NCG140292_MONITORING INFO_20190305

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ '1 O I g 030 -5
YYYYMMDD

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No NCG140000
Calendar Year 2018
'Report ALL WASTEWATER monitoring data on this form (include No FlowTNo Discharge' and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year
Certificate of Coverage No NCG14
Facility Name cccl-Edwardla Plant
County Guilford
Phone Number (336 ) 233 7975
Certified Laboratory Prism Lab
Lab # 402
Lab #
Total no of outfalls monitored 2
Wastewater (WW) Discharge Outfall No 001
Does this outfall discharge WW to SA waters? Yes ❑ No
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No ❑✓
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ✓❑
If so, what is the 7010 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No E]
Were there any limit violations in the calendar year? Yes ❑ No ✓❑
Outfall No
Daily Flow Rate,
pH,
TSS,
SS,
Non -Polar O&G (EPA Method 1664
cfs
SU
mgtl
mill
(SGT-HEM)), mg/1
aQ,
rr applicable
Standard
Effluent
HOW or ORIN
50% of 7Q10
freshwater
6 0-9 0
30
HOW W SA
No Limit
Limitations
HQW
20
SB P AR or any
Trout
Indicate NO FLOW d
saltwater
6
Samples above Benchmark
applicable
6 R ff��
HQW ! ORW and Tr or
subject to Tiered Responses
Daily Maximum
"-"
PNA
15
10
Dates
I "� r;f
�k�p'fr
is j4,4
�{ A{
+'ii
6
3 �a"f 0, 0
`
Sample
r t
r' , I
�
, a
I
��� l: E
�
Collected
� ��
I rq
�
L
d
^ r
I # tf
mo/dd! r
r
s
a
u d f u A
2/16/2018
NO FLOW
1
!
1
EG E i—"D
R
3/14/2018
RW 001
85
106
<0 1
[,LN I KAL ILr_!6
6/13/2018
NO FLOW
IJv r1vl d
9/12/2018
001
73
5
<0 1
12/19/2018
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No NCG14 Y197W
Additional Outfall Attachment (make copies as needed for additional outfalls)
Wastewater (WW) Discharge Outfall No 002
Does this outfall discharge WW to SA waters? Yes ❑ No ❑
Does this outfall discharge WW to SIB or PNA waters? Yes ❑ No ❑
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ❑
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ❑
Were there any limit violations in the calendar year? Yes ❑ No ❑
Outfall No
Daily Flow Rate,
cfs
pH,
SU
TSS,
mgll
SS,
mill
d applicable
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mgll
Effluent
Limitations
Daily Maximum
HOW or ORW
50% of 7010
lnditate NO FLOW d
applicable
freshwater
6 0-9 0
saltwater
6 p-p 5
V v
Standard
OW
20
HOW ! O W and Tr or
10
SB PNA o a Y
Trout
5
No Lima
Samples above Benchmark
subject to Tiered Responses
15
Date
Sample
Collected,
molddlyr
1 it
tr+ T yV
�� a i�t
1 4
4 i
,�
(i r 9 iBt
;
i jt1
h �,
�
!d,£, �,� e ���
aw en 3 r,1' 3££+ 1 = E '1
K7i �
a ��
t � 3£ 4
lid _ a b
2/16/2018
PW 002 NO FLOW
6/13/2018
NO FLOW
9/12/2018
NO FLOW
12/19/2018
PW 002 NO FLOW
Permit Date 8/112017 — 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No NCG14 ®Ca0-7
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 §t22 22]
Signature
Date c
Mail Annual Summary Wastewater 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 [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at
[phone]
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE`
General Permit No NCG140000
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 1 of each year
Certificate of Coverage No NCG14 ®2[]
Facility Name M-Edwardia Plant
County Guilford
Phone Number (336 ) 233 7975 Total no of SDOs monitored 2
Certified Laboratory Prism Lab Lab # 402
Lab #
Stormwater Discharge Outfall (SDO) No 001 VMA Outfall? Yes ❑ No ❑✓
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No Ej
Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑✓ iECEIVE 1)
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes enough consecutive samples below benchmarks to decrease frequency ❑ MAR 0 4 W9
Yes received approval from DEMLR to reduce monitoring frequency ❑ OFNTRAL FILE
Other ❑ DWR SECT10j\3
Outfall No
001
Total Rainfall,
inches
inches(
Total
Suspended
Solids (TSS),
m ll
pH,
SU
Non -polar O&G
(EPA Method
1664 SGT-HEM))'
mg/1 (VMA)
frappllcable
New Motor Oil
Usage (gallmo )
lfappbcable
Stormwater
Benchmarks
lndreateNOFLDWrr
applicable
ClrclaBanctmarkA
1001to
6
6 V-9 Q
� �
66 allmo average requires 75S and
g g 9
Non polar OSG monitonng
Date Sample
Collected,
molddlyr
tl '+t !
5 p �`F 9
f'P8 f( �.�
ffi,. '9 ) H'� Pl'�ic xi3
a4{ v a #r0 L g� �X?
jB
I.�f } { r` ll'P i ➢' .H F h
�
Y{
yid f I
211612018
NO FLOW
3/14/2018
RM
10 6
85
6/13/2018
NO FLOW
9/12/2018
001
c5
73
12/19/2018
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No NCG14 o1 2ME
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No 002 VMA Outfall? Yes ❑ No ✓0
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 ❑r
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 ❑
Other _ ❑
Outfall No
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
mg/1
pH,
SU
Non -polar O&G
(EPA Method
1664 SGT-HEM)) ,
mgll (VMA)
if applicable
New Motor Oil
Usage (gallmo )
If applicable
Stormwater
Benchmarks
Indicate nr0 FLOW u
applicable
Circle Bonchmarl
1 OU1rJU
S �-g Q
1 �
>ss gallmo average requires T55 and
Non polar 0&0 monitoring
Date Sample
p
Collected,
molddlyr
�;
dip B 1
E w
6 Q !
1 ra,
[YF #F
'h 0 ,
i 1JN
,, lrpp
�
iJ4 Af F " i
2/16/2018
NO FLOW
6/13/2018
NO FLOW
9/12/2018
NO FLOW
12/19/2018
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No NCG14 ,,�j[J[j[0-,
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 informatio , including the possibility of fines and imprisonment for knowing violations '
(Required by 40 CFR §122 22]
Signature
Date
r�
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 [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at
[phone]
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE`
General Permit No NCG140000
Calendar Year 2017
*Report ALL WASTEWATER monitoring data on this form (include No Flovv"/ No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 9Lof aachtyear /r-- r~
^Certificate of Coverage No NCG14 0� 2E 9❑ 2❑ ^
Facility Name Greensboro/CC1 APR 13 2018
:,>rlv i rrtAL FILES
County Guilford DWR SECTIQN1
Phone Number (336 ) 233 7975 Total no of outfalls monitored 2
Certified Laboratory Research & Analytical Lab Lab # 34
Lab #
Wastewater (WW) Discharge Outfall No 001&2 CAA
Does this outfall discharge WW to SA waters? Yes ❑ No Q✓ of
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No]✓�
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No 0
Were there any limit violations in the calendar year? Yes ❑ No ❑✓
Outfall No
Daily Flow Rate,
pH,
TSS,
SS,
Non -Polar O&G (EPA Method 1664
cfs
SU
mgll
mill
(SGT-HEM)), mgll
It applicable
Standard
Effluent
HOWor ORW
50% of 7Q10
rreshwater
6 0-9 0
IN SA
Ro
No Limit
Limitations
O
20
SB PAHOW
any
Trout
Indicate NO FLOW if
saltwater
5
Samples abvvv Benchmark
applicable
6 p-8 G
HOW I ORpNnand Tr or
sub]vct to Tlomd Responses
Daily Maximum
V 5
10
1 5
Date
'I
5
Sample,
b` : ;
:s I Q t
%1 `� t� �3
s
9 i
t€x ! r r'
`
P P i'I f Sy i F E f U ;(t
E}I°fe'a.q ,
d t I # I3�rt$fyii4
Collected,,1j
g
aF h
; i i+ l I
molddl r
mP ss..,�� p � r {I gic Z I egg �g ({ E ii 8
;t BLAB F EC E^ € °YY'j l 3 d �'iti e& i 4 q?
�3 i�,i
3/3/2017
PWO01 RM
31612017
PW002 RM
6/30/2017
P1N001 RM
8 52
126
<0 1
6/30/2017
PW 002 NO FLOW
I
1
9/27/2017
PW001 NO FLOW
9/27/2017
PWO02 rm
6 7
1236
2
12/18/2017
PW NO FLOW
Permit Date 8/112017 — 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No NCG14 ®2[]® 2❑
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 t
Mail Annual Summary Wastewater 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 [phone]
Questions? Contact DEMt_R Stormwater Permitting Staff in the Central Office at
[phone]
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) -- STORMWATER
II SUBMIT TO CENTRAL OFFICE' II
General Permit No NCG140000
Calendar Year 2017
'Report ALL STORMWATER monitoring data on this form (Include No Flow"1 No Discharge and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each'year
Certificate of Coverage No NCG14 ®ff1® 20
Facility Name Greensboro/CCC1 CEN i 111H . r-iLLb
County
Guilford WVVIN;5=1019
Phone Number 3( 3fi ) 233-7975 Total no of SDOs monitored 2
Certified Laboratory Research & Analytical Lab Lab # 34
Lab #
Stormwater Discharge Outfall (SDO) No 001 & 002 VMA Outfall? Yes ❑ No ❑✓
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No E]
Was this outfall ever in Tier 2 during the past year? Yes ❑ No 0
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 0
Other ❑
Outfall No
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
mg/1
pH,
SU
Non -polar O&G
(EPA Method
1664 (SGT-HEM)),
mgll (VMA)
N applicable
New Motor Oil
Usage (gallmo )
If applicable
Stormwater
Benchmarks
Indicate NO FLOW if
applicable
Circle Benchmark
,� UU1rJO
6 O_S O
1 �
a55 g ailmo average requires TSS and
Non polar O&G monitoring
Date Sample
Collected f
molddlyr
f 1' 1i
! 1 �r r
,,„
,�� _ '� � I
v s�"'a ' j e
a; f
r�<�
F ie AP ^� ' .�
€ -s 1 i "� }8"yn�;, d (�
=, 3s
i6E9 r8� +� i s d > ^ Y�1, F ,
IFb�e
3/3/2017
001 No Flow
316/2017
002 No Flow
6/30/2017
001 No Flow
6/30/2017
002 No Flow
9/27/2017
001 No Flow
9/27/2017
002 No Flow
12/18/2017
001 No Flow
Permit Date 811/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No NCG14 ❑D®FM®
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 §1/Z12 221
Signature
Date ?/
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 [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at
[phone]
Permit Date 8/1/2017 - 6/30/2022
Last Revised 8-22-2015

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No NCG140000
CERTIFICATE OF COVERAGE NO NCG140292
FACILITY NAME GB#1
PERSON COLLECTING SAMPLES Shawn Brown/David Morris
CERTIFIED LABORATORY Prism Lab # 402
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Monitorine Reauirements
SAMPLE COLLECTION YEAR 2017
SAMPLE QUARTER ❑Jul -Sept ❑Oct -Dec ®Jan -March ❑April -June
COUNTY Guilford
PHONE NO [phone]
ADD TO LISTSERVE? DYES ®NO EMAIL
DISCHARGING TO CLASS [:]SA ❑HQW
OPTIONAL INFO
❑PNA ❑Trout ®Other
Outfall No
Date Sample
i
Collected
(mm/dd/yr)
Type of Wastewater
Z
(VERMMD)
, ,
pH
[standard}
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
S (mg/L)
Duration
[minutes]
Total Flow
7
[gallons/day}
-
-
RM, MD-
6-93 4
303 5
53
(15)r,
-
-
001
3/3/2017
RM
002
3/6/2017
RM
Y
5 lult
FILES
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
`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 VIVA 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
[phone]
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 direlily responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am aware at th a are si ficant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
2 t
ignature 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 NCG140292���w�®
FACILITY NAME GB#1
PERSON COLLECTING SAMPLES Daniel Brown .TAN 2 3 2017
CERTIFIED LABORATORY Prism Lab # 402
CENTRAL FILES
LIMIT VIOLATIONS? YES [:]NO ® DWR SECTION
Part A Wastewater Monitorine Reouirements
SAMPLE COLLECTION YEAR 2016
SAMPLE QUARTER ❑]ul-Sept ®Oct -Dec ❑Jan -March ❑April -June
COUNTY Guilford
PHONE NO [phone]
ADD TO LISTSERVE7 ❑YES ®NO EMAIL
DISCHARGING TO CLASS [:]SA ❑HQW ❑PNA [—]Trout ®Other
OPTIONAL INFO
Outfall No
Date Sample
i
Collected
(mm/dd/yr)
Type of Wastewater
z
(VE, RM, MD)
PH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SGT-HFN16
(mg/L)
Duration
(minutes)
Total Flow
7
{gallons/day)
-
-
RM, MD-
6 934
3035
53
(n)6
-
-
001
11/09/2016
NO FLOW
002
11/30/2016
NO FLOW
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
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
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
' Flow rate can be measured continuously or calculated Flow limits for wastewater discharges to HQW waters shall beset to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B 0224 Permrttees 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 permrttee 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
[phone]
YOU MUST SIGN THIS CERTIFIC4TION 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 direQtly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am awilr"hat tfore arejWmficant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
(Signatur4 of Permittee)
Permit Date 7/1/2010 06/30/2015
di 767 - --
(Date)
Last Revised 07/13/11
Page 2 of 2

1�
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No NCG140000
CERTIFICATE OF COVERAGE NO NCG140292
FACILITY NAME GB#1
PERSON COLLECTING SAMPLES Daniel Brown
CERTIFIED LABORATORY Prism Lab # 402
LIMIT VIOLATIONS? YES ® NO ❑
Part A Wastewater Monitorine Reauirements
SAMPLE COLLECTION YEAR 2016
SAMPLE QUARTER ®Jul -Sept ❑Oct -Dec ❑Jan -March ❑April -June
COUNTY Guilford
PHONE NO [phone]
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)2
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPFi usrngDischarge
method 1664A
SGT-HEM'
(mg/L)
Duration
(minutes)
Total Flow
,
(gallons/day)
-
-
RM, MD-
6-936
3035
53
(15)6
-
001
9/22/2016
RM
104
BRL
10
N/A
1
At
002
9/22/2016
RM
7
<5
<0 1
N/A
u
CEN
F: c
f,
NED
DWIR
SECTION
NOV 01 C r
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
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
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

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 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 1N CASE OF "NO FLOW") TO
Division of Water Quality
Attn DWQ Central Files
1617 Mall Service Center
Raleigh, North Carolina 27699-1617
[phone]
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 d ectly 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�her�'ai re significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
natu{e of Permitteej
Permit Date 7/1/2010 06/30/201S
(o 12K / I ;
(Date)
Last Revised 07/13/11
Page 2 of 2

w PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
` GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG14O292
FACILITY NAME GB#1
PERSON COLLECTING SAMPLES David Morris
CERTIFIED LABORATORY Prism Lab # 402
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Monitorine Reauirements
SAMPLE COLLECTION YEAR 201
SAMPLE QUARTER []Jul -Sept ❑Oct -Dec ❑Jan -March ®April -June
COUNTY Guilford
PHONE NO [phone]
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
(VE, RM, MD)2
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(ml/L)
TPH usingDischarge
method 1664A
SGT-HEM6
(mg/L)
Duration
(minutes)
Total Flow
(gallons/day)
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
4/15/2016
NO FLOW
' T`
J Y
k-U U
„ It-
rF/
irl-b
A I l -f
f
11,,E
(�
CENTRAL Fr
X19OR 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
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
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

t'
6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VIVIA 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 beset 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 bans
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
[phone]
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 firectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I an; ayyare tq4t the are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
(Signature of Permittee)
Permit Date 7/1/2010 06/30/2015
'Y 4c//('
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG140292
FACILITY NAME GB#1
PERSON COLLECTING SAMPLES David Morris
CERTIFIED LABORATORY Prism Lab # 402
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Monitorine Reauirements
SAMPLE COLLECTION YEAR 201
SAMPLE QUARTER ❑Jul -Sept ❑Oct -Dec ®Jan -March ❑April -June
COUNTY Guilford
PHONE NO [phone]
ADD TO LISTSERVE7 ❑YES ®NO EMAIL
DISCHARGING TO CLASS [:]SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO
Outfall No
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
z
(VERM, MD)
,
pH
(standard]
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
6
5
(mg1LM
Duration
(minutes)
Total Flow
7
(gallons/day]
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
3/31/2016
RM
76
62
<0 1
002
3/31/2016
RM
89
94
<0 1
C'.I
- N
r
rf=j%1TRA1
Fit FR
OWR 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
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 permrttee 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 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
,4-

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
[phone]
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 directl responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am awake that the�ar�significant penalties for submitting false information, including the possibilFty of fines and imprisonment for knowing violations "
ature of Permittee)
Permit Date 7/1/201D 06/30/2015
4i2s�/6
(Date)
Last Revised 07/13/11
Page 2 of 2

r-
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG140292
FACILITY NAME GB#1
PERSON COLLECTING SAMPLES Daniel Brown
CERTIFIED LABORATORY Prism Lab # 402
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Monitnrine Renuirements
SAMPLE COLLECTION YEAR 2014
��OLINTYAMPLE QGuARTER ilfard ❑1ul-Sept ®Oct -Dec ❑tan -March
K�U�t Y
JAN 2 0 2015 PHONE NO [phone]
ADD TO LISTSERVE? DYES ®NO EMAIL
CENTRAL FILES DISCHARGING TO CLASS [:]SA ❑HQW
DWR SECTION OPTIONAL INFO
❑April -June,
❑PNA ❑Trout ®Other
Outfall No
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
:
RMMD)
(VE, ,
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SG 6
(mg/L)/L)
Duration
(minutes)
Total Flow
(gallons/day)
-
-
RM, MD-
6 934
3035
53
115)s
-
-
001
12/23/2014
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
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
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
4 pH limits are 6 9 S U for wastewater discharges to freshwaters, and 6 S S 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
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 beset to 50% of the Summer 7Q10 Flow as per 15A
-NCAC &2B 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"1_TO_
Division of Water Quality
Attn DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
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 Rersonnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons direc y res ble for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
l am awpr"hat Wh l ii,46ificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations"
of Permittee)
Permit Date 7/1/2010 06/30/2015
Z�JZ/:5_-
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO NCG140292 SAMPLE COLLECTION YEAR 2014
FACILITY NAME GB#1SAMPLE QUARTER ❑Jul -Sept ❑Oct -Dec ❑Jan -March ®April -June
PERSON COLLECTING SAMPLES Tony Hardison p j�D COUNTY Guilford
CERTIFIED LABORATORY f mw Lab # 34 2414 PHONE NO [phone]
Re-AC,6-> ADD TO LISTSERVE? ❑YES ®NO EMAIL
LIMIT VIOLATIONS? YES [:]NO ® CENT RALFILES DISCHARGING TO CLASS [:]SA❑HQW ❑PNA []Trout ®Other
OW018QG OPTIONAL INFO
Part A Wastewater Mnnitorina Renuirements
Outfall No
Date Sample
a
Collected
(mm/dd/yr)
{VE, RM, MD} Type of Wastewater
z
pH
{standard}
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
S (mg/L)
Duration
(minutes)
Total Flow
7
(gallons/day]
-
-
RM, MD-
6-934
3035
53
{15}6
-
-
001
6/26/2014
RM
657
19
N/A
N/A
>1
>1
002
6/26/2014
RM
662
20
N/A
N/A
>1
>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
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
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
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

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 beset 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 Seance Center
Raleigh, North Carolina 27699-1617
[phone]
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/peirnnel operly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons directle for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am swage V)at tt"nrnificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
of Permittee)
Permit Date 7/1/2010-06/30/2015
-fff
(Date)
Last Revised 07/13/11
Page 2 of 2

w
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No NCG140000
CERTIFICATE OF COVERAGE NO NCG140292-
FACILITY NAME GB#1
PERSON COLLECTING SAMPLES David Morris
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 Guilford
PHONE NO [phone]
ADD TO LISTSERVE7 ❑YES ®NO EMAIL
DISCHARGING TO CLASS []SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO
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
SGT-N£N1s
(mg/L)
Discharge
Duration
iminutesj
Total Flow
7
tgallons/dayj
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
3/17/14
No Flow
T
CENTRALFILES
UV
UWG
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 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 beset 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
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED
"I certify, under penalty of law, that th document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel pro y gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons dir ctiy esponsibl r gath the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am aware that ier are sigrpfi nt es for submitting false information, including the possibility of fines and imprisonment for knowing violations "
C
(si ture o Pe ittee) (Date)
Permit Date 7/1/2010 06/30/2015 Last Revised 07/13/11
Page 2 of 2

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585 Waughtown St, Winston-Salem NC 27107 to 585 Waughtown St
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Driving directions to 585 Waughtown St, Winston-Salem, NC 27107 3D
I of3 3/24/2014 8 18 AM