No
Qprf-eel
If so, what is the 7Q10 flow rate? or Tidally influenced
waters,
7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters?
Yes ❑
No ✓❑
Were there any limit violations in the calendar year?
Yes ❑
No 0
Outfall No
001
Daily Flow Rate,
cfs
pH,
SU
TSS,
mgll
SS,
mill
rf appricaWe
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mgll
Effluent
Limitations
Daily Maximum
HQW or ORW
50% of 7Q10
Indicate NO PLOW Itsaltwater
apprrcable
freshwater
6 0-9 0
6 Q-8
O
Standard
QW
20
HOW I ORW and Tr or
10
HOW OARare Y
Trout
5
No Limit
Samples above Benchmark
subject to Tiered Responses
15
Date
Sample
Collected,
moldd! r
8 t ti i� ¢{t } t r
2 f i i � � qyP
t
y
1 P t §d
p i n
4 w iy �'! 1�
f w � F .f h�i P �
f
. ?E r
i1 �' ii d
� 1 5 3$ �
r ; ,
7 t
r
I � P � F @ It 4F i F � le "f #4i 4id�4 P� Sb:t«i iPtp i
� D�� 31 f 7 ) ! �
r �� 4M r
3/28/2017
PW 001 No Flow
6/30/2017
PW 001 RM
852
126
101
9/29/2017
PW 001 No Flog
12/28/2017
PW 001 No Flow
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No NCG14 1 13❑ 9❑
Additional Outfall Attachment (make copies as needed for additional outfalls)
Wastewater (WW) Discharge Outfall No 002
Does this outfall discharge WW to SA waters? Yes ❑ No ❑✓
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No ❑✓
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ✓❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout jr) designated waters? Yes ❑ No ❑✓
Were there any limit violations in the calendar year? Yes ❑ No ❑J
Outfall No
D02
Daily Flow Rate,
cfs
pH,
SU
TSS,
mgll
SS,
mlll
if applicable
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mgll
Effluent
Limitations
Daily Maximum
HQW or ORW
50% of 7Q10
Indicate NO FLOW ifsaltwater
applicable
freshwater
6 0-9 0
r p_p 6
6 V v
Standard
t od
20
HQW ! ORVY 01 Tr or
10
Hse° FNRRara Y
Trout
c
5
No Limit
Samples above Benchmark
subject to Tiered Responses
15
Date
Sample
p
Collected,
molddl r
f L
e
a 9{ r l P �9Y I �,
°
�
d
r,� F P �` w E S4,
t 1 d �¢
}
�@ a^ .
p
°� � Pba r � T r� r t' � % g MF
3 ?A r
3/2812017
PW 002 NO FLOW
6/3012017
PW 002 NO FLOW
9/29/2047
PWO02 NO FLOW
12/28/2017
PWO02 NO FLOW
Permit Bate 8l112017 — 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No NCG14 E 3EIIE
CERTIFICATION
"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 I am aware that there are significant penalties for
submitting false information,
[Required by 40 CFR §122 A2]
Signature
Date l
ng the possibility of fines and imprisonment for knowing violations "
Mail Annual Summary Wastewater DMR to the NCDEQ Central Office
Note the address is correct — Central Files is housed in DWR (not DEMLR)
N C Department of Environmental Quality (DEQ)
Division of Water Resources
Attn DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at
[phone]
Permit Date 81112017 — 6/30/2022
Last Revised 8-22-2017

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) —STORMWATER
SUBMIT TO CENTRAL OFFICE"
General Permit No NCG140000
Calendar Year 2017
*Report ALL STORMWATER monitoring data on this form (include "No FlowTNo Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year
Certificate of Coverage No NCG14
MAR 0 7 2018
Facility Name Lowery Plant
County Forsyth Ut-N I KAL t It, ES
DWR SECTION
Phone Number 70( 4 607-4456 Total no of SDOs monitored 2
Certified Laboratory Research & Analytical Lab Lab # 34
Lab #
Stormwater Discharge Outfall (SDO) No 001 & 002 VMA Outfall? Yes ❑ No ❑✓
Is this outfall currently In Tier 2 for any parameter? Yes ❑ No ❑�
Was this outfall ever in Tier 2 during the past year? Yes ❑ No 0
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes enough consecutive samples below benchmarks to decrease frequency ❑
Yes received approval from DEMLR to reduce monitoring frequency 0
Other
A
Outfall No
Total Rainfall,
Inches
Total
Suspended
Solids (TSS),
mg/1
pH,
SU
Non -polar O&G
(EPA Method
1664 (SGT-HEM)),
mgll (VMA)
rfappricabre
New Motor Oil
Usage (gallmo )
lrapplicable
Stormwater
Benchmarks
indicate NO I=LOW!!
applrcable
CrrcleBenchmark
1 00���
A if
6 V-7 0
1 �
>55 gallmo average requires TSS and
Non polarOBG monitoring
Date Sampler
Collected,
molddl r
$Z
,
I
N'it�tpl3 rvm
}� r 1r€i(�
k,byt�
3/28/2017
001 No Flow
3/28/2017
002 No Flow
6/30/2017
001 No Flow
6/30/2017
002 No Flow
9/29/2017
001 No Flow
9/29/2017
002 No Flow
12i28l2017
001 No Flow
Permit Date 8/112017 — 6/3012022
Last Revised 8-22-2015

Certificate of Coverage No NCG14 ®©ff1®
CERTIFICATION
"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 I am aware that there are significant penalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations "
[Required by 40 CFR § 122 221
Signature
Date "2
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office
Note the address is correct — Central Files is housed in DWR (not DEMLR)
N C Department of Environmental Quality (DEQ)
Division of Water Resources
Attn DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at
[phone]
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

14 w
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO NCG140000
133y
CERTIFICATE OF COVERAGE NO NCGi
FACILITY NAME Lowery St
PERSON COLLECTING SAMPLES Greg Smith
CERTIFIED LABORATORY Research and Analytical Lab # 34
LIMIT VIOLATIONS) YES [:]NO
Part A Wastewater Monitorine Reauirements
SAMPLE COLLECTION YEAR 2017
SAMPLE QUARTER ❑Jul -Sept ❑Oct -Dec ®Jan -March ❑April -June
COUNTY Forsyth
PHONE NO [phone]
ADD TO LISTSERVE) ❑YES ®NO EMAIL
DISCHARGING TO CLASS [:]SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO
Outfall No
Date Sample
Collected
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)'
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
S T-HEM'
Discharge1
Duration
(minutes)
Total Flow
,
(gallons/day]
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
3/28/17
RM
No Flow
REUtIVED-
002
3/28/2017
RM
No Flow
t �"
CENT
DWR
ECTION
If wastewater systems have not discharged in this quarter — report "No Flow' or "No Discharge' here Please make sure to mark the sample quarter above
z Report the abbreviation for the type of Authorized Wastewater Discharges here Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD) Report more than one type if the waste stream is commingled
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months unless DWQ RO staff
notifies you to continue monitoring
4 pH limits are 6-9 S LO for wastewater discharges to freshwaters, and 6 8-8 5 S U for discharges to saltwaters
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications
Permit Date 7/1/2010 06/30/2015 Last Revised 07/13/11
Page 1 of 2

6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas TPH does not have a limit for wastewater
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action
Flow rate can be measured continuously or calculated Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B 0224 Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case by -case basis
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW" TO
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
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 sponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am aware thaA there sigcyficant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
ure of
Permit Date 7/1/2010-06/30/2015
5-h���
(Date)
Last Revised 07/13/11
Page 2of2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No NCG140000
AX&14o33q
CERTIFICATE OF COVERAGE NO 4CG4496"3T
FACILITY NAME Lowery St
PERSON COLLECTING SAMPLES Tony Hardison
CERTIFIED LABORATORY Research and Analytical Lab N 34
LIMIT VIOLATION57 YES [:]NON
Part A Wastewater Monitorine Reauirements
SAMPLE COLLECTION YEAR 2015
SAMPLE QUARTER ®Jul -Sept ❑Oct -Dec ❑Jan -March ❑April -June
COUNTY Forsyth
PHONE NO [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL
DISCHARGING TO CLASS [:]SA ❑HQW
OPTIONAL INFO
❑PNA ❑Trout ®Other
Outfall No
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)'
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SGT
(mg/L) /L)
Duration
(minutes)
Total Flow
7
(gallons/day)
-
RM, MD-
6-934
3035
53
(15),
-
-
001
09/01/15
No Flow
5
TR'/
L FILES
1 IUN
` If wastewater systems have not discharged in this quarter — report No Flow or No Discharge here Please make sure to mark the sample quarter above
z Report the abbreviation for the type of Authorized Wastewater Discharges here Vehicle and Equipment Cleaning (VE) Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD) Report more than one type if the waste stream is commingled
31f an effluent limit is exceeded twice in a row the permittee is required to institute monthly monitoring for that parameter for six months unless DWQ RO staff
notifies you to continue monitoring
4 pH limits are 6 9 S U for wastewater discharges to freshwaters, and 6 8 8 5 S U for discharges to saltwaters
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications
Permit Date 7/1/2010-06/30/2015 Last Revised 07/13/11
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e Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action
Flow rate can be measured continuously or calculated Flow limits for wastewater discharges to HQW waters shall beset to 50%of the Summer 7Q10 Flow as per 15A
NCAC 02B 0224 Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ and the DWQ Regional Office may require an annual flow
report on a case -by case basis
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING_ PERIOD IN CASE OF "NO FLOW") TO
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
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 du ctly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am awiirq1that iere'�re significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
of Permittee)
Permit Date 7/1/2010 06/30/2015
(Date)
Last Revised 07/13/11
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