NCG140006 DMR WW

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PROCESS WASTEWATER — Quarterly .Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000 .
CERTIFICATE OF COVERAGE NO. NCG14-O 061J U SAMPLE COLLECTION YEAR:
FACILITY NAME: Z- 6?S11 2�/ int- SAMPLE QUARTER: []Jul -Sept []Oct -Dec Jan -March; []April -June
PERSON COLLECTING SAMPLES:, COUNTY:
CERTIFIED LABORATORY: Lab # PHONE NO. �'/'/U l� 7s
Lab # - ADD TO LISTSERVE? ❑YES QNOEMAIL: f
LIMIT VIOLATIONS? YES ❑ NO Q DISCHARGING TO CLASS: QSA ❑HQW OPNA []Trout. QOther C - j1c/
OPTIONAL INFO:
Part A: Wastewater Monitoring Requirements -
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Date Sample: _ Suspend D harge
Total ed . Settleable TPH using isc
1 Type of Wastewater pH _ method 16644 Total Flow
Outfall No. Collected z _ - - ' �.
Solids Solids Duret�on
(VE, RM, MD) (standard) SGT HEIVl6 I m = {gallons/day)
(mm/dd/yr) _ _ (mg/L) (mL/L) _ { mules)
_- - _
LV
_ _ — - --
- _
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F I
1 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). Repori 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 waste, Jater discharges to freshwaters, and 6.8-9`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/{.'for all other water' classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11.
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a 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 1SA
NCAC 02B;,0224. Perm itteegWi h6d.ischarge wastewater to HQW waters shall obtain a Summe? VQ10 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 tray require an annual flow
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report on a, case-by-case basis.
YOU MUSTSIGN 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 wiih a system designed to
assure that 'qualife l personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons wt�o 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.'!.j
57 -/-
(Signature
-/(Signature of Permittee)
Permit Date: 7/1/2010-06/30/2015
i=
(Date)
Last Revised 07/13/11
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