NCG020536 DMR WW (4)

ANNUAL SUMMARY DMR - WASTEWATER
IL. ,SEND TO CENTPAL OFFICE*. OI
PROCESS MINE/DEWATERING WASTEWATER
GENERAL PERMIT NO. NCG020000
Report All .Wastew ter disch rge monitoring data on this form (including No Flow and No Discharge and Permit Linut 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 within 30 days of receiving sample results from. a lab.
CERTIFICATE OF COVERAGE NO. NCCBIP,Ou SAMPLE COLLECTION YEAR: r /J
FACILITY NAME: /COUNTY:L'Y.
PERSON �c.15 L b
COLLECTING SAMPLES: PHONE NO. (Z-5 Z) -3 Z 1 -
CERTIFIED LABORATORY: Lab # ADD TO LISTSERVE? YES ❑ NOD EMAIL:
Lab #
LIMIT VIOLATIONS? YES ❑ NO ❑
Part A: Wastewater Monitoring Requirements
INDUSTRIAL SAND'? ElDISCHARGING TO SA WATERS4. ❑
e
Outfall No. Date Sample
Collected
Total Flow Total Suspended Turbidity'
Settleable Solids
pH Fecal Coliforms
- mm/dd/yr
MG m01'2 NTU2,3 ..w2
Standard col/m12'4
�9ED
FEB
CENTRAL FILES
DWR SEC *f ION
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
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Part A Continued: Wastewater Monitor ng Requirements
Outfall No.
Date Sample
Collected)
Total Flow Total Suspended Turbidity' Settleable Solids II Fecal Coliforms
Solids) p
-
mm/dd/yr
MG mg/iI,2 NTU' mUl' Standard2 col/ml2'4
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."
(Signature of Permittee)
Permit Date: 1/1/2010-12/31/2014
(Date)
Last Revised 01-21-11
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