NCG140288 DMR WW (3)

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
CERTIFICATE OF COV � NO.
FACILITY NAME:
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY: �S
LIMIT VIOLATIONS? YES ❑ N
"art A: Wastewater Monitoring Requirements
GENERAL PERMIT NO. NCG140000
a 2 SAMPLE COLLECTION YEAR: �� k-5,
SAMPLE QUA TER: []Jul -Sept Oct -Dec ❑Jan -March []April -June
COUNTY: S
i # PHONE NO: /
Lab # ADD TO LISTSERVE? YES ❑NO EMAIL: . L
DISCHARGING TO CLA S: ❑SA ❑HQW ❑PNA ❑Tro her_
OPTIONAL INFO:
-'
Outfall No
Da#e Sample
oil ected)
(mm/dd(standard)
_ Total Sus` ended
T e of:Wastewater H p ,
YP p ,-
x Solids"
-
method 1664A '70
ett eab e. TPH using Discharge
Solids Duratin
o -
SGT HEAD
m lmg/) minutes)
Total Flow
(gallons/day)'
53., .::
2i
�
,
JAN 13 2016
ENTIF
x - "—NUI Ecu a Ila yUa, Ml — I t:PUF L rvv r;ow or No uiscnarge-- nere. Niease make sure to mark the sample quarter above.
Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
a If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly. monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue.monitoring..'
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwater&
s TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 1 of 2

6 Process wastewater discharges shall only; be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and i,provisions of Part IV, Section A, including the Tiered Response Action.
Flow -rate can be measured continuously nor calculated. Flow limits for wastewater discharges to HQW waters shall beset to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B.0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the.DWQ Regional Office may require an annual flow
report on a case-by-case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING -ALL "NO FLOW". "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED.-
"I
EPORTED:"I certify, under penalty of law, that.this;document and all attachments were prepared under my direction or supervision in accordance with a'system designed to
assure that qualified personnel properly;gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the,system, or
those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. 1 am aware that there are significant penalties for submitting false information, including the.possibility of fines and.imprisonment for knowing
violations."
t;
of Permittee)
Permit Date: 7/1/2010-06/30/2015
(Date)
Last Revised 07/13/';11
Page 2 of 2