NCG020019 DMR WW (2)

ANNUAL SUMMARY Dl , WASTEWATER
SEND TO CENTRAL OFFICE*
PROCESS NUNE/DEWATESING WASTEWATER
GENERAL PER.1dJ[1T NO. NCG020000
* Report All Wastewater discharge monitoring data on this form (including No Flow and No Discharge and Permit Limit Violations) by MARCH I of each year. If
you have limit violations, you inust also have turned in a Limit Violation DMR to your local Regional Office. within 30 days of receiving sample results from a lab.
CERTIFICATE OF COVERAGE N?. NCGO2 0 d) �I
FACILITY NAME: F I e_
PERSON COLLECTING SAMPL S: eo e a -r r5
CERTIFIED LABORATORY: ce� i Lab #
Lab #
LIMITS VIOLATIONS? YES ❑ NO
SAMPLE COLLECTION YEAR: g -pi �t
COUNTY: FRRIVKLIN , r
PHONE NO. Q( Cq t 7
ADD TO LISTERVE? YES ❑ NO❑ EMAIL: 61 recimorj®tual (tore " CeW -
INDUSTRIAL SAND'? Rr DISCHARGING TO'SA WATERS'? ❑
Part Al wasrewerer
OutfaII No.
'All
lYl011Ut0 " JL%cq uu C1LLGuaa
Date Sample
t
Collected
50050
Total Flow
00530 00400
Total Suspended Turbidity3
Solids i
00545
Settleable Solids•:.
"
00400
pH
31616.
Fecal Coliforms
mm/dd/yy
MG
mg/1,2 NTU
la
StandardZ
coUml2 .
6A .-D
0 -?- Q_ 1
Kot' biz
do Uj
S.9 D
D,'7
p(D m L L Ar .
1VDnt L L hi
7,0
;S
D?-aq_r
o Flow
1b.S 14-13'
4-
AIDmL t4-
'All mines must monitor WW discharges for TSS. Oniy Fmdustnal sane mine aiscnarges are suglect to 1, ,imas.
2 If an effluent limit is exceeded, the permittee is required to institute monthly monitoring for that parameter for the remaining permit term.
'The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes, and reservoirs
designated as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; .50 NTU for all other streams and surface waters. Turbidity may be monitored at the
Stormwater Discharge Outfall. Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the discharge.
4 Only facilities discharging to SA waters are required to monitor for Fecal coliforms.
Permit Date: 1/1/2010-12/3112014 Last Revised 01-05-10
Page I of 2

M R ements
'art A tonanued:
Outfall No.
-
VFastewater omtorm
Date Sample
Collected
mmldd/yr
16;4 u►r
50050
Total Flow
MG
00530
Total Suspended
Solids,
mg/11'2
00400
Turbidity3
NTLI
00545 00400 31616
Settleable Solids pH Fecal Coliforms
mUIZ Standard coling",
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY(INCLUDING ALL "NO FLOW", "NO DISCHARGE" & LIIi�iIT
VIOLATIONS) BY MARCH I OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617 .
YOUMUST SIGN MS CER TIFICA TION FOR ANY INFORMATION REPORTED:
"I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
those persons directly responsible for gathering the -information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am, aware that t re ar ig ' ant pe 'es fo ubmitting false information, includin ossibility of fines and imprisonment for knowing violations."
.t
(SignahirO of Per 'ttee)
Last Revised 01.05-10
Permit Date: 1/1!201:0=12/31/2014 PagePage 2 of 2