NCG030627 DMR SW (4)

imi'- z
' Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 5-17-16
CERTIFICATE OF COVERAGE NO NEGO306 SAMPLE COLLECTION YEAR 2016 —
FACILITY NAME ERICO International Corporation SAMPLE PERIOD ❑Jan-June ❑July-Dec
COUNTY Moore or ® Monthly' April (month)
PERSON COLLECTING SAMPLES_Frank Bryant DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY Microbac Lab Cert.#_NCDNR#11 CEIVE ❑Zero-flow ❑Water Supply EISA
Comments on sample collection or analysis:_Outfall#1&Outfall#2 � ❑Other
samples were taken after a dolomite lime check dam was installedMAY 2 4 201
prior to each outfall_ L PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -
DON
Part A: Stormwater Benchmarks and Monitoring Results
❑ No discharge this period?2
Date Sample 24-hour rainfallpH, Non-Polar O&G/
p Total Toxic
Outfall No. 1 Total Suspended SolidsCopper Lead Zinc Total Petroleum s
Collected amount, Standard units Organics
(mo/dd/yr) Inches3 Hydrocarbons
Benchmarks=__> - - 100 mg/L or 50 mg/L4 6.0—9.0 0.007 mg/L 0.03 mg/L' 0.067 mg/L • 15 mg/L 1 mgJL
Outfall#1 4-1-16 0.20 29.6 7.4 0.378 <0.003 0.164 <5.00 N/A
Outfall#2 4-1-16 0.20 4.50 6.8 0.115 <0.003 0.083 <5.00 N/A
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall,you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on-site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit,Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
s Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement-to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12;for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date: 11/1/2012-10/31/2017 , SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver,the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
4(7-6:R:r
Name(Print name)
"414/7—
Title(P
41111.11 5/Z.3
(Signature) (Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non-detect, ND, or other similar non-numerical
format. When results are below the applicable limits,they must be reported in the format, "<XX mg/L",where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier Z or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging> 55 gal of new oil per month.
No discharge this period?2
Date Sample 24-hour rainfall
Outfall No. 1
Collected amount, Non-polar O&G/TPH by
(mo/dd/yr) Inches3 EPA 1664(SGT-HEM) Total Suspended Solids pH
Benchmarks===> - - 15 mg/L 100 mg/L or 50 mg/L* 6.0—9.0 SU
•
Footnotes from Part A also apply to this Part B
*See General Permit text,Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART AAND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ® NO❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO❑
REGIONAL OFFICE CONTACT NAME: Mr. Mike Lawyer
Mail an original and one copy of this DMR, including all"No Discharge"reports, within 30 days of receipt of the lab results(or at end of monitoring period
in the case of"No Discharge"reports)to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 res•onsible for gathering the information,the information submitted is,to the best of my knowledge and belief,true,accurate, and complete I
am aware that ther- . e sig ficant penalties for.submitting false information, including the possibility of fines and imprisonment for knowing violations."
5723:1/6
(Sit ature of Permit -e) (Date)
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 5-17-16
CERTIFICATE OF COVERAGE NO. SAMPLE COLLECTION YEAR_2016
FACILITY NAME ERICO International Corporation SAMPLE PERIOD ❑Jan-June ❑July-Dec
COUNTY Moore or ® Monthly1 March (month)
PERSON COLLECTING SAMPLES
E@I lifitaIlif. TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY Lab Cert.# MAY 2 4 2016 ❑Zero-flow ❑Water Supply ESA
Comments on sample collection or analysis:
❑other
DWR SE CTto
CENTFILE LEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -
Part A: Stormwater Benchmarks and Monitoring Results
XI No discharge this period?2
Non-Polar O&G/
Date Sample 24-hour rainfall .pH, Total Toxic
Outfall No. Total Suspended Solids Copper Lead Zinc Total Petroleum s
Collected' amount, Standard units Organics
(mo/dd/yr) Inches3 Hydrocarbons
Benchmarks===> - - - 100 mg/L or 50 mg/L° 6.0—9.0 0.007 mg/L 0.03 mg/L 0.067 mg/L 15 mg/L 1 mg/L
Outfall#1 •
Outfall#2
Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall,you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on-site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit,Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals,or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11;for semiconductor
manufacture use the definition as found in 40 CFR 469.12;for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date:11/1/2012-10/31/2017, • SWU-245, last revised 10/25/2012
Page 1 of 3

Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver,the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
Cc 4c
Name(Print name)
Title(Print t
(Signature) (Date)
Note: Results must be reported in nume 'cal for B a report Below Detection Limit, BDL,<PQL, Non-detect, ND, or other similar non-numerical
format. When results are below the applicable limits,they must be reported in the format, "<XX mg/L",where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
No discharge this period?2
Date Sample 24-hour rainfall
Outfall No. Collected) amount, Non polar O&G/TPH by
(mo/dd/yr) Inches3 EPA 1664(SGT-HEM) Total Suspended Solids pH
Benchmarks===> - - 15 mg/L 100 mg/L or 50 mg/L* 6.0—9.0 SU
•
Footnotes from Part A also apply to this Part B
*See General Permit text,Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date:11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

p
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ® NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO111
REGIONAL OFFICE CONTACT NAME: Mr. Mike Lawyer
Mail an original and one copy of this DMR, including all"No Discharge"reports, within 30 days of receipt of the lab results(or at end of monitoring period
in the case of"No Discharge"reports)to:
' Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 : are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
411
signature of Permitte- (Date)
•
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

. J
Ir Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG030000
Date submitted 5-17-16
CERTIFICATE OF COVERAGE N o. xPc c 0306 SAMPLE COLLECTION YEAR_2016
FACILITY NAME ERICO International Corporation SAMPLE PERIOD ❑Jan-June ❑July-Dec
COUNTY Mooreor ® Monthly1 February (month)
PERSON COLLECTING SAMPLES_Frank Bryant DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY Microbac Lab Cert.#_NCDNR#11 ❑Zero-flow ['Water Supply ESA
Comments on sample collection or analysis:_Outfall#1&Outfall#2 ['Other
samples were taken after a dolomite lime check dam was installed RECEIVED
prior to each outfall PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 -*
MAY 24 nib
Part A:Stormwater Benchmarks and Monitoring Results CENTRAL FILES
DWR SECTION ❑ No discharge this period?2
Non-Polar O&G/
Date Sample 24-hour rainfall pH, Total Toxic
Outfall No. Collected1 amount, Total Suspended Solids Standard units Copper Lead Zinc Total Petroleum Organics5
(mo/dd/yr) Inches
Hydrocarbons
Benchmarks===> _ - 100 mg/L or 50 mg/L4 6.0—9.0 0.007 mg/L 0.03 mg/L 0.067 mg/L 15 mg/L 1 mg/L
Outfall#1 2-3-16 1.75 96.5 6.5 1.25 0.008 0.550 <5.00 N/A .
Outfall#2 2-3-16 1.75 8.80 5.7 0.161 <0.003 0.089 <5.00 N/A
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall,you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on-site rain gauge. Unattended sites may be eligible fora waiver of the rain gauge requirement.
4 See General Permit,Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12;for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date:11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3

Fac?iities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
Permit. For those facilities electing to employ the TTO monitoring waiver,the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report. I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan."
ozNam % 426e-6--
Name
e(Print name)
P44,; 4.-2/4-6-65K
Title(P
(Signature) (Date) •
Note: Results must be reported in numeric: 'mat. Do not report Below Detection Limit, BDL, <PQL, Non-detect, ND, or other similar non-numerical
format. When results are below the applicable limits,they must be reported in the format, "<XX mg/L",where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging> 55 gal of new oil per month.
No discharge this period?2
Date Sample 24-hour rainfall
Outfall No. Collected) amount, Non-polar O&G/TPH by
(mo/dd/yr) Inches3 EPA 1664(SGT-HEM) Total Suspended Solids pH
Benchmarks===> - - 15 mg/L 100 mg/L or 50 mg/L* 6.0—9.0 SU
Footnotes from Part A also apply to this Part B
*See General Permit text,Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

dote: if you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ® NO❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO❑
REGIONAL OFFICE CONTACT NAME Mr. Mike Lawyer
Mail an original and one copy of this DMR, including all"No Discharge"reports, within 30 days of receipt of the lab results(or at end of monitoring period
in the case of"No Discharge"reports)to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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 th- - . :nificant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
dii
e5-/z3,hc,
(Sigr.ture of Permittee (Date)
•
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3

Apr
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No:NCG030000'
Date submitted 5-17-16
•
CERTIFICATE OF COVERAGE NO. NCG030627 SAMPLE COLLECTION YEAR_2016
FACILITY NAME ERICO International Corporation SAMPLE PERIOD ❑Jan-June ❑July-Dec
COUNTY Moore or ® Monthly' January (month)
PERSON COLLECTING SAMPLES RE E1, x!'DING TO CLASS ❑ORW ❑HQW Trout ❑PNA
LABORATORY Lab Cert.# ❑Zero-flow ❑Water Supply EISA
Comments on sample collection or analysis: MAY 2 4 2.016 ❑Other
ENR AL FILE PLEASE REMEMBER TO SIGN ON PAGES 2 AND/OR 3 )
Part A:Stormwater Benchmarks and Monitoring Results
• 17<1 No discharge this period?2
Non-Polar O&G/
Date Sample 24-hour rainfall pH, . Total Toxic
Outfall No. Collected1 amount, Total Suspended Solids Standard units Copper Lead Zinc Total Petroleum Organicss
(mo/dd/yr) Inches3 „ Hydrocarbons
Benchmarks==_> - - 100 mg/L or 50 mg/L4 6.0—9.0 0.007 mg/L 0.03 mg/L - 0.067 mg/L 15 mg/L 1 mg/L
Outfall#1
Outfall#2
1 Monthly sampling (instead of semi-annual) must begin with the second consecutive benchmark exceedance for the same parameter at the same outfall.
2 For sampling periods with no discharge at any single outfall,you must still submit this discharge monitoring report with a checkmark here.
3The total precipitation must be recorded using data from an on-site rain gauge. Unattended sites may be eligible for a waiver of the rain gauge requirement.
4 See General Permit,Table 3 identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
5 Total Toxic Organics sampling is applicable only for those facilities which perform metal finishing operations, manufacture semiconductors, manufacture
electronic crystals, or manufacture cathode ray tubes. For purposes of this permit the definition of Total Toxic Organics is that definition contained in the EPA
Effluent Guidelines for the facility subject to the requirement to sample (for metal finishing use the definition as found in 40 CFR 433.11; for semiconductor
manufacture use the definition as found in 40 CFR 469.12;for electronic crystal manufacture use the definition as found in 40 CFR 469.22; and for cathode ray
tube manufacture use the definition found in 40 CFR 469.31).
Permit Date:11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 1 of 3 •

Air
Facilities that incorporate a solvent management plan into the Stormwater Pollution Prevention Plan may so certify, and the requirement for TTO monitoring
may be waived. The solvent management plan shall include a list of the total toxic organic compounds used and the other elements listed in the General
- Permit. For those facilities electing to employ the TTO monitoring waiver,the discharger shall sign the following certification statement:
"Based upon my inquiry of the person or persons directly responsible for managing compliance with the permit monitoring requirement for total toxic organics
(TTO), I certify that to the best of my knowledge and belief, no dumping of concentrated toxic organics into the stormwater or areas which are exposed to rainfall or
stormwater runoff has occurred since filing the last discharge monitoring report I further certify that this facility is implementing the all the provisions of the
solvent management plan included in the Stormwater Pollution Prevention Plan "
itince
Name(Print name)
�._ Oki-e/1-1,;4--7
Title(Pr' t title) , /
dS 2a `it
(Signature) (Date)
Note: Results must be reported in numerical format. Do not report Below Detection Limit, BDL, <PQL, Non-detect, ND, or other similar non-numerical
format. When results are below the applicable limits,they must be reported in the format, "<XX mg/L",where XX is the numerical value of the detection
limit, reporting limit, etc. in mg/L.
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new oil per month.
No discharge this period?2
Date Sample 24-hour rainfall
Outfall No. Collected) amount, Non-polar O&G/TPH by
(mo/dd/yr) Inches3 EPA 1664(SGT-HEM) Total Suspended Solids pH
Benchmarks=__> - - 15 mg/L 100 mg/L or 50 mg/L* 6.0—9.0 SU -
•
Footnotes from Part A also apply to this Part B
*See General Permit text,Table 5, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Permit Date: 11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 2 of 3

Air
-Nyou report a sample value in excess ofthe benchmark, you must implement Tier 1, Tier 2, or Tier 3 responses. See General Permit text.
IfP PPp
FOR PART AAND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ® NO❑
IF YES,HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ® NO❑
REGIONAL OFFICE CONTACT NAME: Mr. Mike Lawyer
•
Mail an original and one copy of this DMR, including all"No Discharge"reports, within 30 days of receipt of the lab results(or at end of monitoring period
in the case of"No Discharge"reports)to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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."
71 "2714_01--.‘ 05--- 7 -Z-114,
(Signature of Permittee) (Date)
Permit Date:11/1/2012-10/31/2017 SWU-245, last revised 10/25/2012
Page 3 of 3