NC0005274_Regional Office Historical File Pre 2018

PERMIT NO.:NC0005274 PERMIT VERSION:3.0_ ECE VED PERMIT STATUS:Expired 3
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC -fp1 e ` J COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDor T 16 2o19 ORC CERT NUMBE 3
GRADE:WW-4. ORC HAS CHANGED.No ��EOMCDENR/DWR
CENTRAL FILES i
eDMR PERIOD:07-2019(July 2019) VERSION:2.0 D\NR SECTION STATUS:Processed OCT 21 2019
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DIg IRMEI es: NAL OFFICE
50050 00010 00400 QD3I0 QD530 00300 QD600 QD665 00940
P I ifi a c
1i ° a
y "� I :; m Once per 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week
a a` a Eq
I. U �', 2 O S Instantaneous Grab Grab Composite Grab Grab Grab Grab Grab
. E U o
C U h2 O O O C. FLOW TEMP-C pH ROD-Qly Daily TSS-Qty Dilly DO TOTAL N-Qty Total P-Qty CHLORIDE
2400 clock Hrs 2400 cloak Hrs V/B/N mgd deg c su lbs/day lbs/day mg/1 lbs/day lbs/day mg/1
I 13:00 4 Y 0.2 19.5 6.32 48.4 14.7 5.66 26.5 2.2 75.7
2 NOFLOW
3 NOFLOW
4 NOFLOW
5 NOFLOW
6 NOFLOW
7 NOFLOW
8 NOFLOW
9 NOFLOW
in NOFLOW
11 NOFLOW
12 NOFLOW
13 NOFLOW
14 NOFLOW
IS NOFLOW
16 NOFLOW
17 NOFLOW
10 NOFLOW
19 NOFLOW
20 NOFLOW
21 NOFLOW
22 NOFLOW
23 NOFLOW
24 NOFLOW
25 NOFLOW
26 NOFLOW
27 NOFLOW
28 NOFLOW
29 NOFLOW
30 NOFLOW
31 NOFLOW
Monthly Average Limit: 0.2 123 156 144 7.6
Monthly Avenge:
0.2 19.5 48.4 14.7 5.66 26.5 2.2 75.7
Daily Maximum:
0.2 19.5 6.32 48.4 14.7 5.66 26.5 2.2 75.7
Daily Minimum:
0.2 19.5 6.32 48.4 14.7 5.66 26.5 2.2 75.7
:ss.No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION:2.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
00083 TCP3B 32730 C0456 QD456 00945
e
F E F 'a II. 11C ..
E 6 a 5 X week See Permit 5 X week 5 X week 5 X week 5 X week
m - a
z
d 8 uoE <` E O $ Grab Grab Grab Grab Grab Grab
a Y z z
C U 2 O O Z' COLOR-AD CERI7DPF PREM.TR PAH-CO PAH-QV SULFATE
2400 clock Hn 2400 clock Hn V/B/N admi unit pass/fail lbs/day ug/1 lbs/day mg/1
i 13:00 4 Y 103.5 0.242 <1011 <166.8 <15
2 NOFLOW
3 NOFLOW
4 NOFLOW
5 NOFLOW
6 NOFLOW
7 NOFLOW
8 NOFLOW
9 NOFLOW
10 NOFLOW
11 NOFLOW
12 NOFLOW
13 NOFLOW
14 NOFLOW
15 NOFLOW
16 NOFLOW
17 NOFLOW
Ill NOFLOW
19 NOFLOW
20 NOFLOW
21 NOFLOW
22 NOFLOW
23 NOFLOW
24 NOFLOW
25 NOFLOW
26 NOFLOW
27 NOFLOW
28 NOFLOW
29 NOFLOW
30 NOFLOW
31 NOFLOW
Monthly Average Limit: 1.67 0.012
Monthly Average: 103.5 0.242 0 0 0
Daily Maximum:
103.5 0.242 0 0 0
Daily Minimum: 103.5 0.242 0 0 0
:"'s No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; EN VWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments 1 LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION:2.0 STATUS:Processed
Report Comments:
The Aquatic Toxicity sampling was done 6/19/2019 prior to any discharge of any Effluent. The sample for this discharge was a PASS.
Revision for No Flow days and Operator error on calculating Phenols(had decimal in the wrong place).

PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION:2.0 STATUS:Processed
SAMPLING LOCATION: UPSTREAM DISCHARGE NO.: 001
00300 000e3 00094
Weekly Monthly Weekly
nGrab Grab Grab
E �
DO COLOR-AD CNDUCTVY
2400 clock mg/I admi unit umhos/cm
NOFLOW
2 NOFLOW
3 NOFLOW
4 NOFLOW
5 NOFLOW
6 NOFLOW
7 NOFLOW
0 NOFLOW
NOFLOW
t0 NOFLOW
11 NOFLOW
12 NOFLOW
13 NOFLOW
14 NOFLOW
15 NOFLOW
16 NOFLOW
17 NOFLOW
Ill NOFLOW
19 NOFLOW
20 NOFLOW
21 NOFLOW
22 NOFLOW
23 NOFLOW
24 NOFLOW
25 NOFLOW
26 NOFLOW
27 NOFLOW
20 NOFLOW
29 NOFLOW
30 NOFLOW
31 NOFLOW
Monthly Average Limit:
Monthly Average:
Daily Maximum:
Daily Minimum:
"••No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

S PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION:2.0 STATUS:Processed
Outfall 001-Upstream Comments:
Sampling was done 6/28/2019

PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments 1 LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION:2.0 STATUS:Processed
SAMPLING LOCATION: DOWNSTREAM DISCHARGE NO.: 001
34 00300 00083 00094
D
0
Weekly Monthly Weekly
Grab Grab Grab
A DO COLOR-AD CVDUCTVY
2400 clock mg/I admi unit umhos/cm
NOFLOW
2 NOFLOW
3 NOFLOW
4 NOFLOW
5 NOFLOW
6 NOFLOW
7 NOFLOW
8 NOFLOW
9 NOFLOW
to NOFLOW
11 NOFLOW
12 NOFLOW
13 NOFLOW
16 NOFLOW
15 NOFLOW
16 NOFLOW
17 NOFLOW
18 NOFLOW
19 NOFLOW
20 NOFLOW
21 NOFLOW
22 NOFLOW
23 NOFLOW
26 NOFLOW
25 NOFLOW
26 NOFLOW
27 NOFLOW
28 NOFLOW
29 NOFLOW
30 NOFLOW
31 NOFLOW
Maathly Average Limit:
Monthly Avenge:
Daily Maximum:
Daily Minimum:
ooss No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION:2.0 STATUS:Processed
Outfall 001-Downstream Comments:
Sampling was done 6/28/2019

S PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION:2.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:09/18/2019
#de/ 40 e4, 09/17/2019
O C i ertifier Signature: Rojeana McDonald E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES permit.
V -4/L K.- , `sCO 9 09/18/2019
Permittee/Submitter Signature:*** Shannon Hughes Doster E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 1602 N Main St Lowell NC 28098 Permit Expiration Date: 12/31/2013
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME:Statesville Analytical
CERTIFIED LAB#:37755
PERSON(s)COLLECTING SAMPLES:Rojeana Howard
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

Pb
IT NO.:NC0005274 PERMIT VERSION:3.0 ` 'E C EIV PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC S E P 0 4 2019 COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonadEN I KAL FILES ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No DWR SECTION RECEIVEDINCDENR/OWR
eDMR PERIOD:07-2019(July 2019) VERSION:1.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISC � E*.t'NS
1LLE REGIONAL OFFICE
50050 00010 00400 QD310 QD530 00300 QD600 QD665 00940
E
Fli
a S `4 a I
F Once per 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week
.0 r
Q
L u � O Instantaneous Grab Grab Composite Grab Grab Grab Grab Grab
U o<
a U f2 S. O i FLOW TEMP-C pH BOD-Qty Daily TSS-Qty Daily DO TOTAL N-Qty Total P-Qty CHLORIDE
2400 clock Hrs 2400 clock Hrs V/B/N mgd deg c su lbs/day lbs/day mg/1 lbs/day lbs/day mg/1
1 13:00 4 Y 0.2 19.5 6.32 48.4 14.7 5.66 26.5 2.2 75.7
2
3
4
5
6
7
a
9
10
11
12
13
14
15
16
17
Ill
19
20
21
22
L3
24
25
26
27
28
29
30
31
• •
Monthly Average Limit: 0.2 123 I% 144 7.6
Monthly Avenge: 0.2 19.5 48.4 14.7 5.66 26.5 2.2 75.7
Daily Maximum: 0.2 19.5 6.32 48.4 14.7 5.66 26.5 2.2 75.7
Daily Minimum: 0.2 19.5 6.32 48.4 14.7 5.66 26.5 2.2 75.7
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION: 1.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
00083 TCP3B 32730 C0456 QD456 00945
F B I
B ~ i O
t 5 X week See Permit 5 X week 5 X week 5 X week 5 X week
S u S = S Grub Grab Grab Grab Grab Grab
e' 3 $$ a
U F 6 O COLOR-AD CERI7DPF PHEN,TR PAH-CO PAH-QY SULFATE
2400 clock Ws 2400 clock Ma Y/BM admi unit pass/fail lbs/day ug/I lbs/day mg/I
1 13:00 4 Y 103.5 241.9 <100 <166.8 <15
2
3
4
5
6
7
9
10
i
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Monthly Average Limit: 1.67 0.012
Monthly Average: 103.5 241.9 0 0 0
Daily Maximum: 103.5 241.9 (1 0 0
Daily Minimum: 103.5 241.9 0 0 0
oaa»No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

,
NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments 1 LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION: 1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:08/15/2019
G��J //n, 08/14/2019
4.1
OR ertifier Signature: Rojeana McDonald E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES permit.
4r40-- 08/15/2019
Permittee/Submitter Signature: Shannon Hughes Doster E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 1602 N Main St Lowell NC 28098 Permit Expiration Date: 12/31/2013
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME:Statesville Analytical
CERTIFIED LAB#:37755
PERSON(s)COLLECTING SAMPLES:Rojeana Howard
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION: 1.0 STATUS:Processed
SAMPLING LOCATION: UPSTREAM DISCHARGE NO.: 001
00300 00083 00094
E Weekly Monthly Weekly
Grab Grab Grab
DO COLOR-AD CNDUCTVY
2400 clack mg/I admi unit umhos/cm
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Monthly Avenge Limit:
Monthly Average:
Dolly Maximum:
Daily Minimum:
• 4.*No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION: 1.0 STATUS:Processed
Outfall 001-Upstream Comments:
Sampling was done 6/28/2019

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments 1 LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION: 1.0 STATUS:Processed
SAMPLING LOCATION: DOWNSTREAM DISCHARGE NO.: 001
00300 00083 00094
re
Weekly Monthly Weekly
s a Grab Grab Grab
e` z
v, ;4 DO COLOR-AD CNDUCTVY
2400 eloeh mg/I admi unit umhos/cm
2
3
4
5
6
7
9
10
1
12
13
14
15
16
17
1N
19
20
21
22
23
24
25
26
27
20
29
30
31
Weekly Average Limit:
Monthly Average:
Daily Minimum:
Daily Minimum:
9sss No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION: 1.0 STATUS:Processed
Outfall 001-Downstream Comments:
Sampling was done 6/28/2019

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:07-2019(July 2019) VERSION: 1.0 STATUS:Processed
Report Comments:
The Aquatic Toxicity sampling was done 6/19/2019 prior to any discharge of any Effluent. The sample for this discharge was a PASS.

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 nPERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC RECEIVE OUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald O C T 16 2019 ORC CERT NUMBER:ii&EIVEDMCDENR/DWR
GRADE:WW-4. ORC HAS CHANGED:No
CENTRAL FILES
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 DWR SECTIONSTATUS:Processed 0 C T 21 ?131H
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCIMEHMENOGIONAL OFFICE
50050 00010 00400 Q0310 Q0530 00300 QD600 Q0665 00940
IE — `7' S
A. w C a
I 'S i `e �c Once per 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week
5 < i= ti
u° -°
E. - e O` $
o`C
Instantaneous Grab Grab Grab Grab Grab Grab Grab Grab
a E $ $ C
G U F2 O 6 O Z' FLOW TEMP-C pH BOD-Qy Daily T.SS-Qy Daily DO TOTAL N-Qy TotalP-Qy CHLORIDE
2400 clock Hrs 2400 clack Hrr Y/B/N mgd deg c su lbs/day lbs/day mg/I lbs/day lbs/day mg/I
I NOFLOW
2 NOFLOW
—
3 NOFLOW
4 NOFLOW
5 NOFLOW
6 NOFLOW
7 NOFLOW
a NOFLOW
9 NOFLOW
10 NOFLOW
11 NOFLOW
12 NOFLOW
13 NOFLOW
14 NOFLOW
15 NOFLOW
16 NOFLOW
17 NOFLOW
is NOFLOW
19
20 NOFLOW
21 NOFLOW
22 NOFLOW
23 NOFLOW
24 NOFLOW
25 NOFLOW
26 NOFLOW
27 NOFLOW
28 11:00 4 Y 0.2 26 8.54 11.54 19.47 8 4.2 1 35
29 NOFLOW
i0 NOFLOW
Monthly Average Limit: 0.2 123 156 144 7.6
Monthly Average: 0.2 26 11.54 19.47 8 4.2 1 35
Daily Maximum: 0.2 26 8.54 11.54 19.47 8 4.2 1 35
Daily Minimum: 0.2 26 8.54 11.54 19.47 8 4.2 1 35
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
00083 TCP38 32730 C0456 QD456 00945
y I B :; 5 X week See Permit 5 X week 5 X week 5 X week 5 X week
< E
u Eta E O` E. Grab Grab Grab Grab Grab Grab
AE e J. I. Y
U F- O OkT. COLOR-AD CERI7DPF PHEN.TR PAH-CO PAH-QY SULFATE
2400 clock Hrs 2400 clock Hrr YBM admi unit pass/fail lbs/day ug/I lbs/day mg/1
1 NOFLOW
2 NOFLOW
3 NOFLOW
4 NOFLOW
5 NOFLOW
6 NOFLOW
7 NOFLOW
8 NOFLOW
9 NOFLOW
10 NOFLOW
1I NOFLOW
12 NOFLOW
13 NOFLOW
14 NOFLOW
15 NOFLOW
16 NOFLOW
17 NOFLOW
IN NOFLOW
19 PASS
20 NOFLOW
21 NOFLOW
22 NOFLOW
23 NOFLOW
24 NOFLOW
25 NOFLOW
-
26 NOFLOW
27 NOFLOW
28 11:00 4 Y 53 <83.4 <15
29 NOFLOW
30 NOFLOW
Monthly Average Limit:
1.67 0.012
Monthly Average: 53 0 0
Daily Maximum: 53 0 0
Daily Minimum: 53 0 0
ssss No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather, NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Processed
Outfall 001-Effluent Comments:
The PAH sample for June 28,2019 was lost per lab. A letter from the lab will be attached to the back of the DMR.

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Processed
SAMPLING LOCATION: UPSTREAM DISCHARGE NO.: 001
00300 00083 00094 00010
$
9 .. Weekly Monthly Weekly
Grab Grab Grab Calculated
e'
S f DO COLOR-AD CNDUCTVY TEMP-C
2400 dark mg/1 admi unit umhos/cm deg c
NOFLOW
2 NOFLOW
3 NOFLOW
4 NOFLOW
5 NOFLOW
6 NOFLOW
7 NOFLOW
s NOFLOW
9 NOFLOW
10 NOFLOW
11 NOFLOW
12 NOFLOW
13 NOFLOW
14 NOFLOW
Is NOFLOW
16 NOFLOW
17 NOFLOW
10 NOFLOW
19 NOFLOW
20 NOFLOW
21 NOFLOW
22 NOFLOW
23 NOFLOW
24 NOFLOW
25 NOFLOW
26 NOFLOW
27 NOFLOW
28 11:40 8.45 <20 99.8 25
29 NOFLOW
30 NOFLOW
Monthly Average Limit:
Monthly Average: 8.45 0 99.8 25
Daily Maximum: 8.45 0 j 99.8 25
Daily Minimum: 8.45 0 99.8 25
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Processed
SAMPLING LOCATION: DOWNSTREAM DISCHARGE NO.: 001
00300 00083 00094 00010
Weekly Monthly Weekly
nGrab Grab Grab Calculated
e �
DO COLOR-AD CNDUCTVV TEMP-C
2400 clack mg/I admi unit umhos/cm deg c
NOFLOW
2 NOFLOW
3 NOFLOW
4 NOFLOW
5 NOFLOW
6 NOFLOW
7 NOFLOW
8 NOFLOW
9 NOFLOW
to NOFLOW
i NOFLOW
12 NOFLOW
13 NOFLOW
14 NOFLOW
15 NOFLOW
16 NOFLOW
17 NOFLOW
18 NOFLOW
19 NOFLOW
20 NOFLOW
21 NOFLOW
22 NOFLOW
23 NOFLOW
24 NOFLOW
25 NOFLOW
26 NOFLOW
27 NOFLOW
28 12:05 8.55 36.5 90.6 25
29 NOFLOW
30 NOFLOW
Monthly Average limit:
Monthly.Average. 8.55 36.5 90.6 25
Daily Maximum: 8.55 36.5 90.6 25
Daily Minimum: 8.55 36.5 90.6 25
'•"No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather, NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

•
NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Processed
Report Comments:
Revision for No Flow days except 6/28/19. Also Chronic Toxicity was sampled 6/19/2019 from Tank#1 and#2 before any discharge of wastewater.

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:09/18/2019
//4(04. ele;7<-49-e, 09/17/2019
OR' /'ertifier Signature: Rojeana McDonald E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part 11.E.6 of
the NPDES permit.
L. 09/18/2019
Permittee/Submitter Signature:*** Shannon Hughes Doster E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 1602 N Main St Lowell NC 28098 Permit Expiration Date: 12/31/2013
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME:Statesville Analytical
CERTIFIED LAB#:37755
PERSON(s)COLLECTING SAMPLES:Rojeana Howard
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per I5A NCAC 2B
.0506(b)(2)(D).

f ]
NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired 3
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC R EC,�";\ COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonaldie ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No AUG~U 09 2019
eDMR PERIOD:06-2019(June 2019) VERSION: 1.0 CEN I i\I,i_ FI r STATUS:Processed RECEIVEDMCDENR,DWR
AUG 1 9 11-
SAMPLING LOCATION: DOWNSTREAM DISCHARGE NO.: 001
WQROS
MOORESVILLE REGIONAL OFFICI
00300 00083 00094
Weekly Monthly Weekly
e Grab Grab
Grab
DO COLOR-AD CNDUCTVY
2400 clock
mg/I admi unit umhos/cm
2
3
4
5
6
7
8
9
10
I1
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28 12:05
8.55 36.5
90.6
29
30
Monthly Average Limit:
Monthly Average:
8.55 36.5
90.6
Daily Maximum: 8.55
36.5 90.6
Daily Mlnlmum.
8.55 36.5
90.6
`***No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; EN V WTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

f %
NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3_0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION: 1.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
50050 00010 00400 QD310 QD530 00300 QD600 QD665 00940
I
F E F 2a:
8 — G : a
9 A e Once per 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week
aE
u S E Instantaneous Grab Grab Grab Grab Grab Grab Grab Grab
E 7..
Egg C cc
S J F' O 6 O ' FLOW TEMP-C pH BOD-Qty Daily TSS-Qty Dail
y DO TOTAL N-Qty Total P-Qty CHLORIDE
2400 clock Hrs 2400 clock Hrs V/B/N mgd deg c so lbs/day lbs/day mg/I lbs/day lbs/day mg/I
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28 11:00 4 Y 0.2 26 8.54 11.54 19.47 8 4.2 1 35
29
30
alanthly Average Limit: 0.2 123 156 144 7.6
Monthly Average: 0.2 26 11.54 19.47 8 4.2 1 35
Daily Maximum:
0.2 26 8.54 11.54 19.47 8 4.2 1 35
Daily Minimum:
0.2 26 8.54 11.54 19.47 8 4.2 1 35
`***No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3_0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION: 1.0 STATUS:Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
00083 't0P38 32730 C0456 QD456 00945
a F
o S
9 6`_ ��«' 5 X week See Permit 5 X week 5 X week 5 X week 5 X week
u 8 8 g Grab Grab Grab Grub Grab Grab
e
5 e u pt
Gg
G U COLOR-AD CERI7DPF PHER,TR PAH-CO PAH-QY SULFATE
2400 clock Hrs 2400 clock Hn YBM admi unit pass/fail lbs/day ug/1 lbs/day mg/I
2
3
4
5
6
7
9
10
11
12
13
14
15
16
17
18
19
PASS
20
21
22
23
24
25
26
27
28 11:00 4 Y 53 <83.4 <15
29
30
Monthly Average Limit: 1.67 0.012
Monthly Average: 53 0
0
Dolly Maximum: 53 0
0
Dolly Minimum: 53 0
0
'***No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION: 1.0 STATUS:Processed
SAMPLING LOCATION: UPSTREAM DISCHARGE NO.: 001
00300 00083 00094
61
2 Weekly Monthly Weekly
Grab Grab Grab
E �
ti y Z DO COLOR-AD CNDUCTVY
2400 cloak
mg/I admi unit umllos/cm
2
3
4
5
6
7
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28 11:40 8.45 <20 99.8
29
30
Monthly Average Limit:
Monthly Average: 8.45 0 99.8
Daily Maximum: 8.45 0 99.8
Daily Minimum: 8 45 0
99.8
`***No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; EN V WTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3_0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION: 1.0 STATUS:Processed
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:07/30/2019
5 \&Jy Y\v/.. - 4I" ' 07/30/2019
ORC/Certifier Signature: Shannon Hughes Doster E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES permit.
SkeLAtiAtfn- 4 ' ,J 07/30/2019
Permittee/Submitter Signature:*** Shannon Hughes Doster E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 1602 N Main St Lowell NC 28098 Permit Expiration Date: 12/31/2013
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME:Statesville Analytical
CERTIFIED LAB#:37755
PERSON(s)COLLECTING SAMPLES:Rojeana Howard
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
k*ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
k**Signature of Permittee:If signed by other than the pennittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
0506(b)(2)(D).

NPDES PERMIT NO.:NC0005274 PERMIT VERSION:3.0 PERMIT STATUS:Expired
FACILITY NAME:former Yorkshire Americas site CLASS:WWNC COUNTY:Gaston
OWNER NAME:Lowell Investments I LLC ORC:Rojeana Howard McDonald ORC CERT NUMBER:27833
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION: 1.0 STATUS:Processed
Outfall 001-Effluent Comments:
The PAH sample for June 28,2019 was lost per lab. A letter from the lab will be attached to the back of the DMR.

r
STATESYILLE
ANALYTICAL
July 23, 2019
Subject: June 28, 2019 PAH sample for Forsite# 190628-22-01
Dear Concerned Parties:
,* The purpose of this letter is to explain missingPAH data :w
p from the June 28, 2019 report for Forsite . The PAH �°�'
sample was lost after being removed from the refrigerator in prep for pickup of subcontracted lab. We were unable to
locate the sample at either location. Since that error no replacement sample was analyzed. We have marked this
sample with an L/A (lab accident) on the COC. We apologize for any inconvenience this unforeseen accident has caused.
If you have questions concerning this matter please feel free to contact our office at: 704-872-4697.
Thank you for your attention in this matter.
.. Sincerely, Lit ii
41
4.
Crystal Little
Sr Lab Manager
Statesville Analytical Holdings, LLC
l

EFFLUENT
3
NPDES PERMIT NO. /"G G401$ 7J DISCHARGE NO.UO/ MONTH 2/,cf''?"F/1 YEAR.020/6
FACILITY NAME hartvll, A.vfrigef4,04T//( CLASSN/4 COUNTY 6 LcTO/f
CERTIFIED LABORATORY(1) CERTIFICATION NO. N/4
(list additional laboratories on the backside/page 2 of this orm)
OPERATOR IN RESPONSIBLE CHARGE(ORC) ,(//l GRADE'�� CERTIFICATION NO. N///
PERSON(S)COLLECTING SAMPLES (WI! ORC PHONE i(//4
CHECK BOX IF ORC HAS CHANGED r 1 NO FLOW/DISCHARGE FROM SITE*
Mail ORIGINAL and ONE COPY to: 1 RECEIVED/NCDENR!DWR
ATTN:CENTRAL FILES x
DIVISION OF WATER RESOURCES (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) - - -DATB•
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS r -
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
WOROS
e 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 p, 1FSVIl iIF REGIDNAL(.FFICE
F x E cFLOW au -Jul p G o ENTER PARAMETER CODE ABOVE
>$ P Si: EFF 0 _ Q�y m m a W J J W Z —Oa NAME AND UNITS BELOW
Q i to C INFO WJ a WMre 0 0% °° OUZ in O} 1-0 0 it I.
A e a c U -I lW- M y m 2 1- I-Co U.0 In ca 0 I-I- f"co
a W Q Ott O W Q Z V G Z n=.
O O 0 ~ disinfection CO
HRS HRS Y/B/N MCD ° C UNITS UG/L MG/L MG/L MG/L A/IOOML MG/L MG/L MG/L
I RECE E 0
2
3 [1E6 0-J 7Oli
4
5 CD TRAL FILE
6 DWR SECTIO
7
8
9
10
11
12
13 -
14
16 K
16 N
17
18 uo3 nri
19
20
21
22 QA
23
24
25 26 FEB 0 3 2617
27
28
29
30 •
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit
DWR Form MR-1(08/05)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements 4/4(including weekly averages,if applicable)
Compliant
nj
All monitoring data and sampling frequencies do NOT meet permit requirements I "'
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"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 managed 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."
? >k' � / 7/
Permittee (Please print or type)
//2/7
ignature of Permittee*** Date
�,I/ (Required unless submitted
electronically)
J?20 OO, 4'vf/6lf//f e'4 (, -2I2/7 7d/41e/1-7/o/ �• Qjx,me-4
Permittee Address Phone Number e-mail address Permit Expiration Date
ADDITIONAL CER 1'l>N Hi D LABORATORIES
Certified Laboratory(2) Certification No.
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)807-6300 or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforms.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2

EFFLUENT
NPDES PERMIT NO. /UCDDD5,2� DISCHARGE NO. 4W MONTH ///area,,41 YEAR 207
FACILITY NAME jog,'Ec, AvF52Al+i,rl75 r/LC CLASSit/`,¢ COUNTY �y�574A/
CERTIFIED LABORATORY(1) /UM CERTIFICATION NO. ,v//f
(list additional laboratories on the backside/page 2 of this fo ) ww_ti�
OPERATOR IN RESPONSIBLE CHARGE(ORC) .U7/9 GRADE CERTIFIC TION NO. /l/z/
PERSON(S)COLLECTING SAMPLES N/j� ORC PHONE
CHECK BOX IF ORC HAS CHANGED I I NO FLOW/DISCHARGE FROM SITE* 041
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES x RECEIVED/NCDENRIDWI�
DIVISION OF WATER RESOURCES (SIGNATURE OF OPERATOR IN RESPONSIBLE CHAR
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS '
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 Ws]R06
F E 4, FLOW wtr a z Z c t, to EN>��'��I�Vttcg �o`�rEl OFFICE
E>o EFF❑ y p a W J 0 J ft W Z J W NAME AND UNITS BELOW
t I e INFO J o w= Oo ,0 OOW. WJ 00 O42 pd
A oN a U JIW-- �o �� tnN �I- 1-U) I.0 en00 1-1- t'0
. 0 g ag W I oUv aZ 0 p Z d
0 0 I disinfection U)
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L 11/I00ML MG/L MG/L MG/L
1
2 RECEIVED
3
4 JAN OS 7C17
5
6 CENT-RAL FILES
7 DWR SECTION
8
9
10
11
12
13 WG
14
16 JAN 10 3017
17
18
19
20 •
21
22
23 A 24
25 !AA 0 2017
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit
DWR Fonn MR-1(08/05)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements N/
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements ft/
Noncompliant
The pennittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part 11.E.6 of the NPDES permit.
"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 managed 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."
,fS ' 4 ,1 277,i&&C%
Permittee (Please print or type)
/2%fl/%
Si re of Perm ttee*** Date J
equired unless submitted electronically)
- 2' /40fsrf' /#/#7i �l-2/,1/) 7oY-///y/40 7' 4ec,7b-� •
Permittee Address Phone Number e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) Certification No.
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)807-6300 or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforms.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per I5A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2

EFFLUENT 3
NPDES PERMIT NO. #C Oda 1.27r DISCHARGE NO. G+o I MONTHD/27.59*' YEAR 2o/G
FACILITY NAME ,(dt:c.)uG /4 /E ;rt007S Ll< CLASS004 COUNTY 6A-r70,V
CERTIFIED LABORATORY(1) it///Il CERTIFICATION NO. Nfn7
(list additional laboratories on the backside/page 2 of this fo ) WNU_AlC.
OPERATOR IN RESPONSIBLE CHARGE(ORC) //4 GRADE CERTIFI ATION NO.4/1
PERSON(S)COLLECTING SAMPLES ti74 ORC PHONE /(///1-
CHECK BOX IF ORC HAS CHANGED I I NO FLOW/DISCHARGE FROM SITE*
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES x
DIVISION OF WATER RESOURCES (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
50050 00010 J 00400 50060 00310 00610 00530 31616 00300 00600 00665 I I I
F Y E �. FLOW w Q z Q O m ENTER PARAMETER CODE ABOVE,
>o P :: EFF 0 5 w p ii: u Q W J J K W Z J W NAME AND UNITS BELOW
FD o In INF 0 vi° OV ZO QZ QO JW .150
<O
(. ao " e �H x ct, wx 00 t-W V W I-O �_
A m� a C J� o.v CL m �F OI-Cl. Ul fn U. WX 0CC F'O
8. O tY. Q w D UV QZ D V 00 Z d
0 A 0 ~ disinfection CO
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/100ML MG/L MG/L MG/L
1
2 RECEIVED
3
4 s DEC 01 Liss
6 CE'VTRieiL FILE'S
7 DWR SECTION
8
9
10
11 W G
12
13 y q '
14 nFCX22016
15 •
16
17
18
19
20 •
21
22 O 23 A
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit
DWR Form MR-I(08/05)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements /�
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements !4
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"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 managed 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."
7e..;-- - % j_ 6-,e;7,- G
Permitt-- - ,se print or type)
--rikirP.I."--- 7 ?ir
Si• ature of Permittee*** Date
•equired unless submitted electronically)
,r320 aLD Aitadit Ct t.,, ( (2/ ,O 6 • to <®/*, ✓1r/re.4w
Permittee Address Phone Number e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) Certification No.
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)807-6300 or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforms.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2

P - EFFLUENT
NPDES PERMIT NO. /U, GbJa'?75 DISCHARGE NO.JO/ MOTH -Ji&F�Yaf/I YEAR plc'/t
FACILITY NAME L-D c' ,Z /(S r,/ ,//i7S 16<C CLASS A COUNTY 5��A�
CERTIFIED LABORATORY(1) ,v/4 CERTIFIC TION NO. N
(list additional laboratories on the backside/page 2 of this form) /� A
OPERATOR IN RESPONSIBLE CHARGE(ORC) /j�f GR�►DL�we CERTIF CATION NO. N/,!
PERSON(S)COLLECTING SAMPLES /V� ORC PHONE /1////
CHECK BOX IF ORC HAS CHANGED r NO FLOW/DISCHARGE FROM SITE*
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES x
DIVISION OF WATER RESOURCES (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 I I I
E Y �- FLOW me a Z Z 0 y ENTER PARAMETER CODE ABOVE
>8 I- It EFF 0 '4. p n a W J O J W Z J W NAME AND UNITS BELOW
IW. 'Ea ors INFO gv� x wO Oo OO I zo a-W Ott JOili I--O ia-= f , f 4
A mN a U 1I- ice a zV mN EIS— Oa ium u'O (J30 o� OFO
c 0 OG Q< ut D UV aZ D c. p0 z d
C O 0 ~ disinfection CO
HRS HRS Y/B/N MGD ° C UNITS UGIL MG/L MG/L MG/L 11/100ML MG/L MG/L MG/L
I
2 RECEIVED
3 4 RECEIVED Nov (i , -
5
6 NOV 0 ZuiF; CENTRAL FILES
7 CEN I KAL FILES DWR SEC—ION
8 9 DWR SECTION
10
II
12
13
14
15
16 O A
17 NOV �r1 18 N
OV 1 20)6
19
20 •
21
22
23
24
25
26 WG27
28 NOV 0 9 am
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit
DWR Form MR-1(08/05)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements N�
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements 1/-1/'
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"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 managed 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."
Permi a (P1 ase print or type)
L
/7-
gnatu of Pe ittee*** Date
(Req ' ed unless submitted electronically)
- 44DiiiPtOoall atifellif I.2 /7 / /e-it P 9 4in' /c,&7ir/ae, for
Permittee Address Phone Number e-mail address Permit Expiration Date
ADDITIONAL CER MUD D LABORATORIES
Certified Laboratory(2) Certification No.
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)807-6300 or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforms.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2

EFFLUENT
3
NPDESPERMITNO. /1/CON327!u DISCHARGE NO. e9O/ MONTH/cGvS7 YEAlt.a/g
FACILITY NAME Zowez.G ..-NdISr £0,7f r/lc CLASS/V/if COUNTY G,ISTav
�(
CERTIFIED LABORATORY(1) 1 /jJ CERTIFICATION NO. A.//}
(list additional laboratories on the backside/page 2 of this 9rm)
OPERATOR IN RESPONSIBLE CHARGE(ORC) //7 GRADE S CERTIFICATION NO. AIM
PERSON(S)COLLECTING SAMPLES ORC PHONE t(/ � ` -
CHECK BOX IF ORC HAS CHANGED r NO FLOW/ ISCHARGE FROM SITE* �J
Mail ORIGINAL and ONE COPY to: 1 RECEIVEDlNCDENRIDWR
ATTN:CENTRAL FILES x
DIVISION OF WATER RESOURCES (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) SE p D4 ? 16
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. W(�ROS
o ' 50050 1 00010 00400 50060 00310 00610 00530 31616' 00300 00600 00665 M OOR1ESVILLq NEGIgNAL OFrICE
y t E
F E 4. FLOW Ura Z CI co ENTER PARAMETER CODE ABOVE
>o :: EFF ❑ y pre a iZ J J ui K W Z i iZ1i NAME AND UNITS BELOW
(y 14 ae P. INF ❑ gr, x w_1 OV 00 HW QUO. J0 <0 ia-S
A :N 0 >'W aw �' o.
CC mN �iZ Oa WJ Wk 0cz F„,
S S. U JF. ,AV ...2 CZ
Ftj LLO ° i—i— O
. O a' a4 w G UV aZ O 0 00 Z X
0 0¢ ~ disinfection rn
a.
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L ///100ML MG/L MG/L MG/L
I
2 RECEIV D -
3
4 SEF 06 1u
5
6 UN rRAL FIL S
7 DWR SECTIO
8
9
10
II
12 0 A
13
14 SFP 1 4 2C
15
16
17
18
WG
19
20 SP 13/016
21
22
23
24
25
26
27
28 .
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit
DWR Form MR-I(08/05)

Facility Status:(Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements I
l/�
(including weekly averages,if applicable) N
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements ki
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 certity,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 managed 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."
CA '77�r.,.Y
P itte (Please print or type)
/ /‘
ignatur o Permittee*** Date
/ (Required unless submitted electronically)
/qo,s3,&o�O�.r«.ur rx,�.e-?F,7i7 Tvt=�Gysiay T�'C��v�E��Cow
Permittee Address Phone Number e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) Certification No.
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)807-6300 or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforms.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2
i

EFFLUENT
3
NPDES PERMIT NO. /V Ge'ers�?V DISCHARGE NO.e / MONTH J ULy YEAR,7-0/S
FACILITY NAME ../.e.,22,), ,Z,,,I/fS ,regi /, LLC CLASS09/4 COUNT IO/ 6'fiST)4 f
CERTIFIED LABORATORY(1) ,&/i9 CERTIFICATION NO. "l4
(list additional laboratories on the backside/page 2 of this form) ww �/
OPERATOR IN RESPONSIBLE CHARGE(ORC) 4///f GRADE�C- CERTIF ATION NO.
PERSON(S)COLLECTING SAMPLES //�- ORC PHONE /� /9
CHECK BOX IF ORC HAS CHANGED r NO FLOW/DISCHARGE FROM SITE*
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES x RECEIVED/NCDENR/DWR
DIVISION OF WATER RESOURCES (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS ri 1 1(1 1 5 2 U 16
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
e 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 WQ RqS
e -1 w N n� IONAL OFFICE
F Y O. FLOW K Z Z p y E ETER CODE ABOVE
>o F :: EFF❑ y p m Q 2 J 0 -1 FL Z J W w NAME AND UNITS BELOW
FW. <p « INFO yqv� rail) po OO zo aw UO. pO Ia-O rax
A o� m O }W I yw c CZ Ere On. W.=, In} Ore Oa�i
a U F- 2 V m a 1- H W °-O Cl)p 1 1- t"O
n O a Q tY O UV <E V Z d
0 c ~ disinfection y
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L H/100ML MG/L MG/L MG/L
1
2
3 RECEIVED
4
5 AL 0 ZQ16
6
7 CEO NAL rlLhS
8 DWR SEC1 ION
9
10
11 OA/'�
13 AUG I i 2)16 VVG
14
15 ALG102016
16
17
18
19
20 •
21 -
22
23
24
25
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit
DWR Form MR-1(08/05)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements /I/A
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements 14"
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part B[.E.6 of the NPDES permit.
"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 managed 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."
/t --1 /e 7/Prr�/
P= ittee (Please p t or type)
,�
All Ii!/�- F- i /
'gnatu - f'e-°ittee*** Date
/� �L�� d� C(Required unlesss submitted electronically)
.�j'2/ 44-114Weteldiae iel ,v ?f2/2 Jl/Kie� -540 �iX(c�/vi'PS,7•/,ce, oHr
Permittee Address Phone Number e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) Certification No.
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)807-6300 or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appfonns.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2

EFFLUENT
— 3
NPDES PERMIT NO. NC" 5_2717 DISCHARGE NO. MONTH "-�/ �ti e YEAR�/4
FACILITY NAME LoGvf,Gc r 'ec A'l�7S i LL C CLASS/VI COUNTY ��70/�
CERTIFIED LABORATORY(1) d jci CERTIFICATION NO. A/l4
(list additional laboratories on the backside/page 2 of this form), ll
OPERATOR IN RESPONSIBLE CHARGE(ORC) /Vll2 GRADE s�6 CERT ICATION NO. /1/�/>t
PERSON(S)COLLECTING SAMPLES AV& ORC PHONE A/ i� 1 �
CHECK BOX IF ORC HAS CHANGED I NO FLOW/DISCHARGE FROM SITE* 14
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES x RFCFLI/ED/ CpnNIRI WR
DIVISION OF WATER RESOURCES (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) I)ATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS i
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
e 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 I WJ.1ROS I
FY E FLOW to -Jut
0 y 1449/fAfieFiliatterilf MON McVICE
W o - :: EFF❑ 5= p O Z W J W .J 14 >W J W NAME AND UNITS BELOW
B INFO g.yt = 00 00 I--W Vu- p0 la-0 1--d
IL, to O >- nto rZ mta ECG Oa WM c I OW FO-m
o a U -I F v 2 F- I-M u-O F-F- p
n 0 OS Q D 1fy Q Z U p Z d
o 0 0 disinfection
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L H/100ML MG/L MG/L MG/L
1
2
3 4 RECEIVED
5
6 AJG 0 , Au:
7
8 OA CEN I RAC FILE
9 DT< SECTION
10 AL)G 1'j 2C16
11
12
13
14
15 WG
G
16
17 ALG 102016
18
19
20 •
21
22
23
24
25
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit
DWR Form MR-1(08/05)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements 1,0
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements N/d
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"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 managed 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."
#.,..
..y.------ -,4,---;,/
Permitte- (Pleas•i
;t or type)
it
'In*
Signature of P ittee*** Date
(Required unless submitted electronically)
S1-o 040%Nso44f,/a 7//A 71:20 lay-y M//" �,h 4eA►a/zem-e.l
Permittee Address Phone Number e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) Certification No.
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)807-6300 or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforms.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2

EFFLUENT 3
NPDES PERMIT NO. /f/L-a0OS'.2 7V DISCHARGE NO. 4/ MONTH/ /I - YEAR a)/‘
FACILITY NAME �(e-ou f '',iesry ,y Z 4 CLASS, COUNTY
CERTIFIED LABORATORY(1) N/4 CERTIFICATION NO. Az/9-9
(list additional laboratories on the backside/page 2 of this fo ) tau
OPERATOR IN RESPONSIBLE CHARGE(ORC) //7/7 Q RAI,E -tiCCERTIFICATION NO.4/
PERSON(S)COLLECTING SAMPLES /V/1 'ORC PHONE A/��L
CHECK BOX IF ORC HAS CHANGED I JUL 1 2 2016 NO FLOW/DISCHARGE FROM SITE*
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES x
-DIVISION OF WATER RESOURCES (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) 'BATE' p r
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
m s
150050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 1 1 1
E * FLOW iw Q z t] p to EIIfiER PARAMETER CODE ABOVE !"
EFF 0 = p 14 rog Z W J R W W C NAME AND UNITS BELOW
oo INFO J c w= Oo 00 IQ—W VLL 00 QO a-d
N m O W aw mu ma �IZ Oa III:1 to O� Og
o a U -�t- c� I- I-to U.O N F-I- p
n O Q� w W QZ c. p0 z a
l] ~ disinfection
co
HRS HRS Y/B/N MGD o C UNITS UG/L MG/L MG/L MG/L ///100ML MG/L MG/L MG/L
2 _ #
3 ktieti V ED
4
5 JUL 0 5 alb
6
7 CENTRAI FILES
8 DWR SECTIO V
9
10
11
12
13 WG
G
14
15
16 JUL 11 2)16
17
18
19
20 •
21
22
23
24
25
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit
DWR Form MR-I(08/05)

Facility Status:(Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
(including weekly averages,if applicable) N/1
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements AM
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"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 managed 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."
P rmittee (Pleas rint or type)
G 2
Sig tore of P rmittee*** Date
(R quired unless submitted electronically)
,53�ono%ilrur .e/M.272 7 7ly3<Y/Po ..era/C-0327r/
Permittee Address Phone Num e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) Certification No.
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)807-6300 or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforms.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2

EFFLUENT A
JUN 0 9 2016 -3
NPDES PERMIT NO. G G J 2 7y DISCHARGE NO.Lk,/ MONTH 7/00 " YEAR�/C
FACILITY NAME ..Z ufsjyw- Zill' CLASS/t//� COUNTY ft2. -5-7pi(/
CERTIFIED LABORATORY(1) it/i/4 CERTIFICATION NO. /L///7
(list additional laboratories on the backsi e/page 2 of this form) W%(/G
/�
OPERATOR IN RESPONSIBLE CHARGE(ORC) GRADE CCERTIFICATION NO. /� ,
PERSON(S)COLLECTING SAMPLES ORC PHONE ///
CHECK BOX IF ORC HAS CHANGED I I NO FLOW/D CH GE FROM SITE* 17a
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES x
DIVISION OF WATER RESOURCES (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
a a, 50050 00010 00400 50060 00310 00610 00530 31616 ' 00300 00600 00665 I I 1
E JW
F m E *. FLOW wtr Q z z 0 p to CENTER P • R CODE ABOVE
QU EFF❑ 5a; O Z W J D J >w W NAM 1.Ty TS BELOW
Y� INF ❑ K• W mN �K Oa W j 00 O0 6. `� c A o a V J FW- c) re V E l- I-CI) 1.0 to F-I- ~O JUN V - ' ZO U
o. 0 0.' Q� DUV < 0 p0 z a.0 0 disinfection
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L 11/100ML MG/L MG/L MG/L
1
2 REUEIV ' ,D
3
4
5
6 JUN (`6ZU'6
CFNTRL f IL S
7 Q NR SECTI•
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit
DWR Fonn MR-I(08/05)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
(including weekly averages,if applicable)
Compliant
IN
All monitoring data and sampling frequencies do NOT meet permit requirements -)
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"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 managed 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."
Z7. "/'/--/ . -,--;-- i,e-77,„
Permitte ase print or type)
G
„4-1?,a-K
S' ature Pe ittee*** Date
Required unless submitted electronically)
c320 o4 4,Jfimit460//1 4 4'/ >D/ /') ;-4►,oiwwfr/t.4
Permittee Address Phone Number e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) Certification No.
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)807-6300 or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforms.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per I5A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B.0506(b)(2)(D).
Page 2

EFFLUENT
NPDES PERMIT NO.Are °°t9J 27/ DISCHARGE NO. Oa/ MOTH /3e,C YEAR �/‘
FACILITY NAME Lvw ecG rda'snote*7S 2' LCG CLASS/(/4- COUNTY /4-5 T6N
CERTIFIED LABORATORY(1) Al//� / CERTIFICATION NO. iOl' 4
(list additional laboratories on the backside/page 2 of this form) ,w-NC
OPERATOR IN RESPONSIBLE CHARGE(ORC) N'4 GRADE CERTIF CATION NO. N/4.
PERSON(S)COLLECTING SAMPLES /N/ ORC PHONE N / 14
CHECK BOX IF ORC HAS CHANGED r I NO FLOW/DISCHARGE FROM SITE* EZI
Mail ORIGINAL and ONE COPY to: RECEIVEU'NCCF NR!DWR
ATTN:CENTRAL FILES x
DIVISION OF WATER RESOURCES (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
�E °i 50050+ FLOW 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 MOA�C, , -Z F.�,T „ I cFICE
,� E *, Q Z 0 m ENTER PARAMETER CODE ABOVE
EFF 0 y p K Q W J D J W Z J W NAME AND UNITS BELOW
(W. o $ INFO ga� wO Oo 0p iaz-tu ao 'J}o} Ia-O FQx
Q N a 0 JIW dV re. mN �� �� �J N!C �I� ��
n 0 a a� WE l7IN aZ V Ei Z za
0 0 ~ disinfection
HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/I00ML MG/L MG/L MG/L
2 QA
3
a 1\ { 1 2 ?O16
5
6
7
8
9 �1
10 RFCFIVFr
11
12 MAY —3 zo•6
13
to DWR S5 CTION
15 ' JFORMFTIONPROCESSING11NI1
16
17
18
19
20 •
21
22
23
24
25
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM _
Comp.(C)/Grab(G)
Monthly Limit
DWR Fonn MR-1(08/05)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements /VA
(including weekly averages,if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements N/4
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"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 managed 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."
kg- ......__
•I- / 4 - r,?r
rmitte (Plea print or type)
16 /
S' nature of ermittee*** Date
� equired unless submitted electronically)
.7 f-� az,a4"w iwl•,4(6i ''AK 2 1 70Y-36-fia �i�00i7t/.rr.6y*
Permittee Address Phone Number e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) Certification No.
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)807-6300 or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforms.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

EFFLUENT
MAR232016
NPDES PERMIT NO. /l/G Q�j�J�'�7 y DISCHARGE NO. ljQ/ MONTH�cj i//blor YEAR /
/
FACILITY NAME JpLuf�/�vt/17 Fv7S�4I - CLASS/A/4 COUNTY �iIc70 6
CERTIFIED LABORATORY(1) fL/ CERTIFICATION NO. /li�,l
(list additional laboratories on the backside/page 2 of this form) Ww-N C
OPERATOR IN RESPONSIBLE CHARGE(ORC) GRADE CERTIFICATION NO. /1///,
PERSON(S)COLLECTING SAMPLES ,(//4 ORC PHONE /Upl
CHECK BOX IF ORC HAS CHANGED r I NO FLOW/D1S HARGE FROM SITE*
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES N DENR/DWR
DIVISION OF WATER RESOURCES (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS : 2 t
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
0 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 1 I
F x c� FLOW in Q z 0 0 a� Erit'ER mit-o it BODE A l l�%E r_'I C E
$ P = EFF 0 y� .tr Q W —I 0 J W Z J W NAME AND UNITS BELOW
EW. ao INFO gy Wm 0$ 00 i--llU OH. p0 Fa-0 Fa
N (� JF fV �V mN Etc on.�H I—U) V-0 (0 �I_re OQ
0 pL Qg C UVaZ v —DO z
0.
° O 0 disinfection
HAS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L #/100ML MG/L MG/L MG/L
1
2
3
4 RECEIVED
5
6 MAR 232016
7
8
9 CEV7RQ r=llErS
to DWR SErCTIC].q
II
12
13
14
15
•
16
17
18
19
20
21
22
23 /�
24 MAR2Q4 2016
25
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit
DWR Form MR-1(08/05)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements N/A
(including weekly averages,if applicable) Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements 141/d
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"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 managed 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."
Permi e (PI: • print or type)
it
3 /e-
'_nature . 'Permittee*** Date
'equired unless submitted electronically)
s O1DdverAF/?4, ,P i/e,?f'.a7 Mzle j TiPO4ef,7e,Ae�om
Permittee Address ' Phone Nber e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) Certification No.
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)807-6300 or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appfonns.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2

EFFLUENT
LIAR 3 - 20%
NPDES PERMIT NO.�C OGY,,iZJy �7�DISCHARGE NO. ��/ MONTH�//T�"� YEAR
FACILITY NAME (.11f.LG /r✓F57 t#W.S. LL! CLASS Alt COUNTY e" AC
CERTIFIED LABORATORY(1) /V / CERTIFICATION NO. iv/j7
(list additional laboratories on the backside/page 2 of this form) / /�
OPERATOR IN RESPONSIBLE CHARGE(ORC) /(/ GRADE" CERTIFICATION NO. /`�/7/'
PERSON(S)COLLECTING SAMPLES ORC PHONE eiCHECK BOX IF ORC HAS CHANCED r INO FLOW/ E FROM SITE*
Mail ORIGINAL and ONE COPY to:
ATTN:CENTRAL FILES
DIVISION OF WATER RESOURCES (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS
RALEIGH, NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
0 50050 00010 00400 50060 00310 00610 00530 31616 00300 00600 00665 I 1 1
F m f FLOW w J W y c;��
x E �, Q z 0 p a� E 1TE R PARAMETER cope ABOVE
o F _« EFF ❑ y p a W J p J W Z J W NAME AND UNITS BELOW
Fw. ao $ INF 0 tn� a VI ZO Qz QO JW QO QO
s. m o >-w i a WWOX mN �M wu ore o�
o a U JF- 50 �F F(n IL e)O F-1-
a 0 a << to 0 UV aZ O V p Z a
o 0 Cl ~ disinfection
HRS HRS Y/B/N MGD c C UNITS UG/L MG/L MG/L MG/L #/100ML MG/L MG/L MG/L
1
2 RECEIVED
3
4 MAR 02 2016
5
6 CENTRAL FILES
7 DWR aECTlON
8
9
10
11
12
13
14
15
16
17
18
19
20 • 4A21 1�
22 M " 0-4 n jh
23
24
25
26
27
28
29
30
31
AVERAGE
MAXIMUM
MINIMUM
Comp.(C)/Grab(G)
Monthly Limit
DWR Fonn MR-1(08/05)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements(including weekly averages,if applicable) IE
�
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements kvn
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"1 catty,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 managed 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."
Permittee (P ase print or type)
-.1t44
Signatu e o rmittee*** Date
/ (Required unless submitted electronically)
LV
r-3 ,0 G .,arliW/01/a,d,1142607 7W-Jo!k,0 /9• .,16• /..&! g -iir,
Permittee Address Phone Number e-mail address Permit Expiration Date
ADDITIONAL CERTIFIED LABORATORIES
Certified Laboratory(2) Certification No.
Certified Laboratory(3) Certification No.
Certified Laboratory(4) Certification No.
Certified Laboratory(5) Certification No.
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit at(919)807-6300 or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforms.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and,as a result,there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2