HomeMy WebLinkAboutNCG210136_MONITORING INFO_20190107STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v D 3�
DOC TYPE
❑ HISTORICAL FILE
-JQ MONITORING REPORTS
DOC DATE
❑ 3010,
YYYYM M D D
Semi-annual Stormwater Discharee Monitoring; Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted' 26/2018
CERTIFICATE OF COVERAGE NO. NCG2101 1 3 6 SAMPLE COLLECTION YEAR 2078
FACILITY NAME cdumtAa FareM Products SAMPLE PERIOD [] Jan -June X July -Dec
COUNTY McDowell E C I= I �zu❑ or Monthly' _ (month)
PERSON COLLECTING SAMPLES Auer) Bad- p /� rSRGING TO CLASS ❑ORW ❑❑❑ HQW Trout PNA
LABORATORY Pate A-4tirai Lab Cert. # 375 JN N 0 1 rf Z 01 s ❑Zero -flow ❑Water Supply ❑SA
Comments on sample collection or analysis: ❑Other
CENI3 Intl. FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
n No dischorae this oeriod?2
outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches'
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks - >
-
-
120 mg/L
100 mg/L or 50 mg/L
Outfall #1
12/12/2018
1.00
3.12
3.05
Outfall #2
12112/2018
1.00
5.59
2.95
outfall #3
12112/2016
1.00
c3
1.70
Outfall #4
12112/2018
1.00
<3
1.78
Outfall #5
1211212018
1.00
3.13
1.30
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
' For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
` See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported In numerical format. For example. do not report Below Detection Limit, BDL, aPQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported In the format.'cM mpt/L , where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L
Note., If you report a sample value in excess of the benchmark you must Implement Tler 1, 77er Z or 71er 3 responses. see General Permit text
Permit Date: 8/1/2018-7/31/2023 SWU-245, last revised 8/6/2018
Page 1 of 2
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample
ColleCted'
(mo/dd/yr)
24-hour rainfall.
amount,
inches
Mon -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks ===>
-
-
15 mg/L
100 mg/L or 50 mg/L
Not Applicable
Footnotes from Part A also apply to this Part B
Note: If you report a sample value In excess of the benchmark, you must Implement 71er 2, 71er 2, or 71er 3 responses. See General Permit tart
FOR PART AAND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑■
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YEs ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mall an orfglool and one copy of this DMI, Including all 'No Discharge' reports, within 30 days of receipt of the lab results (or of end
in the case of 'No Discharge' reports) to.-
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 there 7are significant penatt s for submitting false information, including the possibility of fines and imprisonment for knowing violations."
{Signature of Perm (Date)
Permit Date: 9/l/2018-7/31/2023 SWU-245, last revised 8/6/2018
Page 2 of 2
May 24, 2018
Division of Water Quality
Attn: DWQ Central Files RE(tf!jVLz8
1617 Mail Service Center
Raleigh, North Carolina 27699-1617 MAY 31 2018
CENTRAL FILES
RE: Stormwater Discharge Outfall Monitoring Report DWR SECTION
Columbia Forest Products, Old Fort, North Carolina
COC No.: NCG210136
To Whom It May Concern:
Please find attached the Stormwater Discharge Outfall Monitoring Reports for Columbia Forest
Products located in Old Fort, North Carolina (Columbia Carolina). Columbia Carolina operates
under Certificate of Coverage Number NCG210136. Stormwater samples were collected from the
stormwater outfalls on April 26, 2018 and all results met the benchmark values in the permit.
If you have any questions or comment, please contact me at (828) 460-6245.
Sincerely,
Jarrett Rhinehart
Maintenance Manager
Semi-annual Stormwater Discharge Monitorine Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted 01252018
CERTIFICATE OF COVERAGE NO. NCG210136
FACILITY NAME Columbia Forest Products ----
COUNTY McDoweil
PERSON COLLECTING SAMPLES Allan Bartlett
LABORATORY ESC Lab Sciences Lab Cert. 0 375
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2018
SAMPLE PERIOD X❑ Jan June Q July -Dec
or ❑ Monthly} month
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Watersuppty ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A. Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
n No discharge this period??
Outfall No.
Date Sample
Collected'
(coo/ Collected'
244tour rainfall
amount,
inches'
Chemical Oxygen Demand
Total suspended Solids
Benchmarks
-
-
120 mg/L
100 mg/L or 50 mg/L
Outfall#1
4126/2018
0.65
9_18
21A
Outfall #2
4/26/2018
0.65
11.5
11,7
Oudall93
4/2672018
0.65
15.2
11.0
Outfall04
4/26/2018
0.65
8.87
12.0
Ouffall #5
426/2018
0.65
67.7
14.4
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites maybe eligible for a waiver of the rain gauge requirement.
`See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported In numerical format. For gMamglq, do not report Below Detection limit, BDL, cPQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported In the format. `<10l' where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L
Note. if you report a sample value In excess of the benchmark, you must implement Tier I, Tler Z or ner 3 responses. See Generaf Permit text
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
n No discharge this period?2
Outfall No.
Date Sample
Collected'
(mo/dd1 }
24-hour rainfall
amount
Inches
Non -polar 0&0 by EPA
1664 (SGT•HEM)
Total Suspended Solids
Benchmarks —=a
-
15 mg/L
100 mg/L or 50 mg/L
Not Applicable
Footnotes from Part A also apply to this Part B
Note: it you report a sample value In excess of the benchmark, you must Implement Tier 1, Tler 2, or Tier 3 responses. See General permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
e 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACIUTY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMUR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Note- Smmiwatar intensity data was taken frorn Wundergtound.com for the Rvtlterfordton, NC station. The facility will be using a rain gauge going forward for future events.
Mall an orfainal and one coov of this AMR. kncludina all "No Discharge" reoorm. wlihin 30 days of mcelat of the lob resuha for at end of monitorina aerlod
in the case of "No Discharge" rel
Division of Water Quality
Attn: DWQCentral Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
9 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.
am aware that there are significant penalties for submitting false Information, Including the possibility of fines and Imprisonment for knowing violations."
Permit Date: B/1/2013-7/31/2016 SWU-245, last revised 7/31/2013
Page 2 of 2
Semi-annual Stormwater Discharge_Monitorine Report
for North Carolina DEMLR General Permit No. NC6210000
Date submitted 01n512018
CERTIFICATE OF COVERAGE No. NCG21 0136
FACILITY NAME Columbia Forest PtoduCts — — — —
COLINTY MCDuwell
PERSON coiLECTING SAMPLES Allen Bartlett
LABORATORY ESC Lab SCKmXM Lab Cert. # 375
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2017
SAMPLE PERIOD ❑ Jan -June ® July -Dec
or ❑ Monthly' _�monthl
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout QPNA
❑Zero -flow ❑Water Supply ❑SA
[—]Other
PLEASE REMEMBER TO SIGN ON THE REVERSE -i
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
F j No discharge this period??
Outfall No.
Date Sample
Collected'
Imo/ cted
24-hourrainfall
amount,
Inches'
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks
120 mg/L
300 mg/L or so mg/L
Outfall #1
12r21r1017
0.73
-3.0
1.7
Outfall #2
12r21M17
0.73
4.63
3.1
Outfall #3
12/21/2017
0.73
9.64
7.7
Outfall94
12/21=7
0.73
3.81
5.05
Outfall #5
12/21/2017
0.73
3.09
4.9
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
`See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported In numerical format. For example, do not report Below Detection Limit, BDh <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must he reported in the format. '<XX mft/L'. where XX is the numerical value of the
detection limit, reporting limit, etc. In mg/L
Note: !f you report a sample value In excess of the benchmark, you must Implement Tier 1, Tler 2, or 17er 3 responses. see General Permit text:
Permit Date: 8/l/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2
REC I EED
FEB 15 2013
CENTRAL FILES
OWR SECTION
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gai of new oil per month.
n No discharge this period ?2
Outfall No.
Date Sample
Collected'
(mo/dd/ )
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM
Total Suspended Solids
Benchmarks =>
-
-
15 nWL
100 mg/L or 50 mg10
Not Applicable
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the berichmorik, you must implement Tier 1, Tier 2, or Tier 3 responses. See Genera} Permit t text
FOR PART A AND PART B MONITORING RESULTS:
a A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
a 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
a TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMUR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Raw S my watu intensity data was taken from Wunderground.com for the Rutherfordton, NC station. The facility will be using a rain gauge going forward for future events.
Mail on orlafnal and one copy of this DMR Including all No Discharee'reports, within 30 days of receipt of the lob results for at end of monftaring im!?�
In the case of No Dlscharne'reportsl o:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 directly responsible for gathering the Information, the Information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that there are significant penalties for submitting false Information, Including the possibility of fines and Imprisonment for knowing violations."
(Signature of Pe eel (Date)
Permit Date: B/l/2013-7/31/2018 SWU-245, last revised 7/3112013
Page 2 of 2
February 8, 2017
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Stormwater Discharge Outfall Monitoring Report
Columbia Forest Products, Old Fort, North Carolina
COC No.: NCG210136
To Whom It May Concern:
PIease find attached the Stormwater Discharge Out -fall Monitoring Reports for Columbia Forest
Products located in Old Fort, North Carolina (Columbia Carolina). Columbia Carolina operates
under Certificate of Coverage Number NCG210136. Stormwater samples were collected from the
stormwater outfalls on December 21, 2017 and all results met the benchmark values in the permit.
Due to weather there was a delay in the cooler reaching the lab. The final lab report was received
on January 24, 2018.
If you have any questions or comment, please contact me at (828) 460-8556.
Sincerely,
earre'tt Rhinehart
Maintenance Manager
February 8, 2017
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Stormwater Discharge Outfall Monitoring Report
Columbia Forest Products, Old Fort, North Carolina
COC No.: NCG210136
To Whom It May Concern:
Please find attached the Stormwater Discharge Outfall Monitoring Reports for Columbia Forest
Products located in Old Fort, North Carolina (Columbia Carolina). Columbia Carolina operates
under Certificate of Coverage Number NCG210136. Stormwater samples were collected from the
stormwater outfalls on December 21, 2017 and all results met the benchmark values in the permit.
Due to weather there was a delay in the cooler reaching the lab. The final lab report was received
on January 24, 2018.
If you have any questions or comment, please contact me at (828) 460-8556.
Sincerely,
Jarrett Rhinehart
Maintenance Manager
July 24, 2017
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Stormwater Discharge Outfall Monitoring Report
Columbia Forest Products, Old Fort, North Carolina
COC No.: NCG210136
To Whom It May Concern:
Please find attached the Stormwater Discharge Outfall Monitoring Reports for Columbia Forest
Products located in Old Fort, North Carolina (Columbia Carolina). Columbia Carolina operates
under Certificate of Coverage Number NCG210136. Stormwater samples were collected from the
stormwater outfalls on June 29, 2017 and all results met the benchmark values in the permit.
If you have any questions or comment, please contact me at (828) 460-8556.
Sincerely,
Jarrett Rhinehart
Maintenance Manager
RECEIVED
JUL � g 2017
CeNTRAL FILES
DWR SECTION
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted 7/24/2017
CERTIFICATE OF COVERAGE NO. NCG21 0136
FACILITY NAME Columbia Forest Products — — — —
COUNTY McDowell
PERSON COLLECTING SAMPLES Bill Presnell
LABORATORY ESC Lab Sciences Lab Cert.1i 375
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2017
SAMPLE PERIOD x❑ Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow [-]water Supply [:]SA
[-]Other
PLEASE REMEMBER TO SIGN ON THE REVERSE --!
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
❑ No discharge this period?z
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
inches"
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks ===�
_
-
120 mg/L
100 mg/L or 5d mg/L
Outfall #1
6/29/2017
0.15
3.17
11.2
Outfall 42
6/29/2017
0.15
5.09
6.84
outfall #3
6/29/2017
0.15
<3.0
6.3
Outfatl #4
6/29/2017
0.15
<3.0
9.33
Outfall #5
6/29/2017
0.15
<3.0
7.8
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX me/L". where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note: if you report a sample value in excess of the benchmark, you must implement firer 1, Trer 2, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?'
Out#all No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks
15 mg/L
100 mg/L or 50 mg/L
Not Applicable
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART It SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXC£EDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Note: Stormwater intensity data was taken from Wunderground.com for the Rutherfordton, NC station. The facility will be using a rain gauge going forward for future events.
Mall an original and one copy of this DMR, including all "No Discharsre" reports, within 30 days of receipt of the lob results for at end of monitorina period
in the case of "No Discharae" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 personas 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 penaltjwsl"bmitting false information, including the possibility of fines and imprisonment for knowing violations."
Permittee)
Permit Date:8/1/2013-7/31/2018
(Da(e)
SWU-245, last revised 7/31/2013
Page 2 of 2
Semi-annual Stormwater Discharge Monitorinp, Report
for North Carolina DEMLR General Permit No. NCG210000
CERTIFICATE OF COVERAGE NO. NCG210136
FACILITY NAME Columbia Forest Products — —
COUNTY McDowell
PERSON COLLECTING SAMPLES
LABORATORY ESC Lab Sciences
Bill
Lab Cert. # 375
Comments on sample collection or analysis:
Date submitted 1/2/2016
SAMPLE COLLECTION YEAR 2016
SAMPLE PERIOD ❑ Jan -June 0 July -Dec
or ❑ Monthly' _(month)
RECE f �QILCCVjRGING TO CLASS ❑ORW ❑Haw ❑Trout ❑PNA
❑Zero -flow ❑Water Supply [_]SA
JAN 1 3 2017 []other
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
❑ No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks W=->
_
-
120 mg/L
100 mg/L or 50 mg/L
Outfall #1
12/28/2016
0.03
<3.0
0.526
Outfall #2
12/28/2016
0.03
9.35
1.19
Outfall #3
12/28/2016
0.03
9.41
0.9
Outfall #4
12/28/2016
0.03
4.490
0_7
Outfall #5
12/28/2016
0.03
<3.0
0.7
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
° See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX me/L", where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?-7
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks =__>
-
-
15 mg/L
100 mg/L or 50 mg/0
Not Applicable
Footnotes from Part A also apply to this Part B
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, includina all "No Discharae" reports, within 30 days of receipt of the lab results for at end of monitorina oeriod
in the case of "No Discharae" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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
am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
-AZI
(Date)
Permit Date: 8/1/2013-7/31/2018
SWU-245, last revised 7/31/2013
Page 2 of 2
September 13, 2016
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Stormwater Discharge Outfall Monitoring Report
Columbia Forest Products, Old Fort, North Carolina
COC No.: NCG210136
To Whom It May Concern:
Please find attached the Stormwater Discharge Outfall Monitoring Reports for Columbia Forest
Products located in Old Fort, North Carolina (Columbia Carolina). Columbia Carolina operates
under Certificate of Coverage Number NCG210136. During a review of facility files it was
identified that DMRS for the:2014 and 2015 reporting years had not been submitted to the Division
of Water Quality.
Columbia Carolina has set up a system to prevent this from happening again. Our new system is set
up with sampling kits complete with instructions ready for an event. The kits/coolers are shipped
directly to the lab. Once data is available it is provided electronically jointly to Columbia and our
consultant for prompt review and preparation of the DMRs. Additionally Columbia has clarified the
requirements and expectations with the individuals involved in the sampling and reporting roles.
This is training beyond our annual stormwater training.
If you have any questions or comment, please contact me at (828) 460-6245.
Sincerely,
,�A., 4
Jarrett Rhinehart
Maintenance Manager
RECEIVED
SEP 2 2 2016
CEN'RAL FILES
DWR SECTION
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted 814/2016
CERTIFICATE OF COVERAGE NO. NCG21 0136
FACILITY NAME Columbia Forest Products — — — —
COUNTY McDowell
PERSON COLLECTING SAMPLES
LABORATORY
SAMPLE COLLECTIONXEAR -20141
SAMPLE PERIOD x❑ Jan -June ❑ July -Dec
or []monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow []Water Supply ❑SA
Comments on sample collection or analysis: ❑Other
No sample was collected during this period Columbia Carolina has since set up a system to prevent this from happening again.
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
3
Inches
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks
120 mg/L
100 mg/L or 50 mg/L4
Outfall #1
Outfall #2
Outfall #3
SEr 2 2 Z01b
Outfall #4
CENT
Outfall #5
DWR SECTION
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not retort Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX me/L". where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 1, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2
Part 6: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
No discharge this period:2
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks ===>
-
-
15 mg/L
100 mg/L or 50 mg/L4
Not Applicable
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART It SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMUR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one cony of this DMR, includina all "No Discharge" reports, within 30 days of receipt of the lob results (or at end of monitoring period
in the case of "No Discharge" re orts to:
Division of Water Quality
Attw DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
,(Signature of
9i� iG
( Date
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 2 of 2
Semi-annual Stormwater Discharge Monitoring Report
For North Carolina DEMLR General Permit No. NCG210000
Date submitted 8/4/2016
CERTIFICATE OF COVERAGE NO. NCG21 0136
FACILITY NAME Columbia Forest Products
COUNTY McDowell
PERSON COLLECTING SAMPLES James and James Environmental Management
LABORATORY Research & Analytical LaboratofWb Cert. # 34
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2014
SAMPLE PERIOD ❑ Jan -June x0 July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
[]zero -flow ❑Water Supply ❑SA
❑Other
PLEASE REMEMBER TO SIGN ON THE REVERSE ->
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
inches'
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks =__>
-
-
120 mg/L
100 mg/L or 50 mg/L4
Outfall #1
12/19/2014
0.06
13
7•B1
Outiall #2
12/19/2014
0.06
9
4.31
Outfall #3
12/19/2014
0.06
<5
2.5
OutfaO #4
12/1912014
0.06
<5
3.3
Outfall #5
211912014
0.06
No Flow
No Flow
RECEIVED
SEP 2 2 2016
CENTRAL. FILES
DWR SECTION
' Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mpL where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
-Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 1, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 SWU-245, last revised 7/31/2013
Page 1 of 2
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks ===>
-
-
15 mg/L
100 mg/L or 50 mg/L4
Not Applicable
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE SAME OUTFALLTRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one co��o this DMR, includina all "No Discharae" reports, within 30 days of receipt of the lab results (or at end of monitoring period
in the case of "No Discharae" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
.(Signature of
Permit Date: 8/1/2013-7/31/2018
(Date)
SWU-245, last revised 7/31/2013
Page 2 of 2
Semi-annual Storm_ _water Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted 8/4/2016
CERTIFICATE OF COVERAGE NO. N.CG210136
FACILITY NAME Columbia Forest Products
COUNTY McDowell
PERSON COLLECTING SAMPLES Sill Presnell
LABORATORY SSC Lab Sciences Lab Cert. # 375
Comments on sample collection or analysis:
SAMPLE COLLECTION YEAR 2016
SAMPLE PERIOD x❑ Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
RECEIVED ❑Zero -flow ❑Water supply ❑SA
AUG 0 9 2016 ❑Other
CENTRAL PILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DVVR SECTION
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.),O
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks
-
-
120 mg/L
100 mg/L or 50 mg/0
Outfall #1
6/29/2016
0.16
10.8
2.7
Outfall #2
6/29/2016
0.16
14.6
10.4
Outfall #3
6/29/2016
0.16
13.8
13
Outfalf #4
6/29/2016
0.16
11.2
9.89
Outfall #5
6129/2016
0.16
11.2
9.79
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format. "<XX me/L", where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date: 8/1/2013-7/31/2018 5WU-245, last revised 7/31/2013
Page 1 of 2
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?'
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
inches
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarlcs
15 mg/L
100 mg/L or 50 mg/L
Not Applicable
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS, SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDANCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, includina all "No Discharae" reports, within 30 days of receipt of the lab results for at end of monitorina period
in the case of "No Discharae" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
( ate)
Permit Date: 8/1/2013-7/31/2018
SWU-245, last revised 7/31/2013
Page 2 of 2
At
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina DEMLR General Permit No. NCG210000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG21-0136
FACILITY NAME Columbia Forest Products -"'-
COUNTY McDowell
PERSON COLLECTING SAMPLES
LABORATORY Lab Cert. #
SAMPLE COLLECTION YEAR 2015
SAMPLE PERIOD ❑ Jan -June X❑ July -Dec
or ❑ Monthly) (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply [:]SA
Comments on sample collection or analysis: ❑Other
No sample was collected during this period Columbia Carolina has since set up a system to prevent this from happening again.
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results (Monitoring is required only if the facility stores exposed accumulations of sawdust, wood chips,
bark, mulch, or other similar material on site for longer than seven (7) days.)
❑ No discharge this period?z
Outfall No.
Date Sample
Collected
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Chemical Oxygen Demand
Total Suspended Solids
Benchmarks
120 mg/L
100 mg/L or 50 mg/L4
Outfall #1
Outfall #2
Outfall #3
Outfall #4
Outfall #5
RECEIVED
W 2 2 2016
CENTRAL FILES
DWR SECTION
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
Z For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
3 The total precipitation must be recorded using data from an on -site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Note: Results must be reported in numerical format. For example, do not report Below Detection Limit, BDL, <PQL, Non -detect, ND, or other similar non -
numerical format. When results are below the applicable limits, they must be reported in the format, "<XX mg/L", where XX is the numerical value of the
detection limit, reporting limit, etc. in mg/L.
Note. if you report a sample value in excess of the benchmark, you must implement T1er 1, Tier 2, or Tier 3 responses. See General Permit text.
Permit Date:8/1/2013-7/31/2018
SWU-245, last revised 7/31/2013
Page 1 of 2
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
❑ No discharge this period?z
Outfall No.
Date Sample
Collected'
(mo/dd/yr)
24-hour rainfall
amount,
Inches3
Non -polar O&G by EPA
1664 (SGT-HEM)
Total Suspended Solids
Benchmarks ===>
-
-
15 mg/L
100 mg/L or 50 mg/L°
Not Applicable
Footnotes from Part A also apply to this Part B
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 1, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DEMLR REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one copv of this DMR. includina all "No Discharae" reports. within 30 days of receipt of the lab results for at end of monitorina period
in the case of "No Discharge' reports) to
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
Permit Date: 8/1/2013-7/31/2018
7/
(Date)
SWU-245, last revised 7/31/2013
Page 2 of 2