NCS000389_OTHER_20091029

STORIVIVI/ATEKDIVISfON-CODING-SHEET- -
PERMIT NO.
NCS ;J 8c(
DOC TYPE
❑FINAL PERMIT
❑ MONITORING INFO
❑ APPLICATION
0 COMPLIANCE
OTHER
DOC DATE
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YYYYMMDD

PROCESSIMINE DEWATERING WASTEWATER DISCHARGE MONITORING REPORTl)
Please Mail Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCG020000
Part A: Facility Information
Samples Collected to Quarter. 1Q 2Q eq 4Q (ell sarnples shall be reported within 30 days following monitoring period)
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Certificate Of Coverage No. NCGO20172 County of Facility
Facility Name Vulcan Materials Co./Cabanus Name of Laboratory
Faculty Contact David Hoer Lab Certification p
Facility Contact Phone No. [phone]
Part B. Process Wastewater and Mine Dewatering Wastewater Monitoring Requirements
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Measured continuously using a flow rneasuring device or estimated using manufacturer's pump curves and pump loge.
Part C• Gerhjication
"I certify, under penalty of low, that this document and all attachments were prepared udder my direction or supervision In accordance with a
system designed to assure that qualified personnel property gather and evaluate the Information submitted. Based on my inquiry of the person
or persons who manage the system, of those persons directly responsible for gathering the Information, the faformatior submitted Is, to the best
of my knowledge and bend, true, accurate, and complete. I am aware that there are signliil aaltkLfor submitting false Information,
Including the possibility of fines and Imprisonment for knowing vlolatoas." 41-7
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(Date)
Part D: Mailing Address
Attu: Central Files, DENK N.C. Division of Water Quality,1617 Mail Service Center, Raleigh, NC 27699-1617
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STORMWATER DISCHARGE MONITORING REPORT (DMR)
Please Mall Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCG020000
Part A.' Facility Information
Sangrles Collected In Calendar Year: (all samples shell be reported within 30 days following monitoring period)
Certificate Of Coverage No. NCGO20251 County of Facility
Facility Name Vsk= Materials Cojeacme Name of Laboratory
Facility Contact Rormic Godman Lab Certification #
Facility Contact Phone No. [phone]
Part B: Land Dimrbance and Process Area Monitoring Requirements
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F" ' ldentify dw receiving nreurr: Imurol lark
Part D.- :Storm Event Characteristics
Total Event Precipitation (Inches):
Event Duration (hours):
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Part C: Vehicle Ma#denance Monitoring Requirements
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Total Event Precipitation (Inthes)o
Event Duration (hours):
(if a separate storm went is sampled)
Part E: Certification
"I certify, under penalty of law, that this document end all attachments were prepared under my direction or supervision In accordance with a
system designed to assure that qualified personnel properly gather end evaluate the Information submitted. Based an ally Inquiry of the person
or persons who manage the system, of those persona directly responsible for gathering the Information, the Information wb altted Is, to the hest
,of ruy knowledge sad bdiK true, somrstq and complete. I sun aware that there ire significant penaltles for submitting false information,
Induding the possibility of flocs and Imprisonment for knowing violations."
(Signaatitre of Permittee) (Date)
Part F. Mailing Addrew
Attn: Central Files, DENR, N.C. Division of Water Quality, 1617 Mali Servlce Center, Raleigh, NC 27699-1617
SWl!-243-1201"