NCG140305_MONITORING INFO_20190305

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
1v 3 0�
DOC TYPE
❑HISTORICAL FILE
19 MONITORING REPORTS
DOC DATE
❑ �nl � 03 o J,
YYYYMMDD

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE'
General Permit No NGG140000
Calendar Year 2018
"Report ALL WASTEWATER monitoring data on this form (include No FlovV1 No Discharge and Limit Violations) from
the previous calendar veer to the DEQ by MARCH 1 of each veer
Certificate of Coverage No NCG14
Facility Name Stokesdale
County Guilford
Phone Number (704 ) 529-6364
Certified Laboratory Prism Lab
Lab # 402
Lab #
Total no of outfalls monitored 1
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 0
If so, what 1s the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout jr) designated waters? Yes ❑ No 0
Were there any limit violations in the calendar year? Yes ❑ No ❑✓
Outfall No
Daily Flow Rate,
cfs
pH,
SU
TSS,
mgll
SS,
mill
ri applrcabfe
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mgll
Effluent
Limitations
Daily Maximum
HOW or ORIN
50% of 7Q10
fnd¢itwa afe NO FLOW
apphcabfe
freshwater
6 0-9 0
saltter
8-p s
OO
Standard
low
20
HOW ! ORINA nd Tr or
10
IN SA
HOW P AR or any
Trout
5
No Limit
Samples above Benchmark
subject to Tiered Responses
Date
Sample
Collected�i
1
molddlyr
+vc< : avx` i i i V i
i A e a:d r dt�3w 2
Rn
1, ,,��
4eq� 14
§ E$ Sd °@'
dsfS �C
{ ds �� ue'tr
f M8 P3 d i k F o- if54� i'• r1t'# P'�f ¢ 49 3� <PB
311412018
001 NO FLOW
6/2912016
001 NO FLOW
NIAR
8/22/2018
PW 001 NO FLOW
(`( r �� Fit l=q
owR SECTION
1015120108
PW 001 NO FLOW
Permit Date 8/112017 — 6/30/2022
Last Revised 8-22-2017

i
Certificate of Coverage No NCG14 [a[- E011;�-
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 22]
Signature
Date
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 6-22-2017

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 I No Discharge and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year
Certificate of Coverage No NCG14 O 3
Facility Name stokesdale Plant
Countv Guilford
Phone Number (704 5296364
Certified Laboratory prism Lab
Lab # 402
Lab #
Total no of SDOs monitored 1
Stormwater Discharge Outfall (SDO) No 001 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 ❑✓ RECEIVED
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 2m
Yes received approval from DEMLR to reduce monitoring frequency ❑ CENTIRJ\l- FILE j
Other ❑ DIPIR SECTION
Outfall No
aa�
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
mg/1
pH,
SU
Non -polar O&G
(EPA Method i
1664 (SGT-HEM)),
mgll (VMA)
If applicable
New Motor Ott
Usage (gallmo )
It applicable
Stormwater
Benchmarks
Indicate NO FLOW rt
applicable
Circle Benchmark
1 ooleo
! J
rt
6 Q_9 lJ
1 C
5
>65 gaGmo average requlrea TSS and
Non polar O&G monitoring
DateSampler�-
Collected,
molddlyr
�
� � ii li �
�iwx{r 'x�YW P � W ��
{p 5;�, 1{ Mt 1 3
if }� #h 9 kY�✓ P `aim I�
i�! �� �� �y'9 E�i� 4 3�� S
3/14/2018
NO FLOW
06/29/2018
NO FLOW
8/22/2018
NO FLOW
101512018
NO FLOW
Permit Date 8/1/2017 — 6/3012022
Last Revised 8-22-2015

r
Certificate of Coverage No NCG14 �21,CFG--
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 informatiory, including the possibility of fines and imprisonment for knowing violations "
(Required by 40 C,,R §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 811/2017 — 6/30/2022
Last Revised 8-22-2015

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) —STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No NCG140000
Calendar Year 2017
"Report ALL STORMWATER monitoring data on this form (include "No Flow'T'No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH,,9rof eachtyear- l
Certificate of Coverage No NCG14 ®3❑© 5❑ MAR 0 7 Z018
Facility Name Stokesdale Plant CEN I KAL 1=1LES
County Guilford DWR StL I IVN
Phone Number (_EL_) 513-4492 Total no of SDOs monitored 1
Certified Laboratory Prism Lab Lab # 402
Lab #
Stormwater Discharge Outfall (SDO) No 001 VIVA Outfall? Yes ❑ No ❑✓
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑�
Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑✓
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes enough consecutive samples below benchmarks to decrease frequency ❑
Yes received approval from DEMLR to reduce monitoring frequency
Other ❑
Outfall No
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
m !I
pH,
SU
Non -polar O&G
(EPA Method
1664 SGT-HEM)) ,
mg/I (VMA)
!!applicable
New Motor Oil
Usage (gallmo )
If applicable
Stormwater
Benchmarks
Idicate NO FLOW ll
applicable
Circle Benchmark
1 UUIFJV
6 0-n� 0
1 �
>55 gallmo average requires 75S and
Non polarC&O monitoring
Sample
molddlyr
°
P ph;- } 5ro�
dP$ �1..q, SSSf „ti1 dxNd7r
`Ig{pi.#$rc -?tn '"I, <�i R s°��•'sf
L ���@ i b �p'aw�Y es R �:s�2a # a s iY cf "£ x'riff�x
rS
Rp¢�ID,Ip�Collected,
IM''g
t* tSi if'
s ti,i 1
i d<d � 1l�i "es�aj4ya4 ss4Date
=F3
3/28/2017
001 No Flow
6/19/2017
001 No Flow
9/13/2017
001 No Flow
12111 i2017
001 No Flow
Permit Date 8/1/2017 — 6/3012022
Last Revised 8-22-2015

Certificate of Coverage No NCG14 d[ 151FQ1 "
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 2
Signature r
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 Centra! 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 NCG14O3O5
FACILITY NAME Stokesdale
PERSON COLLECTING SAMPLES Steve Wilson
CERTIFIED LABORATORY Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES [:]NO
Part A Wastewater Monitorine Reouirements
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 using
method 1664A
HEVDuration
S (mg/L})
(mg/
Discharge
(minutes)
Total Flow
p
(gallons/day)
-
RM, MD-
6 93 °
303 5
53
(15)6
-
-
001
11/30/15
No Flow
'
i0 P
SE
fris��
SAMPLE COLLECTION YEAR 2015
SAMPLE QUARTER ❑Jul -Sept ®Oct -Dec ❑Jan -March ❑April -June
COUNTY Stokes
PHONE NO [phone]
ADD TO LISTSERVP []YES ®NO EMAIL
DISCHARGING TO CLASS [:]SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO_
cc
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
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

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 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
N 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 perso directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
l am aware Wiat there are significant 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
/ (? 7--
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO NCG140000
RECEl1f ED
CERTIFICATE OF COVERAGE NO NCG140305
FACILITY NAME Stokesdale
PERSON COLLECTING SAMPLES Steve Wilson
CERTIFIED LABORATORY Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Monitorme Reauirements
JUL 27
Z017 SAMPLE COLLECTION YEAR 2017
SAMPLE QUARTER []Jul -Sept []Oct -Dec ❑Jan -March ®April -June
CENTRAL FILEeOUNTY Stokes
DWR SECTIV&ONE NO [phone]
ADD TO LISTSERVE7 ❑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
z
(VE, RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SGT-HE&f
(mg/L)
Duration
(minutes)
Total Flow
,
(gallons/day)
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
6/19/2017
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
3If an effluent limit is exceeded twice in a row, the permkttee 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 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 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 thaitheWgre significant 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
l
(Date)
Last Revised 07/13/11
Page 2 of 2

f
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No NCG140000
CERTIFICATE OF COVERAGE NO NCG140305
FACILITY NAME Stokesdale
PERSON COLLECTING SAMPLES Steve Wilson
CERTIFIED LABORATORY Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES []NON
Part A Wastewater Monitoring Reauirements
SAMPLE COLLECTION YEAR 2017
SAMPLE QUARTER ❑Jul -Sept ❑Oct -Dec ®Jan -March ❑April -June
COUNTY Stokes
PHONE NO [phone]
ADD TO LISTSERVE7 []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
z
(VE, RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
S mHlIW
Duration
(minutes)
Total Flow
(gallons/day)
-
-
RM, MD-
6-934
3035
S3
(15)6
-
-
001
3/28/17
No Flow
-- t
7 j
5 2017
06141
c
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 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 DWQCentral 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 dir?ctly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am aWargy that tAiere W significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
(Signatuie 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 NCG140305
FACILITY NAME Stokesdale
PERSON COLLECTING SAMPLES Steve Wilson
CERTIFIED LABORATORY Research & Analytical
LIMIT VIOLATION57 YES ❑ NO
Part A Wastewater Monitonne Requirements
FREcc SAMPLE COLLECTION YEAR 2016
CEI Fr)SAMPLE QUARTER ❑]ul-Sept ®Oct -Dec Dian -March ❑April -June
JAN 2 COUNTY Stokes
Lab #, 4 Z�t% PHONE NO [phone]
DER RAL FILES ADD TO LISTSERVE7 ❑YES ®NO EMAIL
ECTiON DISCHARGING TO CLASS [:]SA ❑HQW
OPTIONAL INFO
❑PNA ❑Trout ®Other
Outfall No
Date Sample
Collected
(mm/dd/yr)
Type of Wastewater
z
RMMD)
(VE, ,
pH
(standard}
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
HEW
(mg/L) L)
Discharge1
Duration
(minutes)
Total Flow
(gallons/day}
-
-
RM, MD-
6-93 4
303 5
53
(15)6
-
001
12/6/16
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 8 8 5 S U for discharges to saltwaters
5 TSS Irmits 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
rvCAC 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 personsPtherq4_relsignificant
rectly r risible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am ayKare th 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
f 7l�
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG140305
FACILITY NAME Stokesdale
PERSON COLLECTING SAMPLES Steve Wilson
CERTIFIED LABORATORY Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Morntorins Reautrements
SAMPLE COLLECTION YEAR 2016
SAMPLE QUARTER ®Jul -Sept ❑Oct -Dec ❑Jan -March ❑April -June
COUNTY Stokes
PHONE NO [phone]
ADD TO LISTSERVE7 ❑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
SG
1L) 6
(mg/L)
Discharge
Duration
(minutes)
Total Flow
7
(gallons/day}
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
9/19/16
No Flow
016
CENT-ReiL
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
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 ,s 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 R0 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

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 Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ If the permrttee 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 awarq that then are s)gnificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations"
nature of Permittee)
Permit Date 7/1/2010 06/30/2015
fo &
(Date)
Last Revised 07/13/11
Page 2 of 2

ok
PROCESS WASTEWATER -- Quarterly Discharge Monitoring Report
GENERAL PERMIT NO NCC3140000 ^S
CERTIFICATE OF COVERAGE NO NCG140305 SAMPLE COLLECTION YEAR 2016
FACILITY NAME Stokesdale SAMPLE QUARTER ❑Jul -Sept ❑Oct -Dec ❑Jan -March ®April -June
PERSON COLLECTING SAMPLES Steve Wilson COUNTY Stokes
CERTIFIED LABORATORY Research & Analytical Lab # 34 PHONE NO [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL
LIMIT VIOLATIONS? YES ❑ NO ® DISCHARGING TO CLASS [:]SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO
Part A Wastewater Monitorine Requirements
Outfall No
Date Sample
a
Collected
(mm/dd/yr)
Type of Wastewater
z
{VE, RM, MD]
pH
(standard}
Total Suspended
Solids
(mg/L)
Settleable
Solids6
(mL/L)
TPH usingDischarge
method 1664A
SGT-HE)
{mg/L
Duration
(minutes)
Total Flow
gallons/day}'
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
6/24/16
No Flow
• s 4... w m� -
-^—
AUG
n AID CFr`T!
?%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
a pH limits are 6-9 S U for wastewater discharges to freshwaters, and 6 8-8 5 5 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 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 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 SAM_ PLE FOR
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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am awar'9 that tyre 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
�s t /l
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No NCG140000
CERTIFICATE OF COVERAGE NO NCG140305
FACILITY NAME Stokesdale
PERSON COLLECTING SAMPLES Steve Wilson
CERTIFIED LABORATORY Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES []NO
Part A Wastewater Monitoring Reouirements
SAMPLE COLLECTION YEAR 2016
SAMPLE QUARTER [_]Jul -Sept ❑Oct -Dec ®Jan -March ❑April -June
COUNTY Stokes
PHONE NO [phone]
ADD TO LISTSERVP ❑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 i
Solids
(mL/L)
TPH usingDischarge
method 1664A
6
SGT
/L)!
(mg/L)
Duration
(minutes)
Total Flow
>
{gallons/day)
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
2/16/16
No Flow
L_ I V L;. Lj
M
f 6
t1N I H
A_L 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
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

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`Y 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 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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am awpre tha,f there 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
4/Z-z1lr'.
(Date)
Last Revised 07/13/11
Page 2 of 2

J
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
I GENERAL PERMIT No NCG14OOOO
CERTIFICATE OF COVERAGE NO NCG140305
FACILITY NAME Stokesdale
PERSON COLLECTING SAMPLES Steve Wilson
CERTIFIED LABORATORY Research & Analytical
LIMIT VIOLATION57 YES ❑ NO
Part A Wastewater Monitonne Reauirements
SAMPLE COLLECTION YEAR 2015
cn
SAMPLE QUARTER ®Jul -Sept ❑Oct -Dec []Jan -March ❑April -June
RECEIVED COUNTY Stokes
Lab # 3AT 2 3 2015 PHONE NO [phone]
ADD TO LISTSERVE7 ❑YES ®NO EMAIL
CENTRAL FILES DISCHARGING TO CLASS ❑SA ❑HQW ❑PNA ❑Trout ®Other
DWR SECTION OPTIONAL INFO
Outfall No
Date Sample
a
Collected
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)'
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
SGT-HEM'
(mg/L)
Discharge
Duration
(minutes)
Total Flow
(gallons/day),
-
-
RM, MD
6-93 4
303 5
53-
001
09/10/15
No Flow
' If wastewater systems have not dischargers 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 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 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 i of 2
-.T-j

a
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 late 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 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 person erectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am jpv4re tl�t there 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
to
(Date)
Last Revised 07/13/11
Page 2 of 2

—` PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO NCG140305 SAMPLE COLLECTION YEAR 2015
FACILITY NAME Stokesdale SAMPLE QUARTER ❑Jul -Sept ❑Oct -bet Dian -March ®April -June
PERSON COLLECTING SAMPLES Steve Wilson COUNTY Stokes
CERTIFIED LABORATORY Research & Analytical Lab #RECEIVE )PHONE NO [phone]
ADD TO LISTSERVE? [:]YES®NO EMAIL
LIMIT VIOLATIONS? YES ❑ NO ® JUL 2 2015 DISCHARGING TO CLASS [:]SA [-]HOW ❑PNA ❑Trout ®Other
CENTRAL FILES OPTIONAL INFO
Part A Wastewater Monitorine Reouirements DWR SECTION
Outfal! No
Date Sample
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 6
(mg/L) m�/L)
Duration
(minutes]
Total Flow 7
(gallons/day)
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
6/18/15
No Flow
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) 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
° 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 Pro,.;ss 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 W, 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 Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED
N 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 personlldireesponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
?er I am are t t t4e lFere significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
of Perrnittee)
Permit Date 7/1/2010-06/30/2015
h-3r1i
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG 140305
FACILITY NAME Stokesdale
PERSON COLLECTING SAMPLES. Steve Wilson
CERTIFIED LABORATORY Research & Analytical Lab # 34
LIMIT VIOLATiONS7 YES ❑ NO
Part A Wastewater Monitorine Reouirements
SAMPLE COLLECTION YEAR 2015
SAMPLE QUARTER ❑Jul -Sept ❑Oct -Dec ®Jan -March ❑April -June
COUNTY Stokes
PHONE NO [phone]
ADD TO LISTSERVE7 DYES ®NO EMAIL
DISCHARGING TO CLASS [_]SA ❑HQW
OPTIONAL INFO
DPNA Trout ®Other
Outfall No
Date Sample
Collected
(mm/dd/yr)
Type of Wastewater
I
(dERMMD)
, ,
pH
(standard)
Total Suspended
Solids
(rng/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
mg/L) 5GT-Hfl1/16 1
(
Duration
(minutes)
Total Flow
z
{gallonsJdaYj
-
-
RM, MD-
6-934
3035
53
(iV
-
-
001
03/02/15
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 limas 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
�j
—077

i
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 provistons 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 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 di ctly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am pore thalgerelaMsignificant 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
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
a GENERAL PERMIT No NCG140000
CERTIFICATE OF COVERAGE NO NCG1403O5
FACILITY NAME Stokesdale
PERSON COLLECTING SAMPLES Steve Wilson
CERTIFIED LABORATORY Research & Analytical Lab # 34
LIMIT VIOLATIONS) YES ❑ NO
Part A Wastewater Monitoring Reauirements
SAMPLE COLLECTION YEAR 2014
p 1r11% I= 1X I LE QUARTER ❑Jul -Sept ®Oct -Dec ❑Jan -March
REbbky Stokes
JAN 2 0 2ftJONE NO [phone]
ADD TO LiSTSERVE7 ❑YES ®NO EMAIL
CENTRAL FIk�HARGING TO CLASS ❑SA ❑HQW
QWR SECT&
OPTIONAL INFO
❑PNA ❑Trout ®Other
Dutfall Na
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
SGT HEM6
(mg/L)
Duration
(minutes)
Total Flow
�
(gallons/day)
-
-
RM, MD-
6-93 °
303 i
53
(15),
001
12/23/2014
RM
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 7/1/2010 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 Flgw rat; ran 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 DWQCentral 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 qualif ed personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons dteyfi-bre
ctly sponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
1 am �wre thansignificant 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
�S /3C)
(Date)
Last Revised 07/13/11
Page 2 of 2

c
PROCESS WASTEWATER -- Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO NCG140305
FACILITY NAME Stokesdale
PERSON COLLECTING SAMPLES Tony Hardison
CERTIFIED LABORATORY Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Monitorine Requirements
SAMPLE COLLECTION YEAR 2014
SAMPLE QUARTER ®Jul -Sept ❑Oct -Dec ❑Jan -March ❑April -June
COUNTY Stokes
PHONE NO [phone]
ADD TO LISTSERVE7 DYES ®NO EMAIL
DISCHARGING TO CLASS [—]SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO
Outfall No
Date Sample
Collected'
(mm/dd/yr)
Type of Wastewater
2
[VE, RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method1664A
)Vr
S (mg/L)
Discharge
Duration
(minutes)
Total Flow
7
(gallons/day]
-
-
RM, MD-
6-934
3035
53
(IS)6
-
-
001
9/23/2014
RM
No Flow
T ?014
' 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 7/1/2030-06/30/2015 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 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 directly r onsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am aware thgghere a sign x9 nt penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
of Pe
Permit Date 7/1/2010-06/30/2015
l2 [
{Date}
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report RECEIVED
GENERAL PERMIT No NCG140000 JUL 18 2014
CENTRAL FILES
DWQIBOG
CERTIFICATE OF COVERAGE NO NCG140305
FACILITY NAME Stokesdate
PERSON COLLECTING SAMPLES Tony Hardison
CERTIFIED LABORATORY Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Monftorine Reauirements
SAMPLE COLLECTION YEAR 2014
SAMPLE QUARTER ❑Jul -Sept ❑Oct -Dec ❑Jan -March ®April -June
COUNTY Stokes
PHONE NO [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL
DISCHARGING TO CLASS ❑SA ❑HQW ❑PNA [-]Trout ®Other
OPTIONAL INFO
Outfall No
Date Sample
Collected'
(mm/dd/yr}
Type of Wastewater
(VE, RM, MD)
PH
{standard}
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1bb4A
SG /L)16
{mg/L}
Discharge
Duration
(minutes)
Total Flaw 7
(gallons/davl
-
-
RM, MD-
6-93 4
303 5
53
(15)6
-
-
001
6/26/2014
RM
941
S
N/A
N/A
>1
>1
002
6/26/2014
RM
945
25
N/A
N/A
>1
>1
Sample for Both Outfalls were sampled in the wrong
location, they were sampled from onsite holding areas,
not at the point of discharge
` 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
Permit Date 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

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
a 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
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 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
N 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 direct) resp risible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
lam aware th,qt the, ar gnificant penalties for submitting false information, Including the possibility of fines and imprisonment for knowing violations"
re of
Permit Date 7/1/2010-06/30/2015
7 , A
(Date)
Last Revised 07/13/11
Page 2 of 2

RECEIVED
APR 15 2014
CENTRAL FILES
DWOIBOG
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE No NCG140305
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215 1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Concrete Supply Co , LLC
is hereby authorized to discharge process wastewater and stormwater from a facility Iocated at
Concrete Supply Co — Stokesdale Plant
6819 US Hwy 158 East
Stokesdale
Guilford County
to receiving waters designated as unnamed tributary to Haw River, a class WS-V,NSW water in
the Cape Fear River Basin, in accordance with the effluent limitations, monitoring requirements,
and other conditions set forth in Parts 1, II, III, 1V, V, and VI of General Permit No NCG140000
as attached
This certificate of coverage shall become effective April 14, 2014
This Certificate of Coverage shall remain in effect for the duration of the General Permit
Signed this day April 14, 2014
for Tracy E Davis, P E , Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

Division of Water Quality / Surface Water Protection
NCDENRNational Pollutant Discharge Elimination System
"o" ""°` Naum""n`r°' EPERMIT NAME/OWNERSHIP CHANGE FORM
MnRONf10R ANO N,Gl1R,u, ACap/�CG'
FOR AGENCY USE ONLY
Dato Received
Year
Month
Day
I Please enter the permit number for which the change is requested
NPDES Permit (or) Certificate of Coverage
N I C I S 10 N I C I G I 1 14 10 1 3 0 5
11 Permit status prior to requested change
a Permit issued to (company name) CEMEX Construction Materials Atlantic, LLC
b Person legally responsible for permit Larry McSwain
First MT Last
VP/GM Carolinas
Title
101 Young Court
Permit Holder Mmttng Address —�
Greenville SC 29615
City State Zip
[phone] [phone]
Phone Fax
c Facility name (discharge) CEMEX — Stokesdale
d Facility address 6819 US Hwy 158 East
Address
Stokesdale NC 27357
City State Zip
e Facility contact person Johnny M Tapia [phone]
First / MI / Last Phone
III Please provide the following for the requested change (revised permit)
a Request for change is a result of ® Change in ownership of the facility
® Name change of the facility or owner
If other please explain
b Permit issued to (company name)
c Person legally responsible for permit
1§@-
OLT172013
Nw . WA t1ALI
d Facility name (discharge)
e Facility address
f Facility contact person
Concrete Supply Co, LLC
H_ e_nry
Batten
First
MI bast
President
Title
P O Box 5247
Permit Holder Marling Address
Charlotte
NC 28299
City
State Zip
704) 372-2930
Hen Batten a ConereteSu 1 yCo coin
Phone
E-mail Address
Stokesdale
6819 US Lin 158 East
Address
Stokesdale
NC 27357
City
State Zip
Johnie
Alexander
First
MI Last
Johme Alexander@ConereteSupplyCo
704 372-2930
coin
iN
— 1 11

' NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV Permit contact information (if different from the. person 1Lgally rLsponsiblL for the pLrm►t)
Permit LontaLt Johnic A1LxandLr
First M I Last
EnvironmLntal ManagLr
F Title
P O Box 5247
Mailing Address
Charlotte NC 28299
City St it(. Zip
s;704�372-2930 Johnte AlexandLr r, LonLretesupplyLo co_m
Phone E mail Address
V Will the permitted facility continue to conduct the same industrial activities conducted prior to
this ownership or name change`
x Yes
❑ No (please Lxplain)
V1 Required Items THIS APPLICATION WILL RE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING
X This completed application is required for both name change and/or ownership change requLsts
X Lcgal documentation of the transfer of ownership (such as relevant pages of a contract deed, or
a bill of salt.) is required for an ownership change request ArtiLlCs of incorporation are not
suffiCILnt for an ownership LhangL
The certifications below must be completLd and signed by both the permit holder prior to thL changL, and the
new applicant in the case of an ownership change request For a name change request, the signed Applicant s
Ccrtiflcation is suffictcnt
PERMITTEE CERTIFICATION (Permit holder prior to ownership change)
I, Larry McSwain, attest that this application for a name/ownership change has bcLn reviewed and is accurate
and complete to thL best of my knowledgL I understand that it all rLquircd parts of this appltLation arc not
complLted and that if all required supporting information is not included, this appliLation package, will bL
returnLd as tncompletc
Signature Datc
APPLICANT CERTIFICATION
1, HLnry BattLn, attest that this application for a namclowncrship change has been reviewed and is accurate
and LomplLte to the, best of my knowlLdgL I understand that it all rLquirLd parts of this application are not
complLted and that if all rLquircd supporting information is not inLludLd, this application paLkagL will be
rLturnLd as incomplete
I - z 7- Z013
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO
Division of Water Quality
SUrfdLL Water ProtLLtion Section
1617 Mail Scrvicc Center
Raluigh, North Carolina 27699-1617
Revised 712008

ANTO
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr Johnie Alexander
Concrete Supply Co, LLC
P 0 Box 5247
Charlotte, NC 28299
Dear Mr Alexander
John E Skvarla, III
Secretary
April 14, 2014
Subject NPDES General Permit NCG140000
Certificates of Coverage -Multiple
Concrete Supply Co, LLC
Formerly CEMEX Construction Materials Atlantic, LLC
Counties - Multiple
Division personnel received your request to revise your stormwater permit Certificates of Coverage
to accurately reflect your new company and/or facility name
Please find enclosed the revised Certificates of Coverage for the 17 facilities that changed
ownership from CEMEX Construction Materials Atlantic, LLC to Concrete Supply Co, LLC The
terms and conditions contained in the General Permit remain unchanged and in full effect These
revised Certificates of Coverage are issued under the requirements of North Carolina General
Statutes 143-215 1 and the Memorandum of Agreement between North Carolina and the U S
Environmental Protection Agency
If you have any questions or need further information, please contact the Stormwater Permitting
Program at [phone]
Sincerely,
ORIGINAL SIGNED 131
KEN PICKLE
for Tracy E Davis, P E, CPM, Director
Division of Energy, Mineral and Land Resources
cc Mooresville RO, Z Khan
Winston-Salem RO, M Gantt
Fayetteville RO, B Cole
Asheville RO, L Herbert
Raleigh RO, J Holley
Division of Energy, Mineral, and Land Resources
Energy Section - Geological Survey Section - Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699 1612 - 919 707-92001 FAX [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet htto Hiportal ncdenr org/web/Ift
An Equal opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

Deborah Reese, DEMLR Budget Office — please update billing info
Stormwater Permitting Program Files
Central Files
Mecklenburg County DEP, Water Quality, 700 N Tryon Street, Charlotte, NC 28202
Wake County Environmental Services, Ann Eric Green, P O Box 550, Raleigh, NC 27602