NCG500676_2018 DMR_20190107

EFFLUENT
NPDES PERMIT NO. NCG500676 DISCHARGE NO. Effluent MONTH December YEAR 2018
FACILITY NAME Hexion Specialty Chemicals CLASS N/A COUNTY Columbus
CERTIFIED LABORATORY (1) Environmental Chemists CERTIFICATION NO. #94
(list additional laboratories on the backside/page 2 ofthis form)
OPERATOR IN RESPONSIBLE CHARGE (ORC) Phil Busovne
PERSON(S) COLLECTING SAMPLES Phil Busovne
CHECK BOX IF ORC HAS CHANGED Q
Mail ORIGINAL and ONE COPY to:
ATTN: CENTRAL FILES
DIVISION OF WATER RESOURCES
1617 MAIL SERVICE CENTER
GRADE II CERTIFICATION NO.
ORC PHONE [phone]
NO FLOW / DISCHARGE FROM SITE
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
WW2 987116
DATE
DWR Form MR-1 (08/05)

UPSTREAM/DOWNSTREAM
NPDES Permit No
Facility Name
Stream
Location
NCG500676
Hexion Specialty Chemicals
Livingston Creek
UPSTREAM
cl--
Discharge No. 002
Month December Year 2018
County Columbus
Stream Livingston Creek
Location
DOWNSTREAM
•
ffII, M,
DWR Form MR-3 (Revised 8/2014)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
(including weekly averages, if applicable)
Compliant
All monitoring data and sampling frequencies do NOT meet permit requirements
Noncompliant
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially
threatens public health or the environment. Any information shall be provided orally within 24 hours from the time the
permittee became aware of the circumstances. A written submission shall also be provided within 5 days of the time the
permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for
improvements to be made as required by Part II.E.6 of the NPDES permit.
"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 managed 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."
f-10"Z_V �� N-Z , fLrrz I'
Permittee (Please print or type)
- /d I /
�l
Si nature of P rmittee*** Date
(Required unless submitted electronically)
Permittee Address Phone Number e-mail address Permit Expiration Date
Certified Laboratory (2)
Certified Laboratory (3)
Certified Laboratory (4)
Certified Laboratory (5)
ADDITIONAL CERTIFIED LABORATORIES
PARAMETER CODES
Certification No.
Certification No.
Certification No.
Certification No.
Parameter Code assistance may be obtained by calling the NPDES Unit at [phone] or by visiting
http://portal.ncdenr.org/web/wq/swp/ps/npdes/appforrns.
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be
entered for all of the parameters on the DMR for the entire monitoring period.
"* ORC On Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*X* Signature of Permittee: If signed by other than the permittee, then the delegation of the signatory authority must be on
file with the state per 15A NCAC 2B .0506(b)(2)(D).
Page 2