NCG020537 DMR WW (2)

11 ANNUAL SUMMARY DMR - WASTEWATER 11
SEND TO CENTRAL OFFICE*
PROCESS MINE/DEWATERING WASTEWATER
GENERAL PERMIT NO. NCG020000
* Report All Wastewater discharge monitoring data on this form (including No Flory and No Discharge and Permit Limit Violations) by MARCH 1 of each year. If
you have limit violations, you must also have turned in a Limit Violation DMR to your local Regional Office n-ithin 30 clays of receiving sample results from a lab.
CERTIFICATE OF COVERAGE NO. NCG02
FACILITY NAME:
PERSON COLLECTING SAMPLES•
CERTIFIED LABORATORY: Lab # /,' %G S % 7
Lab #
LIMIT VIOLATIONS? YES ❑ NO ❑
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTIONYEAR: ,7/J /,6'-
COUNTY:
5^COUNTY: S�
PHONE NO. () -
ADD TO LISTSERVE? YES ❑ NO❑ EMAIL:
INDUSTRIAL SAND'? F-1DISCHARGINGTO SA WATERS'? ❑
Date Sample
Outfall No. Collected'
Total Flow
Total Suspended
Solids'
Turbidity3
Settleable Solids pH Fecal Coliforms
mm/dd/yr
MG
MO 1,2
NTU2'3 nm2 Standard' coUml2,4
zz S
8 7. 270
AUG 0 3 206
CENTRAL
D R SECTION
All mines must monitor WW discharges for TSS. Only industrial sand mine discharges are subject to TSS limits.
' If an effluent limit is exceeded, the permittee is required to institute monthly monitoring for that parameter for the remaining permit term.
3 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: 1/1/2010-12/31/2014 Last Revised 01-21-11
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Part A Continued: Wastewater Monitoring Requirement
Outfall No.
Date Sample
Collected
Total Flow Total Suspended Turbidity3 Settleable Solids
Solids
pH
Fecal Coliforms
-
mm/dd/yr
MG mgnl,2 NTU2'3 ml/1'
Standard
coUml2'4
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE" & LIMIT
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
[phone]
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 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."
15—
(Signature of Permittee) (Date)
Permit Date: 1/l/2010-12/31/2014 Last Revised 01-21-11
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