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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ ► a
YYYYMMDD
PROCESS WASTEWATER — Semi -Annual Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. N(�[' G,,1I4 O Q,2I SAMPLE cOLLECTION Y R: Q
FACILITY NAME: Nyh 1Xa) 7 t�64(rii /i7 k ' - SAMPLE PERIOD: December ❑January -June
SAMPLE COLLECTOR: COUNTY: 4)m d)•'
CERTIFIED LABORATORY: Lab N PHONE NO.: L2&_0_j 7a -Qgt5q
Lab# ADD TOLISTSERVE? ❑YES []NO EMAIL:
LIMIT VIOLATIONS? YES ❑ NO E DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other
OPTIONAL INFO: A10 N 51ZAI PEE
art A:
'If wastewater systems have not discharged in this quarter— report "No Flow" or 'No Discharge here. riease rnaxe sure m rnarx me sarnpic quaver auuvc.
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-strearn is commingled. '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 DEMLR RD staff
notifies you to continue monitoring.
pli limits are 6-9 SAL for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
Permit Date: 8/1/2017-06/30/2022
Last Revised 07/27/17
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5 TSS limits are 20 mg/L for wastewater discharges to HOW 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 FIQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A NCAC
02D .0224. Permittees who discharge wastewater to HOW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot obtain a
Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow report on
a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF T}IIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR AT END
OF MONfiORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
(919)807-6379
YOU MUST SIGN 1NIS CERTIFICATION rOR ANY INFORMAHON 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, orthose persons
directly responsihle. for fptherinp .he infbrhation, the information submitted is, to the hest of my knowledge and belief, true, accumte, and complete. I am aware thatthere
are.signif2tntp nat'esforsu ttingP ein�rtlon, including the possibility offinesand imprisonment for knowing violations."
(Signature of Pe mittee) (Date)
Permit Date: 8/1/2017-06/30/2022 Last Revised 07/27/17
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