NC0085936_Remission (Request)_20041019

�QF W A 7. t9 Michael F.Easley,Governor
William G.Ross Jr.,Secretary
O . (� North Carolina Department of Environment and Natural Resources
`
Alan W.Klimek,P.E. Director
Division of Water Quality
O T
October 19, 2004
Mark Williams
Jerry G Williams & Sons Inc
P.O. Box 2430
Smithfield,NC 27577
Subject: Payment Acknowledgement and Remission Request
Civil Penalty Assessment
Wet Log Deck Storage site
Johnston County
NPDES Permit Number: NC0085936
Case Number: LM-2004-0037
Dear Mr. Williams:
This letter is to acknowledge receipt of check number 15346 in the amount of$941.40 received from
you on October 5, 2004. This partial payment does not satisfy in full the civil assessment levied
against the subject facility and this case remains open. Partial payment of this penalty in no way
preclude future action by this Division for additional violations of the applicable statutes,regulations,
or permits.
This letter also acknowledges receipt of your request for remission of civil penalties assessed in the
matter of the case noted above. However, your remission request was not accompanied by a
completed form waiving your right to an administrative hearing,which must be received before your
request may be processed. Please complete the attached waiver form immediately and return it to my
attention at the letterhead address. The subject case will be tentatively scheduled for the next
Director's Enforcement Conference; however, failure to return the completed waiver form will result
in delays in your case being heard.
Once the completed waiver form has been received, the Division will be able to proceed with your
remission request. If you have any questions,please call me at 919-733-5083 Ext.532.
Sincerely,
Vanessa E. Manuel
Eastern NPDES Program
Attachment
Cc: Enforcement File#:LM-2004-0037 w/3 attachments
DWQ Raleigh Regional Office Supervisor w/attachments
Central Files
N""o, hCarolina
Naturally
1617 Mail Service Center Raleigh,NC 27699-1617 [phone] Customer Service 1 800 623-7748

STATE OF NORTH CAROLINA ENVIRONMENTAL MANAGEMENT
COMMISSION
COUNTY OF Johnston
Jerry G Williams & Sons Inc
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINSTRATIVE HEARING AND
Wet Log Deck Storage site ) STIPULATION OF FACTS
PERMIT NO. NC0085936 )FILE NO. LM-2004-0037
Having been assessed civil penalties totaling$1,141.40 for violation(s)as set forth in the
assessment document of the Division of Water Quality dated September 1, 2004,the undersigned,
desiring to seek remission of the civil penalty,does hereby waive the right to an administrative hearing
in the above-stated matter and does stipulate that the facts are as alleged in the assessment document.
The undersigned further understands that all evidence presented in support of remission of this civil
penalty must be submitted to the director of the Division of Water Quality with thirty(30)days of
receipt of the notice of assessment. No new evidence in support of a remission request will be allowed
after(30)days from the receipt of the notice of assessment.
This the day of , 2004
SIGNATURE
ADDRESS
TELEPHONE

i • c,„Tefyy tO: ilPtAwns, sc (ions., Yae.
.fil* , ,. ..,
, ,...,.._,
P.O. Box 2430 / .
524 Brogden Road 29 September, 2004 / /�
Smithfield, / / ,-
Smithfield,
North Carolina 27577 State of North Carolina /� ��//l
919-934-4115 Department of Water Quality C'' J,^
919-934-4956 Fax Point Source Compliance/Enforcement Unit
Attention: Kenneth Schuster ,' .
1617 Mail Service Center c.
Raleigh, NC 27699-1617 - . 7
Mr. Schuster:
This is supplemental information in support of our Justification for
" aleietwLzr Remission Request for DWQ Case Number LM-2004-0037. Our permit
Quality` number is NC 0085936, the amount assessed is$1,141.40. We are
yarubpil submitting a payment of$941.40. Enclosed is our Justification for
Remission Request for the remaining monitory fines.
1. In response to violations three—six: failure to properly monitor
NO2 and NO3; failure to monitor PHOS-TOT; failure to monitor
TOT KJEL; and failure to monitor TOTAL N. The dollar amount
assessed by the State is$25.00 per violation, total amount is
$100.00. We did not discharge during the 1 S`quarter,Jan 2004
thru MAR 2004 (see enclosure A, B, and C). We did however,
submit our Discharge Monitoring Report for APR 2004 and it did
include these additional sampling requirements(see enclosure D)
,��‘.1,�� 2. In response to the seventh violation, for failure to submit
3, monitoring reports for the entire month. The dollar amount
i. • L
B OFfGlN UOUN PRiN iCo Of!CFE,n IC n:RC qt;Ivrq f:li WIfR,I UOf+RIR TED DOFDER Set REVER•>E`IUL FUR COMPLIte SLCUFITY FEC UFLS
JERRY G. WILLIAMS&SONS,INC. EXPLANATION AMOUNT es t
P.O.8°x 2430 15346
SMITHFIELD, NC 27577
[phone]
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CHECK
TO THE ORD R OF DESCRIPTION NUMBER
CHECK AMOUNT
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_•
P.O. Box 2430 /
524 Brogden Road 29 September, 2004 /
Smithfield, / • r
North Carolina 27577 State of North Carolina ,,7�/
919-934-4115 Department of Water Quality r (11
/-
919-934-4956 Fax Point Source Compliance/Enforcement Unit
Attention: Kenneth Schuster — �
1617 Mail Service Center
Raleigh,NC 27699-1617 _
Mr. Schuster:
This is supplemental information in support of our Justification for
Remission Request for DWQ Case Number LV-2004-0037. Our permit
number is NC 0085936, the amount assessed is $1,141.40. We are
y,,yyri ' submitting a payment of$941.40. Enclosed is our Justification for
Remission Request for the remaining monitory fines.
1. In response to violations three—six: failure to properly monitor
NO2 and NO3; failure to monitor PHOS-TOT; failure to monitor
TOT KJEL; and failure to monitor TOTAL N. The dollar amount
assessed by the State is $ 25.00 per violation, total amount is
$100.00. We did not discharge during the 1St quarter, Jan 2004
thru MAR 2004 ( see enclosure A, B, and C). We did however,
submit our Discharge Monitoring Report for APR 2004 and it did
include these additional sampling requirements( see enclosure D)
2. In response to the seventh violation, for failure to submit
�,�° '% monitoring reports for the entire month. The dollar amount
s , ' assessed by the State is$100.00. See the above Justification for
!vi ' ' Remission Request item# 1.
Thank you for any considerations.
SPIB
Sincerely,
�°..»,,,•` FR IL(A,e1. Mil,'-•c .
1. [Ill " Mark Williams
President
'••eeu,wM

• JUSTIFICATION FOR REMISSION REQUEST
/: � •
DWQ Case Number: LM-2004-0037 County: Johnston
Assessed Party: Jerry G Williams &Sons Inc
Permit No. (if applicable): NC0085936 Amount Assessed: $1,141.40
Please use this form when requesting remission of this civil penalty. You must also complete the
"Request For Remission, Waiver of Right to an Administrative Hearing, and Stipulation fFacts" __I
form to request remission of this civil penalty. You should attach any documents that you believe ,
support your request and are necessary for the Director to consider in evaluating your request for
remission. Please be aware that a request for remission is limited to consideration of the five factors
listed below as they may relate to the reasonableness of the amount of the civil penalty assessed.
Requesting remission is not the proper procedure for contesting whether the violation(s)occurred or
the accuracy of any of the factual statements contained in the civil penalty assessment document.
Pursuant to N.C.G.S. § 143B-282.1(c),remission of a civil penalty may be granted only when one or
more of the following five factors applies. Please check each factor that you believe applies to your
case and provide a detailed explanation,including copies of supporting documents,as to why the
factor applies(attach additional pages as needed).
S ' (a) one or more of the civil penalty assessment factors in N.C.G.S. 143B-282.1(b)were
wrongfully applied to the detriment of the petitioner(the assessment factors are listed in the civil
penalty assessment document);
(b) the violator promptly abated continuing environmental damage resulting from the
violation (i.e., explain the steps that you took to correct the violation and prevent future occurrences);
(c) the violation was inadvertent or a result of an accident(Le., explain why the violation
was unavoidable or something you could not prevent or prepare for);
(d) the violator had not been assessed civil penalties for any previous violations;
_ (e) payment of the civil penalty will prevent payment for the remaining necessary remedial
actions (i.e., explain how payment of the civil penalty will prevent you from performing the activities
necessary to achieve compliance).
EXPLANATION:
SCO" CNC I O SCA

STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
COUNTY OF JOHNSTON
Jerry G Williams&Sons Inc
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINSTRATIVE HEARING AND
Wet Log Deck Storage Site ) STIPULATION OF FACTS
)
)
)
)
PERMIT NO.NC0085936 ) FILE NO. LM-2004-0037
Having been assessed civil penalties totaling$1,141.40 for violation(s)as set forth in the
Division of Water Quality assessment document for the above file number,the undersigned,desiring
to seek remission of the civil penalty, does hereby waive the right to an administrative hearing in the
above-stated matter and does stipulate that the facts are as alleged in the assessment document. The
undersigned further understands that all evidence presented in support of remission of this civil
penalty must be submitted to the director of the Division of Water Quality within thirty(30)days of
receipt of the notice of assessment. No new evidence in support of a remission request will be allowed
after(30)days from the receipt of the notice of assessment.
This the day of ,20
SIGNATURE
ADDRESS
TELEPHONE

• W A T., Michael F.Easley,Governor
9 William G.Ross Jr.,Secretary
• Ct North Carolina Department of Environment and Natural Resources
Alan W.Klimek,P.E.Director
f -� Division of Water Quality
o liw '
September 1, 2004
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mark Williams
Jerry G Williams& Sons Inc
PO Box 2430
Smithfield,NC 27577
SUBJECT: Notice of Violation and Assessment of Civil Penalty
for Violations of North Carolina General Statute (G.S.) 143-215.1(a)(6)
and NPDES Permit NC0085936
Jerry G Williams & Sons Inc
Wet Log Deck Storage site
Case No. LM-2004-0037
Johnston County
Dear Mr. Williams:
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of
$1,141.40 ($1,100.00 civil penalty+$41.40 enforcement costs)against Jerry G Williams & Sons
Inc.
This assessment is based upon the following facts: a review has been conducted of the discharge
monitoring report(DMR) submitted by Jerry G Williams& Sons Inc for the month of June 2004.
This review has shown the subject facility to be in violation of the discharge limitations and/or
monitoring requirements found in NPDES Permit NC0085936. The violations which occurred in
June 2004 are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that Jerry G Williams & Sons Inc
violated the terms, conditions or requirements of NPDES Permit NC0085936 and G.S. 143-
215.1(a)(6)in the manner and extent shown in Attachment A. In accordance with the maximums
established by G.S. 143-215.6A(a)(2),a civil penalty may be assessed against any person who
violates the terms, conditions or requirements of a permit required by G.S. 143-215.1(a).
Based upon the above findings of fact and conclusions of law, and in accordance with authority
provided by the Secretary of the Department of Environment and Natural Resources and the
Director of the Division of Water Quality, I,Kenneth Schuster,P.E.,Division of Water Quality
Regional Supervisor for the Raleigh Region,hereby make the following civil penalty assessment
against Jerry G Williams & Sons Inc:
Raleigh Regional Office 1628 Mail Service Center phone[phone] Customer Service
Water Quality Section Raleigh,NC 27699-1628 NCDEN facsimile [phone] 1-877-623-6748
No hCarolina
Naturally

Jerry Williams&Sons,Inc. •
Case No.LM-2004-0037
4 of the 4 violations of G.S. 143-215.1(a)(6)and NPDES Permit No.
$400.00 NC0085936,by discharging waste water into the waters of the State
in violation of the Permit Daily Maximum limit for RES/SET.
1 of the 1 violations of G.S. 143-215.1(a)(6)and NPDES Permit No.
$500.00 NC0085936,by discharging waste water into the waters of the State
in violation of the Permit Monthly Average limit for RES/SET.
$25.00 For 1 of the 1 failures to properly monitor NO2&NO3 in violation of
NPDES Permit No.NC0085936.
$25.00 For 1 of the 1 failures to properly monitor PHOS-TOT in violation
of NPDES Permit No.NC0085936.
$25.00 For 1 of the 1 failures to properly monitor TOT KJEL in violation of
NPDES Permit No. NC0085936.
$25.00 For 1 of the 1 failures to properly monitor TOTAL N in violation of
NPDES Permit No.NC0085936.
$100.00 For 4 of the 4 failures to submit monitoring reports or portions of
monitoring reports in violation of NPDES Permit No. NC0085936.
$1,100.00 TOTAL CIVIL PENALTY
$41.40 Enforcement Costs
$1,141.40 TOTAL AMOUNT DUE
Pursuant to G.S. 143-215.6A(c),in determining the amount of the penalty I have taken into
account the Findings of Fact and Conclusions of Law and the factors set forth at G.S. 143B-
282.1(b),which are:
(1) The degree and extent of harm to the natural resources of the State,to the public health,or
to private property resulting from the violation;
(2) The duration and gravity of the violation;
(3) The effect on ground or surface water quantity or quality or on air quality,
(4) The cost of rectifying the damage;
(5) The amount of money saved by noncompliance;
(6) Whether the violation was committed willfully or intentionally;
(7) The prior record of the violator in complying or failing to comply with programs over
which the Environmental Management Commission has regulatory authority; and
(8) The cost to the State of the enforcement procedures.
Within-thirty days of receipt of this notice,yomust do one of the following:
/

•
• Jerry Williams&Sons,Inc.
Case No. LM-2004-0037
1. Submit payment of the penalty:
Payment should be made directly to the order of the Department of Environment and Natural
Resources(do not include waiver form). Payment of the penalty will not foreclose further
enforcement action for any continuing or new violation(s). Please submit payment to the
attention of:
Point Source Compliance/Enforcement Unit
Division of Water Quality
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
OR
2. Submit a written request for remission or mitigation including a detailed justification
for such request:
Please be aware that a request for remission is limited to consideration of the five factors listed
below as they may relate to the reasonableness of the amount of the civil penalty assessed.
Requesting remission is not the proper procedure for contesting whether the violation(s)
occurred or the accuracy of any of the factual statements contained in the civil penalty
assessment document. Because a remission request forecloses the option of an administrative
hearing, such a request must be accompanied by a waiver of your right to an administrative
hearing and a stipulation and agreement that no factual or legal issues are in dispute. Please
prepare a detailed statement that establishes why you believe the civil penalty should be
remitted,and submit it to the Division of Water Quality at the address listed below. In
determining whether a remission request will be approved,the following factors shall be
considered:
(1) whether one or more of the civil penalty assessment factors in NCGS 143B-282.1(b)
was wrongfully applied to the detriment of the petitioner,
(2) whether the violator promptly abated continuing environmental damage resulting from
the violation;
(3) whether the violation was inadvertent or a result of an accident;
(4) whether the violator had been assessed civil penalties for any previous violations; or
(5) whether payment of the civil penalty will prevent payment for the remaining necessary
remedial actions.
Please note that all evidence presented in support of your request for remission must besubmitted
in wrig. The Director of the Division of the Division of Water Quality will review your
evidence and inform you of his decision in the matter of your remission request. The response will
provide details regarding the case status,directions for payment,and provision for further appeal
of the penalty to the Environmental Management Commission's Committee on Civil Penalty
Remissions(Committee). Please be advised that the Committee cannot consider information that
was not part of the original remission request considered by the Director. Therefore,it is very
important that you prepare a complete and thorough statement in support of your request for
remission.

Jerry Williams&Sons,Inc. • •
Case No.LM-2004-0037
In order to request remission,you must complete and submit the enclosed"Request for Remission
of Civil Penalties,Waiver of Right to an Administrative Hearing,and Stipulation of Facts"form
within thirty(30)days of receipt of this notice. The Division of Water Quality also requests that
you complete and submit the enclosed"Justification for Remission Request." Both forms should
be submitted to the following address:
Point Source Compliance/Enforcement Unit
Division of Water Quality
1617 Mail Service Center
Raleigh,North Carolina 27699-1617
OR
3. File a petition for an administrative hearing with the Office of Administrative Hearings:
If you wish to contest any statement in the attached assessment document you must file a petition
for an administrative hearing. You may obtain the petition form from the Office of Administrative
Hearings. You must file the petition with the Office of Administrative Hearings within thirty(30)
days of receipt of this notice.A petition is considered filed when it is received in the Office of
Administrative Hearings during normal office hours. The Office of Administrative Hearings
accepts filings Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m.,except for
official state holidays. The original and one(1) copy of the petition must be filed with the Office
of Administrative Hearings. The petition may be faxed-provided the original and one copy of the
document is received in the Office of Administrative Hearings within five(5)business days
following the faxed transmission. The mailing address for the Office of Administrative Hearings
is:
Office of Administrative Hearings
6714 Mail Service Center
Raleigh,North Carolina 27699-6714
Telephone[phone] Facsimile: [phone]
and
Mail or hand-deliver a copy of the petition to
Dan Oakley,General Counsel
Department of Environment and Natural Resources
1601 Mail Service Center
Raleigh,North Carolina 27699-1601
Please indicate the case number(as found on page one of this letter)on the petition.
Failure to exercise one of the options above within thirty(30)days of receipt of this letter,as
evidenced by an internal date/time received stamp(not a postmark),will result in this matter being
referred to the Attorney General's Office for collection of the penalty through a civil action. Please
be advised that additional penalties may be assessed for violations that occur after the review
period of this assessment.

• Jerry Williams&Sons,Inc.
•
Case No.LM-2004-0037
•
If you have any questions,please contact the Water Quality staff of the Raleigh Regional Office at
919-571-4700.
Sincerely,
Kenneth Schuster,P.E.
Water Quality Regional Supervisor
Raleigh Regional Office
ATTACHMENTS
cc: Point Source Compliance w/attachments
Enforcement File w/attachments
Central Files w/attachments
J
•
•
•

ATTACHMENT A
Jerry G Williams&Sons Inc
CASE NUMBER: LM-2004-0037
PERMIT: NC0085936 FACILITY: Wet Log Deck Storage site COUNTY: Johnston REGION: Raleigh
Limit Violations
MONITORING OUTFALU VIOLATION UNIT OF CALCULATED %OVER
PENALTY REPORT PPI LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE., LIMIT VIOLATION TYPE
$100.00 6-2004 001 Effluent RES/SET 06/03/04 Weekly mill 0.2 ' 0.5 150.00 Daily Maximum Exceeded
$100.00 6-2004 001 Effluent RES/SET 06/17/04 Weekly mIA 0.2 0.3 50.00 Daily Maximum Exceeded
$100.00 6-2004 001 Effluent RES/SET 06/24/04 Weekly ml/I 0.2 I 0.6 200.00 Daily Maximum Exceeded
$100.00 6-2004 001 Effluent RES/SET 06/30/04 Weekly mill 0.2 1 1 / 400.00 Daily Maximum Exceeded
1
Cif $500.00 6-2004 001 Effluent RES/SET 06/30/04 Weekly ml/I 0.1 \,,. 0.5 400.00 Monthly Average Exceeded
1
Monitoring Violations
MONITORING OUTFALU VIOLATION UNIT OF CALCULATED %OVER
PENALTY REPORT PPI LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE LIMIT VIOLATION TYPE
$25.00 6-2004 001 Effluent NO2&NO3 06/03/04 Quarterly mg/1 7 Frequency Violation
$25.00 6-2004 001 Effluent PHOS-TOT 06/03/04 Quarterly mg/I Frequency Violation
`e $25.00 6-2004 001 Effluent TOT KJEL 06/03/04 Quarterly mg/10 Frequency Violation
$25.00 6-2004 001 Effluent TOTAL N 06/03/04 Quarterly mgA Frequency Violation
Reporting Violations
MONITORING OUTFALU VIOLATION UNIT OF CALCULATED %OVER
PENALTY REPORT PPI LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE LIMIT VIOLATION TYPE
$25.00 6-2004 001 Effluent NO2&NO3 06/03/04 Quarterly mg/I Parameter Missing
$25.00 6-2004 001 Effluent PHOS-TOT 06/03/04 Quarterly mg/I 7 Parameter Missing
116° $25.00 6-2004 001 Effluent TOT KJEL 06/03/04 Quarterly mg/I T Parameter Missing
$25.00 6-2004 001 Effluent TOTAL N 06/03/04 Quarterly mg/I v Parameter Missing

•
' EFFLUENT
NPDES PERMIT NO. -4),4)e 00,55-936-7 DISCHARGE NO. MONTH�+-a`" Y" YEAR 2-6.-X)'471
FACILITY NAME 71112.(2 t.l
( -7• •••• l_
Nl i_IA+.1.S 50 r-f-r CL4SS COUNTY s.fort. 'si ,yl
OPERATOR IN RESPONSIBLE CHAyGE(ORC) SArri,ti .n GRADE PHONE('i )9j'{-41- 'S—
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Mail ORIGINAL and ONE COPY to: � �7 1
ATTN:CENTRAL FILES x !LJ 2J-
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665
ay� .* FLOW ENTER PARAMETER CODE ABOVE
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DWQ Form MIR-1(01/00) CC/C/SC. '. ,1

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NPDES PERMIT NO. AI/4C do(9—<-9,36. DISCHARGE NO. " MONTH f G~ fee/ YEAR Ze
FACILITY NAME 2-V G1.(,3,,i_i.LkrmS b ,..5, CLASS COUNTY 1/4.Aot.F t- /-z':/t1
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ATTN:CENTRAL FILES x C 3-1�d
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER " BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665
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m-MI ■ Complete items 1,2,and 3.Also complete A. RQceiveby� Veas, P`gnt Clearly) B. Date of Delivery
® item 4 if Restricted Delivery is desired. <, c,4-
MI. Hmuguumm•'— ■ Print your name and address on the reverse i,�;,�lgnature ,
so that we can return the card to you. jam., r\ ❑Agent
1 ■ Attach this card to the back of the mailpiece, °)IR 9 4;: 2004 i ❑Addressee
or on the front if space permits. . `�fl,t
20 D. Is delivery address different from item 1? ❑Yes
Bblomm iii1. Article Addressed to: ti If YE�S,�.enter delivery,ddress below: 0 No
22 \-- ,•
i111111 NCDENR
DIV . OF WATER QUALITY e'
24I1617 HAIL SERVICE CTR .
RALEIGH , NC 27699-1617 3. Service Type
26 A Certified Mail ❑ Express Mail 1--.,,,
0 Registered , Return Receipt for Merchandise ;` ,
28 ❑ Insured Mail 0 C.O.D.
4. Restricted Delivery?(Extra Fee) 0 Yes r ?.'? ?
2. Article Number
7001 1140 0004 7907 3873
ti;ii-iiE.d.i
(Transfer from service label) F g'i'—.'
AVERAGE PS Form 3811, March 2001 Domestic Return Receipt 102595-01-M-1424
.i
MINBVIUM .
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onthly Limit
DWQ Form MR-1(01/00)
e1 c%aw'G 4

EFFLUENT NV-1
NPDES PERMIT NO. Atte cog, 3c, DISCHARGE NO. MONTH-/G Y YEAR 2054
FACILITY NAME -'- G. W,:u_cpys+'•-S f WI, C,_ C ASS COUNTY l S be-1
OPERATOR IN RESPONSIBLE CHARGE(ORC) Eu GRADE PHONE"/"-9341-V//S -
CER'1'1HhD LABORATORIES(1) L . 1"7"S-C.1 - (2) - `` }
CHECK BOX IF ORC HAS CHANGED PERSON(S)COLT FCTING SAMPLES !_�� Y`�'
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES x c crY7 5 _.2t '471-/-C47
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER . BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665
d * FLOW �, ENTER PARAMETER CODE ABOVE
a y If eZ EFF a W z W 2 •
d ...
z z p NAME AND UNITS BELOW
Er � "
pI
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2
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6
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12 V 5L
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'16.......'`.''``l`-...COMPLETE THIS SECTION ON DELIVERY..:...:...`:....._ SENDER: COMPLETE THIS SECTION
16
• Complete items 1,2,and 3.Also complete A. Received by(P a P inf Clearly) B. Date of Deliv ery
item 4 if Restricted Delivery is desired. ���;�, ,,� Imo'-•----
18 .................... ■ Print your name and address on the reverse C. SI�la %'` 4`' i
: ;;;; ;;;; so that we can return the card to you.
;;;;;;;;; ,�, \ ❑Agent � :.::.:.:.:.:.:.:.::
■ Attach.this card to the back of the mailpiece, X /� �;��, El Addressee
:.
20 . ,.. ..., or on the front if space permits.?::...•.::. ... '—i
D. I: eli d d tli , or m 1? El Yes Yes :?,:
.::: ::' ':
1. Article Addressed to: If YES,enter delivery address bel : 0 No �`�`"`' *"�`�'
22 �
bing*nignmaiiiNCDENR - a
111V.OF WATER QUALITY ' ` •
h'iHIlliiifiili
ig ' ;;; ` _a. s '?::;::1617 MAIL SERVICE CTR.
. 26 RALEIGH, NC 27699-1617
3. e9,irceType
ertified Mail 0 Express Mail
280 Registered 'Return Receipt for Merchandise i
.:.:.: .:.:.:.;..:.:..::.:.
. .::.:.:..:.. ❑ Insured Mail ❑ C.O.D. ..
4. Restricted Delivery?(Extra Fee) 0 Yes
30 •
,ii i `i 'i'i. '
''i''?i: i '': '':: Article Number: 2. 7001 1140 0004 7907 388❑ `'3
AVERAGE (Transfer from service fab
i ':iii€iii PS Form 3811, March 2001 Domestic Return Receipt 102595-01-M-1424.:.::.....:.:
MINIMUM -
Monthly Limit.OVItY;13W01 -7111,: iii .:.I.i I:i: : :::::I:::::::; �::: :::::::
:: �i=:::: :: ::::::i::::'::: :::::;:;:;:;::: :::::;:::
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DWQ Form MR-1 (01/00) n
/)C/OSu'tf C

EFFLUENT
NPDES PERMIT NO.NAIC.Cces9 3E DISCHARGE NO. 0- MONTH 42,2:L YEAR .:2eeI
FACILITY NAME . rry G. Ne-l;I I;R,,,S CLASS COUNTY acs hn siaN►
OPERATOR IN RESPONSIBLE CHARGE(ORC)i C CRiZi GRADE PHONE �tl f- `1311• '///S
CER 1.1 -.1hD LABORATORIES (1) c14-l.e:iu -TE s+,1 (2)
CHECK BOX IF ORC HAS CHANGED f PERSON(S)COLLECTING SAMPLES —T-C Or22:..0
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES x r
DIVISION OF WATER QUALITY (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAH,SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 ct s-4'S'6C5Sfc CC3c OC'-3C'
d * FLOW w ENTER PARAMETER CODE ABOVE
EFFJ rr z W W ,� W z z NAME AND UNITS BELOW
11.", " 0 ❑1a� g6-) p8 ElEAz5F. ..ac E- c) Ems. x •
° O da w �' U dz : ! A
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HRS HRS Y/B/N MGD °C UNITS 0 UG/L MG/L MG/L MG/L #/100ML MG/L MG/L MG/L PY//L 07V
is ;:::::;
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20
22 O c.ft' .406: �• 1t o / .3y,3 �o5a
24
26
28
30
I` �,p
AVERAGE ©,14f�S,S • tv.5 C f 5 .� 1 .343 Z.esa
fn v t:*
MINIMUM _ t I L C•l 8
Monthly Limit 30.0 C. ( 60
DWQ Form MR-1(01/00)
Ci%x.d.e. I

EFFLUENT
NPDES PERMIT NO./(}/G' 6'0 3 DISCHARGE NO. -2 MONTH /*CC, YEAR
FACILITY NAME ..kr ' G. V-F:t<< S F So!-E= CLASS COUNTY �AJ
.)1,1st%'
OPERATOR IN RESPONSIEh.F CHARGE(ORC) 'Y° C;re:2,. GRADE PHONE �.L j 4 3`F
CER 11F hD LABORATORIES(1) y Thi-{-11( ,7;i s i1C (2) - -
CHECK BOX IF ORC HAS CHANGED [ PON(S)COTJ.FCTING SAMPLES Tr • J
• Mail ORIGINAL and ONE COPY to: U .
ATTN:CENTRAL FILES
DIVISION OF WATER QUALITY (SIGN OPERATOR IN RESPONSIBLE CHARGE) DA
1617 MAIL SERVICE CENTER • BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
50050 00010 00400 50060 00310 .00610 00530 31616 00300 00600 00665 CZ.>
F * FLOW w „, ENTER PARAMETER CODE ABOVE
EFF ❑ a z W m A Z Z p NAME AND UNITS BELOW
W .a a a w .a w x
wo � INF ❑ FP as AU z8 C � clO n" d8 � o
F" �� ° a � a . AO Oo 00 F' W '�V .� � O >+ l:-. O E" x
O >• w aw rWn ,a aaN F ° % W��y •78 ,7) FOF
o 0 � � FU g3 � Z UOQ AO z a ti R .t
a o MG/L X
HRS HRS Y/B/N MGD °.0 UNITS ❑ UG/L, MG/L MG/L MG/L #/100ML MG/L MG/L MG/L tt$11- r117 ft-
HiMH
SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
4 ■ Complete items 1,2,and 3.Also complete A. Received by(Please Print Clearly) B. Date of Delivery
item 4 if Restricted Delivery is desired.
IN Print your name and address on the reverse
6 so that we can return the card to you. C. Signature
ij!!I]i
X
• Attach this card to the back of the mailpiece, El Agent
...
❑Addressee .. .. _......
or on the front if space permits.
8 D. Is delivery address different from item 1? ❑ Yes
1. Article Addressed to:
If YES,enter delivery address below: ❑ No
10 ftDC/kJ I�
12 • i kbfee Quad/ _
lf/: /n4;1$ ct4e
14 3. Service Type
��
AIC C �6�7- I C j ' CertifiedMail ❑ Express Mail .
��l �r`J Registered
ed yl,Return Receipt for Merchandise :"
16 ff 0 Insured Mail 0 C.O.D.
X 4. Restricted Delivery?(Extra Fee) ❑ Yes
18 2. Article Number —- ——- - -
20 PS F 102595-01-M-1424 ..
1
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24
26
28
30 •
3
AVERAGE 43t -................-.......,......:.............. ,ZGC 544
MINIMUMIf .Z Off
Monthly Limit
DWQ Form MR-1 (01/00) nc( 6