NCG020803 DMR WW (3)

ANNUAL SUMMARY DMR - WASTEWATER
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PROCESS -1 M/13EWATERING WASTEWATER
GENERAL PERMIT NO. NCG020000
CERTIFICATE OF COVERAGE -No. NCG02-8,8 O 3
FACILITY NAME: 00416 tFT —!MOMS 7—
R_ -4C_'7 -PERSON COLLECTING SAMPLES: •XBAIr--S
CERTIFIED LABORATORY: Lab #
Lab #
LIMIT VIOLATIONS? YES ❑ NO ED
Part A: Wastewater Monitoring Reauirements
SAMPLE COLLECTION YEAR: 2!m `.6-
COUNTY: Le `,Kl4&iQAW
PRONE NO. (75A `�02%� b`�t�✓
ADD TO LISTSERVE? YES ❑ NOK EMAIL: _
INDUSTRIAL SAND'? 9 DISCHARGING TO SA WATERS°? E]
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1 All mines must monitor WW discharges for TSS. Only industrial sand mine discharges are subject to TSS limits.
2 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
Page 1 of 2

Part A Continued: Wastewater Monitarina`'Renniremenk
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MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW'. "NO DISCHARGE" & LIMIT
VIOLATIONS),BY MARCH 1'.0F 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, underrpenalty of law, that -this d`ocument'and'`all~_attachments were prepared under my direction or supervision in accordance with a system designed to
assure -that ilified personnel pro ecly gather and evaluate the information submitted. Based on my inquiry of the,person or persons who manage the system, or
those`p o directly o e4fo h information; the information submitted is, to the best of my knowledge and belief, true, accurate, and -complete.
I am that th ntfi t penalties for su6mittmg'false information, including the possibility of fines and imprisonment for knowing violations."
20/9
(Si lure o 'ttee) (Date)
Permit Date: 1/1/2010-12/31/2014 Last Revised 01-21-11
Page 2 of 2
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW'. "NO DISCHARGE" & LIMIT
VIOLATIONS),BY MARCH 1'.0F 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, underrpenalty of law, that -this d`ocument'and'`all~_attachments were prepared under my direction or supervision in accordance with a system designed to
assure -that ilified personnel pro ecly gather and evaluate the information submitted. Based on my inquiry of the,person or persons who manage the system, or
those`p o directly o e4fo h information; the information submitted is, to the best of my knowledge and belief, true, accurate, and -complete.
I am that th ntfi t penalties for su6mittmg'false information, including the possibility of fines and imprisonment for knowing violations."
20/9
(Si lure o 'ttee) (Date)
Permit Date: 1/1/2010-12/31/2014 Last Revised 01-21-11
Page 2 of 2