Cat NC0074233 2 of 2

NPDES PERM NO): NC00742,13.
FAO NAME: Black'Eorn Elementary School
()INNER. NAME: edawba.Cuenly Schools
GRADE: WV/71
U)MR PERIOD: 08-2019 (August 2019)
6.4114 61Fel,
PERMIT VERSION: 4.0
CLASS: WW.I
ORC: David P MeCorkle
OR( HAS CII AN GED: No )
VERSION: 1.0
"440-0 Foy
" 1
STATUS: Aenve
COUN'Ili: Catawba
()RC CERT NUMBER: 10881
STATUS: Processml
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 901 NO DISCHARGE*: NO
1411.11666tF
**** No Reporting ReasonNLRO,'E
\Piater Ou:.?
222SO EN
Week%
IT.dartancms
FLO%
-419
flA4y Nualmote
COMO
222
20212
31616
°rah
IFS221
116616
EWE DIN; 440 t [0: 0'4 RIDW1440
• 13/, CF../ of .3.3F10„ 1„3
.•
666667
ENVWTHIt. No Visw.i.tiOn Adv ern Wealher, NOFLOW No F 222 HOLIDAY , No Visitarion -- Holiday

NPDES PERMIT NO.: NC0074233
FACILITY NAME: Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: WW-1
eDMR PERIOD: 08-2019 (August 2019)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-1
ORC: David P McCorkle
ORC IlAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 10881
STATUS: Processed
SUBMISSION DATE: 09/19/2019
c�*
09/1612019
ORC/Certifier Signature: David Patrick McCorkle 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.
/A4 bu
09/19/2019
PermitteelSubmitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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.
LAB NAME: Water Tech. Lab.
CERTIFIED LAB #: N. C.50
PERSON(s) COLLECTING SAMPLES: David P. McCorkle
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.orglweb/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 I5A 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 1 SA NCAC 2B
.0506(b)(2)(D).

N P D ES PERMIT NO.: 'N'C0074233
FACILITY NAME: Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: WW-I
eDMR PERIOD:07-2111 } (July 201' p
PERMIT `'ERSI.OYxi: 4.0
CLASS: WW-1
ORC: David P McCorkle
ORC HAS CHANGED: N'
VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERTNUfMBE+.R: 1088 1
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISC
2400 clock Ilre 1400 clack
2 0940
4
1E
12
13
t4
10 09119
0.46
Y
v
NOF90')
NUI,A110
NOF'LOW
50940 00010
U+eekly Weekly
Inatarrtax1e.na Crab
FLOW TF Il'(t
mgd
00400 50009
2 X month Weekly
Crab iizaSa
Fll CHLORINE
120310
Grab
Grab
00R-Cunt Nli:A-Cane
(0,30
TSS- lame
:,1616
Utah
MCIS1.111R
17
19
21
22 090
0,2
T
h0F'LIIW
23
24
29
2a
29
NOFLOW
31
\ 49114l2 :leverage 221014,
0.01.0
30
90 290
""°" No Reporting Reason: ENI-RLSE No k7
91001001y Nve:rage:
Ditty bis,iao o,
Rawly %llnlmxm.
Reuse/Recycle; E4'VWTIIR No Visitation --Ad
her; ti(
I_IDAY = No Visitation - Holiday

•
NPDES PERMIT NO.: NC0074233
FACILITY NAME: Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: WW-1
eDMR PERIOD: 07-20 9 (fatty 2019)
COMPLIANCE STATUS: Compliant
PERCVIIT VERSION:4,0 PERMIT STATUS: Active
CLASS: WW-1 COUNTY: Catawba
ORC: David P McCorkle ORC C'.ERT NUMBER: 10881
ORC HAS CHANGED: No
VERSION: 1,0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 08119120I9
08/14,/201.9
ORC/Certi.tier Signature: David Patrick McCorkle E-Mail:david mecorkie,i catawbaschools.nct Phone #:[phone] Date
By this. signature. 1 certify^ that this report is accurate and complete to the best of my knowledge.
The permtttee 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 pertnittee became aware of the circumstances, A written submission. shall also be
provided within 5 days of the time the pernittee'becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a tun table for improvements to be made as required by part II.'E,0 of
the NPDES. permit.
08/ 1972019
PermitteetSubmitter Signature:*** Rick Sain E-Mail:. rick_ sain.(r;catawbaschools„net Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 1(1 W Newton NC 28658 Permit Expiration Date: 07/31/2020
I certify, under penalty of law, that this document and all attachments were prepared under my direction. or supervision in accordance w itl't 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 die possibility of fines and imprisonment for
knowing violations.
LAB NAME: Water Tech, Lab.
CERTIFIED LAB #: N.C.50
PERSON(s) COLLECTING SAMPLES: David P, McCorkle
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES tinit (9'I9) 807-6300 or by visiting http:Ilportal.ncdenr-orgl'weblwq/swplps/npdes/forms.
only u
FOOTNOTES
of measurement designated in the reporting 'facility's NPDES permi
eporting 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 alI of the parameters on the DMR
for entire monitoring period.
ORC on Site?: OR.0 must visit facility and document visitation of facility as required per l5A NCAC 8G .0204,
*** Signature of Permittee: If signed by other than the peanut hen delegation of the signatory authority must be on file with the state per 1SA NCAC 2B
.0506(b)(2)(D),

NPDES PERMIT NO.: NC0074233
FACILITY NAME: Blackburn ElernenUry School
OWNER NAME: Catawba County Schools
GRADE: WW-I
cDMR PERIOD: 06-2019 (June 2019)
PERMIT VERSION: 4
CLASS: WW-I
ORC: David P McCorkle 1 3 0 2 0 19
ORC HAS CHANCED:
VERSION: im
tD
PERMIT STATUS: Aativa
COUNTY: Catawba
ORC CERT NUMBER: IORWMVEDINCOENRIDWR
STATUS: .Processed
Th
v5.530:l Oal
-?; 010 NAL 0 F
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARG
1
a
1
4.,
Y
....'„
..e
..-7,
Z
f..
PA
.z
.
A
-3-,
t
i,,,
4
t,
-ie
4
‘;'' 4
.i:Instarateieaus
4 2
5.0050
:man
MOO
VHF
COM
COW
COMO
ISIFIF
, Weekly
,
i `ea
I Grab
2 X moat
Grab
Wceisly
2 X month
Grab
2 X ,54111th
Grab
2 X MOT
Grab
2 X meth
i Grab
FLOW
; TEMP-(
MI
_Grab
CHLORINE
ROO - Com,
MINN - Cam
INS; - C.222
;711OLI RR
......,
1440 dock
1-11r3
2400 ilotk.
tin
'413/N
1154i
t55 4,- ......
.,A4.
11.5.1
R-451
.....
122-451
Mail
5;10052i
5
.•
.
.
i
•
4
11H5
0338
Y
0,00006
423 4
67
, 11
3.1
8,7
:
• ,„
6
: N
„
, 16
... ......
•
!.
.. ,..,
It
12
13
14
...„
• -- -
1247
0.33
Y
0.00005
i 23..4
4 t 7
< 2
2..57
31
i N
16
1.7
, 095i
'
I
,1!. 43
Y
0.00006
24 2
6A
< 10
IS
t
,
14
_ .3,3.
20
......,_
...._.
..._._ „........
21
22
- •
23
-
-...
• ---.3---- ----
.
„_..........
____.-------„
24
0916
0.43
NUFLOW
15
NOFL OW
26
NOFLOW
47
---- _
. - ----
: NOFLOW
217
:
NOFLOW
29
50
Monthly ,‘veroge Limit;
. ,,,.,,
3.II
—.
:6
..... . _
MI
24151
52on177y Average,.
16,, 0000:52
23 6455667
0
265
- "+---
5 ---- ---------
,2-84
19.85
t).00006
24.2
6,70
5 a
4.
3,
Wily Minilmmu
.01).007
23.4
6.4
0
0
2,58
0
."* No Reporting Reason: ENFR USE ii- No Flow- Rouse'Recclet ENVWI-14R °No Viisiration - Adverse Weather; NOFLOW 5, No Flow; HOLIDAY 50, No Visitation - licAiday

MITES PERMIT NO.: NO.8)74233
Blackburn Fi rnt:rtic SU
OWNER \.AN-1E: Catawba County Schools
GRADE: AVW-1
tI)%iR PERIOD: 06-2019 (.tune 2019)
COMPLIANCE STATUS: C'srnaplsarrt.
OR(C"�url
13v this saltnat
i"he penztatte shall
PERMIT v I RSION: 4 0
I CLASS: \ti'\1`a1
OR(a': David P McCorklc
()RC HAS CHANGED: No
VIf,RSiON: 1.()
CONTACT PHONE #: [phone]
Signature: David Patrick
Mc 1"-Mail:daw`id__ mccorkleio`c
certify that this report is accurate and complete to the befit o
PERMIT STATIL
COUNTY: Cat
ORC C°ERr NUMBER: Ittnrl
STATUS: Processed
SUBMISSION DATE: tl'' 2;3'2t?19
asvhtaschc
appropriate Regional Office any noncon°ITrlia,na e that potenti
Any inforuthtion shall be provided orally vs dt ain 24 hours from the time the pcnnitu c became aware of the ei
provided within 5 days of the time the permfttce becomes aware oldie cis atsnstances.,
lithe facility is noncompliant, please attach a list of corrective actions being taken rand a lime -table for improvements to be made as req
the NPDES permit,
07120120 I n
Phonetlw?5-46
eras public health or the envir•
uhrnittcr Sit nr
natty of law, that
Date
stances. A written submiss shall also be
by part 11E6 of
07?23:`20)9
rn4atas haschools.net Phone 4:828-464-3S62 Date
.77 NC flssy )0 W Newton M. 28658 Permit Expiration Date: 07 3)1'2020
'umcnt and all attachments were prepared under my direction or supervisioro in accordance with a system designed
to assure that: qualified personnel properly gather and evaluate the information submittal. Based on my inquiry of th
person or persons who managed the
system, or those persons directly responsible for gathering: the $nforrnation, the information submitted is, to the hest of my knowledge and belief, true,
.accuratc and complete, t am aswia.re that there are sign afic:»tnt penalties for submitting false information, including the possi'hiiity of tines and imprisonment for
knowing violations.
CERTIFIED 1 AE3ORA I'ORiFS
LAB NAME.: Water
CERTIirIEI) LAB #: \,C.50
PERSON(s) COLLECTING S, IPIES: David P. 4cC.'urkle
Parameter Code assistance may be ohta:ned by calling tl
* No
ure:*** Rick Swan
y units of measurement clesigrr,•sted in the reporting facility
ow Dzschar,ge From Site: Check this box if no discharge o
for entire tnonitori.ng period.
*4' ORC: on Site?: ORC must visit tacilify and document visi
*** Signature of Pennittee: 1f signed by other than the permittee, then dale
.0S9ti(b)t2.)(D).
PARAMETER CODES
Lnicr l5)1 S0 6300 or by visitin
FOOTN()''' S
N'PDES permit for
ata.
1v:8pm-tatmcdenr.org/wdhlwq swplpsinp
and, as a result, there are no data to be entered for all of the parameters on the D IR
d per 1,5A NCAC 8C; .0204.
)piatot
ty must he on file with the state per i 5A NCAC 2B

NPDES PERMIT NO.: NC0074233
FACILITY NAME: Blackburn Elementary School
OWNER. NAME: Catawba County Schools
GRADE: WWI
eDMR PERIOD: 05-2019 (bta' " 20I9:S
1808 clock
PERMIT' V'FRSI(i\: 4.0
CLASS: WW"-I
ORC: David P v1cU rkk
ORC HAS CHANGED: N'
VERSION: 1,0
PERMIT STATUS: Active
)UIVTY: Catawba
ORC CERT NUMBS' 7 ,.
STATUS: Processed
MOOR CSVI L4'ONAL OFFICE
SAMPLING LOCATION: EFFLUENT DISCHARGE NG'.: 001 NO DISCHARGE*:
lens k@q flock
202120
IN1488 .WVU5t2
C 22622;
tit D2B
X
th 2 X rax288-1
514YBtd
�n7
TEMP-82 'MINE
11 Oi:l Hit
4
,s
r
V014
0.38
w
2i
22
„2
(L422
0 1SI(1(122,
2.8
28
2q
A§I tiitl
iuB
f ,4
n e li
wr22>X _ ,
'`!i,) Repo Rca�x�a. P:'~1P6TLifih: - Ns) Pau-Rcus€�?Re�cyele. EN tiiti V3sl�u:et:i2aT A *.�rsr: Wcailr'r. NUFI_t.1W - uVl) Flow: hPOL.VUA1* _ A'i, Clalieuon—Flrrllday

SPEWS FLAME T NO.: [ C'( ?""4233
VACUA ' ":A41E: 13lackbum hterneror's School
OWNER NAM E:: C:at:xwr ba County Schools
GRADE: WW I
et)MR PERIOD: 05.20l ih1r 2t:1litp
?WPI.TANCE STATUS: S: Compliant
ORCIC'ertifier Signature:
The
PERMIT VERSION; 4_0
CLASS: WW-I
ORC. David P McCor
ORC." HAS CHANGE
VERSION: To
CONTACT E PHONE #: [phone]
n
Patrick Mc,( orkle F Mai1:david mccorkl
signature, I certify that this report is accurate and complete to the best of my knowledge.
PERMIT STATUS:
COUNTY: (.ataw1
ORC CERT NUMBER: V 0ti81
St l;MISSION DATE: 06'0br200
vbaschotals.net Phone it.1128-464-3562 Date
shall report 1aa the Director or the appropriate Regional Office any nancrcn{rliarrce that p
reatcns public health or the en.w
t.
Any infttannattran shall he provided orally within 24 hours .from the tithe the pertm ec became aware of the c<rcnrs stanees. A written submission shall also he
provided within 5 days ofth.e time' the pernuttce becomes aware or the circurrwsianccs.
If the facility is .noncompliant, please: attach a list ofcorrective actions being taken and as tin tab for impnaverrtents to he made as required by part I of
the NPDI"S permit.
Pcrr
Pent)
Sig
Rick Sain f Mai➢:rusk sat
06/06120 19
a¢aeabaschools,nct Phone :t(211 464-3562 Dale
dress: 4377 NC. Hwy It Newton NC 28658 Permit Expiration Date. 07 31.12020
1 certify, under penalty of law, that this document and all attachments were prepared under my direction or sulicrvisinn in accordance ww°0h a system des gncd
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 gatheri
accurate, and complete. I ant aware that there are signiClea+nt pcnatt
knowing violations.
LALI NA.M:F: Water'Icuh
CERTIFIED LAB #tt N.C.50
PFRSONts) C'Ol t ECTI"(,` SAMPLES: David P
" Nwr Flow l
I des
isehargt.
itCrrimg period.
te'': ORC must visit
*** Signature of Permitlee= It si
0506(b )(2)(D ).
nation. the information submitted is, .to die hest of my kmowwledge and belief, true,
submitting fake intcrnn:ation, including the possibility of fines and imprisonment for
"1 RTIFIFf7
PARAME.`FER 1 Li1)f:S
obtained by calling the NPDES Unit [phone]) or by visiting http.11portaal.rocdcnr.org,weblwq swvplpstnpdesltorms.
the rcptamaitag
is box lino iliac
document
s NPDES permit itwr re.pcartittg data.
curs araad, as at result. there are no data to he emoted for all of the parameters can' the'D;4IR.
facility ° as required pear I SA NCAC S(J .02114.
han the paint tee, then delegation of the si
authority must be on file with the state per 1 SA NCAC 2B

NPDES PERMIT NO.: NC0074233
F ('t' ME Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: WW-,1
eDMR PERIOD; 04-2019 (April 2019).
PERMIT VPIRSION: 4.0
CLASS: WW-1
OR.C: David P McCorkle
()RC HAS CHANGED: No,
VERSION: 1,0
PERM I r STATUS: ALtive
/FTWNTY: Catawba
NiliA)' 2 201rc CERT NUMBER: 1088I
NT.A MS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
Weekly
lnktontannous
0 W6
1116
M11111111111111•1
111=111111111111111111111111111111
11111=11•111•1111111111111
IIIIIIMM11111111111111111111
1111111111111111•1111MMI
MON111111111111111111111111111
1111111111111111111111111111111111111111111111111
oothly
Monthh 3Aergge,
001
1.10.0006
II 0{1006 h
Groh
C0330
2 X month
Grab
HOD
tow
COMA
ttrob
0111-N - Cute
rthgt2
ED/NCDE
LLE RECIO
2.43
C0530
2 X month
004 C'exot
15
**** Reponing Reason: FNFR UST No 'Flow-Retisc,'Ro:y,Ac.:. EN Vvati k No Visitation Adverie Weather. NOFLOW - No ot..IDAy - ',/ittion Holiday
2 X tronth
Grab
WOO RR
. „ .
()Orb

NPE)ES PERM Ir N().: \C007421:i
FACIlts4,TX NAME: Blackburn flew.
OWNER NAME,: (:°,ttawha ConntV SelouI
GRADE: > tY.al
eDMR PERIOD: 04-2
COMPLIANCE SLATES: Crtmmnliant
By this Signature,
The pertmtta
Any in'fortnat
hall rep
e pr0vt
PERMIT %''E'RSION: 4.0
CLASS: L'•I
ORC: D.av"id F fiale("c�rkly
ORC AS C\GEW No
VERSION: 1 1)
CONTACT PHONE Si: 828464,3562
and complete to the best of t#ry knos%ledge.
Director or the appropria
tcf aara[iv writhin 24 hours
PIR.MI°CS'FATLS: Active
(Or N'rti'. (atarvh.r
OR( ("ER°I' NUMB7,R: 10880
STATES, Processc
SUBMISSION DATE: 1)5'10120e S)
Rcgwnal Office any noncompliance that potentially threatens public health or the envil( 1rn nt.
:trtm the time the peramittee became aware of the circumstances. A written submission shall also he
provided tic ithin 5 days of the time the perrnittee becomes aware of the circumstances.
lithe facility is noncompliant, please attach a fist of corrective actions being taken and a timetable for improvements to be made as required by part
the NPDE S permit.
Pertmmittee.'Suh
ores:*** Rick Sain E- ali rick
atavm basehools.nct.
Pennitt ,e Address: 43 N(` Ilavy fl➢W Nevsuan N(' ?865) Permit Exxpiratiora Date: 07/31/2021)
I certify, under penalty of law, tthat this d
and all attachments va ere prepared under my direction or sun
to assure that qualified personnel properly gatlterand evaicaate the information submitted. Based on my
system, or those persons directlyresponsible for gathering the information, the information submitted i„, to ti
accurate, and complete. I ttm aware that there are significant penalties for submitting false ttaf4ittmati"m1, samcftaa
knowing violations.
LAB SAME: Water Tech. Lib.
CERTIFIED LAB #: N,C.30
PERSON(s) COLLECTING SAMPLES:
1I I E.S:
ParCode ass
'' No Flow/Discharge From Si
ire nmtamitr)ramg Periamd,
(' oar Site, (,:)RC° must visit tacit
** 0
CERTIFIED LABORATORIES
PAR, METER CODES
umg the N'PDIiS unit dc)[f)) f) -6300 or
d in the reporting facility's
FOOTN(
KS permit Oar report
Phone ti:8,28 464-3S62
9
Date
vision in accmmrdance with a system designed
f the person or persons Who managed the
best of my knowledge and belief, true,
g the possihilit), of fines and imprisonment f1t
:'tportaLnvdenr.org web v'y svm'Ia pslrtpdesl
k this box ifnr,r discharge occurs and, as a result_ there are no data to be entered for all of the
e pi:rnmttt
ta.
0
4
he state per 15,A.'NCA(` ?B

NPU S PERMS"r NO.: NC0074233
FACILITY NAME: BlackburnElementary School
OWNER NAME: Catawba County School.
GRADE: W W-1
eDMR PERIOD: 03-2019 (March 20I9)
PERMIT VERSION: 4.0 PERMIT SEATUS:
CLASS: WW-1 RF F V D COUNTb': Catawba
ORC: David P N1ceorkle
ORC HAS CHANGED: No A1)R. 2 5 ?
VERSION: 1..0
)WF $ CTIO1N
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO D1SCH GF \
ORC CERT NUMBER: 108S1
STATUS: Processed
iwta 004110 :3110611
(1061.0 MOM
�'. Weekl
inst mart us
Weekly 2 X month
ti onuenlh 2 X ratorkth
2 X month 2 X month
Chats Grab Grub l:iryb
FLOW TEP4r pe el11,01,1115E 15112-w-flans xss-roe FCoa1
24t4 clock firs 240 cloak tt'rs V 111,1
tnt;:1 ;! 00nrI
2
i
1
tenthly ,af erake 1a8anit:
Daily yt,nlnie
Daily Mini ne,
MINIM
1111
**" No Reporting ROHSfxnt ENFR1 ' 1 = No Pt1 w-Rcasc. Recycle[ EN V ELIR — 4t, Vista is - f\d4 rs Va'eath r: NOFL:O

NPDtS PERM I1 No,: NC0074233
FACILITY NAME: Blackburn f lcmcntr
OWNER NAME: C
(:, RA 0 W^ W-
eDMR PERIOD: 03-3
County SCb001S
COMPLIANCE S'I"A fUS. Compliant
0RC/Certif'ier S.
The permittee shal
Any information si
:ily that this
PERMIT VERSION:4.0
CLASS: VeW-1
ORC'.`^ David P rM1c Comrkle
ORC HAS CHANGED: Ncr
VERSION: J
CO\TrACT PHONE fit: 8284643562
PERMIT SI t`L"'13 tcd?v
COl1N 1' : Catawba
ORC CERr NUMBER: 10881
sl ATL1S: Processed
SUBMISSION DATE 04 0 12
04t0
,id Patrick \ICCork.➢e F-Mail:d°avid rnccorkletc{iea,tawbaschools.net Phone 4:825-464-3562 [Date
lid co
plete to the best of my knowledge.
Dire etot err the appropriate Regional 0t'f"ice any noncompliance that polenti
ail be provided orally within 24 hours front the time
pertntttce became aware of the cite
uhhe health o
n
h
ment,
provided within 5 days of the time the permitted, becomes aow^are of the circumstances.
1f the facility is noncompliant, please attach a list of eonrctive actions being taken and a Fimme-table for improvements, to he made as required by part I'LE.6 of
the NPDLS permit.
Pertnitteei'Stthrnitter S
Pent
04tOS 2019
Rick San F-\^lai{':rick sairtrrreattawbasc.hools.net Phone 0:828-464-3562 Date
dress: 4377 NC F1wy 10 W Newton NC 28658 Permit Expiration Date: l'17 i 1'2020
I cattily, under penalty of law, that this
and all attachments were prepared under my directi
to assure that qualified personnel properly gather and evaluate the infomtation submitted, Based on my in.
e wvitll a systetn designed
ons wlaaa na ttta,ged the
s directly responsible for gathering the information, the iiinidmaatiorrt submitted is, to the hest of my kntowvledge and belied; true,
am aware that there are significant penalties four submitting false information, including the possibility of lines and imprisonment for
1AB NAME: Wafer 1cch. 1..ab.
CERTIFIED IFIED .LAB #: NC.S(1
PERSONIO COLLECTING s
P[ ES: i;yavid P. McCr
CERTIFII°U LABORATORIES
PAR.A.MLTER CO[)1„:.5
Parameter Code atsas,tance may he obtained by calling the: NP DES Unit (9''19) 507-6IT300 or by vis
Use only units
* Nt, i°°low./ Dis
rs
FOOT N
nt designated in the reporting facility's NPI)[ S permit lu
Pc
nedenr.o
eb; w^ur'sm
des
lueck this box if no discharge• occurs wnri, as a result, there rare, no data 'ro he entered for all of the parameters on the I)lAIR
ORC on Site?: ORC must visit f<ac 9ity and document
*** Signature of Pennittee: if signed by other than time perrnitaee, the a'm delegation of`tlme sigamutory authority must he o•n file wi
.0506(b)(2)(F1).
NC.a,(:" 56 .0204.
e per 15A NC.rA
[3

‘PDES PERMIT NO:: N(0 ,4213
17ACILITY STAME: Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: WW-I
eDMR PERIOD: 02-2019 (F brua 2C11 )
PE MIT VERSION:4400
CLASS: WW-1
ORC:: David P McCorklc
ORC HAS CHANGED: No
VERSION: E.0
p
04 VD19
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER:
STATUS: Processed
SAMPLING LO ATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*:
°SE N' Flow.Reuse.' 4` tle; & N `WTHR' cs$t Rs ¢ro ... A+dverse Weather: her: NOPLOW - flows fA'DLID Y =m V isiiatio❑ - ttohdar=

PDES PERMIT NO,: \C0074233
OWNER NAME: Cat utla County'Schook
GRADE: WW-1
eDMR PERIOD: 02-20'➢9 {February 2019)
COMPLIANCE STATUS; Compliant
PERT, I° M"ERSION: 4.0 PERMIT STATUS: Active
AGILITY NAME; Blackburn Elemien ry° School CLASS: WW-1 COUNTY: Catawba
ORC: David P McCorkle ORC CERT NUMBER: 10881
OR(" RAS CHANGED: No
VERSION; 1.&5 STATUS: Processed
CONTACT PRONE #: 8284 62 SUBMISSION DATE: 031'25/2019
03 '25/2019
ORC/Certifier Signature_ Da id Patrick McCorkle E-hail:david_mccorkieC atawhasehoo➢,s..net Phone #:[phone] Date
By this signature, I certify that this repot is accurate and complete to the best of my knowledge.
'The pernaittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health orthe envu0wnent.
Any information shall be provided orally within 2,4 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 perrntttee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time table for improvesnents to be made as required by part Cf,f?.6 of
the NPDES permit,
03/25/2019
Permtttee/Subtnitter Signature;**'* Rick Sain E-Maikrick,,,[e-mail] Phone #:[phone] Date
Permittee Address:4377 NC Hwy 1.0 W :Newton NC 28658 Permit Expiration Date: 07,°31/2020
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. 1 am aware that there are significant penalties for submitting false information, 'including the possibility of fines and imprisonment for
knowing violations,
LAB NAME: Water"Cecil. hab.
CERTIFIED LAB #: N.C.50
PERSON(s) COLLECTING SAMPLE S: Dae id P. McCorkle
CERTIFIED C,ABORA°TORIES
PARAMETER CODES
Parameter Code assistance rnay be obtained by calling the NPDES Unit [phone] or by visiting http;,'lportal.ncdenr.orglweblboq swpr"psinpd
s/fo
FOOTNOTE.'
Use only units of rneasuretnent designated in the reporting facitity"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 DIV1'R
for entire monitoring period,
ORC on Site?: ORC must visit facility and document visitation of facility as required per '15A NCAC 8(3 .0204.
*** Signature of Pertnittee: if signed by other than the permittee, then delegation of the signatory authority must be on file with t:state per 15A NCAC 2B
.0506(b)(2)(D).

1
NPDES PER.MTE NO.: NC0074233
FACILITY NAME: Blackburn Elementary School
OWNER NAME: Catawba County Schook
GRADE: W W-1
eDMIR PERIOW 12-2018 (December 2018)
PERMIT VERSION:—N4'14'"'ECE
CLASS: VV-I David P McCork le
188 .1 8
VED
ORC HAS CHANGED: tTNINAL FILES
VERSION:0 OWR SECTION
PERMIT S'EATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 10l81
888 2 8 888.i
STA'ELS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: flfll NO DISCHARGE*.
Monthl!, V,,rage 1 init:
V$,Antillw et awn
Reporkix% R,L,aion: FR) F — No How-Rouse/Recycle: 1N V WINK No Visitation Ach,erse Weather; NOFLOW =N Flow; HoLIDAY =No v,itation Holiday

NPDES PE li 4il'T NO.:. NC007 k22;3
1 ACIITATV' NAME: Blackburn t3lementary .hoof
1
OWNER NAME: Catawba County Schools
GRADE: WW-1
e1)MR PERIOD: tl2-20➢8 (December 201
COMPLIANCE, STATUS: (7ompliaort
ORC/Certifier Signature: David Patio
By this
The pet
orb
;hat this report is
PERMI1 VERSION:4.0
(:'LASS: W44'-1
ORC: David I'M.Caorkle
ORC HAS CHANGED: ;No
VERSION: I,0
coNTAcr PHONE. #: 42is4643562
PERM El STATUS: Active.
COUNT': Catawba
ORC CERT° NUMBER: l0
STATUS: S: Processed
'ION D,A1El:01?09l201tl
01/0412019
:david me.ct7rkle(a`cata .rhaschuols.net Phone #:[phone] Date
e and complete to the best of my knowledge.
Director or the appropriate Regional Office any noncomphance that potent
y
Any information shall be provided orally within 24 hours from. the time th.e pent -three became aware of the circta
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 imprcauet
the NPDES permit.
public health or thenment.
A written submission shalt also be
lade as required by part 11.E.6 of
01 /09.=`2019
bmitter Siattatttre.*'** Rick Sain 1 Mail:ric:k sat
permittee Address: 4377 NC Hwy l0 W Newton NC" 2865.8 Permit Expiration bate: 1)731/2020
ify„ under penalty of law, that this document and all attar
schools net Phone 4:828-464.3562 Date
is were prepared under my direction or supervision an aceordancc with a sl
to assure that qualified personnel properly gather and evaluate the information Submitted. Based on my inquiry of the person orpersons who managed the
system, or those persons directly' responsible for gathering the information, the in urination submitted is, to the hest of my knowledge and belief, true,
accurate, and complete. lam aware that there are significant penalties for suhmitti
knowing. violations.
LAB NAME: Water "T'eeh. Lab.
CERTiFIED LAB #: N.C..50
P)'RSON(s). COLLECTING SAMPLES: David Mc(orkle
Pararr
* No Flov
d
nnatlon, including the possibility of fines and imprisonment for
C'ERTIF-'rl?b Iw.AI30RA" I"CiR.IES
PARAMETER CODES
ans.e. ntay be obtained by calling the NPDES Unit OM 9) 107-6300 or by visitin). http
f°00T OTES
ility's NPDES pertnir fcr reporting date.
k Ibis box if no discharge occurs tin.d, as a result, there are no data to be entered for all of the lroaramcters oat the I7MR
q/sw pfpsfnpdestforrns.
for enttt°c tnortttor°tng period.
OR.0 on Sitee?: ORC must visit iaa.ility and document viEi
*** Signature of permittee: 1f signed by other than the perm
0506('h)(2)(D).
taf' Ittcthily as required per 15A NCAC 8G ,0204.
hen delegation of the signatory authority must be on tilc witlt the state per 1 5 A NCA( 2B

t �r
NPUES PERMIT NO.: NC.0074233
FACILITY NAME: Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: WW-1
eDMR PERIOD: 10-201S (C}stubet' 2d1 i'4
P'ERMI.T VER;
CLASS: WW-1
ORC: David P McCo
ORC W AS CHANG,
VERSION:
PERMIT STATUS: Active
COUNTY: Catawba
ORC CER`I' NUMBER. ➢ E tN OENR/DW'i.
STATUS: Processed.
SAMPLING LOCATION: EFFLUENT MSCHARGE NO.: 001 NO DISCHA
Vroot6b , Average Litatt:
Dray \i laimium.
II,DDDS
.4
0 7.'.' I2.5
'' I' No Rctxuting R
se/Recycle: ENV'W1 HR No Visatatzon - Atheme G'We€ohcr: NOFLOW = No Flow; HOB 117AY — No V'is.ilatian idray

t
PERMIT NO.: N(.:. 74233
ME: BLS
GRADE: WW-1
e'.t)MR'PERIOD:
COMPLIANCE STATUS.
OR( Certifacr Sian
The peen
ber
PERMIT VE:R:SION:4.4)
CLASS: WW-1
ORC: David P McC.'orkle
ORC HAS CHANGED: No
VERSION: I.(t
CON -FACT PHONE #: [phone]
PERMIT sTAT us: ,A.c[ivc
COUNTY: Caw,: ,: a
ORC CER"I N1:Mll,E R: 10881
I,07,'2018
v=id Patrick NicCorklc. 1::;-Mail:david rrtecorkle ataba,chools.n t Phone :1y8-464.3562 Date
nature, 1 certify that this report is accurate and complete to the best ol" my knowledge.
canto the Director or the appropriate Regiot'tal Office at noncompliance that pratcntial.ly threatens public health or the environment_
Any information shall be provided orally within 24 hours from the time the perntittee became aware of tlae eir tnn.tances, A Written submission shall also be
provided within 5 days of the time the pcnnince 1'rccaysttes aware of the cire.unistartces
lithe facility is noncompliant, please attach a list
the 'NPDES permit
u
is being taken and a Lrne•tahle for improvements to be made as rec{ttired'by part 11,E.6 of
1(09/20 18
gnature:**� RiCk Sain [ -1 ltil:rlck _satawbasehools.net Phorte :a:828-464-3562 Date.
Frertnittee .Address: 4377 NC HwyF 10 \A'' Newton NC 286.58 Permit Expiration Date: 07 31 "2020
I certify, under penalty of law, that this nt and all attachments were prepared under my direc
r supervision in accordance with a system designed
to assure that qualified personnel properly gather and evaluate the inforrnation strbmitted. Based on my inquiry of the ,person or persons who managed the
s steers, ortbose persons directly responsible for gathering the information, the infot-nnation submitted is, to the best ofmy knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for srrbmitfing false information, including the possibility of lines and imprisonment to
knowing violations,
LAB NAME: Ware
CERTIFIED LAB #; tr,C„.
PERSON(s) COLLECTING SAMPLES; t)av'id P,. 54e& orkle
CI:RTI[FIED LAB C)RAT()RIES
PARAMFf ER CODES
Parameter Code assistance may be obtained by calling the NPDES t,;nrt(,919) 807.6300 or by vlsi4ing hit.p portalmcdenrorglweb/w wp:psinpdestfomis.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data,
* No Flow/ [)cschwee From Site: Check this box if no diseharf„c eiee:urs and, as a result there are no data to be entered fir all of the pars
for entire :non ring period.
** ORC on Site": ORC must visit facility and docrune
*** Signature of Pernttttce: l'signed by other than the permi'ttce, then delegation of the signatory authority must he OR file
.0506(b)(2)(D).
of facility as required per '15A NCAC" 8G .0'?04,
e 1)MR

NPDES PERMIT" NO.: NC0074233
F'ACILIIS NAM.F: Blackburn Elementary School
OWNER. NAME: Catawba County Schools
GRADE: WW-I
eUNIR PERIOD: 09-2018 (September. 2018 )
a
6
7
fa
as
zv
ars
PERMIT"VERSION: 44 REC 1! EjJ
CLASS: WW-1
ORC: David P McCorkie
ORC F1:1.5 CHANCED: .1) f l'L FILES
WR SECTION
VERSION: 1,0
PI R.MI"1 4-C- IS: Active
CO UN I \ : Catawba
ORC CERT NUMBER: 10881
STA"1"uS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHA
atlas
tl f14Hltj96
il, (k7UU1+
ti (NIUl3S
23.225
9
Grab
4
taz
Weekly
Grab
CHLORIN
Geri
tt
2XIm 7h
Grab
Grab
2 X Month
Grab
MINN, Conc. 'r7'-Cnnt
ongil r71'
4,665
5.9
4.9
*." Repast- 11g R.e.aSon: E.NFRUSE v V'0 Flow-RetisciRccycle fiN VWTHR No Viaezataixa - Adcerac.'4 i lur: NC/FLO -Ao Row; HOLIDAY — \ , Visitation -- Holiday
2 X month
FCOL 1 1070

NPDES PERMIT NO.: NC0074233 PERMIT VERSION: 4_0 PERMIT STATUS: Active
r,
FACILITY NIAME: Blackburn Elementary School CLASS: WW-1 COUNTY: Catawba
OWNER NAME: Catawba County Schools ORC: David P McCorkle ORC CERT NUMBER: 10881
GRADE: WW-1
eDMR PERIOD: 09-2018 (September 2018)
COMPLIANCE STATUS: Compliant
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 10/18/2018
10/11/2018
ORC/Certifier Signature: David Patrick McCorkle E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to thebest 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.
10/18/2018
Permittee/Submitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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.
CERTIFIED LABORATORIES
LAB NAME: Water Tech. Lab.
CERTIFIED LAB #: N.C.50
PERSON(s) COLLECTING SAMPLES: David P.McCorklo
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] 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.: NC001423'
FACILITY NAME: Blackburn Elementary School
OWNER NAME: Catawba, County Schools
GRADE: WW-I
eDMR PERIOD: 08-2018 (August 2018)
PERMIT VERSION: 4.1
CLASS: WW-1
ORC: David P McCorkle
ORC HAS CHANGED: No
VERSION: 1.0
PERMIT STATUS
DCOUNTV: Catawba
ORC CERT NUMBER: 10881
CENTRAL FILES STATUS: Processed
DWR SECT1.ON
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*:.NO
.."•` No Repodi g Rc11s rr, ENFIU SE — Na I low•ReusesRec"`e".le EN"v` F1THR .Na Visimi ion - Adverse Weather; NOFLOW flow: HOLIDAY = o Visitation - Holid

NPDES PERMIT NO.: NC0074233 PERMIT VERSION: 4,0
FACILITY' NAME: Blackburn Elementary. bchoot CLASS: WW- I
OWNER NAME: Catawba County Schools ORC: David P' McCorkle
GRADE: '44'W-1 ORC HAS CHANGED: No
eDMR PERIOD: 08-201 8 (August 2018) VERSION': l.tl
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone]ii
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 1088!
STATUS: Processed
SUBMISSION DATE: 09/19/201
09/15/2018
ORC/Certifier Signature: David Patrick McCorkle E Mall:david_mccorkle@ca'tawbaschools.net Phone #:[phone] Date
By this signature, i certify that this report is accurate and complete to the best of my knowledge.
The perm' twe 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 perrnittee 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, 1C.E.6 of
the NPDES permit,
09/19/2018
Permittee/Su3trnitter signature:*** Rick Sain E-Maiwbaschools.net Phone #:[phone] Date
Pennittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/
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 offines and imprisonment for
knowing violations,
CERTIFIED LABORATORIES
LAB NAME: Water Tech. Lab.
CERTIFIED LAB It: N-C,50
PERSON(s) COLLECTING SAMPLES: David P. McCorkle
PARAMETER CODES
Parameter Code assistance may be obtained by calling, the NPDES Unit [phone] or by visiting bttptllportal,ncdenr.orgfweb/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 boss if no discharge occurs and, a-s a result, there are no data to be entered for all of the parameters on the TD R
for entire monitoring period,
** ORC on Site?: ORC must visit facility and document visitation of facility as required per l SA NCAC: 8G .0204,
'** Signature of Permittee: if signed by otherthan the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC '28
.0506(b)(2)(D).

&I'nwSPE- NO:N
J' U L1I NAME:
OWNER NAM Catawba Cou»
GRADE »Wi
eDRPERIOD: m-2O
Pwk¥R¥ERSm%4a
CLASS: W!
ORC:David McCorkle
ORC HAS CHANGED: N
VERSION': w
PER
I» R 61w,tK y>
t : Caulwba
OR( CERT NUMBER:
Proixed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.:0 NO DISCHARGE*: NO
®® w Reasorl.rwamr yr rK «R ENVWTHE=w 1,hsthoa w.wr :mu 1.No >vm ,.Hayti ay

NPDES PERMIT NO.: NC0074233 PERMIT VERSION: 4.0 PERMIT STATUS: Active
i ACILITY NAME: Blackburn Elementary School CLASS: WW-1 COUNTY: Catawba
OWNER NAME: Catawba County Schools ORC: David P McCorkle ORC CERT NUMBER: 10881
GRADE: WW-1 ORC HAS CHANGED: No
eDMR PERIOD: 07-2018 (July 2018) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 08/14/2018
08/13/2018
ORC/Certifier Signature: David Patrick McCorkle 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.
74;-/e
08/14/2018
Permittee/Submitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
I certify, under penalty of law, that this document and alI 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.
LAB NAME: Water Tech. Lab.
CERTIFIED LAB #: N.c.50
PERSON(s) COLLECTING SAMPLES: David P. McCorkle
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] 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,: NC0074233
FACILITY NAME: Blackburn, Elementary School
OWNER NAME: Catawba County. Schools
GRADE: WW-1
eDMR PERIOD: 6 2 5
PERMIT VERSION: 4.0
CLASS: WW-1
ORC: David P McCor'k1e
ORC HAS CHANGED: No
VERSION: 3.0
PERMIT STATUS: Active
COUNTY: Catawba
ORC CER`I` NUMBER: 1088 t
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 00I NO DISCHARGE*: NO
241
COMB
y.06111 31616
kl
2 X Month 2 X month nllh 2 X month
Grab Grab Grab Grab 6nab Grab Grab
FLOW TF'II'(. I1n 101L0RINE BOO - C:nnr N LA. Cant FC011 BR
1400 dr, i£ts H,`tU"°k tx"Fd dog, t` va pa
II
11111 III
9.7 6,5
**** No Reporting Reasoal: € N
Re ;Recycle; ENV W 1!IR _.. No Visitatiu❑ ;Adverse Weather, NOFLOW
HOLIDAY mNo Visrtazlcsn-81°1idray

NPDES PERMIT NO.: vt.:dt(i7-8' t3 PERMIT %°k RSI(,d
FACILITY NAME: Blackburn t kmentaary Sehiusl CLASS: WWI
OWNER NAME: Catawba COW) Schools
GRADE: WW1
e'HMR PERIOD: 06-2(l$ (.tuner 2
COMPLIANCE STATUS: Compliant
(}R.C='`Ccrtifi
B this signature,
provided with.i
ORC. [)atvirt f' 'Ice°orkle
ORC RAS CHANGED: No
ERSIO N:.3.0
CONTACT PHONE #a 82846l3
PERMIT STATUS:Actve
COUNTY: Catawba
OR(:' (..'ER 1 NUMBER: 10881
ST"t 1 tl
SliR;vIISSION' DA"IT:, 0112812019
02?22 2019
Patrick McCorhlc E-Mail:david ccorkcatacv°b:+schools.net Phone 4:828-464 3S(2 [.)ate
report is accurate and complete to the best of my knowledge,
shall report to the Director or the appropriate Regional CBfrtce any noncompliance that potentially threatens public health or the environment,
rn shalfl e provided orally within 24 hours from the time the permittee became aware of the c1reu.ntstances, A written submission hall aal cs E
tt 5 days or the time the perrninee becomes aware of the circumstances,
If the facility is noncompliant, please attach a list of corrective actions being taken and a Lim
the NPDFS permit.
,'Submit
b
made its required by part [1:I ( of
Sain E-Mail: rick Batt (a) catawbaschools.net Phone 4:828-464-3562
ss: 4377 NC Hwy 10 W Newton NC:2MF58 Permit 1LLxpiration Date:. 0713112020
[ certify, under penalty ()flaw, that this document and all attachments were prepared under my direction or super
2{) l 9
Date
ordance with a system designed
to assure that qualified personnel properly gather and evaluate the infomaation submitted., Based on my inquiry of the person ctr 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, arts$ complete. I am aware that there are significant penalties for submitting false information,. including the possibility of fine:: and imprisonment for
TAR NAME: Water Tech, Lab.
CERTIFIED LAD tt: V,C.,5
PERSON() COLLECTING C;"PING SAM1IPL
(E RT`1H1Jf:
RU S
PARAMETER CC)DE''S
Parameter Code assist<rnee may he Obtained by calling the NNPDI.S Unit [phone] or by visiting http..`="port,al.ncd'enr.or,g'we'bt><rq,Esw 1ps,'n fo
I4'OO7"N(.)'E F5
rnent designated in the reporting Tacit ty°'s NPLI[:S permit for reporting data.
* Nt F low.'Discharge From Site, ("heck this box ifni:a discharge ocean and, as a result, there aare neo tlaataa to be entered for all of the parameters on the D\1 R
foa r nttrc moetittaring period.
** ORC: on Site?: ORC must visit facility and document v s'ittttiotz of fatcility as required per 15.A NC''.a1C i?Ci ,0204.
ation cs#'the signatory aurtharaty freest lam. ash file with the state per 15A 14C `aC" 2I
** Signature of Permitter:: Ifsigr
,0506(b)(2)(D').
d by other than the pc

NPDES PERMIT NO,: NC0074233 PFRM'IT VERSION: 3.0
FACILITY NAME: Blackburn. I lementary School CLASS: WW-I
OWNER NAME: Catawba County Schools ORC: David P McCorkie
GRADE: WW-I ORC HAS CHANGED: No
eD.M.R PERIOD; 07-201 S {Julye 20I SI VERSION: 2,0
PERMIT ST VI`"US: Active
COUNTY.: Catawba
ORC CERT NUMBER: I088 I
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
.���I O\\`
_-_-_
1•11111111111111=M1011111•11111111111111=MIIIMMIIIIIM
IQB.S KS N{1VC Criu=_-=r1a1111111111111
.
11.11MENIMMIIMMIral
**s`s No Reporting Reason 1 FRI:SE No Flow -Rocs e.''Recycle; 1 NV'\G''F`11R
m - Adverse Weather; NOFLOW
is
6't

NPDES PERa'r" I NO..: NC(4)742„3t
F'ACII..I'1 NAME: Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: W44'-1
eD IR PERIOD: 07-2018 (July 2018)
COMPLIANCE STATUS: Compliant
x1 '\
w
PERMIT VERSION: 4.0
CLASS: WW-1
ORC: David P Mc( orkle.
ORC IiAS CHANGED: No
VERSION: 2.0
CON'T,ACT PiIONE 8: 8284643562
PERAIFI STATES: Acti
COUNTY: Catawwxha
OR( (. ERI" NUMBER: 1088
STATUS: Processed
SUBMISSION DATE: E, 02 2,7,'2019
02''?2/2019
ORC/Certifier Signature.: David Patrick lc(orkic F "alail.daviti mecotkler'i%;catttvvbaschooks.net Phone 0:828-464 , 5tti',? Date
this signature, I certify that this report i aect,€-ate and complete to the hest of my knowledge.
The pern
shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environm
Any infornatfon shall he provided orally within 24 hours from the '(tine the permittee Itecame aware of the cireurnstances. A written submission. shall also be
provided within 5 days of the time the perrniuee becomes aware of c:,treu.mstances.
if the facility is noncompliant, piea.se attae'h a list of corrective action, being taken and a time -table lot intpro'w:erne'nts to be made as required by part I1-E_6 of
the NPDES permit.
ail:rick. ~start;: ttaw'ha:tchools.net Phone 1:828-f4 .f562 Date
Perrnittee Address: 4377 NC Hwy 10 W Newton N( 28658 Permit I3,,xpiration Date; 07/31 F`2020
i certify, under penalty of law, that this document and all attachments were prepared under my direction or supervisiort in aceordanee with a system designed
ualit1ed personnel properly gather and evaluate the information submitted Based on my inquiry of the person or persons who (managed the
se persons directly responsible for gathering the information, the intilrmation submitted is, to the hest of` my knowledge and belief, true,
accurate„ and complete. 1 am aware than there are significant penalties for submitting false :information., including the possibility of fines and imprisonment ty
knowing vtolations.
LAB NAME: Vvate
CERTIFIED LAB : N.c.50
PERSON(s) COLLECTING SAMPLES: David P.
CEaRtTllILD t,.ABORA"f(:)RIES
PAR.AMLTER CODES
Parameter Code assistance may he obtained by calling the NPDES Unit [phone] or by visat¢rrg httlt:/ portal.nedenreorg; weblwgr'ss p,'p inpdes'fi:imis.
I° O()'t" ti0"i"E:4
Case on(y units of measurement cie igrta'tetl in the reporting fitcility's NPDES permit for reporting data.
* No Flow/Discharge From Site: (:`heck this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the C)?4fR
tsar entire monitoring periittl.
" ORC on Site:', ORC must w=isit facility and document visitant)
per 1 iA \C'AC SG .0204.
*** Signature of Permittee. If signed by other than the permiitec, then delegttticzn caf"the wignatory authority must be on file with the state per 15A NCAC: 2i3
.0506(b)(2)(D).

NPUb PERMIT NO.: NC 29
FACILITY FFr £ gH%
OWNER NAME: amww Com&sa
GRADE: W-I
eDMRPERIOD:7, & a1l1 3
P'ERNI IT VERSION: 4M
CLASS: WW-
0Rc:mom P M.
OR HAS CHANGLO
VERSION: 2,,0
PER MS: Active
COU l w 6
OR CERT NUMBER: 10881
SAMPLING LOCATION:ON: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE* NO
NOFL
NOFLOW
Reason: a9ar=wra*mm w:G\ ARNj Visrz,rodorl.Adverse Weather:, m=Non n1 mY=wvm»a

NPDES PERMIT NO.: NC0029297
FACILITY NAME: Fred T. Foard High School
OWNER NAME: Catawba County Schools
GRADE: WW-I
eDMR PERIOD: 07-2018 (July 2018y
PERAIIT VERSION: 4,0
CLASS: WW-1
ORC: David. P Mc(orklc
ORC HAS CHANGED: Na
VERSION: 2.0
FERMI'!" STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 10881
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
Coraposits Sample Time
12
Operator Pam OP
Ns Reporting, R.U.S011.*"
2400 s55sk
2
1
4
5
6
firs UN clack tin V/ I:14N
1024 1,23
NOrl..OW
NOFLOW
1101 IDAY
NOR., OW
NOFLOW
NOFL00.
NOE LOW
1008 0,20
13
25
128
18
2.1
22
I 2.5
NOELOW
NOFLOW
NOFLOW
NOELOW
NOELOW
NOF-IlOS
NO FLOW
NOELOW
NOFLOW
NOELOW
24
25
126
27
104 I 062,, V'
NOE LOW
!NOFLOW
20
55
32
I 01 0 ! 038
• NOFLOW
NOEL OW
NOFLOW
Vivant:Of Average Limit
M601811 Average:
Daily Malihnam:
Daily
**** Reporting. ReasonNFRUSE No Flow-Reuse/Recycle., FiNA/1411112, — No VIIlilIolI — Adverse Weather: NOFLOW - No 2ow:: HOLIDAY No. Visitation — Holiday

NPDF:S PERMIT NO.: NC:
FAMILIA' NAME: Fred T. Food High ehool
OWNER .NAME: Catawba (ou
GRADE:WV 1
e.DMR PERIOD: 07.20 l zt Q,
COMPLIANCE STATUS: Con
By. th
PERAM V EFd.rtC)N: "rt.ti
CLASS: WVV-1
OR(': David 1' \1.( urkle
OR( }IAS C H:VNC'ED: No
VERSION: 2.0
(:ON"UAC71' PHONE p
Signature: David Patrick: Met orkle d -lv°lt
attire, f certify that this report is a
The permidtee
a
2/ 4(+43
PERMIT STATUS: Active
COUNTY: Catawba
ORC CER°1` NUMBER: It
STATUS: Processed
SUBMISSION DAil E: 02,28 2019
ncc
y know
02122/2019
atawbasuhool,net Phone !?:828-464 562 Date
.port to the Director or the appropriate Regional Offrce stray nonconrplianc,e that t.ernially^ threatens public health or the environment,
,Any infanmation shall be provided orally within 24 hours from the time the pennittee
provided, within 5 days (tithe time the permittee becomes aware of the circumstances.
lithe facility is noncompliant, please attach a list of corrective actions being taken rind a time -table
the NPDUS pennit.
Permittee:'Suhrttatter Signature:*** Rick. Sain F-L1ail:riek
Pennittee Address: 34
i certify, under penalty of
aware oldie circumstances.
sub mi'
tents to be made as required by part II.F..6 of
awhasc:hoofs.net Pdtcrne 4:823-464-3562
u Rd IvCSR 2036 Newton NC 2h658 Permit Expiration Date: 07 31/2020
that this document and all attachments were prepared under my direction or supervi:
02/2812019
system designed
to assure that qualified personnel properly gather and evaluate the information subs it-ht. , '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. 1 am aware that there are significant penalties for submitting Use information, including the possibility of fines and imprisonment for
knowing violations,
CERTIFIED IED LA I3 #: N.C50
9'I:;RSON(s) COLLECUING SAJmPLEs
CERTIFIED D LABORATORIES
0ARAMI:'.I"ER CODES
ataee may be obtained by calling the 'NPDES [.lnit (919) 80?-6300 or by v°isittnl http, `.'portal.ncdenr.org^'wehr`wq.<'"swp,"ps npdes/frarms.
1Jsc only unit~ of measurement designated
* No Flow: Irscttatarge Frc?rtr Site: Check this
for entire monitoring period,
OR.0 on 'Site, OICC` rntt
*** Signature ot"Pennittee:.
.0506(b)(2)(D)
he reportit
u
F O(7`1"N O"TES
NPI)ES permit For re on
urge occurs and ids a result, them- are no data to he entered for all of the parameters on the DMR.
as required per 15"=\ NC:AC 0 .0204,
need by other than the permittee, then delegation of the signatory authority must he on file with the state per 15 Ak NCAC 21-3

J®
NPDES PERMIT ¥,: \ m£9
IA ,�+NAME: B+&mElementary School
OWNER NAME; Ca
GRADE: W1W-1
mM■PERIOD: 0ty
PERM FT VERSION: 4.0 PER NRSlq : Aen
CLASS: w ! RECEIVED
C>�tYrt Catawba ,
�R� G m«d1'M G OKC CER NUMBER t0 {
OR( HORC HAS CHANGED: No
/}
CENTRAL FILES
DWR SECTION
SAMPLING LOCATION:EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
VERSION:
wv No ReportingReason: 1 +ar=wH waa u«A VW

i ;.
NPDES PERMIT NO.: NC0074233 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Blackburn Elementary School CLASS: WW-I COUNTY: Catawba
OWNER NAME: Catawba County Schools ORC: David P McCorkle ORC CERT NUMBER: 10881
GRADE: WW-1 ORC HAS CHANGED: No
eDMR PERIOD: 06-2018 (June 2018) VERSION: 2.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 10/18/2018
(ztaA. `k\r\ ',p.kJa.12,
ORC/Certifier Signature: David Patrick McCorkle 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.
1 0/08/20 18
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.
10/18/2018
PermitteefSubmitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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 an 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: Water Tech. Lab.
CERTIFIED LAB #: N.C.50
PERSON(s) COLLECTING SAMPLES: David P.McCorkle
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] 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 80 .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.: 1' C0074233 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Blackburn Elementary School CLASS: WW-1 COUNTY: Catawba
OWNER NAME: Catawba County Schools ORC: David P McCorkle ORC CERT NUMBER: 10881
GRADE: WW-1 ORC HAS CHANGED: No
eDMR PERIOD: 06-2018 (June 2018) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
n
Et'ge
V'
P
6
2
9
N
o
g21
I-
..
g
7
°uti
O
c
Y.
a
X,
50050
00010
00400
50660
C0310
C0610
CO530
31616
Weekly
Weekly
2 X month
Weekly
2 X month
2 X month
2 X month
2 X month
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
7EMP-C
pit
CHLORINECHLORINEBpn
- Cone
hlf3-N•Conn
755-Conn
EMU EMU B R
2480 crock
II..
2400 clock
Iln
TINS
mgd
deg c
su
uglk
mgll
nigll
mgJI
41100mI
1
2
3
4
5
6
1029
0.63
Y
0.00005
20.1
6.7
<20
3.9
2.63
9.7
<1
7
8
9
10
II
12
13
I100
0.35
Y
0.000943
19.7
6.5
< 20
5.8
10.2
165
< I
14
15
16
17
18
1255
0.23
Y
NOFLOW
19
20
21
22
23
24
2S
1058
0.38
Y
NOFLOW
26
27
28
29
30
Mont6[y Arcane Limit:
0.015
35
6
32
246
3mnlulyn.erase:
0000546
19.9
0
4.85
6.415
13.1
1
pally 3[fdmvm:
0.00005
20.1
6.7
0
5.8
10.2
165
0
puily \0nimvm:
9.000043
19.7
6.5
0
3.9
2.63
9.7
0
•is• No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR= No Visitation - Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0074233 PERMIT VERSION: 4_0 PERMIT STATUS: Active
FACILITY NAME: Blackburn Elementary School CLASS: WW-1 COUNTY: Catawba
OWNER NAME: Catawba County Schools ORC: David P McCorkte ORC CERT NUMBER: 10881
GRADE: WW-1 ORC HAS CHANGED: No
eDMR PERIOD: 06-2018 (June 2018) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE#: [phone] SUBMISSION DATE: 07/19/2018
07/18/2018
ORC/Certifier Signature: David Patrick McCorkte 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.
,A‘"" sL"
Permittee/Submitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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: Water Tech. Lab.
CERTIFIED LAB #: N.C.50
PERSON(s) COLLECTING SAMPLES: David P.McCorkle
07/19/2018
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.orglweb/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 PI MLT NO.: NC0074233
•
FACILITY NAME: Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: WW-1
eDMR PERIOD: 04-2018 (April 2018)
PERMIT VERSION: 4.0
CLASS: WW-1
ORC: David P McCorkle
ORC HAS CHANGED: No
VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 10881
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
t
El
.
^
Er
0
e'
i-
1a
_
g
15
9
C
r ,§
-
O
:
n
8
U
O
A
1
2�
2
90050
00010
00100
50060
C0310
Mao
C0530
31616
Weekly
Weekly
2 X month
Weekly
2 X month
2 X month
2 X month
2 X month
Instantaneous
Gmb
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
¶ MP-C
PH
CHLORINE
80D-Coot
NII}N•Cane
155-Coo s
ECOLl BR
1600 clock
Fin
2100 clack
lira
VAIN
mgd
deg
su
vg/1
mg/1
m8/1
mgll
41100m1
•
3
•
5
6
0949
0.2
Y
0.00005
10.6
<20
7
a
9
10
11
1130
0.2
Y
0.00006
12.8
6.4
<20
<2
4.53
4
<1
12
03
14
15
16
17
18
19
1108
0.26
Y
0.00005
15.6
<20
w
21
21
23
21
1010
0.36
Y
0.00005
14.9
6.2
<20
<2
0.6
3.7
<1
25
26
17
28
29
30
Moo
hly Average Mail:
0.015
30
6
30
200
5{oatlly Average:
0.000052
13.475
0
0
2.565
3,85
1
D.ay 1t•.imam:
0.00096
15.6
6.4
0
0
4.53
4
0
DailyNItelmem:
0.00005
10.6
62
0
0
0.6
3.7
0
•••• No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR =No Visitation -Adverse Weather, NOFLOW =Na Flow; HOLIDAY = No Visitation - Holiday

•
NPDES PE::MIT NO.: NC0074233 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Blackburn Elementary School CLASS: WW-1 COUNTY: Catawba
OWNER NAME: Catawba County Schools
GRADE: WW-1
eDMR PERIOD: 04-2018 (April 2018)
COMPLIANCE STATUS: Compliant
ORC: David P McCarkle ORC CERT NUMBER: 10881
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 05/29/2018
05/ 16/2018
ORC/Certifier Signature: David Patrick McCorkle E-Mail:[e-mail] Phone #:[phone] Date
By this signature, 1 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.
ceee:e,
05/29/2018
Permittee/Submitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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: Water Tech Lab.
CERTIFIED LAB #: N.C. 50
PERSON(s) COLLECTING SAMPLES: David P. McCorkle
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] 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 213
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0074233 PERMIT VERSION: 4.0
FACILITY NtiME: Blackburn Elementary School CLASS: WW-1
OWNER NAME: Catawba County Schools ORC: David P McCorkle
GRADE: WW-1 ORC HAS CHANGED: No
VERSION: 1.0
eDMR, PERIOD: 06-2018 (June 2018)
PERMIT STATUS: Active
UNTY: Catawba
C CERT NUMBER 10881
ATUS: Process
SAMPLING LOCATION: EFFLUENT DISCHARGE NO,: 001 NO DLIKIKARGEt
**** No illeporting Reason- ENFRUSE
o Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather„ NOFLOW = No Flow; HOLIDAY - No Visitation - Holiday

-.. {
NPDES PERMIT NO.: NC0074233 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Blackburn Elementary School CLASS: WW-1 COUNTY: Catawba
OWNER NAME: Catawba County Schools ORC: David P McCorkle ORC CERT NUMBER: 10881
GRADE: WW-1 ORC HAS CHANGED: No
eDMR PERIOD: 06-2018 (lune 2018) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 07/19/2018
07/18/2018
ORC/Certifier Signature: David Patrick McCorkle 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 timethe 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 H.E.6 of
the NPDES permit.
07/19/2018
Permittee/Submitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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: Water Tech. Lab.
CERTIFIED LAB #: N.C.50
PERSON(s) COLLECTING SAMPLES: David P.McCorkle
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] 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 DIVER
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).

DES PERMITO:\tm742 PERMIT VERSION Q
t4CILRYN&Ne ackburn ElementarySchool CLASS: W
OWN.ER ¥&N : Catawba CountySchools
GRADE: W
MR PERIOD: 05-2 Rl,»2m
ORC: David #M +»
OR( HAS CHANCED: No
VERSION: w
PERMIT q :A
SAMPLING LOCATION:EFFLUENT DISCHARGE NOwes! NO DISCHARG
hl R v
®w w RupothngR mauve=\ k

NPDES PERMIT NO.: NC007423 3
FACILITY NAME: Blackburn Elementary School
OWNER GAME: Catawba County Schools
GRADE: WW-1
eDMR PERIOD:05-2018 (May 2018)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-.1
ORC: David P McCorkle
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: t328
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: I0881
SID
SUBMISSION DATE: 06/ 13/2018
06/ 1212018
ORC/Certifier Signature: 'David Patrick McCorkle E-Ma.il:da- d_mccorkle(i7catavvbasch.00ls.net Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the hest of my knowledge.
The perm
hall report to the Director or the appropriate Regional Office any nonc,oanpliance that potentially threatens public health or the environment.
Any information shall be provided. orally within 24 hours from the time the permittee becarne aware of the circumstances. A written ;submission shall also be
provided within 5 days of the time the permittee becomes aware ofthe circumstances.
lithe 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.
06/13/2018
PermitteefSubmitter Signature:*** Rick Sail). E-Ma.il [e-mail] Phone t#:828-464-3562 Date
Permit( ee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31 /2020
I certify, tinder 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. 1 am aware that there are significant penalties for submitting false information, inelu.ding the possibility of tines and unprisonmcnt for
knowing violations.
LAB NAME: WaterTech.Lab.
CERTIFIED LAB #: N.C, 50
PERSONS) COLLECTING SAMPLES: ©avid P. McCorkle
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by v=isiting httpalportal.ncdenr,orgrweblwq.'swplpsl'npdeslforms,
FOOTNOTES
Use only. units ofineasurctnent designated in the reporting facility's NPDES permit for reporting data-
* No Flow/Discharge From Site: (:heck this box if no discharge occurs and, as a result, there are no data to be entered for all oldie parameters on th,c DMR
I'm entire monitoring period.
** ORC on Site?: ORC must vi it facility and doetmment visitation of facility as required per ISA NCAC 8(3 .0204.
*** Signature off Perrnittee; If signed by other than the permittee, then delegation of the signatory authority must be on 'file with the slate per ISA NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT" NO.: NtC0074233
FACILITY NAME: Blackburn ElerneIuaySchool
OWNER NAME: Catawba County Schools
GRADE: WW-I
eDMR PERIOD: 04-2018 (April 2018)
PERMIT VERSION: 4,0
CLASS: W1t'-1
ORC": David 1' McCorkd
ORC HAS CHANGED: No
VERSION: 1.0
PERMIT S`e
COUNTY: Catawba
ORC CERT NUMBER: 10881
STATUS: (S: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
**** No Repo Reason: 13NIF81 F-
�pnatatt � (S Watt) COratt raaaaa attrrt
R��.yc.la; ¢ NV'WI)-IR No Vi.s taboo - Atittertie Weather NUFLOW = No Flow, 001 D.AY = \zil VisiliHlon

NPDES PERM.I
FACILITY N.A.
NO.: NCU074233
:kburn Elementary School
OWNER NAME: Catawba C,«tuty Schools.
GRADE: WW-I
eDMR PE„RIOD:04-2018 (April 2W81
COMPLIANCE STATUS: Compliant
TN)
PE;R., 1IT %ERSION: 4,0 PER,MI`I` 5 i`ATUS: Active
CLASS: WW-I COLNTY: Catawba
ORC: David P Me.Curk'1c ORC CE.:RT NUMBER: 10881
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #€ 1284643562 SUBMISSION DATE: OS•`2 201.8
05/16/2018
ORC/Certifier Signature. David T'atrick McCorkle E-Mail:david_tnccorklelwcatawhaschools,net Phone #:828-4fi4-35Ci2 Date
By this signature, 1 certi
ports acourate and complete io the best of my knowledge.
The perm , shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment,
i'ine the permittee became aware of the circumstances. A written submission shall also be
Any information shall he provided orally within 24 hours fr
provided within 5 days of the time the permittee becomes aware of the circumstances..
If the facility is noncompliant, please attach a
the NPDES permit,
Permitt
ions being taken and a time -table for 'improvements to be made as required by part 11.E,6 of
1Subnmittcr Signature:*** Rack Sain E�Mail:ritk lain
05f'29/2018
baschools.net Phone 4:82.8-464-3562 Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expi.ration Date: 07t312020
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 ofthe 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.
I�AB NAME: Water "tech. Lab.
CERTIFIED I) LAB it: N.C. 50
PERSON(s) COLLECTING SAMPLES: David P. McCorkle
CERTIFIED 1.A.BORA'I DRIES
PARAMETER CODES
meter Code assistance may he obtained by calling the NPDES Unit (91.9) 807-6300 or by visiting http t'lportaLncdenr.orgywebiwq`sw pl'psfnpdesifoIms.
EOOTNOTE,S
Use only units of tnerasuret)ment designated in the reporting facility's NPDES permit lamr reportirg data.
* No Flow/Discharge From Site: Check this bon if no discharge occurs and, as a result, there are no data to be entered for all (tithe parameters on the DIrTR
for entire monitoring; period,
ORC on Site"?: ORC mu,s't visit facil,i'ty and doeutnent visitation of facility as required per 15A, •NCAC SC.i ,0204.
*** Signature ofPe'rrnittee: If signed by other than the per/
.0506(b)(2)(D),
m delegation ofi'the signatory authority. must be on file with the state per 15A NCAC 2B

NPl)I,S ER ►)I..I. NCI.. tit:'t 074233
FACILITY N# iE. I3trakhum Hemet
OW NER NAME: C'akawba Coup,
GRADE W'W"l
el)YIR PERIf)1).05-20U tl\lav
PERMIT VERSION:
CI 1\''6ti-I
OR( David I' McCorkle
C)R.0 HAS CHANGED; tit
VERSA).
PERMIT S) ►E' a\c
R"#'NUN 1RER. tt
ed
SAMPLING GCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*:
u kI+IPA1'REancous
.>.* No RvpOTting R vta. FNERUS tw.,' xya'1
Gmb

NPL)F.S PERMIT N().: \( (NJ744233
FACILITY NA,: 3 aekhurn Elenrcrrtaiy SLhrna!
OWNER NAME: C'ataawbaa C.`etnt Scdru<als
(TRADE: 10+W-I
eDNLR PERIOD: 0572018 (Mcay 20l8)
COMPLIANCE STATUS: Contpl..iaant
PERM rr VR:SION. 4.0
CI ASS: w'W-1
ORC: David P Mc(eirrt 1e
ORCDASCMAN(;r1 L):flc
VERSION: 2.0
CON1"k!tCIPHONE 4: 828.4643562
ORC"Certilicr Signature: David Patrick. McC'orkle E-Mad.l:david n
repo
plete
y knowledge,
PERMIT SIAI`US:,/
COUNTY: C;a't:aekra
OR( CERT NUMBER.: 10881.
T`A'l'Id'St Pr+,essed
ItBMISSION DATE: 09:`06:2"
()8 30t20l 8
wbaaschools.net Phone 4:828-464-3562 Date
The penarittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the esnvironment.
Any information shall be provided orally within 24 hours from the time the pertmttce became aware of the t:ircwnstanees. A written submission shall also be
provided ,Nithin 5 days of the time the pernaittee becomes aware oldie circumstances„
If the facility is noncompliant., please attach a list of corrective actions Itx ing taken and a flute -table for itnprovernems to be made as required by part
the NPDES permit.
Pertnittee'Suhattitlea ,Signature:*** Rick gain P Mail:rick aittta?.c.atuwhascho
Permittee Address:4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07 1 2020
1 certify, under penalty of law, that this document and all attachments were prepared under tray directfratt
to assure that qualified personnel property gather and evaluate the information submitted. Based on my at
system, or those persons directly responsible forgathering the information, the information submitted is,
accurate, and complete. l am aware that there are significant penalties for submitting false tbrrnation, it
knowing violations.
LAB NAME: Water &`eeh.Lah.
CERTIFIED LAB 4: Sr("". St
PERSON(8) COL 1,E:CrING SAMPLES:
S:
(: LRT11°i1 D HORA [ DR
PA.RAMETE R CODES
r super
4:828-464.3562
Date
ion in accordance with a system designed
ae person or persons who managed the
the best ol`rny knowledge and belief, true.
rddng the possibility of fines and imprisonment for
Parameter Code assistance rrt;ty be obtained by etall.ing the NPD1..S Unit [phone] or h . wishing http:(Iportal.nedenr.irt•td.'w°
Use only urtit,s rrl`tnea uretat xrt designated in the reportin
* No Flow f)isc:frarle. Fr rm sit.: (heck tilts ba�x it'nr�dis
for entire monitoring parr
** ()RC on Situ.":
*** Signature of Pcrmitta
.0506(b)(2)(D).
FOOTNOTES
N,PDfiS permit for repot atg
arf e C A
;'npdesltorms.
there are rep data to he entered for all of the parameters on the D1\IR
eti'ity and document visitation oequired per I 5A. Nt'AC: 8l1 .1)
sd by other than the permittee, then delegation of the ;signatory authority 050
4,
be on mile with the state per 1 A NC:'AC 2B

NPDES PERMIT NO.: NC0074233
FACILITY NAME: Blackhunl Elementary School
OWNER NAME: Catawba County Schools
GRADE: WWWV-1
eDMR PERIOD: 02-201 it cbrnaty 2lll t3}
PERMIT VERSION: 4.0
CLASS: WW-1
ORC: David P M.cCorkle
ORC HAS CHANCED: No
VERSION: 1.0
PERMIT STATt1S: Active
COUNTY: Catawba
ORC CERT NUMBER: 10881
TATUS: Pt•tace'sed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO D
2484 check Iles
4
7
1.1
14
19
16
18
1 16
23
24
26
26
28
050
116
1204
13 21
1223 Y
S246t46 Average Limit:
Delly, 211n4mon
.614160
FLOW
gd
0.00006
0191I[15
1(41S
0.000042
Weekly
Grab
de4c
7.4
V 11.4
I.6
7.4
146444
2;XITIOn88 Weekly
pn
6.4
6.4
6.4
6.4
(Cab
_< 20
Grab
3."
sql-
CO61U
Grab
(044a
Grab
rh
"i'222.N • C'ana•. TSS ..1',"ooa
2.6
12
6,1
9.4
2, 6
21626
2 X: month
Grab
F(" 1PLI ®R
3.6
#; l OOrn l
0
"r"' No R.purow-Ru-rro. kitcyrV, Ps:V -MR = No Visitation -Adverse WCa1'Imr: •,SUFL OW'No Flow. HOLIDAY = No V'BitatIO

NPDES PERMIT
F°ACILSTY NAM
OWNER NAME: Cam
(:RAVE: WW-1
O.: 5C00742:33
khurn Etenrentaryy
eDMR PERiOII: 02-201'
COMPLIANCE SiATUS:. Compliant
PERMIT VERSION: 4
CLASS; W'W-1
OR(": David P M.Corklc
OR( HAS CHANGED: Nrr
VERSION: 1.0
CON'i',°AC"r PFIONE #: S2846.43562
ORC"aC"ertafier Si rna'tsare: Duv`id Patrick McCorkle 1- Ma.il:da.vid_mccorklei"n
By this signature, 1 certify` that this re
and conro the best of my kno
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 10881
N DATE: 03121'2018
atawhaschools.net Phone
The permittee shall report to the Director or the appropriate Regional Office anv noneornpliance that pote
Any infartnataon shall be provided orally within 24 hours from the time the penm€tee became aware ofthe
provided within 5 days of the time the penn'ittee'becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time table fo
the NPDES perrnit.
pros e1Th nts
Perm sttce.w ubmitter Signature.**'" Rock Sain E-Mail°rick_,stlnacatawbasehooVs.net
Vermittee Address: 4377 NC" Hwy 10 W Newton N( 28658 Permit Expiration Date: 07/3112020
l certify, under penalty of law, that this document and all attachments were prepared u.ndcr my direction or supervision in a
to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry ofthe
system, or those persons directly responsible for gathering the information, the innfunn.ation submitted is, to the best of
accurate, and complete. 1 am aware that there are significant penalties for submitting false infonnnation, includt`ng
knowing v iolation.s.
CERTIFIED [ AEIORAT RIES
LAB NAME! Water Tech. Lab.
CERTIFIED LAB th N,C.50
PERSONts) COLLECTING SAM+!PEES: David P. lcCorkle
0310) 201i
464-%%2 Date
ens taublic heath or the environment.
e
t submission shall also be
ade as required by part II.L.6 of
03'22'2018
Phone 4:8223-46i4-3562 Date
dance sti°ith a system designed
)n or persons who managed the
knowledge and belief, true,
ty of fines and imprisonment for
PARAMETER CODES
Parameter Code assistance anany he obtained by cai otg the NPDES Unit [phone] or by visaling http://portal,nedenr.org/
FC)CYE'NC)1'1 5
enra:tnt tlesignstted in the repaar°tintg I*rcility°s NPDES pennit
box if no djsc:barge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
fear entire monitoring period.
** ORC on Site?: ORC must visi
*** Signature of Permittee: If sit
.0506(h)(2)(D)),
bfw glswplpslnpdcsiforms.
and document v
Other than. die pe
station of facility :ns required per 1 NCAC'" SC,a .0?04.
ittee, then delegation of the stg'rtafory authority must he on tile_ with the state per 15A NCAC 2B

NPDES PERMIT NO.: NC0074233
'FACILITY NAME: Blackburn. Elementary School
OWNER NAME: Catawba County Schools
GRADE: WW1
eDMR PERIOD: 12-2fl17 (December 2017)
2400 clock
3
4
10
17.
12
13
14
15
16
21
23
24
25
26
27
20
30
PERMIT VERSION: 4.0
CLASS: WW-1
ORC: David P McCorkle
ORC HAS CHANGED: No
VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 10881
,'1 TATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISC
1022
k Hr.
t
0 28
Y/B/N
Y
y
Weekly
Weekly
Instantaneous Grab
FLOW TE,WFC
d
HOLIDAY
HOLIDAY
HOLIDAY
HOLIDAY
Monthly Avacasa:. 0.000045
Day Mulmuu:, 0.0000.5
de; e
12.2
9,9
10,566667
12.2
2 X month
Grab
PH
6.7
6.7
50060
CHLORINE
tt
,<20
0
C0310
co5I0
31616
2 X month 2 X month 2 X month 2 X month
Grab
BOD - Coao
Chub
NHYN . Cont
Grab
7.75 5,6
30
11,6 7.35 6.l
23.2 7,75 6.6
** ** No Reporting Reason: ENFRUSE — No Flow-Reuse/Recycle; ENVWT}{R = No Visitation — Adverse Weather, NOFLOW — No Flow. HOLIDAY = No Visitatio
Holiday
Drab
0
5

NPDES PERMIT NO.: NC0074233 PERMIT VERSION: 4.0 PERMIT STATUS: Active
'FACILITY NAME: Blackburn Elementary School CLASS: WW-1 COUNTY: Catawba
OWNER NAME: Catawba. County Schools ORC: David P McCorkle ORC CERT NUMBER: 10881
GRADE: WW-1 ORC HAS CHANGED: No
eDMR PERIOD: 12-2017 (December 2017i VERSION: 1.0 STATUS: Processed
k COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION" DATE: 01/18/2018
01/
ORC/Certifier Signature: David Patrick McCorkle E=Mail:david mccorklecatawbaschools.net Phone #:[phone] Date
By thi
s
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 he
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.
01/18/2018
Permittee/Submitter Signature:*** Rick San E-Mail:rickOes'ain@cataw'baschools.net Phone #:[phone] Date
Permittee Address:4377 NC H'wy l0 `ir Newton NC 28658 Permit Expiration Date: 07/31/2020
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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing, violations.
LAB NAME: Water Tech. Lab.
CERTIFIED LAB #: N. C. 50
PERSON(a) COLLECTING SAMPLES: David P.
Part
eter Code
CERTIFIED LABORATORIES
PARAMETER CODES
e may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ticdenr.orglweb/wq/swpips/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, enure monitoring period.
ORC on Site?: ORC must visa facility and document visitation of facility as required per 'I 5A NCAC 8 r .0.204.
* * 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.: NC0074233
FACILLTY NAME: Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: W W-1
ei)MR PERIOD; 11-2
PERMIT VERSION: 4,
CLASS: WW-I
ORC: David P MeCoda
ORC ETAS CHANGED: 1,44N 0 2 2018
17 (November 2017) VERSION:: 1,0
SECTION
1,!7,0,RMATiniq PI4DecLsm
SAMPLING LOCATION: EFFLUENT DISCHiAR E
PERMIT STATUS: Active
COUNTY: Catawba
TIIIECE1111.1S11.11MIP III:,
ORC CERT NUMBER; 108)11
STATUS:. Processed
u01
MaORES OFFICE'
NO DISCHARGE*: NO
.
I
m
'
1
IIMPIMINMINIMIMMIMINIIIIIIIIIIIIMM
.11111111111111111•11■111111111111111111M1111•1111111111111111111111111.11•11
IMM
EINIIIIIIMIIMIIIIIIIMI
, x rn.
1/111111
,qt.,„.,, .0
, ,
IMIIIIMEMIIIIIIMIIIMIIIIM
IIMMINIIIIIIIMIIIIIII
1111111121111111111111111111M1111111111111=1
141)0 0 L
1111111111111111111.111111111111111111MIIMMIMMIIIIIIMIIIIIIIINIMIN
1111.11111M.1111=1.1111111111M111111111MME
MIME
INIIMIIME
IM
NEMII=MINM11111111111
IMINIIIIIIIIIIIIMIIIIIIIIIIIIIIIIIIIIII
11111111111111111MIIIIIMMIIIIIIIIMIIIIIIIIIIIIMIIIIMMIN
IIIIIIIIIEIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIIIMIIMM=Ill
111111111111111•1111111=11111MMIII1111111111111111111111111111111111111=111111111111•111111
111111111111111111111111
NIIIIIIIIIII■1lNIIIIIIIIIIIIIIIIIIIIIMIII
'=111=M11111111111111111111111111111•1111111111111111•1111
w
M
111111=1•11111==
MIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIII
. MIIIIIIIIMI=IMMIIIIIIMMI1111111•111M1111111111111111111111111111111
MNIMMINIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIIIIIIMMMIIIMIIIMIll
•=IIIIIIMMIIIIIMI=MIIMINIMIIIII11111111111•11111111111111111110111111111111111111111111
OM
emosimmomimuimmummminimmmommumi
M1111111111111111111111111111111111111111111MISM
- 11111•111111111111111
11111111111111111Mi=11•111111•1111111111111111111111111111111111=
11.111111111111111111111111111111111MIMM
ME1111111111111111111111111111111111111111
EMIIIIIIOIIIIIIIIIIIIIIIIIIIIIIIIIIMIIIIIIM
MIIIIIMI1111111111111111111•=1
IIIMMIIMIIIIIMINIIIINI11111111111111MINIIM
IIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
IIIIIMIMMIIIMMIIIIII1111111111111111•11111EMII
11111111111111111111111111111
1.11111111=M11111111111111111111111111111111111=11111111111
=MIIIIIIIIIIIIIIIIIIII
IIIIIIMIIIIM=IIIIMM=M111111M111111•1111111111111111MINIM11111111111111111111111
IIIIIIIIIIIIIIIIIIIIIINMIIIMIIIIIMIIIIIIIIIIIIIII
1111111EIN=11==111101111111111111111111111111111111111111111M1
11=11111111111111111111111111=
MIIIIIIIIIIIIIIIIIIM
=1111111•1111111111111111
1111111111111M=
11111111111111•111111EMMIIIIIMIIIIIIIIIIIIIM
IIIIIIIIIIIIIIIIIII=IIIIIIIIIIIIIIIIIIIIIII
eimmoirmmmimumumwommmm
ilemom
EIMEMIIMINIIIIII111111111■11=11111•11111111M
--
=MIIIIIIIIIIIIIIIIIIIMI-
MIIIIIIIIIIIIIII
1111•111311=110,5
"EtiMniiiiMMEM
IMIMMINIMIIIIIIM,
-.' min—
ilMiiiMiliMMEN=,,
MMEMEMMEIMMiiii
—
No Repotting Reason: .ENFRUSE No How-Reuse/Recycle; ENVINITIR = No Visitation — Adverse Weather; NOFI_OW No 11ow, HOLIDAY No Visitation— Holiday

NPDES PIMi[RM1T NO.: N(00742;33
FACILE It N1#ME: Blackburn 11eta
(}'%NER NAME: Catawba County Schools
GRADE: WW -1
IR PERIOD: 11-2017 (November
LIANCE STATUS: Compliant
Signature: 1)av
7)
PERM
T VERSION: 4.11
CLASS: W W-1
OK(: David P McCorkle
ORC HAS CHANGED: No
VERSION: l.0
CONTACT PHONE #: [phone]
PERMIT STATUS; Active
COUNTY: Catawba
ORC; CE RT NUMBER: 1001
STATUS: P
SUBMISSION DATE: 12+'111 201 7
12.'06/201 7
Patrick McCorkle E-Mail:davidrr• corkle(ri'catawhaschorolsnnet Pltonc 4:828-464-3562 Date
report: ccurate :and complete to th.e best of nay knowledge.
The perrntttee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Arty info nation shall be provided orally within 24 hours from the time the pennittee became aware of the circumstances. A written submission shall also he
provided vtrithin 5 days of the time the permittee becomes.aware of the circuntsra.necs.
lithe facility is noncompliant, please attach a list of cotrucaave actions being taken and a tinie tab
the NPDES permit.
for in
p
he made as required by part 1I.EW..6 of
Permittee'y+ubnaitt€^.r Signature:**" Rick Sato E-Mail:riek„_sain
tawbaschools.net Phone #:[phone] Date.
Pentritt;ee Address: 4377 NC liwy 10 W Newton NC 28658 Pennit'Expiration Date: 07/:31/2020
l certify, under penalty of law, that this document and all at merits 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 in.rluiry 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 nay° knowledge and belief, true,.
accurate„ and complete, 1 am aware that there are si
knowing violations,
I�Aa3 NAME: Water Tech. Lab.
CERTIFIED LAB 4: N.C. 50
PERSON(s) COI. LECTF.0 SAMPLES:
submitting false information, including the possibility of tines and imprisonment for
CERTIFIED LAE3ORATORIES
PARAMETER CODES
Parameter Code assistance may I:roe obtained by calling the NPDES Unit [phone] or by vi sting httpaJport.al_natdcnr.org/weblwylsaup!ps/n
FOOTNt;)TIi.S
Use only um of measurement designated in the reporting faeNPDES permit for reporting data.
*No Flow/Di :charge 'From Site: Cheek this box fin() discharge occurs and, as a result, there are no data to be entered for all of the parameters on the. DM R.
for e
ring period.
ORC on Site?: ORC must visit lity and document visitation of facility as required per I SA NCAC 8G ,0204,
'a'* Signature of Pernnttee: if a;igared by other than the pennihtec, then. delegation of the signatory' authority must he on tale with the state per 1 SA NCAC 2E3
.0506(g(2)(D)..

PCkE,S PERMIT \O.: NC'OO74233
FACILITY N .ME: BC5abtim ElemeVitjry School.
OWNER R NAME: Catawba ba Co(i ttv Schools
GR.,VOE: WW1
e.D\IR PERIOD: 10-21I7 jC?a:t al r tDl,"p
PERMIT VERSION: 4.0
CLASS: W Vl I
ORC: David h,V'1cCorkl
ORC IRS CHANGED: No
V ERSIO\r I.fl
PERMIT STATUS: Active
SAMPLING LOCATION: EFFLUENT DISCI I 1tGE ` the 001 NO DISCIL .RGE*: NO
R u No Visit11crs, —A host LV' , tHscr; NI°)F1 C)V = No FIcwr: HOLIDAY No Visitat

NPDES PERMIT NO : NCI)074233 PERMIT 6'ERSION: 4,0 PERI►IIT STATUS: Active
FACILITY NAME: BlatkhuCLASS: W
OWNER NAME:. Catawba County Sc
GRADE: WW-1
eD\1RPERIOD: 1.0-'01 ([ac1'ober2017)
COMPLIANCE STATUS. Compliant
ORC: David P McCoskIe
ORC HAS CHANGED: No
VERSION: 1,0
CONTACT PHONE #: R2846-135( 2
C)RC/Certif'icr Signature: David Patrick McCorkle E-Mlail:david_rnccorkle
By this signature,' certifvv'that this report is aceurate and complete to the best of my knowledge.
a
COUNTY: Catawba
ORC CERT NUMBER: 10831
STATUS: Processed
SUBMISSION DATE: 1 I; 15/2017
11 /0'8/2017
hoots,net Phone #:[phone] Date
The permittee shall report to the Director or the appropriate K.egional 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,
11/15.,2017
Permitte;e/Submitter Signature:*** Rick Sain E-Mail:ri,ck_saingcatawbaschools.net Phone #:[phone] Date
Permittee Address: 4377 NC Huey 10 W Newton NC 28658 Permit Expiration Date;. 07,/31/2020
certify, under penalty of law, that this document and all attachrn.ents 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 t
ry 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. 1 ant aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing vi,olation.s,
LAB NAME: Water Tech. Lab,
CERTIFIED LAB #: NC, 50
PERSON(sl COLLECTING SAMPLES: David P, McCorklc
Parameter Code assistance may be obtained by calling the
CERTIFIED LABORATORIES
PARAMETER CODES
DES Unit [phone] or by visiting http:ll'porlval ncdeart,orgf"web/wglswp'pslnpdesl'for as,
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 ifno 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 Site7: ORC must visit facility and document visitation of facility as requuired per 15A NCAC 8G ,0204.
** 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).

\PDES PrERMIT %O.: NCO 7 7 PERI•"1LT
FACILITY NAME: E: Blackburn EIEwicultary Stho''I (. LASS.
O1\r\FR \,+l\IE: Cam, C`t?oir=,t
ORC; David P ?
ORC HAS CHI\\Cell:
el)\bRPERIOD: 09-20 7 IStrrzam,;cir 2.0i?i \ERSION
SAMPLING LOCATION: EFFLUENT
+ . No Reporting ReasnrE F3 1'Itl'SI:
PLRMITSTATUS: \t.Live
ENTYr Catawba
OLIC CERT NUMBER: Id?SS1
STATUS: .\3 US: Prcec .-stew;
aRGE NO.: 01 NO I IS IL GE NO
,Rr,use eEyvl : EN HMI DAY' No visUriti rn —Holiday

NPDES PERMIT NO.: NC0074233 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Blackburn Elementary School CLASS: WW-1 COUNTY: Catawba
OWNER NAME: Catawba County Schools ORC: David P McCork]e ORC CERT NUMBER: 10881
GRADE: WW-I ORC HAS CHANCED: No
eDMR PERIOD: 09-2037 (September 2017) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 10/26/2017
;1,0 -v. \A-c\c--zsuND.Q_.
10/11/2017
ORC/Certifier Signature: David Patrick McCorkle 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 clays 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.
10/26/2017
Permittee/Submitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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.
LAB NAME: Water Tech. Lab.
CERTIFIED LAB #: N. C. 50
PERSON(s) COLLECTING SAMPLES: David P. McCorkle
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit (9I9) 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.: NC0074233 PERMIT VERSION: 4 0
FACILITY NAME: Blackburn Element School CLASS: WW-1
OWNER NAME: Catawba. County Schools ORC: David P McC.alkle
GRADE: WW-1 ORC RAS CHANGED:
eDMR, PERIOD: 01-2017 (august 2017) VERSION: 2.0 DWR SECTION JNF RSTATUS: Processed
OCESS/NG UNIT
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCH
PERMIT STATUS: Ac
Catawba
2
0
3
t4aa dock firs
4
a
14
11
13
14
13
le
64
11
23
25
28
27
21
21
31
0741
'9445
0$aR
350
1:1'28
204541 0 014
Moolh65 +5v0a1HLlmlt. 2 2115
Movably 37munn,
Drily Maximum: 0,00006
ORC CERT NUMBI"}
(333in
Week! 2 X month
Grab
['MOWN* HOD -Coat
0
11
222
tinily Minimum, 0A0008 2' hA 0 0'
*"" No Reporting Reason: ENFRI.'SE = No Flow-ReuserRecyclei ENV WrHR No Visitation - Aciversc alher; 3OFI UVo = No Flow: HOLIDAY -NV7 4'asitatio
WO S
NWONAL OFFICE
(9)810 C 5.36
month..
31828

NPDES PERMIT NO.: NC0074233 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Blackburn Elementary School CLASS: WW-1 COUNTY: Catawba
OWNER NAME: Catawba County Schools ORC: David P McCorkle ORC CERT NUMBER: 10881
GRADE: WW-I ORC HAS CHANGED: No
eDMR PERIOD: 08-2017 (August 2017) VERSION: 2.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 01/04/2018
rq3w Uak
ORC/Certifier Signature: David Patrick McCorkle 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.
12/20/2017
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 ILE.6 of
the NPDES permit.
7e6 744—L-
Permittee/Submitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Pennittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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 Imes and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME: Water Tech. Lab.
CERTIFIED LAB ft: N.C.50
PERSON(s) COLLECTING SAMPLES: David P. McCorkle
01 /04/2018
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visitinghttp://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).

SPDES PER\IFS rO.: NC c t>' 4233 PERMI'
1 AC ILITY NAME: BIackl'uCLASS:
[l NNI7 NAME: Csoswb (miniv Schools ORC: "Livid P i.
TIRADE: WW-I
MR PERIOD: ()S 2017 (.'\j:iast e(1
a'ERS
ORC kl<\S CHANGED: Vr
VERSION: 1,f1
PERMIT STATUS: ," dive
SAMPLINGLOC TION: EFFLUE\T DISCHARGE NO.: 001 NO D1S+
..,. No Reporting Rea rmi E iFR.0..'F a,
IBER: 30881
ox c Y=No Visitation -Holiday

FOES PERMIT NO.: Nt 9074?33
FACILITY NAME: Blackburn le9r:ntn&nrtie aclt+at1
OWNER v.(\'IE: Catawba Cui:nn,/Schools
is
GRADE: WW-t
ttD'IR PERIOD: Qr-2{)1
CO 1PUANC'E STATUS: Co
ORCICcrt
E3y thi
fy that this
PERMIT VERSION: 4,0
CLASS: ! W-I
ORC: David P A9CC�ii°kie
ORC I1 S CI3A!\(+ED: Na
VERSION: TO
CONTACT PUO\E #. S_'S
PERMIT STATUS: A
COUNTY (7Jsavv(.a
QRC CERT NI:''�«1RE;
STATU,`S:1'rc a°,,tied
SUBMISSION DATE: ; l
09106?2017
void Patrick L1eCorklc 1-Mail:david kler�i-,catavv-baschools.net Phone 11.1 28-.4Ct4 3562 Date
d complete to the best of my knowledge.
The pertrtittee sh,a11 report to the Director or the appropriate R
Any infatrniation shall be provided orally within 24 hours frog
provided within 5 days of the time the pennittee becomes aware of tue Clicu[nsranceti.
onaphance. that potentially threatens public health or the ena=itt tttnertt.
became aware of the circumstances. A written submission shall also be
If the facility is noncompliant, please attach a list of corrective actions bring taken and a tin table for improvements to be made as required by part II,'E.6 of
t'heNPDES pertrgit.
IS ohm'
/2017
gnature.*** Rick Sain E °,s.'it rick_sain •.catavvbaschools.net Phone #:[phone] Date
Address: 4377 NC I-ivvy 1.0 \V Newton' NC 28658 Permit Expiration Date: 07/.31/2020
inder penalty of law, that' this document and all attachments were prepared under my directit
r supervision in a.ceordance with a system designed
to assure that qualified personnel properly gather and evaluate the information submitted, Based on my inquiry oldie person or persons who managed. the
s directly responsible for gathering the itt
trccurate, and completes d' am aware that there are signifc
knowing violations.
LAB NAME: Water Tech, Lrab,
CERTIFIED LAB #: N.C.50
PERS(')N(s) COLLECTING SAMPLES: l'avid P. °41cC:or
Parameter Code assistar
. the information submitted is, to the hest ofnvy knowledge and belief, true,
submitting I;
CERTIFIED LABURATOR1i3S
PARAMETER CODES
including the possibility of fines and imprisonment for
be obtained by calling the NPDES Unit [phone]) or by visiting httpa/portal ncdenr.orgiwebawglswpipstnpdefo
L°se oni_4 units of measurement ile°si •aaated in t;he reporting facil
FOOTNOTES
penatit ter reposing data.
* No Flow r"Liischarge From Site: Check this 'box if no dis-cba.rge. occurs and, as a result, there are no data to be entered for all ofthe parameterson the DMR
for entire ntonitoring period.
OR,C on Site?: ORC must visit facility and docutnertt visaotr of facty ns required per d. SA NCAC $(,i .0204.
*** Signature of Permitter: If signed by other than the pennittee, then d.elcgation of the sig :atory authority must be on file with the state per 1 Vs NCAC 2B
,0506(b')(2)(D).

NPDES PERMIT Na: NC0074233
FACILITY NAME; Blackburn Elernentary School
.OWNER ,AME: Catawba County Schools
CRADE:
eDVIR PERIOD: 4(772.0.17 (June 20 1.7.)
PERMIT VERSION: 4.0
CLASS: WW-1
ORC: David P .McCorkle
ORC I-IAS CHANCED; No
VERSION: 2.0
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER.: 1
STATUS: Processed
8;5
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
i
i
.Z
t
r-
V
.
irri
t
;
k.
.,.
4
1
72
&.
r
: 00
50050
! 00019
4011
50900
C413111
(100111
0))510
31010
Wectkly
Wog kly
2 X month
!Weekly
2 X month
2 X month
2 X month
2 X month
InsTa3tan4o98
Grob
()rah
Grab
87n-r,t8
Grob
Groh
Groh
01051.
I' EN-11,C
PH
C211011.17rE
SOP rr Cos.
0113.N rr C911,
'ESS -r 0110
01701,1 Pk
2409 dock
Hen , 2000 rlartli
Hr*
1111/2.1
mgrl
deg c
su
ugi1
rnol
mg 'I
mgA
,0100m1
1
12
13
4
5
08
0.28
0
0 001/145
21 1
6 3
20
7.8
9 7
5.4
<1
e
/
8
9
10
2 i
12
' 0930
, 0.43
11 7.}1
13
NOFLOW
4
NOFLOW
18
NOFLOW
16
NOFLOW
17
! ut
!
10 0829
0.2.5 Y
NOFLOW
20
.7i•ittr-Low
21 '
NO FL OW
. ,
2.2
NOFLOW
23
NOFLOW
,74
28
11015
(1 '0 Y
NOFLOW
, 1
'
22
NOFLOW
20
NOFLOW
20
NOFLOW
30
NOFLOW
Ntonidly Akrrege Limit
",
!
30
6
30
.200
5109111.15 ,04e10110r
,,,,,,,,
«1 1
1
0
2.0
4.99
54
0.88 m.ritram,
0 00005
21.1
16.5
3
8
0.7
5.4
0
Daily 514n4r481m
c3000.05
21..1
6,5
0
7.8
0 28
5 4
0
No Reporting Reason: ENFRUSE!= No Flow-Reuse/Recycle: ENVWTHR = No 'Visitation - Adverse Weather; NOFLOW No Flow; HOLIDAY = No Visitation - Holiday

y r NPDES PERMIT NO.: NC0074233 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Blackburn Elementary School CLASS: WW-1 COUNTY: Catawba
OWNER NAME: Catawba County Schools ORC: David P McCorkle ORC CERT NUMBER: 10881
GRADE: WW-1 ORC HAS CHANGED: No
eDMR PERIOD: 06-2017 (June 2017) VERSION: 2.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 10/12/2017
cas‘L' ‘-'0\Q-1C'241),_
ORC/Certifier Signature: David Patrick McCorkle 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.
10/03/2017
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 ILE.6 of
the NPDES permit.
I0/12/2017
Permittee/Submitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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: Water Tech. Lab.
CERTIFIED LAB #: N.C.50
PERSON(s) COLLECTING SAMPLES: David P. McCorkle
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] 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 213
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0074233
)
PERMIT VERSION: 40 PERMIT STATUS: Active
FACILITY NAME: 131:3c:khum EIemenjr heal. CLASS: Ve1V-1 COUNTY: Catawba.
OWNER NAME: Catba 7cionty Schools ORC: David P .McCorkle ORC CERT NUMBER: 10881
GRADE: VW -I ORC HAS CHANGED: No
eDMR PERIOD: 9.6-2017 Clone 2017) VERSION: 2.,9 STATUS: Processed
Report Comments:
School out for the summer! 6-9-17

PIIES PERMIT NO.: NC00742 3
FACILITY NAME: Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: WW-1
cIDMR PERIOD: 06 2017 JLW 201'7)
PERMIT VERSION: 4.0
CLASS: WW-1
ORC: David P McCorkle
ORC I1AS CHANGED: No
VERSION: 1,0
SAMPLING LOCATION: EFFLUENT
t 1
*w: E NT. E\L 6 N
PERMIT STATUS:,sc4iv
COUNTY: Catawba
ORC CER':1" NUMBER: 108111
'A"1 US: Process
`H.ARGE NO.: OOP NO DISCHARGE*: NO
wacios
Nay Nisaltwo
'itas�aemn.
*.." No RclxartingRr:ason: I^.NFRUSE ' No Flow-Rcusc/RucycIL, FNVWT IR No'4`isitati¢ao— Athcrac Wcathcr; NOFLOW •= Ne> Flo w; HOLIDAY a. No Visitatic

:{YPDES PERMIT NO.: NC0074233
FACILITY NAME: Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: WW-I
eDMR PERIOD: 06-2017 (June 2017)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-1
ORC: David P McCorkle
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 10881
STATUS: Processed
SUBMISSION DATE: 07/11/2017
\ .�`�� 07/10/2017
ORC/Certifier Signature: David Patrick McCorkle 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.
07/11/2017
Permittee/Submittcr Signature:*** Rick Sain E-MaiI:rick_sain@a,catawbaschools.net Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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 fuzes and imprisonment for
knowing violations.
LAB NAME: Water Tech. Lab.
CERTIFIED LAB #: N.C.50
PERSON(s) COLLECTING SAMPLES: David P. McCorklc
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting httpJ/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).

:QtPDES PERMIT NO.: NC0074233
FACILITY NAME: Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: WW-1
eDMR PERIOD: 06.2017 (June 2017)
Report Comments:
School out for the summer!
PERMIT VERSION: 4.0
CLASS: WW-1
ORC: David P McCorkle
ORC HAS CHANGED: No
VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 10881
STATUS: Processed

NPDES PERMIT NO,: NCO 7.4233
FACILITY NAME: .Blablchurn Elementary School
OWNER NAME: Catawba County Schools
GRADE': WW4
eDMR PERIOD: 05-2017 (May 2011)
PERM! 1' VERSION: 4 0 PERMIT STATUS: Aaive
CLASS: Vv'W-1 RE e ER/ED COUNTY: _Catawba
ORC: David P MeCorkle ORC CERT NUMBER: 3
ORC HAS CHANGED: No N I
VERSION; 1 o CENTRAL FILES
DINI3 SECTION STATUS: Proomsed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
022
032
NI6nthty 20mrsic
Dil,4120.00
fl 04/004S
O. 000_15
0 OkKX15
KM.1.5,1
2 X 660101 Wecktv
Gmb
eftWittfif
N113,N Corm
0.295
2Xoth ' X math
(irk
ISS— Com
”.* NO :Reporting Reason: ENFRUSE No Flow.ReusetReeyele; ENVWTHR r: Ni Visitation — Adverse Weather, NOFI,OW -::- No Flow; trOLADAY No Visitation — Holiday
rt,OLI RR
Ri 0,001T

NPDES PERMIT NO.: NC0074233
FACILITY NAME: Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: WW-1
eDMR PERIOD: 05-2017 (May 2017)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-1 COUNTY: Catawba
ORC: David P McCorkle ORC CERT NUMBER: 10881
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 06/08/2017
a 4). s C, QI 06/07/2017
ORC/Certifier Signature: id Patrick McCorkle 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.
06/08/2017
Permittee/Submitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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 ray inquiry oldie 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.
LAB NAME: Water Tech Lab.
CERTIFIED LAB #: N. C. 50
PERSON(s) COLLECTING SAMPLES: David P. McCorkle
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] 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 PERM .NO: NC0U74233
FACiL TY NAME: Blackburn Elementary
a
OWNER. NAMIF2 Catawba County Sehwils
GRADE: 1W`N`-S
eDMR PERIOD:
1'7 (April 2017)
boo
PERMIT VERSION:4,0
CLASS: 1W'W-l'
ORC: David P r A
O.RC HAS CHANGED: No
VERSION 1 11
RE
FIVE
PERMIT STATUS:.4ctivc
7OUNT'1": Catawba
ORCCER'TNUMBER: IWOO
CENTRAL FILE STATUS: 1'ruc4' ed
DWR SFC,..rIor
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARG
"*" No Reporting Reason; 1':NI'°RUSE = No FIL1W-RcuserRc--eyele; ENVW'TUR -= NO Visitation m Adverse Weather, ;'101i_0W No Flow; 'ROI.,11`a V\ _ No Visitation

NPDES PERMIT NO.: NC0074233
FA1LITY NAME: Blackburn Elemental School
OWNER NAME: Catawba County Schools
GRADE: WW-1
eDMR PERIOD: 04-2017 (April 2017)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-1
ORC: David P McCorkle
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 10881
STATUS: Processed
SUBMISSION DATE: 05/18/2017
05/ 1 1 /2017
ORC/Certifier Signature: David Patrick McCorkle 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.
05/18/2017
Permittee/Submitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME: Water Tech. Lab.
CERTIFIED LAB #: N.C. 50
PERSON(s) COLLECTING SAMPLES: David P. McCorklc
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/pslnpdeslforms.
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).

NPLS.PERMIT NO.: NC0074233 PERMIT VERSIO.N: 40
FACILITYNAME: Blackburn 'Elementary School CLASS; WW-i
OWNER NAME; Catawba County Schools ORC: David P Mc:Cockle
CRAI)E: WW-I ORC HAS CH„ANGED: No
eDiM R PERIOD; 03-2017 (March 2017) VERSION: 1.0
PERMIT STATUS: ,tNeve,
COUNTY: Catawba
ORC CERT NUMBER:
sTATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISH.
vvoi..Ros
**** No Reporting Reason: LNFRUSE No Flow-ReuaeReeyeie-, ENVWTHR --- No Visitation - Adverse Weather; NOFLOW No Flow; HOLLIDAY No visitation - Holiday
„pv,AL ()FRCP

NPSES PERMIT NO.: NC0074233 PERMIT VERSION: 4.0 . PERMIT STATUS: Active
FACILITY NAME: Blackburn Elementary School CLASS: WW-I COUNTY: Catawba
OWNER NAME: Catawba County Schools ORC: David P McCorkle ORC CERT NUMBER: 10881
GRADE: WW-1 ORC HAS CHANGED: No
eDMR PERIOD: 03-2017 (March 2017) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 04/20/2017
04/05/2017
ORC/Certifier Signature: David Patrick McCorkle 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.
04/20/2017
Permittee/Submitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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: Water Tech. Lab.
CERTIFIED LAB #: N.C. 50
PERSON(s) COLLECTING SAMPLES: David P. McCorkle
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http:l/portal.ncdenr.org/web/wq/swp/pslnpdes/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 ISA 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).

PERMIT VERSION: 4.0
CLASS: 'WW-
ORC: David P McCork
ORC RAS (HANGED: No
'VERSION: 2,0
STATUS: P ceased
NP &ES 'PERMIT NO.: NC0074233
47,1LITY NAME: 'Blackburn Elementary School
OW.NER NAME; Catawba County Schools
GRADE: WW-I
eDMR PERIOD: 0-2017J; • ary 20171
PERMIT S'EATUS: Active:
CE IVE D couNTy: Catiiivba
MAY f
CENTRAL FILES
DVVR SECTION
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHAR
ORC CERT NUMBER: 10881
CIILC*In
"" No Rctporiing Itoson, l'iNFR USE HOW-Reuse/Recycle; F,NVWTHR.,- No 'Visitation - Adverse Weallwr; NOFLOW 'No now; 00I.,.1 DAY - Visiia6orn Holiday

NPDES PERMIT NO.: NC0074233
I'WILITY NAME: Blackburn Elementary School
OV$iIVER NAME: Catawba County Schools
GRADE: WW-1
cDMR PERIOD: 01-2017 (January 2017)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-1
ORC: David P McCorkle
ORC HAS CHANGED: No
VERSION: 2.0
CONTACT PHONE #: [phone]
1 ` \% Qu/tiL
PERMIT STATUS: Active
COUNTY: Catawba
ORC CERT NUMBER: 10881
STATUS: Processed
SUBMISSION DATE: 05/18/2017
05/10/2017
ORC/Certifier Signature: David Patrick McCorkle 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 Iist 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.
,,ee-e.-led /4-A4-
05/18/2017
Permittee/Submitter Signature:*** Rick Sain E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07/31/2020
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. [ 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: Water Tech. Lab.
CERTIFIED LAB #: N.C. 50
PERSON(s) COLLECTING SAMPLES: David McCorkle
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdeslforms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge Prom 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 I5A 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).

Ma NO.: NCO
F.AC ILdF' NAME: Blackburn Elementary School
OWNER NAIVE: Catawba County Schools
GRADE: WW-1
eDMR PERIOB): 1 1-2016'November° 2016)
ORC: David P McCorkle
ORC HAS CHANGED: Na
VERSION: 1,0
AN I, 0 L
PERM.C1" STATUS: eAc'tive
COUNTY: Catawba
ORC CERT NUMBER: 108fi1I
STATUS: Processed
ING LOCATION: EFFLUENT DISCHARGE NO.: 001 N() DUSCH.
**ar No R()pottarty Reason! ENFII.FISr. N
ta:.e.%ft
Sat
RitYWR
WO
NOR E L. aU?`A, !FICA
Grab Grab eirab
R1haR R(an•U'w+< .N/A;hN.0919
it 2
TSS-Cot FOOL] BR
4,1
I<an 2
1.9
42 46,4
TVWT)IR„No Visitation —
ab
0
in
7,.425
6.65
, 44949
6.2
_OW ,= Jot`I) i 01O1 IDA\ No Visitation-k9biWay

N•PDES PERMIT NO,: NC00.74233
FAClury 'NAME: 'Blackburn Elementary School
OWNER NAME: Catawba County Schools
GRADE: WWI
cDMR PERIOD: I I-2016 (November 201()
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 40
CLASS: WW-1
ORC: David P McCorkle
ORC ItAS CHANGED: Mo
VERSION: 1.,0
CONTACT .PHONE ti2S4643562
PERMIT STATUS; Active
COUNTY: Catawba
ORC CERT NUMBER: 10881
STATUS; Processed
SUBMISSION DATE: 12122/2016
12/1512016
ORC/Certifier Signature: David Patrick McCorkie E-Mildavid_mccorkie*catawbaschoois,nct Phone 4:828.-464-3562 Date
.By this signature, 1 certify that thi re
c -ate and complete to the best of my knowledge.
The pertnittee Shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens. public health or the environment,
Any infomiation shall be provided orally within 24 hours from the time the per -mince became aware of the circumstances. A written submission shall also be
provided Within 5 days of the time the pennittee becomes aw'are of the circumstances,
If the facility is noncompliant, please attach a list of COITCtilhic actions being taken and a time -table for improvements to be made as required by part 11.E.6 of
the NPDES permit,
12122/2016
Permittee/Su.bmitter Signature:***R ick Sain F-MaiLrick_sain@catawbaschools..nct Phone 1r:828-464-3562 Date
Perrnittec Address: 4377 NC Hwy 10 NV 'Newton NC 28658 Permit .Expiration Date: 071311202.0
I certify, Wider penalty of law, that this document and all attachments were preparedunder 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 personsdirectly responsible for gathering the intbrmation, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME: Water tech tabt
CERTIFIED LAB #: .50 me,
PERSON() COLLECTING SAMPLES: David MCcorkle
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the 'NPDES Unit [phone] or by visiting 'http://portal.ncdermorg/wcblwq/swp/pslupdeslforms,
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site; Checkthis hox if no discharge occurs and, as a result, there are no data to be entered for all ofthe parameters on the DM R
for entire, monitoring period,
** ORC on Site?: ORC must visit facility and document visitation o 'wilily as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the pemaittec„ then delegation of the signatory authority must be on file with the state per 15A NCAC 213
,0506(b)(2)(D).

IrTES1 E14MIT NO.: N'C0074233 PERMIT VERSION
FACILITY NAME: Blackburn Elcmcntary SchI CLASS: 'WW-1
OWNER NAME: Ca"a arrat4 c,ho ORC°a David P
GRADE: WW-I
el/MRPEKIOD 10-201 ( uoh
()RC HAS CHANGED: No jp, N 1 t
VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Catawba
ORC CURT NUIIHFR: 10881
S"I"A"PUS: Processed.
SAMPLING LOCATION: EFFLUENT DIS ARGE NO.: 00! NO DISC
Weekly
finsd.` L&xanet36 q
rt,UW
"" No Reporting Rctirilnn: ENFR1 ',E - 1 u FIe0v-Itr:exae=`Rocyclo4 1 NV" "TFIR, No Visitation - .dve.rse WVcather; NOILOW =.:'No How; 1-101.,11)a1 r -- No Visit
Pid;ry
(AL,.OFFICE

NpPDES I*EiLMITNO.: NC 0074'233
FACILITY NAME: Black. Flcn.
OWNER NAME: Catawba County Sc
GRADE: WW-V.
cDMR PERIOD: 10-20I6 (C
)her 2016)
COMPLIANCE STATUS: Compliant
ORC/C
0
PERMLT VERSION: 4,0 PERMIT STATUS: Active
CLASS; WW-1 COUNTY: Catawba
ORC: David P MtcCorkle OR(:` CERT NUMBER: tt
ORC ILAS CHANGED: No
VERSION 1.0 STATUS: Processed.
CONTACT PHONE #: 82i34t43 ati2
SUBMISSION DATE: I2/22.t201n
I. 1a'14/2016
Signature: 'David Patrick McCorkle E-M:ail:david_mccorklera c:atawbaschools..net Phone tl':828-464-1 562 Date
that t)ais re]ror) is accurate. and complete tat the best of my knowledge.
The peanatittce shall report to the Director or the appropriate Regional Office any noncompliance that potenti.
Any information shall be provided orally within 24 hours from the time the pennittcc became aware of Mc ci
provided within 5 days of the time the pertnittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of c'orre
the NPDES permit
ly titre
uen taan
public health or the em.ent.
4 written submission shall also be
,stuns being taken and a time -table for ivaprowemen s to be made as requited by part.11,F.6 of
Permittee/Srrbntitter Signature:**'* Rick Satin E-
sain(a catawbaschools.nct Phunc #2'8 464-3562 Date
Perrnittee Address: 4377 NC Hwy 10 W Newton NC 28658 Permit Expiration Date: 07131/2020
1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance wri'th 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. 1 am aware that there are significant penalties for submitting false information, including the possibility of fines and impris<'rntttent ft',
knowing violations,
LAB NAME:: Water tech lab
CERTIFIED LAB it Ne50
PERSON(:;) COLLECTING SAMPLES: Duvid rrrccnrl,L.
ParameterCode a
CERTIFIED LABURAT()
PARAMETER CODES
ay be obtained by calling the NPDES (Unit [phone] or by uisiting http /portal.ncdenr.org,,rveblwgiswpapslnpdestforms.
I=(.)O"f NOTES
Use only units of"measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge ,From Site: Check this box lino 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 Eactliay and document 5 isitatton offa ed per 1SA NCAC 8G .0204.
*** Signature of Permitter: If signed by other than. the permittcc, then delegation of the signatory authority must he on file with the state per 15A NCAC 2B
.050((h)(2)(D),

PN`"a$:I
PE
(.`HECK BOX IFORC HAS CHANGED
Made ORIGINAL and. ONE COPY to:
ATT ;CENTRAL FILES
DIVISION OF WATER QUALITY
1617 MAIL SERVICE CENTER
6t7
<0
0
Q
U
ahoy Lir�ia D O
S(,F1 \..s.:I: -O.
NO FL(>\Y I DLSCHARCE *
(S6C ILIiI (I CiI'II( 1'IC:iE Pii Ftt E`t..rN ! E (flARCCE)
�Y T4IIS S4tffdx, T`0;RE, I CERTIF'I THAT THiti REPORT 9S
ACC I,iRATE P D CO:til4'LETE TO THE BEST OF MY 100 VL EIDd.F4'..
616] 00309 l OIJ{ialj 0066.5
4NTE
NA/ 18E A9
III
HCD
O
©CY
4-4_
3EC

threatens public htta.dth. or the eng«
ante aware of th.e circumstances.
Lie
If the facrli
m
improvements to be made as real
fy arlader penalty sat lst
rith a system d
oat its
complete_, I am aware that
fines and imprisonment for
ariati.on submit
signifie.ant penafi
©wiraa violations.,"
a tta
d by Part ILE.6 attic NPDES per
that
hittt'?4 hours
-wider"
Irrg taken a
his document and all roiachailcnis were prepared 'Hider my direction or supervision
'e that qualified personnel properly gather and evaluate the tnforrnaiican
person or persons who managed the system, 0r those persons directly responsible
best of rny'knowledge and belief, true, accorate, and
ittiraE false, information, including the possibility of
Certifi� l'L'alacratory ()
Certified Laboratory (3)
Certified t.aborater}' (4)
Certified Laboratory (5)
ADDITIONAL
LA'BORA
the reporting fao 4i
R (
(serti(ication
s NFLti S permit lotrcpc. tt.ng data.
No flowrDiseIrrrrge From Site; Check this box if no discharge occuro and, as a result,, Cher are,. no data to be
entered for al't of the. partrrneters art the OMR for the entire monitoring period.
OCR On Site?: ORC must visit facility and document 4�srt
Sipnat'nre of I'er°rnitteer I
file with the state per I .5A NCAC 2B .05
as r+equird per 15A tdCAC FO :0201
, thca the delegation.ofrtte,
�, arrthortty mra 7t lae

PETI(MILN
CERTIFIED I_,
C)PEf,x\[ORI`^
k.SON(S) COLT 1w;.C1
CHECK BOX IF ORC HAS CHANGED
Mail ORIG[NAL and ONE COPY to:
ATTN: CENTRAL FILES
DIVISION OF WATER QUALITY
1617 MAIL, SERVICE CENTER
NC 2769'9•1617
CNA
NA' THIS SIGNATURE, 1 CERTIFY THAT T
ACCURATE AND COMPLETE TO THE B16
Sfii7<o0 Libo3
ct)
NO FLOIO,` % DISCHARGE FROI SITE "
CAI fY' K:NOW""LEOC€.
6
y ENTER PARAMETER CODE AB NE
10 W NAME AND UNITS BELOW
4JS 0 C
V-0
CJ R: 0
1-- 1.n 1 c

rnprervements to
aware of the eiruumstartt ss. air
s aware of the circumstanced,
tstpliant, please attach a fist of corrective actioos b
s required by Part 1T.F;.Ci of the. NPDES pert
hours from the time the
-ovided within 5 days of the time tlh.
ken and a titnc-table for
iaticier penalty of law, that this document and all attachuihents wore prepared under my doer tion or supery
accordance with a system designed to assure that qualified personnel properly, gather and evaluate t
submitted. Based on rny inquiry of the person or persons who managed the system,, or those persons directly respons
for gathering, the
complete. 1 am awaire d.fiat threre
fines and irprisoenient for know
Certified Laboratory (2)
Certified. Laboratory (3)
Certified Laboratory (4)
Certified Laboratory
Parameter Code asp
lifipelportal.thc denr.ot'p
information, the information submitted is, to the best
significant penalties for submitting
iolations.."
'ledge and belief, true, accurate, and
rribhtioti, hhchiding the possibility of
quired unless submitted eleetronicafl
lf:Ft CODES
ti 63OtO or by r
°d in the repoat'inp f cility`sN}'DES permit for reportine raw to
No 1~ inasilU scharge fropts Site: Check this box if no ri
entered for all of"the parameters ors the l) IR for the en
�f2C On al'te?: ORC most visit facility and documen
other ttwn the pen
A NC.A.0 f3 .050d(b)(: )(D).
and, as a result, there are no data to be.
as required Baer ld.A'NC"AC 86 .0204.
authority most be on
file with the state per

NPDES PERMIT NS.A\CD.1711A3...3.
FACILITY NAME
CERTIFIED LABORATORY (0 LAttx.
(list additional laboratories on the backside/page 2 ofthis form
OPERATOR IN .RESPONSIBLE CHARGE (ORC
PERSON(S) COLLECTING SAMPLES
CHECK. BOX IF ORC HAS .CRANGED
Mail ORIGINAL and ONE COPY to:
ATTN. CENTRAL FR,ES
DIVISION OF WATER QUALITY
1617 MAIL SERVICE CENTER.
RALEIGH, NC '276994617
00400
FLOW
EFF
AVERAGE
LN I 4M LTIN1
Monthly Lmit
LIG/L
EFFLUENT
DISCHARGE NO,.iD 1 M0THko
CLASS
CERTIFICATION NO..
5.19NCDENRONk
9 9 ,
WQ R S
MOCr "fair 09IA9 9)epc E
GRADE CERTIF CATION NO. 1 0 8
ORC PHONE
NO FLOW / DISCHARGE FROM SITE°=::1
(Si ,ri 'ATU E OF OPEMIT)R IN REspoNstriLE boacao DATE
BY THIS SIGNATURE, I CER TinTHAT THIS REPORT IS
ACCURATE AND COMPLETE TO TIIE BEST OF MY KNOWLEDGE
00600
ENTER PARAMETER CODE ABOVE
NAME AND UNITS BELOW
MVO Form MR -I (11 /04)

Facility Status: (Please check otae of the following)
All monitoring data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
All monitoring data and sampling frequencies do NOT meet per, sit requtrements
Compliant
Noncompliant
The perrriittee 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 noncr mpliant, please attach a list of corrective actions being taken and a tirne-table fo
improvements to be made as required by Part IILE.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 (Amy knowledge and belief, true, accurate, and
complete, I am aware that there are significant penalties for submitting false information, including the possibility of
fuses and irnpr.isonment for knowing violations."
(Required unless submitted electronically)
ITIONAL CER'I"IFIED LABORATORIE
Certified Laboratory (2) c_9 �� CCT4
Certified Laboratory (2)
Certified Laboratory (4)
Certified Laboratory (5)
PARAMETER CODES
ation No.
No,
Certification No,
Certification No,
Parameter Code assistance rrray be obtained by calling the NPDES Unit at [phone] or b
http:f/portaLncdenr.org/web,/wq,/swp/ps/npd.esiappforms.
aced in th. repc rtiasg fa
g
* N.o Flow/Discharge From Site, Check this box i4 no discharge occurs grad, a a r tult,
entered for all of the parameters on the 17MR for the entire monitoring period.
ORC On Site?: ORC must, visit facility and document visitation of facility as required per I5A NCAC fiG .0204,
* * * Signature of Pertnittee: If signed by other than the permittee, then the delegation of the signatory authority most be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
ing data,
data to he
,ty r?vac)

CERTIFIED II.':I} LA
SPC= I.m"s CH.ARG.,.
FER.0 C)L(5) COLLECTING SAS PLEU'T
4»R"@E mot\ 130X W ORC IIAS CII_A.NGEI?
Mail ORIGINAL, and ONE COPY to
ATTNa CENTRAL 'FILES
D[VISION OF WATER QUALITY
T6i7 MAIL SERVICE CENTER
161.7
GRAD[LI_
(RC PI 10
NO E
Z_E'C
f?ti'TEASSd NATURE, ICERTIFY THAT THIS REPORT IS
ACCURATE, AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
00610 i 905311 31616
TER PARAMETER CODE ABOVE
E4AME AND UNITS BELOW
F

Certified Laboratory (4)
Certified Laboratory (5)
ti t tit tit 5' tiAt Wit t f b itt
raitaPactsaing data apgi ad:am:ding ileapteariciatta itactat Fauna reapPattagarrat
(lac !tiding wtatit itiveragtat, f aiaptic ta)
All monitoring data and sampl feeiricricies do Niyu mut permit requirements
n C. 0 r;1171. ani
P Q. MI tIC S 111hreport to the Director or the appropritate Reglinial Office any noncompliance Mat potentially
threatens public health or the environment A information shall be provided orally within 2,4 hours flann the time the
permidee became aware of the circumstances. A written submission shall also he provided within 5 days of the time the
permittce 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 ILE,6 of the .NPDES permit
"I certify, under penalty of law, that this document and 0J attachments were prepared under my direction or supervision
in accordance With a system designed to assure that qualified personnel properly gather and onithiate 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 inftarmation 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
tines and imprisonment for knowing violations."
qrqw
Pertnitice Address
Phone Number
Signature of 'ennittee " „sato
(Required unless submitted electronically)
b.-matt aditires5
,)NAL CERTIFIED LkBORATORIES
Certified Laboratory (2) CA1-9 (1-- Certification No.
Certified Laboratory (3) Certifieafion No.
Certification No.
Certification Nu.
PARAMETER CODES
Permit Expitatittin Data
Parameter Code assistance may he obtained by calling the NODES Unit at [phone] or by visiting
littpglipertaLmcderaaorglweblwq/svPplpslopdeslapp forms,
1„kse only uths of =acit itanent designated in the, reporting facility's NPIdES permit tor repotting .clata.
How,Discharge From Site: CheA this box if no discharge eceurs and, as a result, there are no data to be
entered for all of the parameters on the 'OMR for tl e. entire monitoring period,
** ORC On Site?: °RCA -mist visit facility and document visitation of facility as required per 15A. NCAC 813.0204,
'"`" Signature of Perrnittee: If signedby oth"r than the pitirtnneci then the cittegiltion of the signatory authority it bo
file with the state per 15A NCJ\C 211 .05060))(2)(D).
Z020

PERSO (S ECTr ti'O SA1vi P
CHECK BOX IF ORC FIAS CHANCED
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL, FILES
DIVISION OF WATER QLALLTY
1617 MAIL SERVICE CENTER
NC .7699-1617
00400
GE
tA
CRC ONE
NO FLOW IT)BC/Lk RCE' FROM SITE *
.1TCRE, I CE'RTBFY TILT THIS REPORT BS
"} AND COMPLETE TO TIItin. 6EST Or MY IKN0w LEDGE,
0
00600
0066

'The p nnittt:e al?' li r :a rt t t e 11 F for ar the apt.,i'Cilit'[at leg ci al Office that p .fen f.
[tile. any n€ i9Ei�)a1.lkl�iC i'� �.ra,llly
threatens public health or the environment. .Any tricot, rtitr It tal be provided orally within 24 hours from the time the
pertuittee became aware of the circumstances. A written suhtt;ission shall also. be provided within 5 rla,ris of the t ine the
parrnttt;e becomes aware of the circumstances,
If the facility is noncompliant, please attacl) a diet of colt"active aetion,s •etng taken and a time
improvements to be made as required by Part the NPDES perm
"I cet tiI ttttder p
dance with a systetrr deli necl to assure that qualified personnel properly gather and 'milt
submitted. I aced on my inquiry of the person or persons who managed the system, or' those persons directly
for gathering tdae information, nformation submitted is, to the best of my knowledge and belief, tr ae, taccu.
complete. 1 a a are that there are significant penalties for submitting false information, including tl:e phis
fines and imprisortmas ut for knowing violations."
Certiified Laboratory (2)
Certified Laboratory (d)
CertifiedLaboratory (4)
Certified Laboratory. (5)
is ciocrrsn
at and all
taclunents were prepared under
(1
nittee"""
equired unless submitted electronically)
FIED LABORATORIES
�i Ccxhi- fr 1-1
Parameter Code assistance may be obis
ltttp://portai_uccienr.or iwelsr`wq ^uprpInpdii
:0
Ication No.
Certification No.
t" rt;l`z atot. No,
Certificatir;,u No,
NFDI S Unit at {i 1 tt'i' 6300 is
NPDEr;S perrni
file fo
ction or° supervision
the ittatirt
pansible
No flowirDis harge Fr arra Site: Cheek this box it no di charge occa.rs and, as a result, there are no de,,
entered for all of the parameters on the DMR for the entire monitoring
ORC On Site?: ORC nmst visit facility and document visitation of
'" Signa
ture of 1'erni'ittee: if signed b»other than the Ise" mrctco, then the drfQ
file with the state per 15A NCAC 213 .05060)(2)(D),
)204.

S JTY NA
CER« GZDZ BORAT
C<ERATORm S? ONS3EEC
PERSONS) COLLECTING SAMPLES
CRC k BOX IF ORC HAS CIIANGED
Mi ORIGfl\A1. and ONE COPY to
ATM; CENTRAL FILES
DIVISION OF WATER QUALITY
»o MAIL SERVICE CENTER
R 9I t NC}g! , r
%c r
ayIBIS SIGNATURE, . CERTIFY THAT ,w REPORT IS
ACCURATE AND COMream TIE .REST OF MY KNOWLE.DGE,
0
L 3
ENTER PARAMETER m>,ma
I.JAME AND UNITS BELOW

lairoadditoSiii too iyininami Okada cue riralni liodird kg)
it'ind moan:, ring. 'itritit and sampiandi crinitucarais tram poirm raimdmornanni
(incitaling weakly avaragera itiappliatMded
Ail monitoring data and. mimpling Ms do NOT matit pennit reiluiremem
lotoncomplinnt
he permirtee shall report to the Director or the, approprittta Rational Office am noncompliance that potentially'
threatens public health or the environment'. Any information shall be provided orally within 24 hours ft-cm the time the
pennittee became aware of the c[rcurnstanees, A v,Titien submission shall also be provided within 5 days of the time the
perrnittee becomes aware of the circumstances,
lithe 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
"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, Rased on my inquiry' of the person or persons who managed the system, or those persons directly responsible
for gathering the infonnatio.n, 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,"
Permitlee AddresS
D
Certified Laboratory' (2) cq
Certified Laboratory (3)
Certified Laboratory (4)
Certified Laboratory (5)
Pennittce (Please print or type)
Sir Date -
(Required unless submitted electronically)
?'es CX. \CAO Pe
NIUTIC, Number c maO address
TIONAL 'ERTIFIED 1 A1IORATORIFS
PARAMETER CODES
Certification.No.
Certification No,
Certification :No.
Certification No,
Permit Exi)iration 'Date
Parameter Code assistance may be obtained. by calling the NPDES Unit at (919) 807-630C) or by .visiting
httpillportal,ncdenr,orewebfwq/swpipsInpdeslapplo.rm,s.
Use only UOOS of neaourcinotat. designated in the reporting, tact 1 ts s NPDES perntit tor reportin.g data.
* No Flow:Discharge From Site: Check this box Of no discharge occurs toil, as a result, there arc no dada to be
entered for all of the parameters on the MR for the entire monitoring period.,
"* ORC On Sit? : ORC .mustvisit facility and document visitation of facty as required per I5A NCAC SG .0204,
Sig Rath re of Pe i rte e : If ahzned by other than the .perintriee, then the delegatiOn Itt the SigMitOrl authority .dnost be on
file with the state Der I5A NCAC 2B ,05061b)(2)(D),

OPERATOR. L$ RES PONIN„E CH.fl" R E
PERSON(S) COLLECTING SAMPLES .
CHECK CK /10.Y IF ORC HAS CHANCED ...
Mar'! ORIGINAL and ONE CC)PY to:
ATT1N CENTRALFI. kES
DIVISION OF WATER QUALITY
1 6 z1 MAIL SERVICE CENTER
ILALEUGL NC 276?9.1617
IYTHIS SIGNATU€ ,10ERTIFYTIEATMISRrPO[ITL'I
ACCURATE AND COMPLETE' TO THE BEST OF MY 1.010-V LELGir.

fk`'ll)DES PERMIT'
z'i.Idi R.[t; d3i:i
i_! r CFL\a
PERSON(5) COLLECTING ,SAMPLE
,'
CHECK BOX IF ORC H.,+,4 CLANGED
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES
DIVISION OF WATER UNLIT"'
1617 `rAIL.SERVICE, CENTER
RAI EIGII, NC 276994617
00400
0
CFR—
BIBB-
HYTIIISSI i'IATIRE 10ERTIFYTItA'TTHIS REPORT IS
AG.CI R.A AND C1»WI''LETE TO ThR. BEST OF MI' KNOWLEDGE,
0 r I$NT III ` 0I1610 I)O SII Ihlh OtI IICI OO ti 00+
ENTER PAP,AMETER CODE AB
NAME AND UNGTS BELOW

talOE
All monitor
The pernr
threatens public health er the envro
pennittce became aware of the circurr't;ta
permittce becomes aware of the circumstances„
uhinis_ itrn sitail ai o
it
the time the
th," tt nt° t
ff the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for
improvements to he made as required by Part tIE 6 of the NPDES permit,
"l certify, under penalty of lases, that this document and all attachments were prepared tuadcr rrty direction of suizcr lion
nrdance with a system designed to assure that qualified personnel properly gather and evaluate the in
rttcd. Based un my inquiry of the person or persons who managed the system, or those persons direr
itag the information, the inf; nnat.ion submitted is, to the best of my knowledge and belief`, titre, accurate, and
! am aware that there are significant penalties for submitting false information, including the possibility of
fines and imprisonment for knowing violations,"
Certified Laboratory (3)
Certified Laboratory (4)
Certified Laboratory (5)
Parameter Code assr
http;/lpnrtal;ncdenrE()
t.1se only units of measurement d
aced
(Required unless
PAR.f;;TER CODES
bmittcd electronically)
No.
No,
1\o,
NPDES Unit art ( l' `r klt ? fi300 or
—71
repo'tin* fat.ility's NPIDE S
No I"losN(plischarge Irrom Site: Check this' Lox if no discharge t
entered for all of the parameters s on the [)NIR for the entire rr
** ORC On Site?. O12C must visit facility' anct document visitation of facility as required per 15A NCAt° $t; 0204
for rrportirrp, datar.���
as 3 remit, there arena data to he
* *'Signature of Perrnittee: If sia;rred by other thEu1 the permittee, then the delegation. ui the si'
fade with the state. per 15A'NC;AC 213 .0506t`hi(2)(1)),.

NP M S PERMIT NO:
FAC"IL ITy 'NA_\1E
CERTIFIES) LABORA''LC)
(list additional laboratories on the b
OPERATOR IN RESPONSIBLE CI-
PERSON(S) COLLEC°'LING Sn\\WL
CHECK HOX I'F ORC HAS C FLt'K ED
NLa'll ORIGINAL and ONE COPY to:
AT'IN CENTRAL FILES
DIVISION OF WAFER QUALITY
i.617 MAIL SERVICE CENTER
ItAL:EIIT NC 2'699.1617
EFFLUENT
ACCURATE
MONTI
CLASSCOG
CERTIFICATION NO.
CR \LSE
ORC PHONE
NO FLOW J DISCHARGE FROM SITE
':ERTI.EY THAT THIS REPORT IS
BETE TO THE IWEST OF MY KNOWLEDGE.
bAft
ENTER PARAMETER CODE. ABOVE
NAME AND UNITS BELOW
IJWQrom MR-1 (11'04)

Please check one of the foil,
g data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
g data and sampling
uenctes
NOT meet permit requir°ements
The perrnittee 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
perrnittee became aware of the circumstances, A written submission shah also be provided within 5 days of the time th
pernrittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of'corr
ons being taken and a time -table for
improvements to be made as required by Part I E.6 of the NIPUES permit:
"1 certify, tinder 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. 1 ant aware that there are significant penalties for submitting false information, including the possibility of
fines and imprisonment for knowing violations,"
Certified laboratory (2)
Certified Laboratory (3))
Certified Laboratory (1)
Certified Laboratory (5)
Permittee (Please print or
(Required unless subm,
T. NAL CERTIFIED LABORATORIES
PMETER CODES
Certrficatr
Certification No,
Certification No,
Certification No,
Pe)
Date
a
Parameter Code assistance may be obtained by calling the NPDES Unit at [phone] or by visiting
httpI/portalncdenr.orgiwebrwq/swp ps,Inpdes,lappforms.
c only units ofrneasurernent designated in the reporting facility"s NPDES perm
No Flow/Discharge Frorn 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 offac'ility as required per 15A NCAC 8G ,0204i
* ** Signature of Permittee: if signed by other than the perrni'ttee, then the delegation of the signatory authority rnu.st be en
file with the. state per 1 SA NCAC 2B ,0506(b)(2)([).

EFFLUENT
NPI)ES PERMI 1" O. DISCHARGE NO. C 1 MONTH
R➢ I I r NAME
FACILITY
ER1EILD LABOI AORY ....-.___._.�mC RTIIC
1TION NO,_
(list ad..ditional laboratories on the backside/page 2
OPERATOR IN RESPONSIBLE CHARGE (ORC
PCHECKBOXI'ORC CTING SAMPLES �k
r
HAS CHANGED
Mail ORIGINAL, and ONE COPY to:
ATTN: CENTRAL FILES
DIVISION OF WATER QUALITY
1617 NIAIL SERVICE CENTER
RALEIGH, NC 27699-1ti7
GRADE CER"CA1'ION NO. ) 6 3 j
CRC PHONE ~ ll '_
NO FLOW / DISCHARGE FROM SITE
5[ta, A °LI12 Ft 1; TORi^ R. P Na1i3LECI1r. t£}
BYTHISSId,NATURE, I CERTIFY'TILA.TTHIS REPORT IS
ACCURATE A.ND COMPLETE TO 'IRE BEST OF MY KNOWLEDGE,
DATE
ENTER PARAMETER CODE ABOVE
NAME AND UNITS BELOW
E}V Q Forst MR-1 (11/04)

Facility Status: (Please check one of the followi
M1 data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
All monitoring. data and sampling frequencies do NOT meet permit requirements
4L-1
Compliant
Noncompliant
The perminee shall report to the Director or the appropriate Regional Office any noncompliance that poten
threatens public health or the environment. Any information shall be provided orally within 24 hours from
permittee became aware of the circumstances, A written submission shall also be provided within 5 days of the ti
permittee becomes aware of the circumstances,.
If the facility is noncompliant, please attach a fist of corrective actions being takers and a time -table for
improvements to be made as required by Part IL.E.6 of the NPDES permit.
the
".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 kknowledge and belief, true, accurate, and
complete. P am aware that there are significant penalties for submitting false information, including the possibility of
fines and imprisonment for knowing violations."
A
Pert,,.
Certified. Laboratory (2)
Certified Laboratory (3)
Certified Laboratory (, )
Certified Laboratory (5)
Permitter; (Plea
print n
nntre of Penstitt
(ltegt.tired unless subi
'3e °'',N�
Phone Number
ADDITNr;L C"ERTIFIP .D I AI AT
Co
type)
Certification No,
Certification No,
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit a
http://portaLncdenr.org,/web/wq/swp/ps!npdes/appforms.
Certification No,
Certification No,
919
Dte
ically)
erasion
07-6300 or by visiti
Use only units ofrraeasurement designated in the reporting facility's NPDES permit for reporting data,
No FIow[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 MU,. for the entire monitoring period.
** ORC On Site??: ORE must visit facility and document visitation of facility as required per 15A NCAC SG .0204,
* ** Signature of Perrnittee: If signed by other than the permittee, their the delegation of the signatory authority must
file with the state per iSA NCAC 2B .0506(b)(2)(D).

NPDES PERMIT NL
FACILITY TY NAME
CERTIFIED LABORATORY
(List additional lal7oratories on the L3t kside/Page
OPERATOR IN RESPONSIi3LE CHARGE (OR
PERSON(S) COLLECTING SAMPLE,
CHECK BOX IF ORC HAS CHANGED
Mail ORIGINAL and ONL* COPY to:
ATTN CENTRAL FILES
DIVISION OF WATER QUALITY
1617 MAIL SERVICE CENTER
R LF1GIi, C 27699.1617
RGI �L(,). '�..� le'IG)NTI
CLASS _ COI ..T T'
CERTIFICATION
GRADE: t
ORC P1EON
NO FLOW / DISCHARGE FROM SITE
CF:R"'E°LFICATION NO. 1
DWG? Farm MLR-1 (1 1104)1

Facility Status: (Please check one of the following)
Afl monilorng data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropri.ate, Regional Office any noncompliance that potentially
threatens public health or the environment. Any infbmiation 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,
lithe facility is noncompliant, please attach a list of corrective actions being taken and a tirnc-able for
improvements to be made as required by Part 11,E6 of the NPDES permit.
"I certil), under penalty of law, that this document and all attachments were prepared under my direction or supemision
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,"
w
Permit -lee Address
Certified I„aboratory (2)
Certified Laboratory (3)
Certified Laboratory (4)
Certified Laboratory (5)
Sii2,na,„tatofittce*** Date
(Required unless submitted electronically)
\ o P C.,, tii6
„ .
e-mail address Permit Expiration Date
ADDITIONAL ORATORIES
Certification N.
Certification No,.
Certification. No.
PARAMETER CODES
7,ettification NO.
Parameter iCode assistance may be obtained by calling the NPDES Unit at [phone] or by visiting
htrp:/„/,pprtaLnedenr.orglweblwqlsviplps/npdes,rappforrns,
Use only units of mea,seternent de'riated in the reporting facility's NPDI S permitfor repodata„
* No Flow1Discharge From Site: Check this box if :na discharge occurs and, as a retult, there are no data to be
enteredfor 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 NOAC. 8(0 0204
" Signature of Per mitteer If signed by other than the perrnirtee, then the dciegation of the ,signatory iimiliority must be on
file with the state per ISA NCAC 2B .0.506(b)(2)(D).

NPDI;S PERMIT N
FACILITY INANE,.
CERTIFIED LABORA
addIitaona! laboratories 4sn tl c baC skk .page 2
OPERATOR OR IN RESPONSIBLE CHARGE. (ORC
.PERSON(S) COLLECTING SAMPLES
CHECK BOX IF' ORC HAS CHANGED
Maul ORIGINAL and ONE COPY to,
ATrN;CENTRAL FIL}S
DIVISION OF WATER QUALITY
161' MAIL SERVICE CENTER
R LEIGH, NC 2'699-16I'
EFFLUENT
THIS SIt:4'PrTI,IIE.
.'RATF. AND COM
YE R.
;1
CFReTIFICATIN ND,
GRADE I _ CEI IF`ICATION NO.
ORC PHONE ..
NO FLOW / DISCHARGE FROM SITE
FY THAT THIS REPORT IS
TETOTHE BEST [?FSMY KNOWLEDGE.
ENTER PARAMETE CODE AB
NAME AND: MOW
DWQ Form MR,-1 G1 It°O4i

Facility Status: (P1eae check one of the following)
All monitoring data and sampling frequencies meet permit requirements
(including weekly averages, ilapplicable)
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The perrnittee shall report to the Director or the appropriate Regional Office any noncomplian.ce that potentially
threatens public health or the environment, Any information shall be provided orally within 24 hours from the time the
pennittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumsta.nces.
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 ILE.6 of the NPDES permit.
certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision
in accordance W th 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
tines and imprisonment for knowing vidations,"
Pcnni.•:ec Address
0
PD-me Numbet
Certified Laboratory-(2)
Certified Laboratory (3)
PrmiUee print or type)
Signature ot Permitee**"
(Required unless submitted electronicall))
ADDITIONAL CfsRT1F1KD LA
Je
cluail address
'MATO{
yc; Certification No
Certified Laboratory (4)
Certi fled Laboratory (5)
PARAMETER CODES
Certification No,.
Certification No,
Certifi.eation No.
Permit Expinilionfl,Date
<6.
Parameter Code assistance may be obtained by calling the NPDES Unit at (919 807-6300 or by visiting
littpillportal..nedenr.orglweblwryis‘NpipsInpdeslappforms.
Use only units of measurement designated in the reporting facilit)'s NPDES permit for reporting data:
* No FlowiDischarge From Site: Check this boK if no dis.etiorge occurs and, as a result, there are no data to be
entered :for all of the parameters on the DIMPC for the entire: monitoring period.
OR( On Site?: ()RC' must visit facility and document 'visitation of facility as required per I 5A NCAC 8G ,0204.
Signature of Permittee: If signed bY other than the permittee, then the, delegation of the signatory atithority must be or
file with the state per 15A NCAC 213 „0,506(b)(2)(D).