NCG140143_MONITORING INFO_20190305

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V y OI 9 3
DOC TYPE
❑HISTORICAL FILE
I� MONITORING REPORTS
DOC DATE
❑ a I � V3 �
YYYYMMDD

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2018
*Report ALL WASTEWATER monitoring data on this form (include "No FloWl"No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG 14 0❑[j]
Facility Name: King Plant
County: Stokes
Phone Number: (336 ) 983-2181
Certified Laboratory Prism Lab
Lab # 402
Lab #
Total no. of outfalls monitored 1
Wastewater (WW) Discharge Outfall No. 001
Does this outfall discharge WW to SA waters? Yes ❑ No F/1
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No n
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 jr) designated waters? Yes ❑ No ❑✓
Were there any limit violations in the calendar year? Yes ❑ No ✓❑
Outfall No.
Daily Flow Rate,
pH,
TSS,
SS,
Non -Polar O&G (EPA Method 1664
cfs
SU
mg/1
mlll
(SGT-HEM)), mgll
001
it applicable
Standard
Effluent
HOW or ORW
50% of 7Q10
freshwater
6.0-9.0
30
HOW, ORW, SA,
N0 Limit
Limitations
HQW
20
0
SB, PNA, or any
Trout
Indicate NO FLOW if
saltwater
5.
Samples above Benchmark
applicable
O VV J
6.p-p-5
HOW 1 ORW and Tr, or
subject to Tiered Responses
Daily Max Imum
15
10
Date
Sample`s
Collected,y
molddl r
3/13/2018
001 NO FLOW
RECEIVED
MAR n
6/29/2018
NO PLOW
CENTRAL FILES
9/27/2018
NO FLOW
U V V i_< 5_(, j N
1212712018
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

;. .
Certificate of Coverage No. NCG14 ®CND
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 8/112017 — 6/30/2022
Last Revised 8-22-2017

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2018
*Report ALL STORMWATER monitoring data on this form (include "No FloWl"No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG14
Facility Name: King Plant
County: Stokes
Phone Number: (336 ) 983-2181
Certified Laboratory prism Lab
Lab # 402
Lab #
Total no. of SDOs monitored 1
Stormwater Discharge Outfail (SDO) No. 001 VMA Outfall? Yes ❑ No ❑Q
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 0
If this outfall was in Tier 2 last year, was monthly monitoring discontinued? RECEIVE[
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑ MAR 0 4 ' 2i)19
Other ❑ r:rNTRAL. FILFF
Outfall No.
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
m /I
pH,
SU
Non -polar O&G
(EPA Method
1664 (SGT-HEM)),
mgll (VMA)
Napplicable
New Motor Oil
Usage (gallmo.)
if applicable
Stormwater
Benchmarks
indicate NO FLOW it
applicable
Circle Benchmark
1 ODICJO
6.0-9.0
1 �
>55 gallmo. average requires TSS and
Non-polarOSG monitoring
Date Sample:
Collected
molddlyr
1" z
3/13/2018
NO FLOW
612912018
NO FLOW
9/27/2018
NO FLOW
12127/2018
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. N CG 14 —dF/ R [N
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 CAR §122.
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 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 Fifes Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

ANNUAL SUMMARY. DISCHARGE MONITORING
REPORT (DMR) —STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2017
"Report ALL STORMWATER monitoring data on this form (include "No Flovv'1"No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG14
MAR 0 7 Mid
Facility Name: King
County: Stokes i�UVR SECTION
Phone Number: (336 ) 983-2181 Total no. of SDOs monitored 1
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 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?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
Other ❑
Outfall No.
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
m 11
pH,
SU
Non -polar O&G
(EPA Method
1664 SGT-HEM ,
( ))
mg/I (VMA)
If applicable
New Motor Oil
Usage (gal/mo.)
If applicable
Stormwater
Benchmarks
Indicate NO FLOW if
applicable
Circle Benchmark
100/50
6.0-9.0
15
>55 gallmo. average requlrea.T55 and
Non -polar O&Gmonitoring
Date Sample
Collected,
moldd/Y
��r i�A
P
3/3/2017
001 No Flow
6/30/2017
001 No Flow
9/282017
001 No Flow
12/11/2017
001 No Flow
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG14 QD ©H®
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 �L N1 l�
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in DWR (not DEMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NC6140000
CERTIFICATE OF COVERAGE NO. NCG1400000
FACILITY NAME: Aberdeen
PERSON COLLECTING SAMPLES: JD Dalrymple RECEIVED
CERTIFIED LABORATORY: N/A Lab N/A JUL 2 7 2017
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitorine Reauirements
CENIVRAL FILES
DWR SECTION
SAMPLE COLLECTION YEAR: 2017
SAMPLE QUARTER: ❑Jul -Sept ❑Oct -Dec ❑Jan -March ®April -June
COUNTY: Moore
PHONE NO. [phone]
ADD TO LISTSERVE? []YES ®NO EMAIL:
DISCHARGING TO CLASS: []SA ❑HQW
OPTIONAL INFO:
❑PNA ❑Trout ®Other
Outfail 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
5 ml
Duration
(minutes)
Total Flow
(gallons/day)7
-
-
-
6-J3,4
303,5
53
(15)5
-
-
001
6/23/2017
NO FLOW
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
Z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

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 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:
"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 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 aware; at th a araignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
Permittee)
Permit Date:7/1/2010-06/30/2015
-7 (,� 4-7
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE N0. NCG140143
FACILITY NAME: King
PERSON COLLECTING SAMPLES: Tony Hardison
CERTIFIED LABORATORY: Research & Analytical LabWCEIVED
LIMIT VIOLATIONS? YES ❑ NO ® JUL 2 7 2011
CENTRAL FILECS
Part A: Wastewater Monitorine Reauirements nwR SFr .TInN
SAMPLE COLLECTION YEAR: 2017
SAMPLE QUARTER: ❑Jul -Sept ❑Oct -Dec ❑Jan -March ®April -June
COUNTY: Fors h
PHONE NO. [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW
OPTIONAL INFO:
❑PNA ❑Trout ®Other
Outfall No.
Date Sample
Collected'
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)2
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
S [mHLM'
Discharge
Duration
(minutes)
Total Flow
(gallons/day),
-
-
RM, MD-
6-93,4
303,5
53
(15)6
-
-
001
6/30/2017
NO FLOW
` If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/l/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.
7 Plow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Plow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED.
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly esponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am aware t4?t therrre�aignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of Permitteej
Permit Date:7/1/2010-06/30/2015
7(",7 /,- 7
(Date)
Last Revised 07/13/11
Page 2 of 2

0%
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140143
FACILITY NAME: King
PERSON COLLECTING SAMPLES: Tony Hardison
CERTIFIED LABORATORY: Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitorine Reauirements
SAMPLE COLLECTION YEAR: 2017
SAMPLE QUARTER: ❑Jul -Sept ❑Oct -Dec Ban -March ❑April -June
COUNTY: Forsyth
PHONE NO. [phone]
ADD TO LISTSERVE? DYES ®NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW
OPTIONAL INFO:
❑PNA ❑Trout ®Other
Outfall No.
Date Sample
1
Collected
{mm/dd/yr}
Type of Wastewater
{VE, RM, MD)
pH
(standard)
Total Suspended
{mg/L}
Settleable
{mL/L)
TRH usingDischarge
method 1664A
SGT-HEM'
(mg/L)
Duration
{minutes]
Total Flow
,
(gallons/day)
-
-
RM, MD-
6-93,4
303,5
53
(15)6
-
-
001
3/3/2017
NO FLOW
-
_L.I
C
NTRAL FIL
ES
' If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
" pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

6 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:abtain 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 lor•-",- ,the permittee shall notify DWQ, and the DWQ Regional office may require an annual flow
report on a case -by -case basis. / f
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFIC4TION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons 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 ther4are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
ure oOermitteej (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. NCG140143
FACILITY NAME: King
PERSON COLLECTING SAMPLES: Tony Hardison
CERTIFIED LABORATORY: Research & Analytical
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitoring Reauirements
SAMPLE COLLECTION YEAR: 2016
RECEIVED
SAMPLE QUARThR: ❑Jul -Sept ®Oct -Dec ❑Jan -March ❑April -June
Lab #,AA4N 2 3 2017 PHONE NO. [phone]
CENTRAL FILES ADD TO LISTSERVE? []YES®NO EMAIL:
DVM SECTION DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO:
Outfali No.
Date Sample
Collected'
(mm/dd/yr)
Type of Wastewater
x
(VE, RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L)
'
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SGT-HEM6
(mg/L)
Duration
(minutes)
Total Flow
7
(gallons/day)
-
-
RM, MD-
6-93.4
303'5
53-
001
12/21/16
RM
No Flow
y .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.
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 Proces's wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
7 Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. if the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: 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 y responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am awV"hat t e aLelignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
I^LY-1 - t1f7 /(7
(Signature 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. NCG140143
FACILITY NAME: King
PERSON COLLECTING SAMPLES: Tony Hanlesia
CERTIFIED LABORATORY: Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitorina Reauirements
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
1
Collected
(mm/dd/yr)
Type of Wastewater
z
{VE, RM, MD)
pH
(standard}
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
6
SG
(mg/L)
/L)
Duration
{minutes}
Total Flow
7
(gallons/day}
-
-
RM, MD-
6-93.4
303,S
53
(15)6
-
001
9/21/16
RM
No Flow
RECEIVED
CENTR
L FILES
R
ECTION
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.
G pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
S TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water, classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall 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 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."
of Permittee)
Permit Date: 7/1/2010-06/30/2015
('9 h-d/(,
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140143
FACILITY NAME: King
PERSON COLLECTING SAMPLES: Greg Smith
CERTIFIED LABORATORY: Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Mnnitnrine Renuirements
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
1
Collected
(mm/dd/yr)
Type of Wastewater
z
(VE, RM, MD)
pH
{standard}
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
6
5 (mg/L)
Discharge
Duration
(minutes)
Total Flow
7
(gallons/day)
-
-
RM, MD-
6-93'4
303,5
53
(15)6
-
001
6/23/16
RM
No Flow
n
CENTRAL
`ILES
DWR SEC
rlON
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
Z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
° pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saitwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

e Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
' Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall 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 directly 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 there/pre significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
re of �ermittee) (Date)
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 2 of 2

f. ..,.wt
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140143
FACILITY NAME: King
PERSON COLLECTING SAMPLES: Greg Smith
CERTIFIED LABORATORY: Research & Analytical Lab #it 34
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitoring 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
i
Collected
mm dd r
(/ /y �
Type of Wastewater
z
{VE, RM, MD)
PH
{standard)
Total Suspended
Solids
m L
{ g/ }
Settleable
Solids
mL L
{ / �
TPH usingDischarge
method 1664A
6
SGT-HAM
(mg/Lj
Duration
minutes
(minutes)
Total Flow
7
{gallons/day)
-
-
RM, MD-
6-93,4
303'5
53
(15)6
-
-
001
3/30/16
RM
No Flow
R«CE)-V
t*,LJ
10
MAY tu
=ENTRAL 1=ILI
:�
V'JR SECTiO
V
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/l/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 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�therejare 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
e-t l-Z-1/�-
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER -- Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
rr"110
CERTIFICATE OF COVERAGE NO. NCG140143
FACILITY NAME: King
PERSON COLLECTING SAMPLES: Greg Smith
CERTIFIED LABORATORY: Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A. Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR: 2015
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
2
RMMD}
(VE, ,
pH
(standard}
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
S
mg/L) l6
j mg/L)
Duration
(minutes)
Total Flow
7
(gallons/day)
-
-
RM, MD-
6-93'4
303s
53
(15)6
-
-
001
10/31/15
RM
No Flow
U
C
VIRAI P
DU
R
J
` 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

a f+ ocess 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 ectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am aware thZthwe)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
( 1.7
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140143
FACILITY NAME: King
PERSON COLLECTING SAMPLES: Greg Smith
CERTIFIED LABORATORY: Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES []NO
Part A: Wastewater Monitoring Reauirements
SAMPLE COLLECTION YEAR: 2015
SAMPLE QUARTER: ❑Jul -Sept ®Ott -De[ ❑Jan -March []April -June
RECE j'K KT�: Forsyth
PHONE NO. [phone]
FEB 0 5 4QJfT0 LISTSERVE? ❑YES ®NO EMAIL:
CENTRAL PISr- HARGING TO CLASS: []SA❑HQW
DWR SECTO&VONAL 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
Sr'T-HEM'
(mg/L)
Duration
(minutes)
Total Flow
7
(gallons/day)
-
-
RM, MD-
6-93'4
303's
53
(15)6
-
-
001
10/31/15
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.
a 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.
s TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2
��-,,z
ca :za

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,
,b-A 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. 1f 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 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 aw?relthat tl#e anew ignificant 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
t l(Yll
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140143 SAMPLE COLLECTION YEAR: 2015
FACILITY NAME: King 'RECEIVED
SAMPLE QUARTER: ®lul-Sept ❑Oct -Dec ❑Jan -March ❑April -June
PERSON COLLECTING SAMPLES: Greg Smith ' 1 V COUNTY: Forsyth
CERTIFIED LABORATORY: Research & Analytical Lab # 3,,CT 2 3 2015 PHONE NO. [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL:
LIMIT VIOLATIONS? YES ❑ NO ®
CENTRAL FILES DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other
IDWR SECTION OPTIONAL INFO:
Part A: Wastewater Monitoring Requirements
Outfall No.
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
z
RMMD}
[VE, ,
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SGT FfE
{mg/L )
Duration
(minutes)
Total Flow
7
{gallons/day(
-
-
RM, MD-
6-93'4
303,5
53
(15)6
-
001
09/28/15
RM
No Flow
1 If wastewater systems have not discharged in this quarter— report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
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.S S.U. for discharges to saltwaters.
s TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
-=7 Q
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,
ut ins;?.ad 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 informations 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 din ctly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am awa(e that Zr"re significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature 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. NCG140143 SAMPLE COLLECTION YEAR: 2015
FACILITY NAME: King SAMPLE QUARTER: ❑Jul -Sept ❑Oct -Dec ❑Jan -March ®April -June
PERSON COLLECTING SAMPLES: Greg Smith COUNTY:.Forsyth
CERTIFIED LABORATORY: Research & Analytical Lab_#_34-- PHONE NO. [phone]
ADD TO LISTSERVE? DYES ®NO EMAIL:
LIMIT VIOLATIONS? YES ❑ NO ® jUL 2 4 2015
Part A: Wastewater Monitoring Requirements CENTF R FILES
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO:
Outfall No.
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
z
(VE, RM, MD)
V rN
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
s
SGT HEM
(mg/L)
Discharge
Duration
(minutes)
Total Flow
(gallons/day)
-
-
RM, MD-
6-93.4
303s
53
(15)6
-
-
001
06/27/15
No Flow
1 if wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
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
M!
wraw
N
_v
Last Revised 07/13/11
Page 1 of 2

IT

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,
blue.Nilte`ad 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 02I3 .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 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 awaAe that t�re 9"gnificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of Permlttee)
Permit Date:7/1/2010-06/30/2015
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCES. ASTEl ATER -- Quarterly Discharge Monitoring Repay
-�� GENERAL PERMIT No. NCG140000
RECEIVE]
CERTIFICATE OF COVERAGE No NCG140143 MAY 13 2015 SAMPLE coLLEcnON YEAR: 2015
FACILITY NAME: King CENTRAL FILES -SAMPLE QUARTER. Dul-Sept Oct -Dec glan-March ]April -.tune
PERSON COLLECTING SAMPLES: Tony Hardison QWR SECTION' COUNTY: Forsyth
CERTIFIED LABORATORY: Research & Analytical Lab I# 34 PHONE NO. (704) 372.-2930
ADD TO LISTSERVE? EYES ZNO EMAIL:
LIMIT VIOLATIONS? YES ❑ NO M DISCHARGING TO CLASS; []SA ❑HQW C]PNA Trout nOther
OPTIONAL INFO:
Part A: Wastewater Monitoring Renuirc-ments
CButfall No.
Date Sample
Collected'
{mmldd/yr}
Type of Wastewater
2
{VE. ItM, tJiB}
pH
{standard}
Total Suspendedt
Solids
{mb/L}
Settleable
Solids
(ML/0
TPH using
method 1664A ,
SGTPL) �
�mg/ L
Discharge
Duration
�rninutes)
Total Flow
, .
{gallans/day}
-
RM, MD-
6.95A
3025
53
(15f
-
-
001
03/27/15
No Flow
It 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 perm ittee 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 TS5 limits are 20 mg/L for wastewater discharges to HQWr waters, 10 mg/L for Trout and PNA waters, .and 30:mg/L for all other water classifications.
Permit Date:.7/i/201"6/30/2015 Last Revised 07/13/11
Page 1 of 2
Io
W(�

5 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.
. a 7Flcfw 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 .022a. 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"I.TO: T
Division of Water Quality
Attn: DWQ Central Flies
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 theinformation submitted. Based on my inquiry of the person or persons who manage the system, or
those persons Vectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am pvAre tha#th9T are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
f /�)
(sign Lure of Permittee) (Date)
Permit Date: 7/1/201"6/30/2015 Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER -- Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140143
FACILITY NAME: King
PERSON COLLECTING SAMPLES: Tony Hardison
CERTIFIED LABORATORY: Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR: 2014
SAMPLE QUARTER: ❑Jul -Sept ®Oct -Dec []Jan -March []April -June
R EC E I VECOUNTY: ForWh
iDN NO. [phone]
JAN 2 0 2,,f l) TO LISTSERVE? ❑YES ®NO EMAIL:
DISCHARGING TO CLASS: ESA ❑HQW ❑PNA ❑Trout ®Other
CENTRAL FILEOPTIONAL INFO:
DWR SECTION
Outfall No.
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)l
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L]
TPH usingDischarge
method 1664A
SGT-HEA?6
('HE)(minutes]
Duration
Total Flow
(gallons/day)'
-
-
RM, MD-
6-93A
3035
53
(15)6
-
-
001
12/22/2014
RM
No Flow
002
12/22/2014
RM
No Flow
1 If wastewater systems have not discharged in this quarter— report "No Flow". or "No Discharge" here. Please make sure to mark the sample quarter above.
Z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
° pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date:7/1/2010-06/30/2015
Last Revised 07/13/11
Page 1 of 2
I_Dki

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:
N certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my Inquiry of the person or persons who manage the system, or
those persons direct resp,nsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am aware that th a significant penalties for submitting false Information, Including the possibility of fines and Imprisonment for knowing violations."
Permittee) (Date)
Permit Date: 7/1/2010-06/30/2015 last Revised 07/13/11
Page 2 of 2

s. ..
,- ��
h- - 1
i .. e F �;
4 .
� � . � _ e � .

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE N0. NCG140133
FACILITY NAME: Gastonia Main St
PERSON COLLECTING SAMPLES: Zane Carpenter
CERTIFIED LABORATORY: Prism Lab # 402
LIMIT VIOLATIONS? YES [—]NO
Part A: Wastewater Monitorin¢ Reauirements
SAMPLE COLLECTION YEAR: 2014
RECEIVED SAMPLE QUARTER: TE
❑Jul -Sept ®Oct -Dec ❑Jan -March ❑April -June
JAN 2 0 Z015 PHONE NO. [phone]
ADD TO LISTSERVE? []YES ®NO EMAIL:
CENTRAL FILES DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other
DWR SECTION
OPTIONAL INFO:
Outfali 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 HFM
(mg/L)
Duration
{minutes]
Total Flaw
(gallons/day)'
-
-
6-93,4
303.s
53
(15)6
-
-
001
12/29/2014
RM
6.9
'BRL
BRL
N/A
BRL
BRL
- 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 RD 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

F
c .-..
r_Lh _

5 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TRH 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 0213.0224. 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 quali d 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 fictly r onsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I an) a0are tott,AEIir significant penalties for submitting false Information, including the possibility of fines and Imprisonment for knowing violations."
(Signa{ure of Permittee)
Permit Date: 7/1/2010-06/30/2015
(Date)
Last Revised 07/13/11
Page 2of2

7 . -
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140143
FACILITY NAME: King
PERSON COLLECTING SAMPLES: Tony Hardison
CERTIFIED LABORATORY: Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR: 2014
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
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'
(mg/L)
Duration
(minutes)
Total Flow
(gallons/day)'
-
-
RM, MD-
6-93'4
303's
53
(15)6
-
-
001
9/30/2014
RM
No Flow
002
9/30/2014
RM
No Flow
�'
WR
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.
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

a Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE _COPY _OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE {OR
AT END OF MONITORING PERIOD 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 that1. there 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
T .?0
(Date)
Last Revised 07/13/11
Page 2 of 2

S
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140143
FACILITY NAME: King
PERSON COLLECTING SAMPLES: Tony Hardison
CERTIFIED LABORATORY: Research & Analytical Lab # 34
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR: 2014
SAMPLE QUARTER: []Jul -Sept []Oct -bet ❑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
Outfail No.
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
Z
(VE, RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
5GT-HEiVr6
(mg/ L)
Duration
(minutes)
Total Flow
7
(gallons/day)
-
-
RM, MD-
6-93'4
303'5
53
(15)6
-
-
001
6/26/2014
RM
9.43
3
N/A
N/A
>1
>1
002
6/26/2014
RM
9.48
4.5
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.
RECEIVED
JUL
2014
' 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

Z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
31f an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
S TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
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 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 person directly respon ' e for gathering the Information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am away t t th ificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
/-r)—
ignature Permittee) (Date)
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 2 of 2

RECEIVED
APR 15 2014
CENTRAL FILES
DWQIBOG
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE No. NCG140143
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Concrete Supply Co., LLC
is hereby authorized to discharge process wastewater and stormwater from a facility located at
Concrete Supply Co. — King Plant
320 Newsome Rd
King
Stokes County
to receiving waters designated as Crooked Run Creek, a class WS-IV water in the Yadkin Pee -
Dee River Basin, in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts I, 1I, I1I, IV, V, and VI of General Permit No. NCG140000 as
attached.
This certificate of coverage shall become effective April 14, 2014
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day April 14, 2014
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

NCDENR
Nam, C nouw Dow'»vrr or
Ew+nRoRMQR mo NAnzw. FzsoURcr.,
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
PERMIT NAME/OWNERSHIP CHANGE FORM
I. Please enter the permit number for which the change is requested.
FOR AGENCY USE ONLY
Date Received
Year
Month Day
NPDES Permit
(or)
Certificate of Coverage y
N
I C 1 $
10
N
C
G 1
14 10
1 1
14
13
II. Permit status prior to requested change.
a.
Permit issued to (company name):
CEMEX Construction Materials Atlantic, LLC
b.
Person legally responsible for permit:
Larry
McSwain
First
MI Last
VP/GM Carolinas
Title
101 Young Court _
Permit Holder Mailing Address
Greenville
SC 29615
City
State Zip
[phone] [phone]
Phone
Fax
c.
Facility name (discharge):
CEMEX - King_
d.
Facility address:
320 Newsome Rd
Address
King
NC 27021
City
State Zip
e.
Facility contact person:
Johnny M Ta is
[phone]
First / MI 1 Last
Phone
III. Please provide the fallowing for the requested change (revised permit).
a. Request for change is a result of: ® Change in ownership of the facility
® Name change of the facility or owner
I, f other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit
o C�6C�0�'IC� pl
Q D
OCT 1 ? 2013
d. Facility name (discharge):
e. Facility address:
Concrete Supply Co., LLC
Henry Batten
First MI Last
President
Title
P.O. Box 5247
Permit Holder Mailing Address
Charlotte NC 28299
City State Zip
[phone]-Henry.Batten ,ConcreteSupplyCo.com
Phone E-mail Address
_ King.
320 Newsome Rd
Address
King NC 27021
City State Zip
f. Facility contact person: Johnie Alexander
First MI Last
Johnie.Alexander@ConcreteSupplyco.
[phone] com

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iz NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
�Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact: Johnie Alexander
First Ml Last
Environmental Manager
Title
P.O Box 5247
Mailing Address
Charlotte NC 28299
City State Zip
[phone] Johnic.AlexanderCaconcretesupplyco.com
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior to
this ownership or name change?
x Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
X This completed application is required for both name change and/or ownership change requests.
X Legal documentation of the transfer of ownership (such as relevant pages of a contract deed, or
a bill of sale) is re uired for an ownership change request. Articles of incorporation are not
sufficient for an ownership change.
.....................................................................................................................
The certifications below must be completed and signed by both the permit holder prior to the change, and the
new applicant in the case of an ownership change request. For a name change request, the signed Applicant's
Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, Larry McSwain, attest that this application for a name/ownership change has been reviewed and is accurate
and complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
G /9.1oi3
Signature Date
APPLICANT CERTIFICATION
I, HenryBatten, attest that this application for a name/ownership change has been reviewed and is accurate
and complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
a
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 712008

w=.
��P
�k ,
NC®ENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. Johnie Alexander
Concrete Supply Co., LLC
P.O. Box 5247
Charlotte, NC 28299
Dear Mr. Alexander:
John E. Skvarla, III
Secretary
April 14, 2014
Subject: NPDES General Permit NCG140000
Certificates of Coverage -Multiple
Concrete Supply Co., LLC
Formerly CEMEX Construction Materials Atlantic, LLC
Counties - Multiple
Division personnel received your request to revise your stormwater permit Certificates of Coverage
to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificates of Coverage for the 17 facilities that changed
ownership from CEMEX Construction Materials Atlantic, LLC to Concrete Supply Co., LLC. The
terms and conditions contained in the General Permit remain unchanged and in full effect. These
revised Certificates of Coverage are issued under the requirements of North Carolina General
Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and the U.S.
Environmental Protection Agency.
If you have any questions or need further information, please contact the Stormwater Permitting
Program at [phone].
Sincerely,
ORIGINAL SIGNED S1
KEN PICKLE
for Tracy E. Davis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Mooresville RO, Z. Khan
Winston-Salem RO, M. Gantt
Fayetteville RO, B. Cole
Asheville RO, L. Herbert
Raleigh RO, J. Holley
Division of Energy, Mineral, and Land Resources
Energy Section • Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, !North Carolina 27699-1612 - 919-707-9200 / FAX: [phone]
512 North Salisbury Street, Raleigh, Worth Carolina 27604 • Internet: http:Hpartal.ncdenr.org/webllrl
An Equal opportunity 1 Affirmative Action Employer -- 50% Recycled 110% Post Consumer Paper

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