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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ a o I o
YYYYMMDD
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14Q I Co
FACILITYNAME: 1a-1001S p"li n1X
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY:?e4cMeMkiANlihc?1 Lab
Lab #
LIMIT VIOLATIONS? YES ❑ NO X
SAMPLE COLLECTION YEAR: ali "I
SAMPLE QUARTER: EgJul-Sept []Oct -Dec [_]Jan -March []April -June
COUNTY: Faits +t N .`r.
PHONE NO. (nL&)
ADD TO LISTSERVE? []YES []NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other
OPTIONAL INFO:
part A: wastewater
Outfall No.
monaonng negwremems
Date Sample
r
Collected
(mm/dd/yr)
Type of Wastewater
YP
z
(VE, RM, MD)
p H
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L) _
TPH using
method 1664A
sGT-HEM'
(mg/L)
bh2r e
DIS*_g
Duration
-
(minutes)
Total Flow
(gallons/day)
-
-
-
6-93.4
303.5
53
Kl�f`I✓IAJ);n
U U 2119
•AI
v�rl_ti
flIern .. -
-••• ��-vilJi'J
' If wastewater systems have not discharged in this quarter- report' NO HOW OF NO Uisalalge ncl U. rrconc me —.-: •••..• ^ ...- - --- :, - -
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RlA) •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.E`
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 otherwater classifications.:.";
Last Revised 07/13/11
Permit Date: 7/1/2010-06/30/2015 `>
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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 beset to 50% of the Summer 7Q10'Flow as per 25A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a summer 7Q10.flow and report this information to DWQ. If the permi[ee 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.
i
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
(919)807-6379
"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 submittlne false Information, including the possibility of fines and imprisonment for knowing
30-aO)' 1
(Date)
Permit Date: 7/1/2010-06/30/201S �:`. Last Revised 07/13/11
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