NCG020793 DMR WW (2)

10,
1W 11 ANNUAL SUMMARY DMR - WASTEWATER
►SEND TO
"FFTCE * ,
PROCESS MINE/DEWATERING WASTEWATER
GENERAL PERMIT NO. NCG020000
*' Report All Wastewater discharge monitoring data on this form (including No Flow and No_Discha-rge and Permit Limit Yiolations) by MARCH 1 of each year. If
you have limit violations, you must also have, turned in a Liniit Violation DMR to your local Regional Office withiW30 days of receiving sample results from a lab.
CERTIFICATE OF COVERAGE NP. N
FACILITY NAME: MA IMO -al -e
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY:_(, 011.1,..
LIMIT VIOLATIONS? YES ❑
Part A: Wastewater Monitorin2 Re uirements
10 SAMPLE COLLECT ON YEAR: �- 0 /y
(ipS Am, COUNTY: /�
A PHONE NO. &157 DIU
Lab # /52 ADD TO LISTSERVE? YES NoLJ EMAIL: P1.V'•�SOhn im„1, Corn
gab #
INDUSTRIAL SAND'? ❑ DISCHARGING TO SA WATERS'? ❑
Outfall No.
Date Sample
Collected) Total Flow
Total Suspended Turbidity3
Solids'
Settleable Solids pH
Fecal Coliforms
N
-
mm/dd/yr MG
mg/1 'Z NTU '3
ml/l Standard
col/m12'
02
031 l,11 zolq ,oIyy
0.0
o•I
02
0i 0.0720
0'0
LO• i.
d i
OX ia 7-0 Iq 0'7 2-0
10
-40-1 P7 •
NAR
002,
Z0 zor 0.0?20
.0
4©• -7.0
OMR SQ�c P
' 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.
pJ
Permit Date: 1/1/2010-12/31/2014 Last Revised 02-02-11
Page 1 of 2

Part A Continued: Wastewater Monitoring Requirement
Outfall No. Date Sample
Collected
Total Flow Total Suspended
Solids
Turbidity3
Settleable Solids pH Fecal Coliforms
- mm/dd/yr
MG mg/1 a
NTU ' MIA2 Standard coUml '
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH 1 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 CERTIFICA TION FOR ANYINFORMATION REPORTED:
"I ce 'fy, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to
assu a at qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or
thoa per ons direr Iy sponsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I a awa a that t e a e significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
of
Permit Date: 1/1/2010-12/31/2014
5
(Date)
Last Revised 02-02-11
Page 2 of 2