NCG020279 DMR WW (2)

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ANNUAL SUMMARY DMR
r
SEND TO CENTRAL OFFICE*
PROCESS MINE/DEWATERING WASTEWATER
GENERAL PERMIT 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 must 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 NO. NCG02 D -X2 I
FACILITY NAME: r'J t �C cQ�Ac rJ 1
PERSON COLLECTING SAMPLES: 5k.0
CERTIFIED LABORATORY: #1 ;L, r O Lab #
r,gt! J,'1!C .C- Lab #
LIMIT VIOLATIONS? YES ❑ NOX
Part A: Wastewater MonitorinL- Requirements
SAMPLE CO�ECTI N YEAR: 2D Ir
COUNTY: 1Z1 /t^,)n -C
PHONE NO. ( /
ADD TO LISTSERVE? YES ElNO❑ EMAIL: 5L2rJ - J
INDUSTRIAL SAND'? X DISCHARGING TO SA WATERS°? ❑
Outfall No.
Date Sample
-
Collected
Total Flow
Total Suspended ..
Solids
Tui btdtty3
Settleable Solids
pH
_
Fecal Coliforms . .
-.
,mm/dd/y_ r
MGa
mg/l ` ...
NTU ::.:
_
mUl
Standard
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' 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.
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
Stonnwater Discharge Outfall. Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the discharge
Only facilities discharging to SA waters are required to monitor for Fecal coliforms.
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Permit Date: 1/1/2010-12/31/2014 Last Revised 0 1 -2 1 -11
Page 1 of 2

Part A Continued: Wastewater Monitoring Requirements
Date Sample:. Total Flow T talSus ended Turbidit'
Outfall No. t p r Settleable Solids pH Fecal:Goliforms
Collected Solids
mm/dd%yr MG mg%I''z NTUi 3 mUlz . Sfandard2 collmlz 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 penalti s for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
(Date)
Permit Date: 1/1/2010-12/31/2014 Last Revised 0 1 -2 1 -11
Page 2 of 2