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Home My WebLink AboutNCG020190_MONITORING INFO_20190218STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT NO. DOC TYPE ❑HISTORICAL FILE @/MONITORING REPORTS DOC DATE o col R 0 a ) g YYYYMMDD ANNUAL SUMMARY DISCHARGE MONITORING REPORT (DMR) — STORMWATER II SUBMIT TO CENTRAL OFFICE'* II General Permit No. NCG020000 Calendar Year 2018 *Report ALL STORMWATER monitoring data on this form (include "No Flow'T No Discharge" and Benchmark Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year._ Certificate of Coverage No. NCG020190 FEB 18 2019 Facility Name: Vulcan Construction Materials, LP/High Shoals Quarry CENTRAL FILES County: Gaston DWR SECTION Phone Number: (704) 525-9678 Total no. of SDOs monitored 1 Certified Laboratory Research & Analytical Laboratories Lab # 34 Lab # Stormwater Discharge Outf all (SDO) No. 010 VMA Outfall? Yes ❑ No Is this outfall currently in Tier 2 for any parameter? Yes ❑ No Was this outfall ever in Tier 2 during the past year? Yes ❑ No If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DEMLR to reduce monitoring frequency ❑ No, turbidity benchmark exceedances did not require monthly monitoring ❑ Other ❑ Outfall No. Total Rainfall, inches TSS, mg/l SS, ml/I Turbidity, NTU Upstream (U) Turbidity, NTU Downstream (D) Turbidity, NTU Non -polar O&G, mg/I (VMA) New Motor Oil Usage (al/mo.) Stormwater Benchmarks indicate NO O W if aRp ficable Circle Benchmark 1 O(]/J�0 0.1 Circle Benchmark 5U/25/10 N/ /� !1 Water Quality Standard applies N/A Water Quality Standard applies 1 �55 e res averagea requires TSS and Non -polar G&G monitoring Date Sample Collected, mo/dd/ r 01/01/18 — 12/31 /18 No Flow Permit Date 10/1/2015 — 9/30/2020 Last Revised 10-2-2015 Certificate of Coverage No. NCG020190 1 Additional Outfall Attachment (make copies as needed for additional outfalls) Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No ❑ Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑ Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑ If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DEMLR to reduce monitoring frequency ❑ No, turbidity benchmark exceedances did not require monthly monitoring ❑ Other ❑ Outfall No. Total Rainfall, inches TSS, mg/l SS, mfll Turbidity, NTU Upstream (U) Turbidity, NTU Downstream (D) Turbidity, NTU Non -polar O&G, mg/I (VMA) . New Motor Oil Usage al/mo. Stormwater Benchmarks fndicate NO FLOW if a licable Circle Benchmark 00/50 0• 1 Benchmark Benchmark 50/25/10 N/A Water Quality Standard applies NIA Water Quality Standard applies 15 >55 a requires average requires TSS and Non -polar 08G monitoring Date Sample Collected, mo/dd/yr Permit Date 10/1/2015 — 9/30/2020 Last Revised 10-2-2015 Certificate of Coverage No. NCG020190 Additional Outfall Attachment (make copies as needed for additional outfalls) Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No ❑ Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑ Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑ If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DEMLR to reduce monitoring frequency ❑ No, turbidity benchmark exceedances did not require monthly monitoring ❑ Other ❑ Outfall No. Total Rainfall, inches TSS, mg/I SS, ml/I Turbidity,Non-polar NTU Upstream (U) Turbidity, NTU Downstream. {D} Turbidity, NTU O&G, mg/I (VMA) New Motor Oil Usage (gal/mo.) Sformwater Benchmarks Indicate NO FLOWit a ficabfe Circle ni Benchmark 1 Q0150 p• t Circle Benchmark 5U/2511 0 N/A Water Quality Standard applies NIA Water Quality Standard applies 1 5 >55 a requires average requires TSS and Non -polar O&G monitoring Date Sample Collected, mo/dd/yr Permit Date 10/1/2015 — 9/30/2020 Last Revised 10-2-2015 Certificate of Coverage No. NCG020190 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 February 5, 2019 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 a - ANNUAL SUMMARY DISCHARGE MONITORING REPORT (DMR) — STORMWATER SUBMIT TO CENTRAL OFFICE* General Permit No. NCG020000 Calendar Year 2017 `Report ALL STORMWATER monitoring data on this form (include "No Flow'T'No Discharge" and Benchmark Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year. Certificate of Coverage No. NCG020190 Facility Name: Vulcan Construction Materials, LP/High Shoals Quarry County: Gaston Phone Number: (704) 525-9678 Total no. of SDOs monitored 1 Certified Laboratory Research_& Analytical Laboratories Lab # 34 Lab # Stormwater Discharge Outfall (SDO) No. 010 VMA Outfall? Yes ❑ No Is this outfall currently in Tier 2 for any parameter? Yes ❑ No El 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 ❑ No, turbidity benchmark exceedances did not require monthly monitoring ❑ Other ❑ Outfall No. Total Rainfall, inches TSS, mgll SS, mlll Turbidity, NTU Upstream (U) Turbidity, NTU Downstream (D) Turbidity, NTU Non -polar O&tG, mg/l (VMA) New Motor Oil Usage gal/mo, Stormwater Benchmarks lredieafe NO FL ' a licable Circle Benchmark V 100/5U 0.1 Circle benchmark 50/25/10 ! NIA wa'eroual'ty 5landard applies NIA Water Cluality Standard applies 15 >55 a requires average requires TSS and Non -polar O&G monitoring Date Sample Collected, mo/ddlyr 01/01/17 — 12/31/17 No Flow Permit Date 10/1/2015 — 9/30/2020 Last Revised 10-2-2015 Certificate of Coverage No. NCG020190 Additional Outfall Attachment (make copies as needed for additional outfalls) Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No ❑ Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑ Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑ If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DEME_R to reduce monitoring frequency ❑ No, turbidity benchmark exceedances did not require monthly monitoring ❑ Other ❑ Upstream �• Outfall No. Tota I Turbidity, (U) Turbidity, -INS •: • inches ` •. MEEMM� Benchmarks app,._ le I I F Water Quality Standard applies Water Quality Standard applies Date Sample 1 Collected, *g� • • • i`.s �,^., _ . �, #L y. f,.r,.;'�e" '7 _ ] ^�.k . • >.� �.. _, i Y % �i7b. c „L.� p:µ Fyn 1 - -q. i P5 i., r-'. �i Permit Date 10/1/2015 — 9/30/2020 Last Revised 10-2-2015 Certificate of Coverage No. NCG020190 Additional Outfall Attachment (make copies as needed for additional outfalls) .11 Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No ❑ Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑ Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑ If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DEMLR to reduce monitoring frequency ❑ 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&tG, mgll (VMA) New Motor Oil Usage (allmo. Stormwater Benchmarks indicate NO FLOW if Applicable Bencrclehmark BCnChmark 100150 0.1 Circle Benchmark 5012511 () NIA Water Quality Standard applies NIA Water Quality Standard applies 15 y55erequi average requires TSS and Nan -polar O&G monitoring Date Sample Collected molddlyr Imp.3� ��#.% S.rnf k 4 y 5 .� R{ s7•: Fh i Y a. A.i$ Permit Date 101112015 — 9/30/2020 Last Revised 10-2-2015 Certificate of Coverage No. NCG020190 V 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 January 29, 2018 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 r ANNUAL SUMMARY DISCHARGE 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 FlowT'No Discharge" and Benchmark Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year. Certificate of Coverage No. NCG020190 Facility Name: Vulcan Construction Materials, LP/High Shoals Quarrx f- 4.8 2017 County: Gaston CENTRAL FILES Phone Number: (704) 525-9678 Total no. of SDOs monitored 1 DWR SECTION Certified Laboratory Research & Analxtical Laboratories Lab # 34 Lab # Stormwater Discharge Outfall (SDO) No. 0100 VMA Outfall? Yes ❑ No ❑ Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑ Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑ If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DEMLR to reduce monitoring frequency ❑ 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, mgll (VMA) New Motor Oil Usage gal/Mo. Stormwater Benchmarks Indicate NO FLOWif a llcable Circle Benchmark 100150 0.1 Benchmark Bencrciehmark 50/25/10 NIA Water Quality Standard applies NIA Water Quality Standard applies 15 >S5 a requires average requires TSS and Non -polar o&G monitoring Date Sample Collected, molddlyr WEEMMMMM 01/01/16 — 12/31/16 No Flow Permit Date 101112015 — 9/30/2020 Last Revised 10-2-2015 Certificate of C4veraga No. NCG020190 Additional Outfall Attachment (make copies as needed for additional outfalls) Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No ❑ Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑ Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑ If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DEMLR to reduce monitoring frequency ❑ No, turbidity benchmark exceedances did not require monthly monitoring ❑ Other ❑ Permit Date 101112015 — 9/30/2020 Last Revised 10-2-2015 Certificate of Coverage No. NCG020190 Additional Outfall Attachment (make copies as needed for additional outfalls) Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑ No ❑ Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑ Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑ If this outfall was in Tier 2 last year, was monthly monitoring discontinued? Yes, enough consecutive samples below benchmarks to decrease frequency ❑ Yes, received approval from DEMLR to reduce monitoring frequency ❑ No, turbidity benchmark exceedances did not require monthly monitoring ❑ Other ❑ Outfall No. Total Rainfall, inches TSS, mg/I SS, mill Turbidity, NTU Upstream (U) Turbidity, NTU Downstream (D) Turbidity, NTU Non -polar O&G, mgll (VMA) New Motor Oil Usage gallmo. Stormwater Benchmarks indicate NO FLOW if applicable circle Benchmark UUIJGe U 0.1 Circle Benchmark 50/2511 0 J NIA Water Quality Standard applies NIA Water Quality Standard applies 15 �55 gallmo, average requires TSS and Non -polar 08G monitoring Date Sample Collected, molddlyr MENEM==== Permit Date 1019/2015 — 9/30/2020 Last Revised 10-2-2015 Certificate of Coverageilo. NCG020190 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 February 5, 2 17 Z-� 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 10-2-2015 � ANNUAL SUMMARY DMR - Sr 'ORMWAr aR I • I SEND TO CENTRAL OFFICE STORMWA TER DISCHARGE OUTFALLS (SDO) GENERAL PERMIT NO. NCG020000 *Report ALL STORMII/ATER Monitoring Data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH I of each year. CERTIFICATE OF COVERAGE NO. NCG020190 SAMPLE COLLECTION YEAR: 2015 FACILITY NAME: Vulcan Construction Materials LP/Hi h Shoals Quarry COUNTY Gaston PERSON COLLECTING SAMPLES: Gabe Kaiser PHONE NO. (704) 525-9679 CERTIFIED LABORATORY:Research & Analytical Labs Lab #34 ADD TO LISTSERVE:r YES ❑ NO ❑ EMAIL: Lab # Part A: Stormwater Monitoring Requirements Outfall No. Date Sample Collected (mo/ddl Y r OR NO FLOW)I In Tier 2 Monthly Monitoring? g'• (y/n) # of Months in Tier 2 Sampling z Total Flow (MG) Total Suspended Solids (mgll) Turbidity (NTU) Settleable Solids (ml/l) Total Rainfall (in) Event Duration (minutes) - - - - - t003,4 See Footnote 3,5 0.13 010 No flow for 2015 f CLJ n I NAL FILE, ON ' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall 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 3 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit. 4 TSS benchmark values are 100 mgll except in ORW, HWQ, trout, and PNA waters where they are 50 mgll. 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. Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month on average Pennit Date: I/1/2010-12/31/2014 Last Revised 02-02-11 Page 1 oF2 Otafall No. ` pate Sample Collected (mo/dd/yr OR NO I LOW)t In Tier 2 Monthly Monitoring? (y/n) # of Months in Tier 2 z Sampling New Motor Oil Usage (al/month) Total Flow (MG) TPH using method 1664A SGT-HEM (m /i) Total Suspended Solids (m Il) pH (Standard Units) Total Rainfall (in) Event Duration (minutes) - - 15 100" 6-9 HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO X HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑ WHO AT THE REGION HAVE YOU SPOKEN WITH? MAIL ORIGINAL AND ONE COPY OF'r[IIS ANNUAL SUMMARY (INCLUDING ALI. "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 (9 19) 807-6300 YOUMUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED: "l certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Signature of Permittee) February 8, 2016 (Date) Permit Date: 1/l/2010-12/31/2014 Last Revised 02-02-11 Page 2 of 2 I ANNUAL SUMMARY DMR - STORMWATER i SEND TO CENTRAL OFFICE STORMWATER DISCHARGE OUTFALLS (SDO) GENERAL PERMIT NO. NCG020000 *Report ALL STORAIWATER Monitoring Data on this forni (including No Flow and No Discharge and Permit Limit Violations) by MARCH I of each year. CERTIFICATE OF COVERAGE NO. NCG020190 SAMPLE COLLECTION YEAR: 2015 FACILI'[ Y NAME: Vulcan Construction Materials LP/11i h Shoals Quarry COUNTY Gaston PERSON COLLECTING SAMPLES- Gabe Kaiser PHONE NO. (704) 525-9678 CERTIFIED LABORATORY: Research & Analytical Labs Lab #34 ADDTO LISTSERVE? YES ❑ NO ❑ EMAIL: Lab # Part A: Stormwater MonitorinL Requirements Outfall No. Date Sample Collected (moldd/yr OR NO FLOW)t In Tier 2 Monthly Monitoring? (yIn) # of Months in Tier 2 Sampling Z Total Flow (MG) Total Suspended Solids (mg11) Turbidity (NTU) Settleable Solids (mlll) Total Rainfall (in) Event Duration (minutes) - - - - - 100 '4 See Footnote X5 0.1- 010 No flow for 2015 1� ENTRAL DWR 5 1 ' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall 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 3 If a value is in excess of the benchmark, or outside the benchmark range (for pl-I), you must implement the Tier 1 or Tier 2 responses in the General Permit. 3 TSS benchmark values are 100 mgll except in ORW, HWQ, trout, and PNA waters where they are 50 mg/l. 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. Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month on average Permit Date: 1/1/2010-12/31/2014 Last Revised 02-02-1 1 Page 1 of 2 Outfall No*(a Date Sample Collected (moldd/yr OR I NO FLOW) ]n Tier 2 Monthly Monitoring? (yln) # of Months in Tier 2 Sampling a New Motor Oil Usage (gal/month) Total Flow (MG) TPH using method 1 S64A SGT--HEM (m /l) Total Suspended Solids (m /l) pH (Standard Units) Total Rainfall (in) Event Duration (minutes) 15 100" 6-9- HAS YOUR FACILITY HAI) 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO X HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑ WHO AT THE REGION HAVE YOU SPOKEN WITH? MAIL ORIGINAL AND ONE COPY OF TI-IIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCIIARGE" & LIMIT VIOLATIONS) BY MARCH 1 OF EACH YEAR TO: Division of Water Quality Attn: DWQ Central Files 1617 Mail Service Center Raleiglti, Nort17 Carolina 27699-1617 (919)807-6300 YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMA TION REPORTED: "I certify, under penalty of law, that this document and all attachments were prepared ender my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." (Signature of Permittee) February S, 2016 (Date) Pennit Date: 1/1/2010-12/31/2014 Last Revised 02-02-1 1 Page 2 of 2