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Home My WebLink AboutNCG020106_MONITORING INFO_20190225STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. /V CiC�UA�D�U�v DOC TYPE 0 HISTORICAL FILE MONITORING REPORTS DOC DATE rl G�Ol� U� YYYYMMDD STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. NCGNE DOC TYPE ❑ HISTORICAL FILE DOC DATE ❑ YYYYMMDD ANNUAL SUMMARY DISCHHARGE MONITORING REPORT (DMR) - STORMWATER SUBMIT TO CENTRAL OFFICE* General Permit No. NCG020000 Calendar Year 2018 *Report ALL STORMWATER monitoring data on this form (Include "No Flow" 1"No Discharge" and Benchmark Exceedances) from the previous calendar year to the DEQ by MARCH 9 of each year Certificate Coverage No NCG020106 Martin Marietta Materials, Inc - Pee Dee Quarry County Anson Phone Number 803 978-6275 Certified Laboratory Pace Analytical Lab # 12 Lab # Total no of SDO's monitored 0 Stormwater Discharge Outfall (SDO) No NIA VMA Outfall? Yes No X Is the outfall currently in Tier 2 for any parameter? Yes No X Was the outfall ever in Tier 2 during the past year? Yes No X If the 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 No turbidity benchmark exceedances did not require monthly monitoring Other Outfall No Rainfall, inches mgll SS, mill ENTW NPAStream [Turbitlity NTU DownstreamR [D} Turbidity NTU NewTotalTSS Motor Oil Usage----------- allmo Stormwater Benchmarks Indicate NO FLOW if a l+cable Benchmark Benccirclehmark 10 50 0 1 BencCirclehmark 6anchmark 1��1125110 NA Water puahty Standard a has NA water Quality Standard al a 15 ere ga�ma average requires t bb and Non l monitoring 9 Date Sample Collected, molddl r WEEMMMMM No SW Outfalls Exist on Site No SW Outfails Exist on Site Pee Dee Quarry is an undeveloped green site S VI t SV Permit Date 10/1/2015 - 9/30/2020 Last Revrsed 10/2/2015 Certificate Coverage No NCG020106 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 violation " [Required by 40 CFR §122 221 Signature Date 2118/19 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 (919) 807-6300 Questions'? Contact DEMLR Stormwater Permitting Staff in the Central Office at (919) 707-9220 Permit Date 1011/2015 - 9/30/2020 Last Revised 101212015 ANNUAL SUMMARY DISCHHARGE MONITORING REPORT (DMR) - WASTEWATER II SUBMIT TO CENTRAL OFFICE* II General Permit No. NCG020000 Calendar Year 2018 "Report ALL WASTEWATER monitoring data on this form (include "No Flow'TNo Discharge" and Limit Violitions) from the previous calendar year to the DEQ by MARCH 1 of each year Certificate Coverage No NCG020106 Facility Name Martin Marietta Materials, Inc - Pee Dee Quarry County Anson Phone Number 803 978-6275 Total no of outfalls monitored 1 Certified Laboratory Pace Analytical Lab # 12 Lab # Wastewater (WW) Discharge Outfall No 001 Is this an industrial sand mine (See 40 CFR §436 Subpart D)? Yes No X Does this outfall discharge WW to SA waters? Yes No X Does this outfall discharge WW to SB or PNA waters? Yes No X Does this outfall discharge WW to li or ORW waters? Yes No X If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7010 not available Does this outfall discharge WW to Trout (Tr) designated water Yes No X Were there any limit violations in the calendar year? Yes No X Outfall No 00,1 Daily Flow Rate, cfs pH, SU TSS, mgll SS, mill f applicable Discharge Turbidity NTiU Upstream (U) Turbidity NTU Downstream (D) Turbidity NTU Fecal Colifarm, co111e ml ISA Effluent Limitations Mo Ave! Daily Max HOW orORW 50% of 7Q10 Indicate NO FLOW t/apphcabla Freshwater 6 0-9 0 Saltwater 6 8-8 5 Industrial 25145 HQW of 20/30 HOW or OR and Tr or PNA 10115 s sa PNA or any Trout 0 1 /0 2 No Limit Circle Water Ouallty Standard that applies (D12511 0 NA Water Quality Standards Applies NA Water Quality Standards Applies NA Date Sample Collected, moldd! r No Discharge No Flow No Discharge No Flow No Discharge No Flow CENTR ; FLEE No Discharge No Flow la VR SECTIL'=' Pee Dee Quarry Is an undeveloped greenslte No Discharges are occuring Permit Date 1011l2015 - 9/30/2020 Last Revised 101212015 Certificate Coverage No NCG020106 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 systei 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 violation " (Required by 40 CFR §122 221 _., Signature /TyGfiG Date 2/18/19 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 (919) 807-6300 Questions'? Contact DEMLR Stormwater Permitting Staff in the Central Office at (919) 707-9220 Permit Date 10/112015 - 9/30/2020 Last Revised 101212015 ANNUAL SUMMARY DISCHHARGE MONITORING REPORT (DMR) - STORMWATER SUBMIT TO CENTRAL OFFICE* General Permit No. NCG020000 RECEIVED Calendar Year 2017 FEB 21 2018 `Report ALL STORMWATER monitoring data on this form (include "No Flow'T No Di0dhhfbaTant1jj3W,%hmark Exceedances) from the previous calendar year to the DEQ by MARCH 1 Wdkbl$�QTI ON Certificate Coverage No NCG020106 Martin Marietta Materials, Inc - Pee Dee Quarry County Anson Phone Number 803 978-6275 Total no of SDO's monitored 0 Certified Laboratory Pace Analytical Lab # 12 Lab # Stormwater Discharge Outfall (SDO) No NIA VMA Outfall? Yes No X Is the outfall currently in Tier 2 for any parameter'? Yes No X Was the outfall ever in Tier 2 during the past year? Yes No X If the 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 No, turbidity benchmark exceedances did not require monthly monitoring Other Permit Date 10/112015 - 9/30/2020 Last Revised 101a2015 Certificate Coverage No NCG020106 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 violation " (Required by 40 c Signature Date Mail Annual Summary Stormwater DMR to the NCDEQ Central Office Note the address is correct — Central Files is housed in DWR (not DEMLR) N C Department of Environmental Quality (DEQ) Division of Water Resources Attn DWR Central Files 1617 Mail Service Center Raleigh, NC 27699-1617 Central Files Telephone (919) 807-6300 Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at (919) 707-9220 Permit Date 10/1/2015 - 9/3012020 Last Revised 101212015 ANNUAL SUMMARY DISCHHARGE MONITORING REPORT (DMR) -WASTEWATER SUBMIT TO CENTRAL OFFICE* General Permit No. NCG020000 Calendar Year 2017 'Report ALL WASTEWATER monitoring data on this form (include "No Flow"1"No Discharge" and Limit Violitions) from the previous calendar vear to the DEQ by MARCH 1 of each vear._ _ __ ., — � Certificate Coverage No NCG020106 Facility Name Martin Marietta Materials, Inc - Pee Dee Quarry FEB 2 2013 County Anson CENTRAL FILES Phone Number (803) 978-6275 Total no of outfalls mWijge�ECTION Certified Laboratory Pace Analytical Lab # 12 Lab # Wastewater (WW) Discharge Outfall No 001 Is this an industrial sand mine (See 40 CFR §436 Subpart D)? Yes No X Does this outfall discharge WW to SA waters? Yes No X Does this outfall discharge WW to SB or PNA waters? Yes No X Does this outfall discharge WW to HQW or ORW waters? Yes No X If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available Does this outfall discharge WW to Trout (Tr) designated water Yes No X Were there any limit violations in the calendar year? Yes No X Permit Date 10/1/2015 - 9/30/2020 Last Revised 10/2/2015 Certificate Coverage No NCG020106 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 syste 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 violation " [Required by 40 CFR §122 22j _ \ , Signature Date 2/9/18 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 (919) 807-6300 Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at (919) 707-9220 Permit Date 10/1/2015 - 9/30/2020 Last Revised 10/2/2015 ANNUAL SUMMARY DISCHHARGE MONITORING REPORT (DMR) -WASTEWATER SUBMIT TO CENTRAL OFFICE" General Permit No. NCG020000 Calendar Year 2016 'Report ALL WASTEWATER monitoring data on this form (include "No Flow"/"No Discharge" and Limit Violitions) from the previous calendar year to the DEQ by MARCH I of each year Certificate Coverage No NCG020106 Facility Name Martin Marietta Materials, Inc - Pee Dee Quarry County Anson Phone Number (803) 978-6275 Total no of outfalls monitored 1 Certified Laboratory Pace Analytical Lab # 12 Lab # Wastewater (WW) Discharge Outfall No 001 Is this an industrial sand mine (See 40 CFR §436 Subpart D)? Yes No X Does this outfall discharge WW to SA waters? Yes No X Does this outfall discharge WW to SB or Pill waters? Yes No X Does this outfall discharge WW to HOW or ORW waters? Yes No X If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available Does this outfall discharge WW to Trout (Tr) designated water Yes No X Were there any limit violations in the calendar year? Yes No X Outfall No 001 Daily Flow Rate, cfs pH, SU TSS, mgll SS, mlll ifapplicable Discharge Turbidity NTU Upstream (U) Turbidity NTU Downstream (D) Turbidity NTU Fecal Coliform, co11100 ml SA Effluent Limitations Mo Ave ! Daily Max HOW orORW 50% of 7Q10 Indicate NO FLOW rfapplrCable Freshwater 6 0-9 0 Saltwater 6 8-8 5 Industrial 25145 HOW or ORW 20130 HOW or OR an Tr or PN 1 0115 HOW or ORW SA SB PNA or any Trout A 0 110 2 No Limit Circle Water Quality Standard that applies �12J11l� V NA Water Quality Standards Applies NA Water Quality Standards Applies NA Date Sample Collected, molddlyr E Mimi= I No Discharge No Flow No Discharge No Flow No Discharge No Flow No Discharge No Flow CENTRAL FILE Pee Dee Quarry is an undeveloped greensite No Discharges are occuring Permit Date 10/1/2015 - 9/30/2020 Last Revised 10/2/2015 C Certificate Coverage No NCG020106 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 syste 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, includin the possibility of fines and imprisonment for knowing violation " [Required by 40 CFR §132 221 A Signature _ /"L"' Date 2/16/17 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 (919) 807-6300 Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at (919) 707-9220 Permit Date 10/112015 - 9/3012020 Last Revised 101212015 ANNUAL SUMMARY DISCHHARGE MONITORING REPORT (DMR) - STORMWATER SUBMIT TO CENTRAL OFFICE* General Permit No. NCG020000 Calendar Year 2016 "Report ALL STORMWATER monitoring data on this form (Include "No Flow"PNo Discharge" and Benchmark Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year Certificate Coverage No NCG020106 Martin Marietta Materials, Inc - Pee Dee Quarry County Anson Phone Number 803 978-6275 Total no of SDO's monitored 0 Certified Laboratory Pace Analytical Lab # 12 Lab # Stormwater Discharge Outfall (SDO) No NIA VMA Outfall? Yes No X Is the outfall currently in Tier 2 for any parameter? Yes No X Was the outfall ever in Tier 2 during the past year? Yes No X If the 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 No, turbidity benchmark exceedances did not require monthly monitoring Other Outfall No ........... Total Rainfall, inches TSS mgll SS, mill Turbidity, NTU Upstream (U) Turbidity NTU Downstream (D) Turbidity NTU Non -polar O&G, mg1I VMA New Motor Oil Usage allmo Stormwater Benchmarks Indicate NO ROW+! a !+cable CircleCr°le Benchmark 0 50 0 1 Benchmark Q25110 NA Water Quality Standard applies NA water aReli Standard a lies 15 'sSgaem° average requires Nor polar Tosc monitoring Date Sample Collected,MEEMIM molddlyr , No SW Outfalls Exist on Site No 5W Outfalls Exist on Site o NR SECTION Pee Dee Quarry is an undeveloped green site Permit Date 10/1/2015 - 9/30/2020 Last Revised 10/2/2015 Certificate Coverage No NCG020106 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 violation " [Required by 40 CFR §122 221 -:pl .I - Signature Date 2/16/17 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 (919) 807-6300 Questions'? Contact DEMLR Stormwater Permitting Staff in the Central Office at (919) 707-9220 Permit Date 1011/2015 - 9/30/2020 Last Revised 101212015 II ANNUAL SUMMARY DMR - STORMWATER II SEND TO CENTRAL OFFICE* STORMWATER DISCHARGE OUTFALLS (SDO) GENERAL PERMIT NO. NCG020000 *ReportAI I STORMWATFR Monitoring Data on this Conn (mcluding No Flox and No Discharge and Pcrrna I ima Violations) by MARCH I of each year CERTIFICATE OF COVERAGE NO NCG020106 SAMPLE COLLECTION YEAR- 2015 FACILITY NAME Pee Dee Quarry COUNTY- Anson PERSON COLLECTING SAMPLES NIA PHONE NO (704) 525-7740 CERTIFIED LABORATORY PACE ANALYTICAL Lab #12 ADD TO LISTERVE9 YES ❑ NO ❑ EMAIL Part A Stonnwater Monitoring Requirements Outfall No Date Sample Collected (mo/dd/yr OR NO FLOW)' In Tier 2 Monthly Monttoring' (1n) # of Months in Tier 2 Sampling Total Flow (MG) Total Suspended Solids (mg/1) Turbidit)4 (NTU) Settleable Solids (mVl) Total Rainfall (in) Event Duration - - - - - low, See Footnote}° 01 ] No SW Outtalls Exist on Site Pee Dee QuarrN is an undevelo ed green site ilt "NO FLOW" or "NO DISCHARGE," enter "NO FLOW" or "NO DISCHARGE' for each outfall here and the Date Range 2Per NCG02 Tier 2 Monthly Sampling shall bt done until 3 consecutive samples are below the benchmark or within the benchmark range `It a value is in excess of the benchmark or outside the benchmark range (for pH) you must implement the Teir l or Tier 2 responses in the General Permit 'TSS benchmark values are 100 mg/l except in ORW HWQ trout and PNA waters where thty are 50 mg/1 SThe discharge shall not cause an instantaneous measurement of thi, turbidity of the receiving water to exceed 10 NTU for freshwater streams, lakes and reservoir designated as trout waters 25 NTU for all lakes and reservois, and all salt water 50 NTU for all other streams and surface waters Turbidity may be monitored at the SDO Alternatively the pennntee may choose to monitor turbidity in the receiving water directly upstream and downstream oftht SDO Permit Date 1/1/2010-12/31/2014 Last Revised 01-21-11 Page 1 of 2 Part A Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month on average Outfall No Date Sample Collected (mo/ddlyr OR NO FLOW)' In Tier 2 Monthly Momtoringl Wit) # of Months in Tier 2 Sampling New Motor Oil Usage (gal/month) Total Flow (MG) TPH using method 1664A SGT-HEAT (mg/1) Total Suspended Solids (mg/0 pH (Standard Units) Total Rainfall (,n) E"ent Duration - - 15' 100 ° 6-9 3 N/A 0 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)9 YES ❑ NO ❑ HAVE YOU CONTACTED THE REGIONS YES ❑ NO ❑ WHO AT THE REGION HAVE YOU SPOKEN WITH-) MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE" & LIMIT VIOLATIONS) BY MARCH l OF EACH YEAR TO Division of Water Quality Attn DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919)807-6300 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMA TION REPORTED "1 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 sumbitted 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 imprisionment for knowing violations " "'A)sz, (Signature of Permittee Permit Date I/l/2010-12/31/2014 (Date) 2/15/16 Last Revised 01-21-11 Page 2 of 2 ANNUAL SUMMARY DMR - WASTEWATER C.- SEND TO CENTRAL OFFICE* PROCESS MINE/DEWATERING WASTEWATER GENERAL PERMIT NO NCG020000 *Report 411 Wastes ater discharge monitoring data on this form (including No Floii and No Discharge and Permit Limit Violations) by MARCH 1 of each year If you have limit violations, you must also have turned in a Limit Violation DMR to your local Regional office within 30 days of receiving sample results from a lab CERTIFICATE OF COVERAGE NO NCG020106 FACILITY NAME Pee Dee Quarry PERSON COLLECTING SAMPLES NIA CERTIFIED LABORATORY PACE ANALYTICAL Lab #12 LIMITS VIOLATIONS? YES [--]NO ❑ Part A Wastewater Monitoring Reauirements SAMPLE COLLECTION YEAR 2015 COUNTY Anson PHONE NO (704) 525-7740 ADD TO LISTERVE9 YES ONO ❑EMAIL INDUSTRIAL SAND I'? ❑ DISCHARGE TO SA WATERS4? L■I Outtall No Date Sample Collected' 50050 Total Flow 00530 Total Suspended Solids 00400 Turbidity3 00545 Settleable Solids 00400 pH 31616 Fecal Coliforms - nmVdd/yr MG m 1 i 2 NTU 2 3 m1/12 Standard' col/nil 2 4 Pit Discharge NO DISCHARGE NIA Pit Discharge NO DISCHARGE NIA Ptt Discharge NO DISCHARGE NIA Pee Dee Quarry is an undeveloped greensite No discharges are occurm 'All mines must monitor WW discharges for TSS Only industrial sand mine discharges are subject to TSS hints 2[t an tAuent limit is exceeded the permitteE is required to institute monthly monitoring for that parameter for the remaining permit term 3The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed 10 NTU for freshwater streems, lakes and reservoirs designated as trout waters, 25 NTU for all lakes and reservoirs, and all salt waters, 50 NTUfor all other streams and srutar a waters Turbidity may be monitored at the Stormwater Discharge Outfall Alternatively the permittee may choose to monitor turbidity in the receiveing water, directly upstream and downstream of the discharge aOnly tacilitit-s discharging to SA watt rs are required to monitor for FLcal coliforms Permit Date 1/1/2010-12/31/2014 Last Revised 01-05-10 Page 1 of 2 Part A Continued Wastewater Monitoring Requirements Outfall No Date Sample Collected 50050 Total Flow 00530 Total Suspended Solids 00400 Turbidity3 00545 Settleable Solids 00400 pH 31616 Fecal Coliforms - mm/ddl MG m /l 12 NTU2 3 ml/Iz Standard col/mlz 4 MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE" & LIMIT VIOLATIONS) BY MARCH I OF EACH YEAR TO Division of Water Quality Attn DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 YOU MUST SIGN THIS CERTIFICA TION 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 sumbitted 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 complet I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisionment for knowing violations " (Signature of Permittee) Permit Date I/l/2010-12/31/2014 2/12/16 (Date) Last Revised 01-05-10 Page 2 of 2 ANNUAL SUMMARY DISCHHARGE MONITORING REPORT (DMR) -WASTEWATER rk SUBMIT TO CENTRAL OFFICE* 11 General Permit No. NCG020000 Calendar Year 2015 *Report ALL WASTEWATER monitoring data on this form (include "No Flow'T'No Discharge" and Limit Volitions) from the previous calendar year to the DEQ by MARCH 1 of each year Certificate Coverage No NCG020106 Facility Name Martin Marietta Materials, Inc - Pee Dee Quarry County Anson Phone Number (803) 978-6275 Total no of outfalls monitored 1 Certified Laboratory Pace Analytical Lab # 12 Lab # Wastewater (WW) Discharge Outfall No 001 Is this an industrial sand mine (See 40 CFR §436 Subpart D)? Yes No X Does this outfall discharge WW to SA waters? Yes No X Does this outfall discharge WW to SB or PNA waters? Yes No X Does this outfall discharge WW to HOW or ORW waters? Yes No X If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available Does this outfall discharge WW to Trout (Tr) designated water Yes No X Were there any limit violations in the calendar year? Yes No X Fecal Daily Flow pH, TSS, SS, Discharge Upstream Downstream Coliform, Outfall No Rate, cfs SU mgll mill Turbidity (U) Turbidity (D) Turbidity co11100 ml 001 if applicable NTU NTU NTU SA Industrial HOW or ORW Freshwater 25145 Effluent 50% of 6 0-9 0 HOW or 01 A SS °NA No Limit NA NA Limitations 7Q10 Saltwater 20130 or any Trout circle Water Water Quality Water Quality NA Quality Standard Standards Applies Standards Applies 6 8-8 5 HOW or OR 0 110 2 that applies Mo Ave ! gaily Max Indicate NO FLOW pLd Tr or PN if applicabin 10115 5 125110 Date Sample Collected, moldd/yr No Discharge No Flow Pee Dee Quarry is an undeveloped greensite No Discharges are occuring Permit Date 101112015 - 9/30/2020 Last Revised 10/2/2015 Certificate Coverage No NCG020106 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 syste 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 violation " [Required by 40 1 Signature Date 2112/16 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 (919) 807-6300 Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at (919) 707-9220 Permit Date 10/1/2015 - 9130/2020 Last Revised 101212015 I ANNUAL SUMMARY DMR - WASTEWATER I II SEND TO CENTRAL OFFICE* 11 PROCESS MINEIDEWATERING WASTEWATER GENERAL PERMIT NO. NCG020000 * Report All Wastewater discharge monitoring data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH I of each year If you have limit violations, you must also have turned in a Limit Violation DMR to your local Regional Office within 30 days of receiving sample results from a lab CERTIFICATE OF COVERAGE NO NCG020089 FACILITY NAME Imerys Mica Kings Mountain, Inc PERSON COLLECTING SAMPLES _Tom Holmes CERTIFIED LABORATORY Prism Laboratories Lab # 402 Lab # LIMIT VIOLATIONS' YES ® NO ❑ Part A Wastewater Monitoring Requirements SAMPLE COLLECTION YEAR 2014 COUNTY. Cleveland PHONE NO (_704__)_739-3105 ADD TO LISTSERVE9 YES ® NO[:] EMAIL dawn whaley@imerys com_ INDUSTRIAL SAND" ❑ DISCHARGING TO SA WATERS°, ❑ Outfall No DateISample Collected t I Total Flow Total Suspended Solids' Turbidity' Settleable Solids pH Fecal Coliforms - mm/ddlyr MG mg/1 NTU ml/l Standard col/ml ' l 2t2l/14 0 5 3900 No Sample No Sample No Sample N/A 1 6/30/14 05 5800 7500 010 7 6 NIA 1 9129/14 05 670 82 brl 68 N/A 1 12/23/14 05 1000 2100 010 64 N/A 2 2/21/14 No Flow 0 0 0 0 N/A 2 6130/14 01 68 13 01 72 NIA 2 9129/14 01 28 3 8 brl 71 N/A 2 12/23/14 of 79 83 brl 6 0 N/A 3 2121/14 No Flow 0 0 0 0 N/A 3 6/30/14 01 10 92 brl 8 0 NIA 3 9/29/14 No Discharge 0 0 0 0 NIA 3 12/23/14 01 51 28 brl 67 N/A 4 2/21/14 03 140 110 brl 67 N/A 4 &30/14 03 62 160 040 6.3 N/A 'All mines must monitor WW discharges for TSS Only industrial sand mine discharges are subject to TSS limits z If an effluent limit is exceeded, the permittee is required to institute monthly monitoring for that parameter for the remaining permit term 3 The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed 10 NTU for freshwater streams, lakes, and reservoirs designated as trout waters, 25 NTU for all lakes and reservoirs, and all salt waters, 50 NTU for all other streams and surface waters Turbidity may be monitored at the Stormwater Discharge Outfall Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the discharge 4 Only facilities discharging to SA waters are required to monitor for Fecal coliforms : - C.2 LJ6' ,.a L.La. Permit Date 1/1/2010-12/31/2014 Last Revised 02-02-1 1 Page] of 2 Part A Continued Wastewater Monitoring Reauirements Outfall No. Date Sample Collected' 1 Total Flow Total Suspended Solids' Turbidity3 Settleable Solids pH Fecal Cohforms - mm/dd/yr MG mg/l 1.2 NTU ml/l Standard 24 col/ml 4 9/29/14 No Discharge 0 0 0 0 N/A 4 12/23/14 01 Brl-ry 140 brl 640 N/A { MAIL ORIGINAL AND! ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT VIOLATIONS) BY MARCH 1 OF EACH YEAR TO: Division of Water Quality) Ann DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919)807-6379 "I certify, under penalty ofllaw, 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 pe al s for submitting false information, including the possibility of fines and imprisonment for knowing violations " 4 I 7 ZIS' (SignatiWe o ermittee) (Date) i Permit Date 1/1/2010-12/31/2014 Last Revised 02-02-1 1 Page 2 of 2 5 Wo I M E RYS Imerys Mica Kings Mountain, Inc. P O Box 1668 Kings Mountain, NC 28086 February 27, 2015 Division of Water Quality Attn DWQ Central Files NC DENR 1617 Mail Service Center Raleigh, NC 27699-1617 RECEIVED MAR 0 2 ZUjo CENTRAL FILES DWR SECTION RE Annual Stormwater and Mine Wastewater/Dewatering Summaries for Reporting Year 2014 To Whom It May Concern Imerys Mica Kings Mountain is herewith submitting the 2014 Annual Stormwater Summary and the 2014 Annual Mine Wastewater/Dewatering Summary for Imerys Mica Kings Mountain, COC NCG020089, located in Cleveland County If you have any questions or need further information, please do not hesitate to contact me at 805-315-6136, or email at dawn whaley@imerys com cerely, ci-� 01 Dawn Whaley EHS Manager I ANNUAL SUMMARY DMR - STORMWATER I t. II SEND TO CENTRAL OFFICE * 11 STORMWA TER DISCHARGE OUTFALLS (SDO) GENERAL PERMIT No. NCG020000 *Report ALL STORMWA TER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by AMRCH I of each year CERTIFICATE OF COVERAGE NO. NCG020089 SAMPLE COLLECTION YEAR _2014 FACILITY NAME Imerys Mica Kings Mountain, Inc COUNTY Cleveland PERSON COLLECTING SAMPLES 'rdw. sl rnt_S PHONE NO (_704__)_L739-3105 Samples collected by Tom Holmes CERTIFIED LABORATORY Prism Laboratories Lab # 402 ADD TO LISTSERVE9 YES ❑ NO ® EMAIL Lab # dawn whaley@imerys com Part A Stormwater Monatorin2 Reauirements Outfall No Date Sample Collected (mo/dd/yr OR NO FLOW) In Tier 2 Monthly Monitoring � (y/n) # of Months in Tier 2 Sampling, Total Flow (MG) Total Suspended Solids (mom) Turbidity ty (NTU) Settleable Solids (ml/l) Total Rainfall (in) Event Duration (minutes) - - I - - - 100 4 See Footnote" 01 5 6/30/14 N 02 3700 9200 010 182 600 5 12/23/14 I N 02 Brl-ry 310 brl 050 240 6 6130/14 I N 0.5 1800 2300 010 182 600 6 12/23/14 N 05 520 790 brl 050 240 j f ' If "NO FLOW" or "NO DISCHARGE Enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range 2 Per NCG02 Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range a If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit 4 TSS benchmark values are 100 mg/I except in ORW, HWQ, trout, and PNA waters where they are 50 mg/1 5 The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed 10 NTU for freshwater streams, lakes, and reservoirs designated as trout waters, 25 NTU for all lakes and reservoirs, and all salt waters, 50 NTU for all other streams and surface waters Turbidity may be monitored at the SDO Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO Permit Date I/l/2010-12/31/2014 Last Revised 02-02-11 Page I of 2 i Part B Vehicle Maintenance Activity Mo itoring Re uirements for facilities using > 55 gal of new motor oil/month on average Outfall No Date Sample Collected (mo/dd/yr OR NO FLOW) In Tier 2 Monthly Monrtoring9 (Y1n) # of Months in Tier 2 Samphng a New Motor Oil Usage allmonth Total Flow (MG) TPH using method 1664A SGT-HEM m I Total Suspended Solids m pH (Standard Units Total Rainfall in 0 Event ij Durations minutes - - 15 1003,4 6-93 , i i 1 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE) a HAVE YOU CONTACTED THE REGION' WHO AT THE REGION HAVE YOU SPOKEN WITH9 VIOLATIONS) BY MARCH I OF EACH YEAR Division of Water Quality j Attn DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919)807-6300 I YES El NON YES ❑ NO ED "NO DISCHARGE" YOU MUST SIGN THIS CERTIFICA TION FOR ANY INFORMA TION REPORTED "I certify, under penalty ofllaw, 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 to Permit Date 1/1/2010-12/3I12014 L'-)7 (Date) Last Revised 02-02-11 Page 2 of 2 f� SEND TO CENTRAL OFFICE* STORMWATER DISCHARGE OUTFALLS (SDO) GENERAL PERMIT NO. NCG020000 *ReportALL STORAIWATE,R Monitoring Data on this torn (including No E lox and No Discharge and Permit Limit Violations) by MARCft t of each year CERTIFICATE OF COVERAGE NO NCG020106 SAMPLE COLLECTION YEAR 2014 FACILITY NAME Pee Dee Quarry COUNTY, Anson PERSON COLLECTING SAMPLES NIA PHONE NO (704) 525-7740 CERTIFIED LABORATORY PACE ANALYTICAL Lab #12 ADD TO LISTERVE? YES❑ NO❑ EMAIL, Part A Stormwater Monitoring Requirements Outfall No Date Sample Collected (mo/dd/yr OR NO FLOW)' In Tier 2 Monthly Momtormg9 (/n) # of Months in Tier 2 Sampling Total Flow (MG) Total Suspended Solids (mg/1) Turbidity' (NTU) Settleable Solids (ml/l) Total Rainfall (in) Event Duration - - - - - 10034 See Footnote34 013 No SW Outtalls Exist on Sac Pee Dee Quarr is an undevelo ed green site t F R �t ilf"NO FLOW" or "NO DISCHARGE " enter "NO FLOW" or "NO DISCHARGE" for each outtall here and the Date Range 'Per NCG02 Tier 2 Monthly Sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range 'If a value is in excess of the benchmark or outside the benchmark range (for pH), you must implement the Te1r I or Tier 2 responses in the General Permit 4TSS benchmark values are 100 mg/l except in ORW, HWQ, trout, and PNA waters where they are 50 mg1l SThe discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed 10 NTU for freshwater streams, lakes and reservois designated as trout waters 25 NTU for all lakes and reservois and all salt water 50 NTU for all other streams and surface waters Turbidity may be monitored at the SDO Alternatively the pennittee may choose to monitor turbidity in the rest ivmg water, directly upstream and downstream of the SDO Permit Date 1/1/2010-12/31/2014 Last Revised 0 1 -21 -11 Page 1 of 2 Part A Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month on average Outfall No Date Sample Collected (mo/dd/yr OR NO FLOW)' In Tier 2 Monthly Momtormg'' (y/n) ## of Months in Tier 2 Samphng2 New Motor Oil Usage (gallmonth) Total Flow (MG) TPH using method 1664A SGT-HEM (mg/1) Total Suspended Solids (Mg/1) pH (Standard Units) Total Rainfall (in) Event Duration - - 153 1003 6-93 NIA 0 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)'? YES p NO ❑ HAVE YOU CONTACTED THE REGION' YES ❑ NO ❑ WHO AT THE REGION HAVE YOU SPOKEN WITH? MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT VIOLATIONS) BY MARCH 1 OF EACH YEAR TO Division of Water Quality Attn DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919) 807-6300 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 it ith a system designed to assure that qualified personnel properly gather and evaluate the information subbitted 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 here are significant penalties for submitting false information, including the possibility of fines and imprisionment for knowing violations " /7 /7 1/30/15 (Signature df Permittee) (Date) Permit Date 1/1/2010-12/3112014 Last Revised 01-21-11 Page 2 of 2 ANNUAL SUMMARY DMR - WASTEWATER SEND TO CENTRAL OFFICE* PROCESS MINEIDEWATERING WASTEWATER GENERAL PERMIT NO NCG020000 *Report All Wwaeivater discharge monitoring data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH I of each year If you have limit violations, you must also have turned in a Limit Violation DMR to your local Regional office within 30 days of receiving sample results from a lab CERTIFICATE OF COVERAGE NO NCG020106 FACILITY NAME Pee Dee Quarry PERSON COLLECTING SAMPLES NIA CERTIFIED LABORATORY PACE ANALYTICAL Lab #12 LIMITS VIOLATIONS9 YES ❑ NO ❑ Part A Wastewater Monitonnu Renuirements SAMPLE COLLECTION YEAR 2014 COUNTY Anson PHONE NO (704) 525-7740 ADD TO LISTERVE9 YES ONO ❑ EMAIL INDUSTRIAL SANDi9 ❑ DISCHARGE TO SA WATERS'? ❑ Outfall No Date Sample Collected 50050 Total Flow 00530 Total Suspended Solids 00400 Turbiditya 00545 Settleable Solids 00400 pH 31616 Fecal Colifonns - mm/dd/ MG mg/I 12 NTU 2 3 m1/12 Standard collmie 4 Pit Dischar e NO DISCHARGE N/A Pit Discharge NO DISCHARGE r+ N/A Pit Discharge NO DISCHARGE �' N/A Pit Discharge NO DISCHARGE %N/A C NTRAL FILPc- Pee Dee Quarry is an undeveloped greensite No discharges are occunng D NIR SECTION `All mines must monitor W W discharges for TSS Only industrial sand mine discharges are subject to TSS hmts 2If an effluent limit is exceeded, the permittee is required to institute monthly monitoring for that parameter for the remaining permit term 3The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed 10 NTU for freshwater streems, lakes and reservoirs designated as trout waters, 25 NTU for all lakes and reservoirs, and all salt waters, 50 NTUfor all other streams and sruface waters Turbidity may be monitored at the Stormwater Discharge Outtall Alternatively, the permittee may choose to monitor turbidity in the receiveing water, directly upstream and downstream of the discharge 4Only taciliucs discharging to SA waters are required to monitor for Fecal eohforms Perim Date 1/l/2010-12/31/2014 Last Revised 01-05-10 Page 1 of 2 Part A Continued Wastewater Monitoring Requirements Outfall No Date Sample Collected 50050 Total Flow 00530 Total Suspended Solids 00400 Turbidity/ 00545 Settleable Solids 00400 pH 31616 Fecal Coliforms - mm/dd/yr MG mg/11 Z NTU2 3 mull Standard col/mlz 4 MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT VIOLATIONS) BY MARCH I OF EACH YEAR 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 INFORMA TION REPOR TED "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 sumbitted Based on my inquiry of the person or persons who manage the System, or those persons directly resp nsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complet I am awary that Mere are signgngicant pees for submitting false information, including the possibility of fines and impnsionment for knowing violations " (Stgnatuirb of Permittee) Permit Date 1 / 1 /2010-12/31 /2014 1/30/15 (Date) Last Revised 01-05-10 Page 2 of 2 II ANNUAL SUMMARY DMR - STORMWATER II SEND TO CENTRAL OFFICE* STO"WATER DISCHARGE OUTFALLS (SDO) GENERAL PERMIT NO. NCG020000 *Report ALL STORMWAI FR Monitoring Data on this form (including No Flox and No Discharge and Permit Limit Violations) by MARCH I of each year CERTIFICATE OF COVERAGE NO NCG020106 SAMPLE COLLECTION YEAR 2013 FACILITY NAME Pee Dee Quarry COUNTY: Anson PERSON COLLECTING SAMPLES NIA PHONE NO (704) 525-7740 CERTIFIED LABORATORY PACE ANALYTICAL Lab #12 ADD TO LISTERVE? YES❑ NO❑ EMAIL Part A Stormwater Monitoring Requirements Outfall No Date Sample Collected (mo/dd/yr OR NO FLOW)' In Tter 2 Monthly Momtormg9 In # of Months to Tter 2 Sampltng2 Total Flow (MG) Total Suspended Solids (mg/1) Turbidtty° (NTU) Settleable Solids (mlll) Total Rainfall (in) Event Duration - - - - - 10034 See Footnote34 0 13 No SW Outtalls Exist on Site Pee Dee Quarr is an undevelo ed green site , . Ij 117- ,!" ENTRA t QWQ1 3ULj i I f "NO FLOW" or "NO DISCHARGE "enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range 2Per NC602 Tier 2 Monthly Sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range 3If a value is in excess of the benchmark, or outside the benchmark range (for pH) you must itnpleme-nt the Teir I or Tier 2 responses in the General Permit 4TSS benchmark values are 100 mgil except in ORW HWQ trout, and PNA waters where they are 50 mg/t SThe discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed 10 NTU for freshwater streams, lakes, and reservois designated as trout waters 25 NTU for all lakes and reservois, and all saltwater, 50 NTU for all other Streams and surface waters Turbidity maybe monitored at the SDO Alternatively the permatee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO Permit Date k/1/2010-12131/2014 Last Revised 0 1 -21 -11 Page 1 of 2 Part A Vehicle Maintenance Activity Monitoring Requirements for facihtiee using > 55 gal of new motor oil/month on average Outfall No Date Sample Collected (moldd/yr OR NO FLOW)' In Tier 2 Monthly Momtormg9 (y/n) # of Months in Tier 2 Sampling New Motor Oil Usage (gal/month) Total Flow (MG) TPH using method 1664A SGT-HEM (mg/1) Total Suspended Solids (mg/1) pH (Standard Units) Total Rainfall (in) Event Duration - - 153 1003 6-93 N/A 0 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO p HAVE YOU CONTACTED THE REGION' YES ❑ NO ❑ WHO AT THE REGION HAVE YOU SPOKEN WITH? MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT VIOLATIONS) BY MARCH I OF EACH YEAR TO Division of Water Quality Attn DWQ Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 (919)807-6300 YO U 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 sumbitted 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 behef, true, accurate, and complete I am aware that there ar ignificant penalties for submitting false information, including the possibility of fines and imprisionment for knowing violat / 2/14/14 ( ignature of Permittee) (Date) Permit Date 111/2010-1213112014 Last Revised 01-21-11 Page 2 of 2