NCG140032 DMR WW (4)

PROCESS WASTEWATER s Quarterl(Discharge Monitoring Report,
GENERAL PERMIT No. NCG140000
CERTIFICATE OF C VERAGE NO. CG14_QQ 3 o� SAMPLE COLLECTION YEAR:
. "SAMPLE QUARTER: ED I -Sept ❑Oct -Dec D§anWarch ❑April -June
FACILITY NAME:
PERSON COLLECTING SAMPLES 'COUNTY:
CERTIFIED, LABORATORY: � Lab # PHONE NO. (11(0. �— -
Lab # " ' �ADD:TO LISTSERVE? []YES NO EMAIL: - -
LIMIT VIOLATIrONS?' YES [:]NO DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑7rout Other �—
_ INFO:
,art A: wastewater rvwnILUIMs Mcyunc441­5­--
Date Sample
P Type of Wastewater
Outfall No. Collected z
(VE, RM, MD)
(mm/dd/Yr)
pH
(standard)
xT6 al�Suspended
'Solids
: _:;; 5 , '
(mg/L)
- - -
TPH using -"
Settleable Discharge
method 1664A I Total Flow
Solids .-Duration 7
SGT-HEIVIs (gallons/day)
(mL/L) (minutes) ' : , ...
(mg/L)
6-9
30
,
CN
1 If wastewater systems have not discharged in this quarter — report "No Flow" or " No'Di'scharge" here. Please make sure to mark the sample quarter,aoove..-
'' Report the abbreviation for the type of Authorized Wastewater Discharges here:.Veh'i'cle and Equipment Cleaning (VE), Raw Material Stockpiles: (RM), Mixing. Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
31f an effluent limit is exceeded twice in a row, the permittee is required to ir.stiEute monthly monitoring for that parameter for six months, unless D.4V.Q,RO stiff
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 saltwaters.
s TS5 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

Process wastewater discharges shall only be monitored for TPH when commingled with storrnwater discharges from VIVIA areas. TPH does not have a limit for wastewater,
but instead -is subject to, benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
' Flow rate can,be"measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to SO% of the Summer 7Q10 Flow as per
NCAC 026 .0224.yPermi'ftees who discharge wastewater to HQW waters shall obtain a, Summer 7Q10 flow and report this information to DWQ If the permittee cannot
obtairi'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 low
report.on,acasebV-case basis.
...j ... ._ ._
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW" "NO DISCHARGE" 1 WITHIN 30 DAYS OF"RECEIPT 4OF SAMPLE (C
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
(919)807-63791-1
YOU MUST SIGN :THIS.CERTIFICATION 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
personsdirectly',responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accu�aie,'arid
complete., L%am:aware.that there are significant penalties for submitting false information, including the possibility fines and imprisonment for knowing
(Signature Permittee) (Date)
r; Last Revised 07/13/11
Permit Date: 7/1/2010-06/30/2015 Page 2 of 2