NCG140392_MONITORING INFO_20190305

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO
IV Cc
DOC TYPE
❑HISTORICAL FILE
b( MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

ANNUAL SUMMARY DISCHARGE MONITORING
,r V1%
REPORT (DMR) — WASTEWATER OCrV--1V t LJj
SUBMIT TO CENTRAL OFFICE* ma 0
General Permit No NCG140000 FILES
Calendar Year 2018 p1f`dR sernoN
*Report ALL WASTEWATER monitoring data on this form (include No Flow'/ No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year
Certificate of Coverage No NCG14 E3❑ 9❑ 2❑
Facility Name Winston Salem
County Forsyth
Phone Number (336 9962841 Total no of outfalls monitored 1
Certified Laboratory Research & Analytical Lab Lab #
Lab #
Wastewater (WW) Discharge Outfall No 001
Does this outfall discharge WW to SA waters? Yes ❑ No 0
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❑
Were there any limit violations in the calendar year? Yes ✓❑ No ❑
Outfall No
001
Daily Flow Rate,
cfs
pH,
SU
TSS,
mgll
SS,
mill
rf appfrcabfe
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mgll
Effluent
Limitations
Daily Maximum
HOW or ORIN
50% of 7Q10
indicate NO FLOW I!
appbcabfe
freshwater
6 0-9 0
saltwater
$-8
Standard
30
Now
20
HOW ! ORand Tr or
INpHA
10
HOW
SB P Agora Y
Trout
5
No Limit
Samples above Benchmark
subject to Tiered Responses
15
Date
Sample
Collected
molddl r
4 33 q� r e
�tf ��E f t
oe i JJ� i'I �aJJ t$ r
!� rFsu s i k o, ,'"9', 4
e,�i`,i$ t,a_
; ram " dr - ��
y
2��'i i�
s t t t
fs i 4F
��
rCj' , F:
p h �,,
r r v. tv, y
�ja7 sf 3�
4f-�
Y; a �t r 1
}e .#��a tf a E
�.,
i
� e
w
t+ S s �N
r& "i?F
Apr
f ��w
ffawF'� C u f a� F
o f Q i' xd'1 ri f! a
�6a't� €°£} f Sad s Irex i a
a'�`�T b�7P r�+, , ik6;y C jw��,f 9f
d� a �1
W i
�j" �; cr lrf days "='fJ;.t�F
'' � � _ P" �h
31512018
NO FLOW
6l212018
NO FLOW
9/20/2018
001
7 8
6 8
SM 4500 H+B 20001SM 2540 F 1997
11/27/2018
PW 001
9 1
<0 1
SM 2540 F 1997
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No NCG 14 0C[9[Z
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 8-22-2017

e 14
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 FlovV1 No Discharge and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year
Certificate of Coverage No NCG14 ] 3�®22
Facility Name Winston Salem
County Forsythe
Phone Number (336 ) 996-2841 Total no of SDOs monitored 1
Certified Laboratory Research & Analytical Lab Lab #
Lab #
Stormwater Discharge Outfall (SDO) No 001 VMA Outfall? Yes ❑ No ❑
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No 0'
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? RECE ED
Yes enough consecutive samples below benchmarks to decrease frequency ❑ NEAR 0 4
Yes received approval from DEMLR to reduce monitoring frequency ❑ �Q,�
Other ❑ t�,.N71.0E L FILE,.-)
r'% t a
—
o�,X JffVs i'I
Outfall Na
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
m 11
pH,
SU
Non -polar O&G
(EPA Method
1664 (SGT-HEM)),
mgll (VMA)
lrapplicable
New Motor Oil
Usage
allmo 9 (9 )
It applicable
Stormwater
Benchmarks
Inaicare NO FLOW A
applicable
Circle Benchmark
100150
C
t) 0-9 fl
1 �
>55 gallmo avenge requires T55 and
Non polar O&G monitoring
Date Sample
Collected,molddlyr
", �� °�'€`����� :
�f�� �;?'�tf
k^.?I
"u;l�d�a �� -N� "r�
� !T""
�� -' l�
3/5/2018
NO FLOW
6/2/2018
NO FLOW
9/2012018
001
68
78
SM 4500 H+B 2000
SM 2540 F 1997
11/2712018
001
9 1
SM 2540 F 1997
Permit Date 8t112017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No NC1314 A®lipE
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 CAR §122 22]
Signature
Date
,I
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office
Note the address is correct - Central Files is housed in DWR (not DFMLR)
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 — 6/3012022
Last Revised 6-22-2015

s
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE`
General Permit No NCG140000
Calendar Year 2Q17
*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 9 of each year
Certificate of Coverage No NCG 14 0
MAR 0 i 2018
Facility Name Winston-Salem Plant e r-wrr, ,-;.,, r--
County Forsyth DWR SECTION
Phone Number (704 ) 617-4152 Total no of SDOs monitored
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 ❑�
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 13
Other ❑
Outfall No
Total Rainfall,
inches
Total
Suspended
Solids ( ),
11
pH,
SU
Non -polar O&G
(EPA Method
1664TSS ( SGT-HEM)) ,
mgll (VMA)
It applicable
New Motor Oil
Usage (gallmo
I/appllcablo
Stormwater
Benchmarks
Indicate NO FLOWN
applicable
circle Benchmark
1 UU15U
6 a-9 0
'� �
55 g allmo average requires TSS and
Non -polar O&G monitoring
Date Sample
p
Collected ,
m old dl r
�YY-�`i it P ¢ 9 t �' `jn
r ��1. ,3
�
v
s�� ass i¢4r E i 6�l 1
i ; 9 , g
Ea igp Pam
� io
3/1/2017
001 No Flow
6112/2017
001 No Flow
9/5/2017
001 No Flow
12/5/2017
001 No Flow
Permit Date 8/V2017 — 6/30/2022
Last Revlst�d 8-22-2015

r
Certificate of Coverage No NCG14 101 ❑9
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 §122 221
Signature
Date 9- )
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 8I112017 — 6/30/2022
Last Revised 8-22-2015

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG140392
FACILITY NAME Winston-Salem
PERSON COLLECTING SAMPLES Will Moore
CERTIFIED LABORATORY Research and Analytical Lab # 34
LIMIT VIOLATIONS? YES [:]NON
Part A Wastewater MonitorinE Reawrements
SAMPLE COLLECTION YEAR 2017
SAMPLE QUARTER ❑Jul -Sept []Oct -Dec ❑Jan -March ®April -June
COUNTY Forsyth
PHONE NO [phone]
ADD TO LISTSERVE? [—]YES ®NO EMAIL
DISCHARGING TO CLASS [:]SA ❑HQW
OPTIONAL INFO
❑PNA ❑Trout ®Other
Outfall No
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)'
pH
(standard)
Total suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SGT-HEM'
(mg/L)
Duration
(minutes)
Total Flow
�
(gallons/day)
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
6/12/2017
NO FLOW
CENTRA
FILES
WR SECTION
If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here Please make sure to mark the sample quarter above
2 Report the abbreviation for the type of Authorized Wastewater Discharges here Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD) Report more than one type if the waste stream is commingled
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

s 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 dictly 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 Zerffltire 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
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG140392
FACILITY NAME Winston-Salem
PERSON COLLECTING SAMPLES Will Moore
CERTIFIED LABORATORY Research and Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Monitoring Reauirements
SAMPLE COLLECTION YEAR 2017
SAMPLE QUARTER ❑Jul -Sept [j]Oct-Dec ®Jan -March ❑April -June
COUNTY Forsyth
PHONE NO [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL
DISCHARGING TO CLASS [—]SA ❑HQW
OPTIONAL INFO
❑PNA ❑Trout ®Other
Outfall No
Date Sample
z
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
method
S (mg/L)
(minutes)
Total Flow
,
(gallons/day]
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
3/1/17
RM
No Flow
a 0 5
coin
CENTRAL
I
DWR SECTION
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
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 Flaw 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 70.10 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 dire ly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am aw9re)0at th7re are 5�rgfj"fr scant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
(Signature/bEf Permittee)
Permit Date 7/1/2010-06/30/2015
SC Zl -';7
(Date)
Last Revised 07/13/11
Page 2 of 2

1. ram,
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG140413
FACILITY NAME Kings Mtn
PERSON COLLECTING SAMPLES Rik Jones
LIMIT VIOLATIONS? YES ® NO ❑
Part A Wastewater Monitorine Reauirements
SAMPLE COLLECTION YEAR 2017
SAMPLE QUARTER ❑Jul -Sept ❑Oct -Dec ®Jan -March ❑April -June
COUNTY Cleveland
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
2
(VE, RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SGT-HEM'
(mg/L)
Duration
jminutes)
Total Flow
(gallons/day),
-
-
RM, MD-
6 934
3035
53
(15),
-
-
001
3/22/17
RM
68
BRL
110
v km Ifto
MAY
2017
WTIGN
NLES
' 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 5 U for wastewater discharges to freshwaters and 6 8-8 5 S U for discharges to saltwaters
5 TS5 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

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 ersonnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons direct respon le for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am aware t"t thgr a nificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
re of Permittee)
Permit Date 7/1/2010-06/30/2015
(Date)
Last Revised 07/13/11
Page 2 of 2

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
F.aw 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 d#ectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I amiapvlaire tha there 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
lll2 /t7
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG140392
FACILITY NAME Winston-Salem
PERSON COLLECTING SAMPLES Wil Moore
CERTIFIED LABORATORY Research and Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Monitorine Reauirements
SAMPLE COLLECTION YEAR 2016
SAMPLE QUARTER ®Jul -Sept ❑Oct -Dec ❑Jan -March ❑April -June
COUNTY Forsyth
PHONE NO [phone]
ADD TO LISTSERVE? DYES ®NO EMAIL
DISCHARGING TO CLASS ❑SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO
Outfall No
Date Sample
n
Collected
min/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-
6 934
3035
53
(15)6
001
9/1/2016
No Flow
i
NOV 0
r+
' 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
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
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 di;tly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
lamawarAthatre a�&& ignificant 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
ZKl
(Date)
Last Revised 07/13/11
Page 2 of 2

t
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No NCG140000
CERTIFICATE OF COVERAGE NO NCG140392
FACILITY NAME Winston-Salem
PERSON COLLECTING SAMPLES Tony Hardison
CERTIFIED LABORATORY Research and Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Monitorine Requirements
SAMPLE COLLECTION YEAR 2016
SAMPLE QUARTER ❑Jul -Sept ❑Oct -Dec ❑Jan -March ®April -June
COUNTY Forsyth
PHONE NO [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL
DISCHARGING TO CLASS ❑SA ❑HQW
OPTIONAL INFO
❑PNA ❑Trout ®Other
Outfall No
Date Sample
f
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
6
SG%NEM
(mg/L)
Discharge
Duration
(minutes)
Total Flow
7
(gallons/day)
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
6/2/2016
No Flow
F=ir f­� ;=e
ie? F,7%
I X1_v L
V L_
' 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 inste,@d 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 028 0224 Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case by case basis
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO
Division of Water Quality
Attn DWQ Central 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 that theA are 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
S-/c 6/�
(Date)
Last Revised 07/13/11
Page 2 of 2

ti -11%
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO NCG140392
FACILITY NAME Winston-Salem
PERSON COLLECTING SAMPLES Tony Hardison
CERTIFIED LABORATORY Research and Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Mon[torine Reauirements
SAMPLE COLLECTION YEAR 2016
SAMPLE QUARTER ❑Jul -Sept ❑Oct -Dec ®Jan -March ❑April -June
COUNTY ForsVth
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
z
(VE, RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L}
Settleable
Solids
(mL/L}
TPH usingDischarge
method 1664A
SGT-HEM'
(mglL)
Duration
(minutes)
Total Flow
>
jgallons/dayj
-
-
RM, MD-
6-934
3035
53-
001
3/26/2016
No Flow
T`ti
- Q . W
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
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

— a
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
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 DWCZ 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 awaxe tha4ere are 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
(-I'l2-, l C'
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
4- GENERAL PERMIT No NCG140000
CERTIFICATE OF COVERAGE NO NCG140392
FACILITY NAME Winston-Salem
PERSON COLLECTING SAMPLES Tony Hardison
CERTIFIED LABORATORY Research and Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Mon[torme Reauirements
CnT21
SAMPLE COLLECTION YEAR 2015
SAMPLE QUARTER []Jul -Sept ®Oct -Dec ❑Jan -March ❑April -June"'
COUNTY Forsyth 5"21
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
method 1664A
SGT-HE&f
(mg/L)
Discharge
Duration
(minutes)
Total Flow
�
(gallons/day)
-
-
RM, MD-
6-93 4
303 s
53-
001
12/17/2015
No Flow
LU
C E
NTRaL r i UMO
D
='-
' 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

e Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas TPH does not have a limit far 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 permtttee 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 aryare that tiere _kre significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations '
( (to
(Signatufe of 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 N[G140392 ��������
FACILITY NAME Winston-Salem
PERSON COLLECTING SAMPLES Tony Hardison CERTIFIED LABORATORY Research and Analytical LAb r 4 2 1 2015
CENTRAL FILES
LIMIT VIOLATIONS? YES ❑ NO ® ©V'IR SECTION
Part A Wastewater Monitonne Reauirements
SAMPLE COLLECTION YEAR 2015
SAMPLE QUARTER ®Jul -Sept ❑Oct -Dec ❑Jan -March ❑April -June
COUNTY Forsyth
PHONE NO [phone]
ADD TO LISTSERVE7 DYES ®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)'
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SGT-HEM'
(m g/L)
Duration
(minutes)
Total Flow
,
'gallons/day)
-
RM, MD
6-934
3035
53
(15)6
001
09/21/2015
No Flow
3 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 tf 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
N

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
FlovLrate caL, 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 70.10 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 directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I anA aware tg0t, Were 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
W z 1 /1
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER —Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO NCG140392
FACILITY NAME Winston-Salem
PERSON COLLECTING SAMPLES Tony Hardison
CERTIFIED LABORATORY Research and Analytical
LIMIT VIOLATIONS? YES []NON
Part A Wastewater Monitonne Reauvements
K�UEt\/F
4 W5
GENYA� ^ES
SAMPLE COLLECTION YEAR 2015
SAMPLE QUARTER ❑Jul -Sept ❑Oct -Dec ❑Jan -March
COUNTY Forsyth
PHONE NO [phone]
ADD TO LISTSERVE? [—]YES ®NO EMAIL
DISCHARGING TO CLASS ❑SA ❑HQW
OPTIONAL INFO
0
®April -Junes
❑RNA ❑Trout ®Other
Outfall No
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
z
(VE, RM, MD)
uvvr\
PH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
6
SGT-HEM
(mg/L)
Discharge
Duration
(minutes)
Total Flow
,
gallons/dayj
---
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
06/26/15
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
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
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

e P'rocess 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 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 di ectly sponslble for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am awlre t4t�h�e significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
(Signatur`e of Permittee)
(3'orf-�-
(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 NCG140392
FACILITY NAME Winston-Salem
PERSON COLLECTING SAMPLES Tony Hardison
CERTIFIED LABORATORY Research and Analytical
LIMIT VIOLATIONS YES ❑ NO
Part A Wastewater Monitorine Requirements
RECE V AMPLE COLLECTION YEAR 2015
MAY 13 2fl$j ►MPLE QUARTER ❑Jul -Sept ❑Oct -Dec ®Jan -March ❑April -June
COUNTY Forsyth
Lab # 34 CENTRAL t"ILPHONE NO [phone]
DIOR W ECTI'—ADD TO LISTSERVE? DYES ®NO EMAIL
DISCHARGING TO CLASS ❑5A ❑HQW
OPTIONAL INFO
❑PNA ❑Trout ®Other
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
method 1664A
SGT HEM'
(mg/L)
Discharge
Duration
(minutes)
Total Flow
�
(gallons/day)
-
-
RM, MD
6-934
303S
53
(15)6
-
001
03/26/15
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
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
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
Pagel 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 HOW 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 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 w�
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 avyare th4fthere are 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
(Date)
Last Revised 07/13/11
Page 2 of 2

%
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No NCG140000
CERTIFICATE OF COVERAGE NO NCG140392
FACILITY NAME Winston-Salem
PERSON COLLECTING SAMPLES Robert Crews
CERTIFIED LABORATORY Research and Analytical Lab # 34
LIMIT VIOLATIONS? YES [:]NO
Part A Wastewater Monitoring Reauirements
REC E I V 99PLE COLLECTION YEAR 2014
JAN 2 0 Z$XMPLE QUARTER ❑Jul -Sept ®Oct -Dec ❑Jan -March ❑April -June
COUNTY Forsyth
CENTRAL FI NE NO [phone]
DWR SECTI� TO LISTSERVE? [-]YES ®NO EMAIL
DISCHARGING TO CLASS [-]SA ❑HQW
OPTIONAL INFO
❑PNA ❑Trout ®Other
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-
6-934
3035
53
(15)6
-
-
001
12/22/14
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 RQ staff
notifies you to continue monitoring
° pH limits are 6-9 S U for wastewater discharges to freshwaters and 6 8-8 S 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
CMD
C*

"'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 di ctly pesponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am awal-e thpt her pre 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
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO NCG140000
CERTIFICATE OF COVERAGE NO NCG140392
FACILITY NAME Winston-Salem
PERSON COLLECTING SAMPLES Tony Hardison
CERTIFIED LABORATORY Research and Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Monitoring Reauirements
SAMPLE COLLECTION YEAR 2014
SAMPLE QUARTER ®Jul -Sept ❑Oct -Dec Dian -March ❑April -June
COUNTY Forsyth
PHONE NO [phone]
ADD TO LISTSERVE? ❑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
{VE, RM, MD}
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
6
SGT FlFM
(mg/L)
Duration
(minutes)
Total Flow
7
(gaifons/day}
-
-
RM, MD
6 93 4
303 s
53
(15)s
-
-
001
9/22/14
RM
726
7
N/A
N/A
>1
>1
/wi,4
owrIGN
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
s TS5 limes are 20 rng/c for wastewater aiscnarges to nQvv waters 10 mg/u Tor Trout ano PIMA waters, ano 30 mg/t Tor an otner water Oassitications
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 dictly sponsible for gathering the information, the Information submitted Is, to the best of my knowledge and belief, true, accurate, and complete
I am aware that rerg,4re 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
(Of6fil
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER -- Quarterly Discharge Monitoring Report RECEIVED
GENERAL PERMIT No. NCG140000 JUL 18 2014
CERTIFICATE OF COVERAGE NO NCG140392
FACILITY NAME Winston-Salem
PERSON COLLECTING SAMPLES Tony Hardison
CERTIFIED LABORATORY Research and Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Monitoring Reauirernents
CENTRAL FILES
DWQ/BOG
SAMPLE COLLECTION YEAR 2014
SAMPLE QUARTER ❑Jul -Sept []Oct -Dec ❑Jan -March ®April -June
COUNTY Forsyth
PHONE NO [phone]
ADD TO LISTSERVE7 []YES ®NO EMAIL
DISCHARGING TO CLASS [:]SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO
Out#all 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 1664A
SGT-HEM6
[mg/Ll
Discharge
Duration
(minutes)
Total Flow
,
(gallons/dayJ
-
-
RM, MD-
6-934
3035
53
(15)6
-
-
001
6/26/14
RM
948
1
N/A
N/A
>1
>1
002
6/26/14
RM
951
2
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
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
" 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 1SA
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 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 CERTIFIG4TION 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 rsonnel 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 Bible for gathering the Information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am aw at t ar igrnficant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations a "
r7�r�-Ar
ign ure lif Permrttee) (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 NCG140413
FACILITY NAME Kings Mtn
PERSON COLLECTING SAMPLES David Morris
CERTIFIED LABORATORY Prism Lab # 402
LIMIT VIOLATIONS? YES ❑ NO
Part A Wastewater Morntorina Requirements
SAMPLE COLLECTION YEAR 2014
REG, .NED
i '1 ti 8 Z014
GEN I KAL FILES
DWQIBQG
SAMPLE QUARTER ❑Jul -Sept [_]Oct -Dec Dian -March ®April -June
COUNTY Cleveland
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, MDRz
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
SGT-HEM'
(mg/L)
Discharge1
Duration
(minutes)
Total Flow
,
(gallons/day)
-
-
RM, MD-
6-93 °
303 5
53
(15)6
-
-
001
6/23/2014
No Flow
JUL 1
8 2014
DWOOOG
..
' 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 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 q lifted personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those person ire y responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am aware 0 a are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
JIY - -7 (-7 BEY
(Sign ture of Permittee) (Date)
Permit Date 7/1/2010 06/30/2015 Last Revised 07/13/11
Page 2 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 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 p onn roperly gather and evaluate the information submitted Based on my inquiry of the person or persons who manage the system, or
those persons direct sp ble for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
I am awarf Aat thgr r nificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations "
atuKe ofPermittee)
Permit Date 7/1/2010-06/30/201S
it fr �t
(Date)
Last Revised 07/13/11
Page 2 of 2