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Home My WebLink AboutNCG020752_MONITORING INFO_20190118STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /V C��a6�ja DOC TYPE ❑-HISTORICAL FILE L7/MONITORING REPORTS DOC DATE ❑ ��I��JI I� YYYYMMDD STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. NCGNE DOC TYPE ❑HISTORICAL FILE DOC DATE ❑ YYWMMDD 9 ANNUAL SUMMARY DISCHARGE MONITORING REPORT (DMR) — STORMWATER SUBMIT TO CENTRAL OFFICE General Permit No. NCG020000 Calendar Year 2018 ;Report ALL STORMWATER monitoring data on this form (include "No Flow"/`No Discharge" and Benchmark Exceedances) from the previous calendar year to the DEQ by MARCH 9 of each year. Certificate of Coverage No. NCG02 0752 `1—ED Facility Name: _ Riley2 Pit JAN 18 2019 County: Harnett CENTHAL FILES Phone Number: 919 ) 499-9322 DWR SEC ,otal;no. of SDOs monitored 1 Certified Laboratory NIA Lab # Lab # Stormwater Discharge Outfail (SDO) No. 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 ❑ No, turbidity benchmark exceedances did not require monthly monitoring ❑ Other ❑ Outfall No. RP-1 Total Rainfall, inches TSS, mgll SS, mill Turbidity, NTU Upstream (U) Turbidity, NTU Downstream (D) Turbidity, NTU Non -polar O&G, mgll (VMA) New Motor Oil Usage al/Mo. Benchmarks r„�„e NO Ff appika McBenchmarkCircle Benchmark 100150 0.1 50/25/10 NIA s;n� �,es NIA standard n i 1 eStormwater averag>55 e T ao"moni Non -polar Date Sampled Collected, y� kMAN �h No Flow Permit Date 1011/2015 — 9/30/2020 Certificate of Coverage No. NCG02 0752 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." (Requit Signa Date Mail Annual Summary Stormwater DMR to the NCDEQ Central Office: Note the address is correct — Central Fifes 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 (919) 807-6300 Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at: (919) 707-9220 Permit Date 10i112015 -- 9/30/2020 (• . 1 i •Ili � ry i` ..• 11. ... .11r .. • r ' ` .. !� r. � Vim• .� - I♦ , -' n V_ l ... .� •-1 �� . ' r-4 Ct '0, ANNUAL SUMMARY DISCHARGE MONITORING REPORT (DMR) — STORMWATER SUBMIT TO CENTRAL OFFICE* General Permit No. NCG020000 Calendar Year 2017 *Report ALL STORMWATER monitoring data on this form (include "No Flow"I"No Discharge" and Benchmark Exceedances) from the previous calendar year to the DEQ by MARCH I of each year. Certificate of Coverage No. NCG02 0752 Facility Name: Riley 2 Pit County: Harnett Phone Number: ( 919 ) 499-9322 Total no. of SDOs monitored 1 Certified Laboratory NIA Lab # Lab # Stormwater Discharge Outfali (SDO) No. 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 ❑ l Yes, received approval from DEMLR to reduce monitoring frequency No, turbidity benchmark exceedances did not require monthly monitoring Other No ❑ No ❑ No ❑ RECEIVED JAN 2 5 201$ CEN`f KAL FILES DWR SECTION Outfall No. RP-1 Total Rainfall, inches TSS mgll SS mill Turbidity, NTU Upstream (U) Turbidity, NTU Downstream (D) Turbidity, NTU Non -polar O&G, mgll (VMA) New Motor Oil Usage (gallmo.) Stormwater Benchmarks lndiCare No aab100150 applicable Circle Benchmark 0.1 nchnCircl Benchmark 50125110 NIA Water ndrapes d p NIA taaes Standard 15 ass a requires average requires TSS lar 0&0 Date Sample Collected, molddlyr i No Flow Permit Date 10/1/2015 — 9/30/2020 Certificate of Coverage No. NCG02 0752 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. Signature Date:►___.��1 President 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 (919) 807-6300 Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at: (919) 707-9220 Permit Date 10/1/2015 - 9/30/2020 ANNUAL SUMMARY DISCHARGE MONITORING REPORT (DMR) — STORMWATER II -11 SUBMIT TO CENTRAL OFFICE* II General Permit No. NCG020000 Calendar Year 2015 *Report ALL STORMWATER monitoring data on this form (include "No Flow/No Discharge' and Benchmark Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year. Certificate of Coverage No. NCG02 0752 Facility Name: Riley 2 Pit County: Harnett Phone Number: l 919 l 499-9322 Total no. of SDOs monitored 1 Certified Laboratory NIA Lab # Lab ## Stormwater Discharge Outfall (SDO) No. 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 ❑RECEIVED If this outfall was in Tier 2 last year, was monthly monitoring discontinued? FEB p 12016 Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DEMLR to reduce monitoring frequency ❑ CENTRAL FILES DWR SECTION No, turbidity benchmark exceedances did not require monthly monitoring ❑ Other ❑ Outfall No. RP-1 Total Rainfall, inches TSS, mg1l SS, mlll Turbidity, NTU Upstream (U) Turbidity, NTU Downstream (D) Turbidity, NTU Non -polar O&G, mgll (VMA) New Motor Oil Usage {gallmo.} Stormwater Benchmarks „> a»xo FLOC e sAWDate cacie 9errchmark 100150 0.1 Circle Besicnmark 50/25110 NIA ncare aWawr W NIA s ry Water d applies ;;tk . (;,i,... .;''Y,= 1 s r ASS paUmo. averapereyui. TOMB aw G mon roriniar Sample Collected molddly r VR tg Y a { f !: No Flow Permit Date 10/1/2015 - 9/30/2020 Certificate of Coverage No. NCG02 0752 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_" [Rat Sig Date January 29, 2016 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 (919) 807-6300 Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at: (919) 707-9220 Permit Date 10/1/2015 — 9/30/2020 ANNUAL SUMMARY DMR - STORMWATER Il SEND TO CENTRAL OFFICE * II STORMWA TER DISCHARGE OUTFALLS (SDO) GENERAL PERMIT NO. NCG020000 *Report ALL STORMWATER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH 1 of each year. CERTIFICATE OF COVERAGE NO. NCG020752 FACILITY NAME: Riley 2 Pit PERSON COLLECTING SAMPLES CERTIFIED LABORATORY Lab # Lab # Part A: Stormwater Monitoring Requirements SAMPLE COLLECTION YEAR: 2014 COUNTY Harnett PHONE NO. (919-499-9322 ) ADD TO LISTSERVE? YES ❑ NO ® EMAIL: gsmaterials@windstream.net Outfall No. Date Sample Collected (moldd/yr OR NO FLOW) In Tier 2 Monthly Monitoring? (y/n) # of Months in Tier 2 Samling= p Total Flow (MG) Total Suspended Solids (mg/1) Turbidit (NTU} y Settleable Solids {mUl) Total Rainfall (in) Event Duration (minutes) - - - - - 100 ' See Footnote ' 0.1 RP-1 No Flow I C, =Nr�a u v� �� 8 1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range. 2 Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range 3 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit. ° TSS benchmark values are 100 mg/l except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l. S The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes, and reservoirs designated as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the SDO. Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO. Permit Date: 1/l/2010-1213112014 Last Revised 02-02-11 Page 1 of 2 Part Bc Vehicle Maintenance Activity Mo itoring Re uirements for facilities using > 55 gal of new motor oil/month on average Outfall No Date Sample Collected (molddlyr OR NO FLOW) In Tier 2 Monthly Monitoring? (y/n) # of Months in Tier 2 Sampling2 New Motor Oil Usage al/month Total Flow (MG) TPH using method 1664A SGT-HEM m I Total Suspended Solids m l pH (Standard Units Total Rainfall in Event Duration minutes _ _ 15 100 '4 6-93 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑ HAVE YOU CONTACTED THE REGION? YES []NOD WHO AT THE REGION HAVE YOU SPOKEN WITH? MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE" & LIMIT VIOLATIONS) BY MARCH 1 OF EACH YEAR TO: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919) 807-6300 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 completaWram re that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violation 2/3/2015 ( ignature of Permittee) (Date) Permit Date: 1 / 1 /2010-12/31 /2014 Last Revised 02-02-11 Page 2 of 2 �q NJa; LM�;I�CSW QW�q PO Box 1335 Burlington, NC 27216-1335 October 4, 2012 Attn: Belinda Henson and Mike Lawyer NCDENR — Division of Water Quality Fayetteville Regional Office 225 Green Street, Suite 714 Fayetteville, NC 28301 RE: NOTICE OF VIOLATION/RECOMMENDATION FOR ENFORCEMENT NOV-2012-PC-0327, Cameron Pit (NCG020487) NOV-2012-PC-0326, Hall-Rackley Pit (NCG020353) NOV-2012-PC-0329, Madeline Hall Pit (NCG020776) NOV-2012-PC-0328, Riley Il Pit (NCG020752) G_S. Materials, Inc. Lemon Springs, Harnett County, North Carolina Dear Ms. Henson and Mr. Lawyer. Please find enclosed a formal response to the above listed Notice of Violations (NOV) certified mailings dated September 21, 2012. Please accept our responses below for the following violations: 1) Qualitative Monitoring Qualitative Monitoring has not been conducted and recorded in accordance with permit requirements_ Response: Based on the Compliance Inspection Reports, the statement above indicates that there was no record for Qualitative Monitoring from the second half of 2011 (July -Dec 2011). G.S. Materials (GSM) did not have this period of record on file on site, however, the monitoring was completed and records from the consultant have been provided herein. GSM will make sure the records are on -site at all times in the future. GSM has consistently checked and recorded the sediment basins for erosion and offsite discharges, which there have been none to date. GSM admits and understands that the sediment basins need more storage capacity and vegetation to ensure their best performance during rain events. GSM cleans out the basins occasionally, but understands there needs to be more improvements. 2) Analytical Monitoring Analytical Monitoring has not been conducted and recorded in accordance with permit requirements. Response: Based on the Compliance Inspection Reports, the statement above indicates that there was no record for Analytical Monitoring for the year 2011. GSM did not have the 2011 Analytical Monitoring Report on file on site, however, the report was completed and records from the consultant have been provided herein. The Raleigh Central Office also confirmed that the 2011 Report was in their database as required. GSM will make sure the records are on -site at all times in the future. Since there are zero discharges from these mines to date, analytical monitoring has not been conducted: These basins were originally designed for the 25-yr storm, and the intent is to keep the runoff onsite to prevent any discharges therefore preventing any analytical monitoring. This is the reason the 2010 and 2011 Analytical Monitoring Reports (Annual Summary DMR Forms) have shown zero discharges from the mines. GSM will conduct analytical monitoring upon discovering any offsite discharges from the basins and report according to Part 111, Section B of the NPDES Permit NCG020000. In conclusion, GS Materials will ensure these NPDES permits are consistently in compliance along with the Stormwater Pollution Prevention Plan (SPPP) for the four mines. Please consider rescinding the NOVs as GSM works through improving the on -site sediment basins and maintaining compliance with the NPDES permits. Sincerely, G. . MATERI , INC. . A. "Jac�ir'l p1. k" Bailey ce President Enclosed: July -Dec 2011 Qualitative Monitoring Record 2011 Annual Summary DMR (Analytical Monitoring Record) ANNUAL SUMMARY DMR - STORMWATER 11 SEND TO CENTRAL OFFICE * II STORMWATER DISCHARGE OUTFALLS (SDO) GENERAL PERMIT NO. NCGO20000 *Report ALL STORMWA TER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH 1 of each year. CERTIFICATE OF COVERAGE NO. NCG02 0752 FACILITY NAME: RILEY II PIT PERSON COLLECTING SAMPLES CERTIFIED LABORATORY Lab # Lab # Part A: Stormwater Monitorins Requirements SAMPLE COLLECTION YEAR: 2011 COUNTY HARNETT PHONE NO. (_919 ) 499-9322 ADD TO LISTSERVE? YES NO ❑ EMAIL: Outfall No. Date Sample Collected (mo/ddlyr OR 1 NO FLOW) In Tier 2 Monthly Monitoring. (yln) # of Months in Tier 2 2 Sampling Total Flow (MG) Total Suspended Solids (Mg/1) Turbidity (NTU) Settleable Solids (m11I) Total Rainfall (in) Event Duration (minutes) - - - - - 1003,4 See Footnote"' 0.1 RP 1 NO FLOW Click here to enter text. ' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range. 2 Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range 3 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. h TSS benchmark values are 100 mgll except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l. s The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes, and reservoirs designated as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the SDO. Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO. Permit Date: 1/1/2010-12/31/2014 Last Revised 02-02-11 Page I of 2 Part B. Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month on average Outfall No. Date Sample Collected (moldd/yr OR NOFLOW) In Tier 2 Monthly Monitoring? (y/n} # of Months in Tier 2 Sampling2 New Motor Oil Usage (gal/month)_ Total Flow (MG) TPH using method I bb4A SGT--HEM m /l Total Suspended Solids 1 pH (Standard Total Rainfall in Event Duration minutes 15 1003.46-9 NIA 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 WHO AT THE REGION HAVE YOU SPOKEN WITH? MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT VIOLATIONS) BY MARCIII OF EACH YEAR TO: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919) 807-6300 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 complet aware here are A nificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violati < L 1/20/2012 JSi nature of PermitteZ1/2014 (Date) Permit Date: 1/1/2010-1 Last Revised 02-02-11 Page 2 of 2 F July - Dec 2011 Monitoring Event d1 Stormwater Discharge Outfall (SDO) Qualitative Monitoring Report For guidance on filling out this fame, please visit: http://h2o.enr.state.nc.us/su/Forms Documents.htm#miscforms Permit No.: NICI_I 1_/ 1 I 1_l Facility Name: RILEY fI PIT County: RARNETT inspector: WRITE Date of Inspection: 0412812011 Time of Inspection: 5:00 PM Total Event Precipitation (inches): 0-5 in or Certificate of Coverage No.: N/C/G/ 9 2l QI 71 5l 2l Phone No. (919) 499-9322 Was this a Representative Storm Event? (See information below) X Yes ❑ No Please check your permit to verify if Qualitative Monitoring must be performed during a representative .storm event (requirements vary). A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no precipitation. By this signature, I certify that this report 1! ,Cgate and complefte to e best of my knowledge: (Signature of Perrdittie or signee) 1. Outfall Description: Outfall No. RP1 Structure (pipe, ditch, etc.) SEDIMENT BASIN Receiving Stream: UT CYPRESS CREEK (Cl. WS-III) Describe the industrial activities that occur within the outfall drainage area: SAND MINING 2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, dark) as descriptors. NIA 0 FLOW 3. . Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine Odor, etc.): NIA 0 FLOW Page 1 of 2 5 WU-242-112608 4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear and 5 is very cloudy: 1 2 3 4 5 S. ' Floating Solids: Choose the number which best describes the amount of floating solids in the stormwater discharge, where I is no solids and 5 is the surface covered with floating solids: 1 2 3 4 5 b. Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy: 1 2 3 4 5 7. Is there any foam in the stormwater discharge? Yes No S. Is there an oil sheen in the stormwater discharge? Yes No 9. Is there evidence of erosion or deposition at the outfall? Yes No 10. Other Obvious Indicators of Stormwater Pollution: List and describe NIA 0 FLOW Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be indicative of pollutant exposure. These conditions warrant further investigation. Page 2 of 2 S WU-242-112608 EN —FRO OCT 10 212 T'�R1AL5,1NC. PO Box 1335 Burlington, NC 27216-1335 October 6, 2012 Mike Lawyer NCDENR Division of Water Quality Fayetteville Regional Office 225 Green Street, Suite 714 Fayetteville, NC 28301 Re: Corrected Dates For Cameron, Hall-Rackley, Madeline Hall & Riley II Pits on SDO Reports for 2011 Dear Mike, Enclosed please find the corrected dates on the above pits for your records. July 2011 -Dec 2011 ,. AATt a M Stormwater Discharge Outfall (SDQ) Qualitative Monitoring Report For guidance on filling out thisform, please visit: http://h2o.enr.state.nc.us/su/Forms_Documents.htm#miscforms Permit No.: N/Cl—l—l_l_l_l_I_l or Certificate of Coverage No.: N/C/G/ 9 2l 0l?I 5l?l Facility Name: RILEY II PIT County: HARNETT Phone No. (919) 499-9322 Inspector: WHITE Date of Inspection: 11/05/2011 Time of Inspection: 5:15 PM Total Event Precipitation (inches): 0-80 in Was this a Representative Storm Event? (See information below) 0 Yes ❑ No Please check your permit to verify if Qualitative Monitoring must be performed during a representative storm event (requirements vary). A "Representative Storm Event" is a storm event that measures greater than 0.1 inches of rainfall and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than 0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no precipitation. By this signature, I certify that this report ' c ca a the (Signature of Permittee or Dcl—ignee) 1. Outfall Description: Outfall No. RP1 Structure (pipe, ditch, etc.) SEDIMENT BASIN Receiving Stream: UT CYPRESS CREEK (Cl. WS-III) Describe the industrial activities that occur within the outfall drainage area: SAND MINING 2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint (light, medium, dark) as descriptors: NIA 0 FLOW 3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak chlorine odor, etc.)-. WA 0 FLOW Page 1 of 2 SWU-242-112608 4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear and 5 is very cloudy: 1 2 3 4 5 5. Floating Solids: Choose the number which best describes the amount of floating solids in the stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids: 1 2 3 4 5 6. Suspended Solids: Choose the number which best describes the amount of suspended solids in the stormwater discharge, where 1 is no solids and 5 is extremely muddy: 1 2 3 4 5 7. Is there any foam in the stormwater discharge? Yes No 8. Is there an oil sheen in the stormwater discharge? Yes No 9. Is there evidence of erosion or deposition at the outfall? Yes No 10. Other Obvious Indicators of Stormwater Pollution: List and describe NIA 0 FLOW Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be indicative of pollutant exposure. These conditions warrant further investigation. Page 2 of 2 SWU-242-112609