NCG140308 DMR WW (3)

PROCESS WASTEWATER -- Quarterly Discharge Monitoring Report
RECEIVED
GENERAL PERMIT No. NCG140000
JAN 21 2M
CERTIFICATE OF COVERAGE NO. -
SAMPLE COLLECTION YEAR:
CENTRAL FI
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ES
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FACILITY NAME: A C449101? ,
PERSON COLLECTING SAMPLES:
SAMPLE QUARTER: Jul -Sept X]Oct-Dec Jan -March
❑
❑April -June
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CERTIFIED LABORATORY:_ �a.� I .L, A Lab # j Z.
COUNTY: nr
PHONE NO. (7) 93 qa
Lab # 40
LIMIT VIOLATIONS? YES NO
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ADD TO LISTSERVE? DYES �A40 EMAIL:
DISCHARGING TO CLASS: DSA DHQW ❑PNA [Trout
DOther
Part A: Wastewater Monitoring Requirements
OPTIONAL INFO:
-�
Date Sample
Outfall No. Collected) fYPe of Wastewater pH
Total Suspended Settleable TPH using
Discharge
(VE RM MD z
(rnm/dd/yr) ) (standard)
method 1664A
Solids Solids
(mg/L) SGT -HEM Duration
Total Flow
(gallons/day)7
- -
(mL/L)
(mg/L) (minutes)
_ 6_93,a
30s,s
Eli : _:1 Z
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.
3If 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.
s 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 Reviseri n7/1 x/11

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 SO% of the Summer 7Q10 Flow as per ISA
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 70,10 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
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]
DISCHARGE") WITHIN
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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
viTlations."
(Signature o- permittee)
(Date)
Permit Date: 7/1/2010-06/30/2015
Last Revised 07
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