NCG140051_MONITORING INFO_20190305

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
DOC TYPE
❑HISTORICAL FILE
C� MONITORING REPORTS
DOC DATE
❑ �OI �i O 3 D 5
YYYYMMDD

it
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) —WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2018
L
Report ALL WASTEWATER monitoring data on this form (include "No Flow'/"No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year. �� !
Certificate of Coverage No. NCG14 g❑nnD
Facility Name: Dallas
County: Gaston
Phone Number: (704 529-6364
Certified Laboratory Prism Lab
Lab # 402
Lab #
MAR 0 b 2019
CENTRAL FILES
DWR SEgTION
Total no. of outfalls monitored
Wastewater (WW) Discharge Outfall No. 001
Does this outfall discharge WW to SA waters? Yes ❑ No [,✓
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No ✓❑
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No 0
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 0
Were there any limit violations in the calendar year? Yes 0 No ❑
Outfall No.
001
Daily Flow Rate,
cfs
pH,
SU
TSS,
mgll
SS,
ml1l
itappticabfe
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mg/1
Effluent
Limitations
Da31y Maximum
HQW or ORW
50% of 7Q10
Indicate NO FLOW ifsaltwator
applicabte
freshwater
6.0-9.0
6.8-8.5
Standard
30
HOW
20
ORIN and Tr, or
HOW f PN A
10
HOW, ORW, SA,
SG,PNA,orany
Trout
$
No Limit
Samples above Benchmark
subject to Tiered Responses
15 ,
Date
Sample
Collected �bng
molddl r
- ¢9t t - hM
i. �� Y<..
r^ , !i:. W, 4, '!�
ay € ra
, f
u r
� , ar.� 7Y
�gti.r rilth
�
�4 ! k.P.' ' 1 r2 S¢.
ilrF ,p1 63
}
e!gtt �4 �v Alik{Frg? 7g 4 a
',
2/7/2016
PW 001
6.8
BRL
BRL
BRL Oli and Grease
4/23/2018
PW 001 NO FLOW
9/26/2018
001 NO FLOW
10/10/2018
001 NO FLOW
Permit Date 8/112017 — 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No. NCG 14 � t uC-T
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
10
Date
Mail Annual Summary Wastewater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in D WR (not DEMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

4 . ,
PROCESS WASTEWATER-- Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140051 FEB � � ��1�
FACILITY NAME: Gastonia (Dallas)
PERSON COLLECTING SAMPLES: Rik Jones CENTRAL FK E8
CERTIFIED LABORATORY: Prism Lab # 402 DWR SEVION
LIMIT VIOLATIONS? YES ® NO ❑
Part A: Wastewater Monitorine Requirements
SAMPLE COLLECTION YEAR: 2017
SAMPLE QUARTER: ❑Jul -Sept ®Oct -Dec Dan -March ❑April -June
COUNTY: Gaston
PHONE NO. [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL:
DISCHARGING TO CLASS: []SA ❑HQW
OPTIONAL INFO:
❑PNA ❑Trout ®Other
Outfall No.
Date Sample
Collected'
(mm/dd/yr)
Type of Wastewater
z
(VE, RM, MD}
pH
(standard)
Total Suspended
Solids
(mg/L} �
Settleable
Solids
(mL/L}
TPH usingDischarge
method 1664A
SGT-HEM'
(mg/L)(minutes}
Duration
Total Flow
�
(gallons/day)
-
-
RM, MD-
6-93,4
303,5
53
-
-
001
12/20/2017
RM
6.8
140
BRL
oil and grease
<5
>1
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 mere: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RNi), 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 TS5 limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

1
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 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 1N 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 qualifi d personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those per dir ctly re onsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am avllare that erignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
71 r
(Signature of Permittee) (Date)
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 2 of 2

� � 1
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 FloW'1" No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH lrof each, year.
Certificate of Coverage No. NCG14 1 1 ] 1[� APR 13 2018
Facility Name: Dallas
County: Gaston DWR SECTION
Phone Number: (704 ) 617-4431 Total no. of SDOs monitored 1
Certified Laboratory Prism Lab Lab # 402
Lab #
Stormwater Discharge Outfall (SDO) No. 001 VMA Outfall? Yes ❑ No n✓,
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 ❑✓ S OTC l e
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 ❑ (�L°O�
Other. ❑
Outfall No.
Total Rainfall
inches
Total
Suspended
Solids (TSS),
m ll
pH,
SU
Non -polar O&G
(EPA Method
1664 SGT-HEM) ),
mgll (VMA)
Napplicabla
New Motor Oil
Usage (gallmo.)
If applicable
Stormwater
Benchmarks
Indicate NO FLOWN
applicable
Gircla Benchmark
100/50
6.0-9.0
15
>56gallmo.average requiresTSSand
Non -polar OaG monitaring
Date Samplei,+'
Collected0.
,
moldd! r
l - , pn.
H
$y,,� :� ,:
1 a
��i��$
''� ie
f§ r
ii 3 y A
8. iF,°d
a ;
g 1X
w b
3/30/2017
001 No Flow
6/22/2017
001 No Flow
9/11/2017
001 RM
BRL
7
1212012017
001 RM
140
6.8
oil and grease
Permit Date 8I112017 — 6/30/2022
Last Revised B-22-2015
)�-S
M.

Certificate of Coverage No. NCG 14 0❑©0 1❑
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 `! (6
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 — 6130/2022
Last Revised 8-22-2015

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF ENERGY, MINERAL AND LAND RESOURCES
RECEIVED
GENERAL PERMIT NO. NCG140000 MAR 0 $ 2018
CERTIFICATE OF COVERAGE No. NCG140051 CENTRAL FILES
DWR SECTION
STORM WATER and WASTEWATER 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 operate approved wastewater treatment systems) and discharge
stormwater and/or wastewater, as approved in the original pen-nit/application or subsequent
permit modification, from a facility located at:
Concrete Supply Co -- Gastonia PI
201 N Hartman Rd
Gastonia
Gaston County
to receiving waters designated as Long Creek, a class C water in the Catawba River Basin, in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth
in Parts I, 11, III, IV, and V of General Permit No. NCG140000 as attached.
This certificate of coverage shall be amended effective March 1, 2018.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day March 1, 2018.
for William E. (Toby) Vinson, Jr., P.E., CPM
Interim Director, Division of Energy, Mineral and Land Resources
By the Authority of the Environmental Management Commission

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) -- STORMWATER
I SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2017
*Report ALL STORMWATER monitoring data on this form:(include "No Flow"/"No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG 14
Facility Name: Dallas -
County: Gaston
Phone Number: (704 617-4431 Total no. of SDOs monitored 1
Certified Laboratory Prism Lab Lab # 402
Lab #
Stormwater Discharge Outfall (SDO) No.- 001 VMA Outfall? Yes ❑ No [2
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 ❑
Other ❑
,Outfall No.
Total Rainfall,
inches
Total
Suspended
p
Solids (TSS),
m ll
p H
SU
Non -polar O&G
(EPA Method
(SGT-HEM
1664 )),
mg/l (VMA)
if applicable
New Motor Oil
Usage allmo.
9 (g }
if applicable
Storm water
Benchmarks
Indicate NO FLOW if
applicable
Circle Benchmark
100150
6.0-9.0
... ...
15
>56 g alJma. average requires 785 and
Non -polar OBGmonitoring
Date Sample
Collected¢p§
molddlyr
° r f a ri
`' 4
5,
¢ d ". r"C° -i("�i
e
d r =,
t? § .. !f F�3 ae" rat
.
� ,r ;, _, O
a�ij:.tFr
- ;:
i �
°�<4
3/30/2017
001 No Flow
6/22/2017
001 No Flow
9/11/2017
001 No Flow
12/20/2017
001 No Flow
Permit Date 8/112017 — 6130/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG14 ®Q©Q
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] A
Signature
Date 9 1
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in D WR (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. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140051
FACILITY NAME: Gastonia (Dallas)
PERSON COLLECTING SAMPLES: David Morris
CERTIFIED LABORATORY: Prism Lab # 402
LIMIT VIOLATIONS? YES [-]NO
Part A: Wastewater Monitoring Reauirements
SAMPLE COLLECTION YEAR: 2017
SAMPLE QUARTER: [_]Jul -Sept []Oct -Dec ®Jan -March ❑April -tune
COUNTY: Gaston
PHONE NO. [phone]
ADD TO LISTSERVE? [-]YES ®NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW
OPTIONAL INFO:
❑PNA ❑Trout ®Other
Outfali No.
Date Sample
a
Collected
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)z
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
SGT-HEM'
(mg/L)
Dis charge
Duration
(minutes)
Total Flow
(gallons/day),
-
-
RM, MD-
6-93,4
303'S
53
001
3/30/2017
NO FLOW
AY 0 5 Z017
DVR
. ,�
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 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 028 .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY {INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons dire 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 th a are Significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
rmittee)
Permit Date: 7/1/2010-06/30/2015
572 (r
(Date)
Last Revised 07/13/11
Page 2 of 2

i�
PROCESS WASTEWATER— Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140051
FACILITY NAME: Gastonia (Dallas)
PERSON COLLECTING SAMPLES: 9j & --7�on1E--RECEIVED
CERTIFIED LABORATORY: Prism Lab # 402
JAN 2 3 z017
LIMIT VIOLATIONS? YES ❑ NO ® CENTRAL FILES
DWR SECTION
Part A: Wastewater Monitorine Reouirements
SAMPLE COLLECTION YEAR: 2016
SAMPLE QUARTER: ❑Jul -Sept ®Oct -Dec ❑Jan -March ❑April -June
COUNTY: Gaston
PHONE NO. [phone]
ADD TO LISTSERVE? []YES ®NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW
OPTIONAL INFO:
❑PNA ❑Trout ®Other
Outfall No.
Date Sample
Collected'
(mm/dd/yr)
Type of Wastewater
z
(VE, RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
5 ( /L)
mgL)
Discharge
Duration
(minutes)
Total Flow.
7
(gallons/day)
-
-
RM, MD-
6-93.4
303'S
53
-
-
001
11/29/2016
NO FLOW
ILI 11!I
ILn ff yr
IIIQ) V
1-1 11 iL,
L� �
U
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.
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,
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

r
f
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, Forth Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFIG4TION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified 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 y responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am awkrflhat th2 are5*nificant 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
lf7
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS STORMWATER— Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NC6140000
CERTIFICATE OF COVERAGE NO. NCG140051
FACILITY NAME: Gastonia (Dallas)
PERSON COLLECTING SAMPLES: David Morris
CERTIFIED LABORATORY: Prism Lab # 402
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitorine Reauirements
SAMPLE COLLECTION YEAR: 2016
SAMPLE QUARTER: ®Jul -Sept ❑Oct -Dec ❑Jan -March ❑April -June
COUNTY: Gaston
PHONE NO. [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL:
DISCHARGING TO CLASS: [-]SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO:
Outfall No.
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
2
(VE, RM, MD}
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
6
SGT-HEM
(mg/ L)
(mg/L)
Discharge
Duration
(minutes)
Total Flow
7
{gallons/day)
-
-
RM, MD-
6-93,4
303,5
53
-
001
9/22/2016
NO FLOW
.03
EN
WR SE
' If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

a Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VIVA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
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."
Signature o0ermittee)
Permit Date: 7/1/2010-06/30/2015
(Date)
Last Revised 07/13/11
Page 2of2

��- PROCESS STORMWATER— Quarterly Discharge Monitoring Report
Y.
GENERAL PERMIT NO. NCG140000
11;�t OT1
y
P
CERTIFICATE OF COVERAGE NO. NCG140051
FACILITY NAME: Gastonia (Dallas)
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY: Prism Lab # 402
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitorine Reouirements
SAMPLE COLLECTION YEAR: 2016
SAMPLE QUARTER: ❑Jul -Sept ❑Oct" -Dec ❑Jan -March
COUNTY: Gaston
PHONE NO. [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO:
®April -June
Outfall No.
Date Sample
i
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
s
SGT-HEM
(mg/L)
Duration
(minutes}
Total Flow
(gallons/day)'
-
-
RM, MD-
6-93,4
303,5
53
-
-
001
5/17/2016
NO FLOW
Kt:
Uti V t
U
^
H
UU
GR
TR .I FIl
;
DW
R SECTIOP
I
' 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.
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,
bu`4istead 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 dir ctly 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 t�iere ye significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signatur�of Permittee)
Permit Date:7/1/2010-06/30/2015
-z' (, //
(Date)
Last Revised 07/13/11
Page 2 of 2

PROCESS STORMWATER— Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140051
FACILITY NAME: Gastonia (Dallas)
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY: Prism Lab # 402
LIMIT VIOLATIONS? YES ❑ NO Fj
Part A: Wastewater Monitoring Reauirements
SAMPLE COLLECTION YEAR: 2016
SAMPLE QUARTER: ❑Jul -Sept ❑Oct -Dec ®Jan -March ❑April -June
COUNTY: Gaston
PHONE NO. [phone]
ADD TO LISTSERVE? ❑YES ®NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other
OPTIONAL INFO:
Outfall No.
Date Sample
Collected'
(mm/dd/yr)
Type of Wastewater
z
[VE, RM, MD)
pH
[standard}
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
SG 6
(mg/L)
Discharge
Duration
(minutes)
Total Flow
7
[gallons/day}
-
-
RM, MD-
6-93'4
303s
53
-
001
3/30/2016
NO FLOW
c IV
11nrt1 F
ON
_
,
Las
r�Y n
' 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

6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
7 Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50`Y of the Summer 7Q10 Flow as per 15A
NCAC 028 .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE"] WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons d ectly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am awarg tha,herg�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
e ,zrl f'
(Date)
Last Revised 07/13/11
Page 2 of 2

.,, STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT No. NCG140000 \\Z
CERTIFICATE OF COVERAGE NO. NCG140051 RECEIVED SAMPLE COLLECTION YEAR:2015
FACILITY NAME: Gastonia (Dallas) SAMPLING PERIOD: ® July -December ❑ January -June
PERSON COLLECTING SAMPLES: Rik Janes OCT 2 3 2015 COUNTY Gaston
CERTIFIED LABORATORY: Prism Lab #i 402 PHONE NO. [phone]
CENTRAL FILES OPTIONAL INFO:�, rR SECTION ADD TO LISTSERVE? ❑YES ®NO EMAIL:
.
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other
Part A: Stormwater Monitoring Requirements
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
PH
(Standard
units)
TSS
(mg/Lj
Event
Duration
(minutes)
Total
a
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
tf of Months in Tier
z
2 Sampling
-
-
6-9
100 ,
-
-
-
-
001
09/28/15
No Flow
If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
Z If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HOW, Trout, and PNA waters where they are 50 mg/l.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
-M
Outfall
No.
Date Sample
Collected
(mo/dd/yr)1
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months
in Tier 2
Samplingz
6-9
15
100 '
-
-
-
-
001
9/28/15
No Flow
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES []NON
REGIONAL OFFICE CONTACT NAME: Mooresville NCDENR
Mail Original and one copy of this DMR {including all "No Flow" & "No Discharge" reports} within 30 days of receipt of sample (or at end of monitorine period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that 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 ctly r ponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am *vaA that erignificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
re of Permitteej
Permit Date:7/1/2011-60/30/2015
(Date)
Last Revised 7/13/11
Page 2 of 2

STORMIMATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
CERTIFICATE OF COVERAGE NO. NCG140051
FACILITY NAME: Gastonia
PERSON COLLECTING SAMPLES: Rik Jones
CERTIFIED LABORATORY: Prism Lab # 402
OPTIONAL INFO:
Part A: Stormwater Monitorins Requirements
GENERAL PERMIT NO. NCG140000
RECEI V EDSAMPLE COLLECTION YEAR: 2015
JUL 2 4 2015 SAMPLING PERIOD: ❑ July -December
COUNTY Gaston
CENTRAL FILES PHONE NO. [phone]
DWrR SECTION ADD TO LISTSERVE? ❑YES ®NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW
® January -June
❑PNA ❑Trout ®Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)1
PH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
a
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2
2 Sampling
-
-
6-4
100 ,
-
-
-
-
001
6/26/2015
No Flow
' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
4 For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/1/2011-60/30/201S Last Revised 7/13/11
Page 1 of 2

� .�
. „t 'i
rt n Ali
.._ '-v%'
4"f
+aa Ste-
s
�kai w
i
= s'ac ;�
;�?��
s

i�a t B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr]1
pH
[Standard
Units}
TPH using method
1664A SGT-HEM
[mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes}
Total
Rainfall°
(in}
New Motor Oil
Usage
(gal/month}
In Tier 2
Monthly
Monitoring?
[y/n}
# of Months
in Tier 2
2
Sampling
6-9
15
100 ,
-
-
-
-
-
001
9/23/14
No Flow
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES [:]NON
HAVE YOU CONTACTED THE REGION? YES []NO
REGIONAL OFFICE CONTACT NAME: Mooresville NCDENR
Mail Original and one copv of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sarnole (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
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 quaffed personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons fere
ectly res nsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am�v{re that a igni€icant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
ature of P#fmittee)
Permit Date{ 7/1/2011-60/30/201S
('/(]-
(Date)
Last Revised 7/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140051 RECE1 I\WLE COLLECTION YEAR: 2014
FACILITY NAME: Gastonia LING PERIOD: ® July -December
PERSON COLLECTING SAMPLES: Scott Miller JAN 2 0 2RUNTY Gaston
CERTIFIED LABORATORY: Prism Lab # 402 CENT PHONE NO. [phone]
OPTIONAL INFO: DVN CENTRAL Fitt TO LISTSERVE? DYES ®NO EMAIL:
`"TIQhCHARGING TO CLASS: ❑SA ❑HQW
Part A: Stormwater Monitoring Requirements
0"
❑ January -June
❑PNA ❑Trout ®Other
Outfalk No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total 4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 Sampling2
-
-
6-9
100 '
-
-
-
-
001
9/23/14
No Flow
' If "NO FLOW" or "NO DISCHARGE, €nter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
Z if a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l.
° For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/l/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

fart B Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month —averaged over a calendar year.
Outfall
No
Date Sample
( Co/dd/y )ollected
i
pH
(standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
,
Rainfall
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
#i of Months
in Tier 2
Sampling2
6-9
15
100 '
-
-
-
-
001
9/23/14
No Flow
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES ❑ NO
REGIONAL OFFICE CONTACT NAME: Mooresville NCDENR
Mail Original and one coDv of this DMR (including all "No Flow" & "No Discharge" reoorts) within 30 days of receipt of samDle (or at end of monitoring Deriod
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST S1GN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"I certify, under pegalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualifi personr roperly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those p rsons it ctly r Bible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am w e tha r e significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(S' ature of P,ermittee) (Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2

S
. • .. �
- � S
_'

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
CERTIFICATE OF COVERAGE NO. NCG1400551
FACILITY NAME: Gastonia
PERSON COLLECTING SAMPLES: Scott Miller
CERTIFIED LABORATORY: Prism Lab ## 402
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
GENERAL PERMIT NO. NCG140000
SAMPLE COLLECTION YEAR: 2014
SAMPLING PERIOD: ® July -December ❑ January -June
COUNTY Gaston
PHONE NO. [phone]
ADD TO LISTSERVE? EYES ®NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ®Other
Outfall No.
Date Sample
Collected
(mo/dd/yr OR
NO FLOW)'
pH
(Standard
Units]
TS5
(mg/L)
Event
Duration
(minutes]
Total 4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n'
# of Months in Tier
2 SamplingZ
-
-
6-9
100 ,
-
-
-
-
001
9/23/14
No Flow
14
CENTRAL
UVWSECTION
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
`For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 1 of 2

a
� �.4•_. _
r Y i

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No.
Date Sample
Collected
(mo/dd/yr}1
pH
(Standard
Units)
TPH using method
1664A SGT-HEM
(mg/L)
Total Suspended
Solids
(mg/0(minutes)
Event
Duration
Total
a
RainfaEl
[in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
ft of Months
in Tier 2
2
Sampling
6-9
1s
100 '
-
-
-
-
�[
ti
l -0
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES []NO
REGIONAL OFFICE CONTACT NAME: Mooresville NCDENR
Mail Original and one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample for 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
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 qua 'fied personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those pe sons i ect responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am a a tha a re significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
fa(oIit
re of
(Date)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of 2