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Home My WebLink AboutNCG140038_COMPLETE FILE - HISTORICAL_20150120STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /v '�& / y oo 3 DOC TYPE �Z HISTORICAL FILE ❑ MONITORING REPORTS DOC DATE ❑ c+� l Got a 0 YYYYMMDD PROCESS WASTEWATER — Quarterly Discharge Monitoring Report GENERAL PERMIT No. NCG140000 CERTIFICATE OF COVERAGE NO. NCG140038 FACILITY NAME: Tri-City PERSON COLLECTING SAMPLES: Rik Jones CERTIFIED LABORATORY: Prism Lab # 402 LIMIT VIOLATIONS? YES ❑ NO Part A: Wastewater Monitoring Reauirements SAMPLE COLLECTION YEAR: 2014 SAMPLE QUARTER: ❑Jul -Sept ®Oct -Dec Dian -March ❑April -June RECEIVED COUNTY: Rutherford JAN 2 0 2015 PHONE NO. (704) 372-2930 ADD TO LISTSERVE? ❑YES ®NO EMAIL: CENTRAL FILES DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other DWR SECTION OPTIONAL INFO: Outfall No. Date Sample i Collected (mm/dd/yr) Type of Wastewater (VE, RM, MD)2 pH (standard) Total Suspended Solids (mg/L) Settleable Solids (mL/L) TPH usingDischarge method 1664A SGT.HEA96 (mg/L) Duration (minutes) Total Flow (gallons/day)' - - RM, MD- 6-93,4 303'5 53 (15)6 - - 001 12/31/14 No Flow 002 12/31/14 No Flow ` 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. 2 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. 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/l/2010-06/30/2015 Last Revised 07/13/11 Page 1 of 2 09 ear t Q-113 6 Prncess wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater, bu?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`Y of the Summer 7Q10 Flow as per 15A NCAC 028 .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 Fifes 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919)807-6379 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 erectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I and �► rare th th9 re significant penalties for submitting false Information, including the possibillty of fines and imprisonment for knowing violations." of Permittee) Permit Date: 7/1/2010-06/30/2015 /-? r (Date) Last Revised 07/13/11 Page 2 of 2 PROCESS WASTEWATER — Quarterly Discharge Monitoring Report GENERAL PERMIT No. NCG140000 CERTIFICATE OF COVERAGE NO. NCG140307 SAMPLE COLLECTION YEAR: 2014 _� FACILITY NAME: Morrisville p �r+ � t� DSAMPLE QUARTER: ❑Jul -Sept ®Oct -Dec Dian -march ❑April-J� PERSON COLLECTING SAMPLES: Joe Kisselburg f� LL..�iCi �/ COUNTY: Wake CERTIFIED LABORATORY: Prism Lab # 34 JAN 2 0 2015 PHONE NO. (704) 372-2930 ADD TO LISTSERVE? DYES ®NO EMAIL: LIMIT VIOLATIONS? YES ❑ NO ® CENTRAL FILES DISCHARGING TO CLASS: (:]SA ❑HQW ❑PNA ❑Trout ®Other DWR SECTION OPTIONAL INFO: Part A: Wastewater Monitoring Requirements outfalf No. Date Sample i Collected (mm/dd/yr) Type of Wastewater 2 (VE, RM, MD) pH (standard) Total Suspended Solids (mg/L) Settleable Solids (mL/L) TPH usingDischarge method 1664A 5GT-HEN16 (mg/L) Duration (minutes) Total Flow (gallons/day), - - RM, MD- 6-93,4 303,5 53 (15)6 - - 01 12/23/14 RM 8.99 <5 <A N/A >1 >1 2 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. 2 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.U. for wastewater discharges to freshwaters, and 6.8-8.5 5.1-1. 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 (919)807-6379 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "I certify, under penalty f law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified pe onnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly sponsi for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aw re gat the re si scant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." 6 //�Slg`niture o Permittee) (Date) Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11 Page 2 of 2 PROCESS WASTEWATER — Quarterly Discharge Monitoring Report GENERAL PERMIT No. NCG140000 CERTIFICATE OF COVERAGE NO. NCG140038 FACILITY NAME: Tri-City PERSON COLLECTING SAMPLES: Rik Jones CERTIFIED LABORATORY: Prism Lab # 402 LIMIT VIOLATIONS? YES ❑ NO Part A: Wastewater Monitorine Reouirements SAMPLE COLLECTION YEAR: 2014 SAMPLE QUARTER: ®Jul -Sept []Oct -Dec ❑Jan -March ❑April -June COUNTY: Rutherford PHONE NO. (704) 372-2930 ADD TO LISTSERVE? ❑YES ®NO EMAIL: DISCHARGING TO CLASS: [:]SA ❑HQW OPTIONAL INFO: ❑PNA ❑Trout ®Other Outfall No. Date Sample Collected' (mm/dd/yr) Type of Wastewater z {VE, RM, MD) pH {standard) Total Suspended Solids (mg/L) Settleable Solids (mL/L) TPH using method .1664A s SGT NEM (mg/L} Discharge Duration (minutes) Total Flow 7 (gallons/day} - - RM, MD- 6-93,4 303,5 53 {15}6 - 001 9/23/14 No Flow 002 9/23114 No Flow OCTZU14 FILES EeENTRAIX 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. 5 i SS ii�iiiu ere Zu 111g/L iur Wastewater discharges to HQ`iv waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for aii other water classifications. Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11 Page 1 of 2 . v. 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 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 7Q1D 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 (1NCL_LIDING 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 (919)807-6379 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 dir tly responsible for gathering the information, the Information submitted Is, to the best of my knowledge and belief, true, accurate, and complete. I am awar,� that t rehle significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (el'r 9i�r� ignature f Permittee) (Date) Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11 Page 2 of 2 PROCESS WASTEWATER -- Quarterly Discharge Monitoring Report GENERAL PERMIT NO. NCG140000 CERTIFICATE OF COVERAGE NO. NCG140039 FACILITY NAME: Lowery St PERSON COLLECTING SAMPLES: Tony Hardison CERTIFIED LABORATORY: Research and Analytical Lab # 34 LIMIT VIOLATIONS? YES ❑ NO Part A: Wastewater Monitorine Reauirements SAMPLE COLLECTION YEAR: 2014 SAMPLE QUARTER: ®Jul -Sept ❑Ott -Dec ❑Jan -March ❑April -June COUNTY: Fors h PHONE NO. (704) 372-2930 ADD TO LISTSERVE? DYES ®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 S [mHlM' Duration (minutes) Total Flow , {gallons/day} - - RM, MD- 6-93'4 303,5 53 (15)6 - - 001 9/10/14 RM No Flow T CENTRAL Fit ES WR SECTION ' 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. 2 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. `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 Revised 07/13/11 Page 1 of 2 � � + �- "l�t,� �''{ ; � 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 (919)807-6379 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 dire responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. i am awareAhat t4gye a"ignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." atur.elof Permittee) Permit Date:-7/1/2010-06/30/2015 V.,CTA� (Date) Last Revised 07/13/11 Page 2 of 2 PROCESS WASTEWATER — Quarterly Discharge Monitoring Report GENERAL PERMIT NO. NCG140000 CERTIFICATE OF COVERAGE NO. NCG140038 FACILITY NAME: Tri-City PERSON COLLECTING SAMPLES: David Morris CERTIFIED LABORATORY: Prism Lab # 402 LIMIT VIOLATIONS? YES []NO Part A: Wastewater Monitorine Reauirements SAMPLE COLLECTION YEAR: 2014 SAMPLE QUARTER: ❑Jul -Sept ❑Oct -Dec Dan -March ®April -June COUNTY: Rutherford PHONE NO. (704) 372-2930 ADD TO LISTSERVE? ❑YES ®NO EMAIL: DISCHARGING TO CLASS: ❑SA ❑HQW OPTIONAL INFO: ❑PNA []Trout ®Other Outfall No. Date Sample i 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-HEAR' (mg/L) Duration [minutes) Total Flow � (gallons/day) - - RM, MD- 6-93.4 303,5 53- 001 6/24/14 No Flow 002 6/24/14 No Flow C 4 wQ1B G ' 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. 2 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 RQ 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 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. 7 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 (919) 807-6379 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 direcoy responsible for gathering the information, the'information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am awareat th ar4nificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." re of Permittee) Permit. Date: 7/1/2010-06/30/2015 (Date) Last Revised 07/13/11 Page 2 of 2 PROCESS WASTEWATER —Quarterly Discharge Monitoring Report GENERAL PERMIT NO. NCG140000 CERTIFICATE OF COVERAGE NO. NCGi140038 FACILITY NAME: Tri-City PERSON COLLECTING SAMPLES: Rik Jones CERTIFIED LABORATORY: Prism Lab # 402 LIMIT VIOLATIONS? YES ® NO ❑ Part A: Wastewater Monitoring Requirements SAMPLE COLLECTION YEAR: 2014 SAMPLE QUARTER: ❑Jul -Sept ❑Oct -Dec ®Jan -March ❑April -June COUNTY: Rutherford PHONE NO. (704) 372-2930 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)2 pH (standard) Total Suspended Solids (mg/L) Settleable Solids (mL/L) TPH using method 1664A SGT-HEhe (mg/L) Discharge Duration (minutes) Total Flow (gallons/day)' - - RM, MD- 6-93'0 303,5 53 (15)6 - - 002 1/11/14 RM 10.6 — Sampled In wrong location BRL .2 BRL 360 1 MA :V�Ilff7n rtd 2 4 2114 .r , I. W r11� r�r -Co ` 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. Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11 Page 1 of 2 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters. 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. 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 lV, 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 (919)807-6379 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 qual' ed per nnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those p ons d ctly ponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am v e thAt re significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Slgnat�re of Permittee) r-:t (r Y (Date) Permit Date:7/1/2010-06/30/2015 Last Revised 07/13/11 Page 2 of 2