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HomeMy WebLinkAboutNC0025763_LV-2015-0275_20151221 ' r PAT MCCRORY DONALD F. i :\ DEF. 's'i't T rrtzs, ?;N.'I t7:JN+✓.EMT.r„ L3 il:°.._. 9. S. A L' Z:NINIEIi:Y A N Certified Mail# 7014 2120 0000 8057 9402 Return Receipt Requested December 21>2015 RECEIVED/DENR/DWR Dean Lambeth Town of Kure Beach DEC 2 8 2015 1 17 Settlers Ln Kure Beach,NC 28449-3943Water ` Permitting Section SUBJECT: Notice of Violation and Assessment of Civil Penalty for Violations of North Carolina General Statute(G.S.) 143-215.1(a)(6) and NPDES WW Permit No. NC0025763 Town of Kure Beach Kure Beach WWTP Case No. LV-2015-0275 New Hanover County Dear Permittee: This letter transmits a Notice of Violation and assessment of civil penalty in the amount of$1,282.90($1,100.00 civil penalty + $182.90 enforcement costs)against Town of Kure Beach. This assessment is based upon the following facts: a review has been conducted of the discharge monitoring report(DMR) submitted by Town of Kure Beach for the month of September 2015. This review has shown the subject facility to be in violation of the discharge limitations and/or monitoring requirements found in NPDES WW Permit No. NC0025763. The violations,which occurred in September 2015, are summarized in Attachment A to this letter. Based upon the above facts, I conclude as a matter of law that Town of Kure Beach violated the terms, conditions or requirements of NPDES Permit No.NC0025763 and G.S. 143-215.1(a)(6) in the manner and extent shown in Attachment A. In accordance with the maximums established by G.S. 143-215.6A(a)(2), a civil penalty may be assessed against any person who violates the terms, conditions or requirements of a permit required by G.S. 143-215.1(a). Based upon the above findings of fact and conclusions of law, and in accordance with authority provided by the Secretary of the Department of Environmental Quality and the Director of the Division of Water Resources, I,James H. Gregson, Regional Supervisor, Wilmington Regional Office hereby make the following civil penalty assessment against Town of Kure Beach: State of North Carolina Environmental Quality Water Resources 127 Cardinal Drive Extension,Wilmington,North Carolina 28405 910-796-7215 $100.00 I of the 1 violations of 143-215.1(a)(6)and NPDES Permit No.NC0025763, by discharging waste water into the waters of the State in violation 6f the Permit Daily Maximum for CHLORLNE. $500.00 1 of the 1 violations of l43-215.1(a)(6)and NPDES Permit No.NC0025763, by discharging waste water into the waters of the State in violation of the Permit Monthly Average for BOD - Conc. $500.00 2 of the 2 violations of 143-215.1(a)(6)and NPDES Permit No.NC0025763, by discharging waste water into the waters of the State in violation of the Permit Weekly Average for BOD-Conc. $1,100.00 TOTAL CIVIL PENALTY $182.90 Enforcement Costs $1,282.90 TOTAL AMOUNT DUE Pursuant to G.S. 143-215.6A(c), in determining the amount of the penalty I have taken into account the Findings of Fact and Conclusions of Law and the factors set forth at G.S. 143B-282.1(b),which are: (l) The degree and extent of harm to the natural resources of the State, to the public health, or to private property resulting from the violation; (2) The duration and gravity of the violation; (3) The effect on ground or surface water quantity or quality or on air quality; (4) The cost of rectifying the damage; (5) The amount of money saved by noncompliance; (6) Whether the violation was committed willfully or intentionally; (7) The prior record of the violator in complying or failing to comply with programs over which the Environmental Management Commission has regulatory authority; and (8) The cost to the State of the enforcement procedures. Within thirty (30) days of receipt of this notice,you must do one of the following: (1) Submit payment of the penalty, OR (2) Submit a written request for remission, OR (3) Submit a written request for an administrative hearing Option 1: Submit payment of the penalty: Payment should be made directly to the order of the Department of Environmental Quality(do not include waiver form). Payment of the penalty will not foreclose further enforcement action for any continuing or new violation(s). Please submit payment to the attention of: Wastewater Branch Division of Water Resources 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Option 2: Submit a written request for remission or mitigation including a detailed justification for such request: Please be aware that a request for remission is limited to consideration of the five factors listed below as they may relate to the reasonableness of the amount of the civil penalty assessed. Requesting remission is not the proper procedure for contesting whether the violation(s)occurred or the accuracy of any of the factual statements contained in the civil penalty assessment document. Because a remission request forecloses the option of an administrative hearing, such a request must be accompanied by a waiver of your right to an administrative hearing and a stipulation and agreement that no factual or legal issues are in dispute. Please prepare a detailed statement that establishes why you believe the civil penalty should be remitted, and submit it to the Division of Water Resources at the address listed below. In determining whether a remission request will be approved,the following factors shall be considered: (1) whether one or more of the civil penalty assessment factors in NCGS 143B-282.1(b)was wrongfully applied to the detriment of the petitioner; (2) whether the violator promptly abated continuing environmental damage resulting from the violation; (3) whether the violation was inadvertent or a result of an accident; (4) whether the violator had been assessed civil penalties for any previous violations; or (5) whether payment of the civil penalty will prevent payment for the remaining necessary remedial actions. Please note that all evidence presented in support of your request for remission must be submitted in writing. The Director of the Division of Water Resources will review your evidence and inform you of his decision in the matter of your remission request. The response will provide details regarding the case status, directions for payment, and provision for further appeal of the penalty to the Environmental Management Commission's Committee on Civil Penalty Remissions (Committee). Please be advised that the Committee cannot consider information that was not part of the original remission request considered by the Director. Therefore, it is very important that you prepare a complete and thorough statement in support of your request for remission. In order to request remission, you must complete and submit the enclosed "Request for Remission of Civil Penalties, Waiver of Right to an Administrative Hearing, and Stipulation of Facts" form within thirty(30) days of receipt of this notice. The Division of Water Resources also requests that you complete and submit the enclosed"Justification for Remission Request." Both forms should be submitted to the following address: Wastewater Branch Division of Water Resources 1617 Mail Service Center Raleigh,North Carolina 27699-1617 Option 3: File a petition for an administrative hearing with the Office of Administrative Hearings: If you wish to contest any statement in the attached assessment document you must file a petition for an administrative hearing. You may obtain the petition form from the Office of Administrative Hearings. You must file the petition with the Office of Administrative Hearings within thirty(30) days of receipt of this notice. A petition is considered filed when it is received in the Office of Administrative Hearings during normal office hours. The Office of Administrative Hearings accepts filings Monday through Friday between the hours of 8:00 a.m. and 5:00 p.m., except for official state holidays. The petition may be filed by facsimile (fax)or electronic mail by an attached file(with restrictions)- provided the signed original, one(1)copy and a filing fee (if a filing fee is required by NCGS §150B-23.2)is received in the Office of Administrative Hearings within seven (7)business days following the faxed or electronic transmission. You should contact the Office of Administrative Hearings with all questions regarding the filing fee and/or the details of the filing process. The mailing address and telephone and fax numbers for the Office of Administrative Hearings are as follows: Office of Administrative Hearings 6714 Mail Service Center Raleigh, NC 27699-6714 Tel: (919) 733-2698 Fax: (919) 733-3478 One (1) copy of the petition must also be served on DEQ as follows: Mr. Sam M. Hayes. General Counsel Department of Environmental Quality 1601 Mail Service Center Raleigh. North Carolina 27699-1601 Please indicate the case number(as found on page one of this letter) on the petition. Failure to exercise one of the options above within thirty(30)days of receipt of this letter, as evidenced by an internal date/time received stamp(not a postmark), will result in this matter being referred to the Attorney General's Office for collection of the penalty through a civil action. Please be advised that additional penalties may be assessed for violations that occur after the review period of this assessment. If you have any questions,please contact Dean Hunkele with the Division of Water Resources staff of the Wilmington Regional Office at(910) 796-7215 or via email at dean.hunkele@ncdenr.gov. Sincerely, Jaiin6 H. Gregson, Regional Supervisor Water Quality Regional Operations Section Wilmington Regional Office Division of Water Resources,NCDEQ ATTACHMENTS Cc: WQS Wilmington Regional Office- Enforcement File (w/attachments) NPDES Compliance/Enforcement Unit-Enforcement File (w/attachments) Central Files, Water Quality Section (w/attachments) • JUSTIFICATION FOR REMISSION REQUEST Case Number: LV-2015-0275 County: New Hanover Assessed Party: Town of Kure Beach Permit No.: NC0025763 Amount Assessed: $1,282.90 Please use this form when requesting remission of this civil penalty. You must also complete the "Request For Remission, Waiver of Right to an Administrative Hearing, and Stipulation of Facts"form to request remission of this civil penalty. You should attach any documents that you believe support your request and are necessary for the Director to consider in evaluating your request for remission. Please be aware that a request for remission is limited to consideration of the five factors listed below as they may relate to the reasonableness of the amount of the civil penalty assessed. Requesting remission is not the proper procedure for contesting whether the violation(s)occurred or the accuracy of any of the factual statements contained in the civil penalty assessment document. Pursuant to N.C.G.S. § 143B-282.1(c),remission of a civil penalty may be granted only when one or more of the following five factors apply. Please check each factor that you believe applies to your case and provide a detailed explanation, including copies of supporting documents, as to why the factor applies (attach additional pages as needed). (a) one or more of the civil penalty assessment factors in N.C.G.S. 143B-282.l(b)were wrongfully applied to the detriment of the petitioner (the assessment factors are listed in the civil penalty assessment document); (b) the violator promptly abated continuing environmental damage resulting from the violation (i.e., explain the steps that you took to correct the violation and prevent future occurrences): (c) the violation was inadvertent or a result of an accident(i.e., explain why the violation was unavoidable or something you could not prevent or prepare for): (d) the violator had not been assessed civil penalties for any previous violations; (e) payment of the civil penalty will prevent payment for the remaining necessary remedial actions (i.e., explain how payment of the civil penalty will prevent you from performing the activities necessary to achieve compliance). EXPLANATION: STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY- COUNTY OF NEW HANOVER IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN OF CIVIL PENALTIES AGAINST ) ADMINISTRATIVE HEARING AND ) STIPULATION OF FACTS Town of Kure Beach ) Kure Beach WWTP ) ) PERMIT NO. NC0025763 ) CASE NO. LV-2015-0275 Having been assessed civil penalties totaling$1,282.90 for violation(s) as set forth in the assessment document of the Division of Water Resources dated December 21, 2015, the undersigned, desiring to seek remission of the civil penalty, does hereby waive the right to an administrative hearing in the above-stated matter and does stipulate that the facts are as alleged in the assessment document. The undersigned further understands that all evidence presented in support of remission of this civil penalty must be submitted to the Director of the Division of Water Resources within thirty(30)days of receipt of the notice of assessment. No new evidence in support of a remission request will be allowed after(30)days from the receipt of the notice of assessment. This the _ day of , 20 SIGNATURE ADDRESS TELEPHONE ATTACHMENT A Town of Kure.Beach CASE NUMBER: LV-2015-0275 PERMIT: NC0025763 FACILITY: Kure Beach WWiP COUNTY: New Hanover REGION: Wilmington Limit Violations MONITORING OUTFALL/ VIOLATION UNIT OF CALCULATED %OVER PENALTY REPORT PP, LOCATION PARAMETER DATE FREQUENCY MEASURE LIMIT VALUE LIMIT VIOLATION TYPE $250.00 9-2015 001 Effluent BOD-Conc 9/5/15 Weekly mg/i 45 69 53.3 Weekly Average Exceeded $250.00 9-2015 001 Effluent BOD-Conc 9/26/15 Weekly mg/I 45 62 37.8 Weekly Average Exceeded $500.00 9-2015 001 Effluent BOD-Conc 9/30/15 Weekly mg/I 30 36.60 22.0 Monthly Average Exceeded $100.00 9-2015 001 Effluent CHLORINE 9/29/15 2 X month ug/! 13 50 284.6 Daily Maximum Exceeded DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT Violator: Town of Kure Beach Facility Name: Kure Beach WWTP Permit Number: NCO025763 County: New Hanover Case Number: LV-2015-0275 ASSESSMENT FACTORS 1) The degree and extent of harm to the natural resources of the State, to the public health, or to private property resulting from the violation; y �,Gv': G-4L ;y,,'� Lw� ,[,yrr �1 1. �.�__`s_:_.---e •`=r-�L'�L'Ci t tom. 2) The duration and gravity of f6 violation; -�...� i. :Z L, c s: y...r.-.�t, -E✓? ".,:i/ , •'N�.,.• .fir^,,✓`;' .`v�•G.>..%�,.`, i„`�':�` i,� 'l_,) 1 tG � i_i. v�,_✓ a. ..�`. �•� `' \ L�1+-'j�.r �_ �`;a �C..�`-: �.ti.' 3) The effect on ground or surface water quantity or quality or on air quality; F• 4) The cost of rectifying the damage; 5) The amount of money saved by noncompliance; 6) Whether the violation was committed willfully or intentionally; 7) The prior record of the violator in complying or failing to comply with programs over which the Environmental /Management Commission has regulatory authority; and �'L ^C- C.. � < .mac � .. r' • . `:� �.,.t r�-'/ � a : � . 8) The cost to the Sfate of the enforcement procedures. $182.90 Date James )ftl. Gregson, Regional upervisor Water 6uality Regional Operations Section Wilmington Regional Office Division of Water Resources, NCDEQ • North Carolina Department of Environmental Quality Pat McCrory Donald R.van der Vaart Governor Secretary November 16, 2015 CERTIFIED MAIL #7014 2120 0000 8057 9358 RETURN RECEIPT REQUESTED Dean Lambeth, Mayor Town of Kure Beach 117 Settlers Ln Kure Beach, NC 284493943 Subject: NOTICE OF VIOLATION &INTENT TO ASSESS CIVIL PENALTY Tracking No. NOV-2015-LV-0748 Permit No. NC0025763 Kure Beach WWTP New Hanover County Dear Hon Lambeth: A review of Town of Kure Beach's Discharge Monitoring Report forthe Kure Beach WWTP submitted forthe month of September 2015 showed the violations indicated below. THE FOLLOWING ARE PARAMETER LIMIT VIOLATIONS: Parameter Date Limit Value Reported Value Limit Type TRC 9/29/2015 13.000 ug/I 50.000 ug/I Daily Maximum Exceeded BOD, 5-Day 9/26/2015 45.000 mg/I 62.000 mg/I Weekly Average Exceeded BOD,5-Day 9/5/2015 45.000 mg/I 69.000 mg/I Weekly Average Exceeded BOD, 5-Day 9/30/2015 30.000 mg/I 36.600 mg/I Monthly Average Exceeded A Notice of Violation/Intent to Issue Civil Penalty is being issued for the noted violation of North Carolina General Statute (G.S.) 143-215.1 and the facility's NPDES Permit. Pursuant to G.S. 143-215.6A, a civil penalty of not more than twenty-five thousand dollars ($25,000.00) may be assessed against any person who violates or fails to act in accordance with the terms,conditions, or requirements of any permit issued pursuant to G.S. 143-215.1. If you wish to provide additional information regarding the noted violation, request technical assistance, or discuss overall compliance please respond in writing within ten (10) business days after receipt of this Notice. A review of your response will be considered along with any information provided on the submitted Discharge Monitoring Report(s). You will then be notified of any civil penalties that may be assessed regarding the violations. If no response is received in this Office within the 10-day period,a civil penalty assessment may be prepared. 127 Cardinal Drive Extension,Wilmington,North Carolina 28405 Phone:910-796-7215\Internet:www.ncdenr.gov An Equal Opportunity\Affirmative Action Employer—Made in part by recycled paper • Remedial actions should have already been taken to correct this problem and prevent further occurrences in the future. The Division of Water Resources may pursue enforcement action for this and any additional violations of State law. If the violations are of a continuing nature, not related to operation and/or maintenance problems,and you anticipate remedial construction activities, then you may wish to consider applying for a Special Order by Consent. Reminder: Pursuant to Permit Condition 6 in Section E,the Permittee is required to verbally notify the Regional Office as soon as possible, not to exceed 24 hours,from first knowledge of any non-compliance at the facility including limit violations, bypasses of, or failure of a treatment unit. A written report may be required within 5 days if directed by Division staff. Prior notice should be given for anticipated or potential problems due to planned maintenance activities,taking units off-line, etc. In addition, you may wish to consider registering to use the Division's new e-DMR process for completion and submittal of monthly monitoring reports, for more information please visit our website at: http://portal.ncdenr.org/web/wq/admin/bog/ipu/edmr If you should have any questions, please do not hesitate to contact Dean Hunkele with the Water Quality Section at (910) 796-7215 or via email at Dean.Hunkele@ncdenr.gov. Sincerely, James\Grjegson, Regional Supervisor Water Quality Regional Operations Section Wilmington Regional Office Division of Water Resources, NCDEQ Cc: DWQ/Wilmington Regional Office-Green File Central Files,Water Quality Section .--...b. . . • A rie.,•vmtir,:;.71r.w.7.N.,!zIlx,:n..!,,,;?"-•,.T.7, s. ,-.0ermice,' .---,,.-, ;Akcii,3-,..',, - , 411-:!'.,'•-,-i;- - ,Z' i''',,- itlEIR5fTIFIED'elVIAtIllgTVECEIPT '' .` - •'-,4: 43 .i•P,,,,K,....r, ,),--t. •-- -..,•,...% „.,..,.. Ix) digq17NVI:9414i 19P1S7,t2.;."'‘ ','''4'1 1:\%-t.:1:1'S''f: ,''' • -.'' ...7-..,/,f,:s4: gr. de,g7gatryZirif ornriticirWiiiiirtAITirelttWitiA74-14yrtp,.,,,t1U4 r- , .1 ,— .5— ..! •'4 :2 .,3 :,<"\ ,',.-^ c} '''.':',i ' -: 1-r) co Postage 1111111111111 0 Certified Fee 0 Return Receipt Fee Postmark D (Endorsement Required) Here Restricted Delivery Fee (Endorsemer t Required) ru ri Total Postage&Fees MEM ru .3- Sept To - Cilr ./. 2- . " .:// ..,.- ..,-, „/..:',.' , ' ..i,,' ..,,,./..• ', Siriet&Apt No.,--- ---- -------::"--.------ --...--'-----' -----------------.--- N Of PO Box No. // . -7 ,e /T'/,....-,, j ,...., -,., , /-'..),. -,..-., ,• City,q&Ite,2176itl ------------------- - ----------- 1----.-—--:------'"..7-"---- '' ./e''-,7.-K.' //4-- -„.:,.j" /-e.14-=-- Form3800 July2gLr4 1 ;;;4..7'''•t' 45•V iai,;}I'Mse fot InVittidn's SENDER COMPLETE THIS§EcTioN,:' :.. COMPLETE-1-1:ilsSEC791YONREL111E17 s Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. Xle D Agent Print your name and address on the reverse CIAddressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery El Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? 0 Yes 1. Article Addressed to: If YES,enter delivery address below: 0 No / ,, ,1,7e-- --- ...- - , / •• /.:.:7 I/ -,./ 5' ./ ? il- •-"" '.'.... .• . 3. Seiyice Type Certified Mail® 0 Priority Mail Dpressr" , 0 Registered 0 Return Receipt for Merchandise 0 Insured Mall 0 Collect on Delivery -, . 2-• ,.- ,-, <• • -, 2 ,...") 7 ; 4. Restricted Delivery?(Extra Fee) 0 Yes -- 2. Article Number (Transfer frrn service lade° 7014 2120 0000 8057 9358 PS Form 3811,July 2013 Domestic Return Receipt EFFLUENT c, \ • :, NPDES PERMIT NO. NC0025763 DISCHARGE NO. 001 MONTH SEPTEMBER YEAR 2015 FACILITY NAME Town of Kure Beach CLASS II COUNTY New Hanover CERTIFIED LABORATORY(1) Environmental Chemists,Inc. CERTIFICATION NO. 37721 (list additional laboratories on the backside/page 2 of this form) OPERATOR IN RESPONSIBLE CHARGE(ORC)Paul Stacey GRADE II CERTIFICATION NO.991088 PERSON(S)COLLECTING SAMPLES Paul Stacey ORC PHONE 910-458-5816 ��--�t CHECK BOX IF ORC HAS CHANGED _� NO FLOW/DISCHARGE FROM SITE* Mail ORIGINAL and ONE COPY to: :: j ,;�� `®�j®y p�' ATTN:CENTRAL FILES 1 x ! _EE d'�' DIVISION OF WATER QUALITY (SIGNATURE F OPERATOR RESPONSIBLE CHARGE) DATE 1617 MAIL SERVICE CENTER 'BY THIS SIGNATURE,I CERTIFY THAT THIS REPORT IS RALEIGH, NC 27699-1617 -I:... ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. m 50050 00010 _ 00400 50060 00310 00610 00530 31616 00300 00600 00665 612111 P E x FLOW W e z 0 O co ENTER PARAMETER CODE ABOVE t o H EFF 0 ~to M 2 a Q W J w J* W, ,1 W J m NAME AND UNITS BELOW W a`� 2 k- INF ❑ tf1J OV El <Z <0 JW QO a0 o u - i W= O 00 1-W V- O F-O 8. Q °e O ) W aw a KV noN 2x Ott WJ u) Oft OFN G vN ti © JF' n.1 UV Q~ 1-? ILO wo F-F = ` ' Oa 0 a 0 F duu'mfcction N U O Z F. c 8 O O i wv HRS HRS Y/B/N MGD ° C UNITS UG/L MG/L MG/L MG/L N/100ML MG/L MG/L MG/L >69 0.50 14 • 12:4`" 5.71 46 1 9:00 1:00 'Y 0.063'` 27 7:1 18:00 ', 2 7:00 0.50 Y 0.055 27 3 7:00 0.50 Y 0.048 27 26.00 4 7:00 0.50 Y 0.119 27 _ - 5 0.125 6 0.125 7 H 0.125 ,.'a 3,', 8 7:00 0.50 Y 0.125 27 9 7:001:00 Y 0.106 27 7 36.00 14 0:30 159 { 10 7:00 0.50 Y 0.094 25 1 11 7:00 0.50 Y 0.083 24 23.00 12 _ 0.073 i3 0.073 14 7:00 0.50 Y 0.073 24 1 15 7:00 0.50 Y 0:064 24 16 7:00 1.00 Y 0.057 25 7.1 _ 30.00 18 _ 45.10 21,9 1 17 '7:00.0.50 Y '0:052 25 18 7:00 0.50 Y 0.063 24 35.00 { 19 0:066 20 0.066 - 21 '7:00-0:50 Y: 0.0.661 25 yg 4. 0) rte r 22 7:00 0.50 Y 0.057 25 L`';` 23 7:00 0.50 B 0.050 25 . : , 24 7:00 1.00 Y 0.045 25 7.2 37.00 >62 0.40 13.6 , -"VatE (L(Eifli;'R§Pinrx I 25 7:00 0.50 Y 0:063 25 Opera loris Sept ops 26 0.116 W.?f wco.rt Regio!al ,i ,: 27 0116 28 7:00 0.50 Y 0.116, 25 29 7:00 1.00 Y 0.119 25 7.3 50.00 20 0.30 23.5 , 14 30 7:00 0.50 Y 0.104 26 31 AVERAGE 0.081 25 7.14 31.88 10 9.32 18 4 MAXIMUM 0:125 27 7.3 50.00 20 45:10 23.5 46 MINIMUM 0.045 24 7 18.00 14 0.00 13.6 : 1 Comp.(C)/.Guth`(G) 0.084 , Monthly Limit DWQ Form MR-1(11/04) EFFLUENT Facility Status:(Please check one of the following) All monitoring data and sampling frequencies meet permit requirements (including weekly averages,if applicable) Compliant All monitoring data and sampling frequencies do NOT meet permit requirements Noncompliant iK 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. "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." ��./,� E gt-eh% J� Permittee ease print or / ' E I. . /,/a//-- ,,ignature of'rmittee*** Date - ` (Required..ss submitted electronically) Permittee Address Phone Number e-mail address Permit Expiration Date ADDITIONAL CERTIFIED LABORATORIES Certified Laboratory(2) Certification No. Certified Laboratory(3) Certification No. Certified Laboratory(4) Certification No. Certified Laboratory(5) Certification No. PARAMETER CODES Parameter Code assistance may be obtained by calling the NPDES Unit at (919)733-5083 or by visiting the Surface Water Protection Section's web site 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 entered for all of the parameters on the DMR for the entire monitoring period. ** ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204. ***Signature of Permittee: If signed by other than the permittee,then the delegation of the signatory authority must be on file with the state per 15A NCAC 2B.0506(b)(2)(D). DWQ Form MR-1 (11/04)