HomeMy WebLinkAboutNCG080928_MONITORING INFO_20180213STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
/v
DOC TYPE
❑HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ p� b! b b
YYYYMMDD
0
i-ann
Monitoriniz Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted February 13, 2018
CERTIFICATE OF COVERAGE NO. NCG080928
FACILITY NAME Waste Industries - Stedman
COUNTY CUMBERLAND
PERSON COLLECTING SAMPLES J D FREI/ SwSG
LABORATORY Pace Anaytical Lab Cert. # __12/ 633
Comments on sample collection or analysis: pH measure by SwSG
#5054
0
SAMPLE COLLECTION YEAR 2018
SAMPLE PERIOD 0 Jan -June ❑ July -Dec
or ❑ Monthly' (month)
DISCHARGING TO CLASS ❑ORW ❑HQW []Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
0 Other C. Sw
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ✓ e�
(if yes, report your analytical results in the table immediately below) REC • Lid
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
FEE 2 2 Nit
_pi,e mm FILES
no
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400,E��ION
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 -- 9.0
15
-
001
01/29/18
140
7.85
< 5.0
+/- 115
002
No discharge during this rainfall event
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0-9.0
1 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 Last revised April 11, 2013
Page 1 of 2
STORMENT CHARACTERISTICS: • •
Date 01/28-29/18(first event sampled)
Total Event Precipitation (inches): 1.99"
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
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 EXCEE DANCE 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 ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one copy o f this DMA, including all "No Discharge" reports, within 30 days of receipt ofthe lab results (or at end of monitoring period in
the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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 inoormation, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that
there are signific pen Ities for sub itting false information, including the possibility of fines and imprisonme t for knowing violations.
16�.-..
(Signature of P rmittee) (Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-250 Last revised April 11, 2013
Page 2 of 2
Semi-annual Stormwater DI'�schar a MonitoringReport
for North Carolina Division of Water Quality General Permit No. NCGO80000
Date submitted May 102018
CERTIFICATE OF COVERAGE NO. NCG080928 SAMPLE COLLECTION YEAR 2018
FACILITY NAME Waste Industries - Stedman SAMPLE PERIOD 0 Jan -June ❑ July -Dec
COUNTY CUMBERLAND or ❑ Monthly' (month)
PERSON COLLECTING SAMPLES J D FREI/ SwSG DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
LABORATORY_ Pace Anaytical _ Lab Cert. # _12/ 633 ❑Zero -flow ❑Water Supply ❑SA
Comments on sample collection or analysis: IH measure by SwSG RECEIVED 0 Other c 5w
#5054
JUL 0 2 2018 PLEASE REMEMBER TO SIGN ON THE REVERSE 4
CENTRAL FILES
Did this facility perform Vehicle Maintenance Activities using more than 531AallonsCOf"r>Cew motor oil per month? ✓ yes _no
(if yes, report your analytical results in the table immediately below)
Part A; Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L'
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
15
-
001
04/24/18
21.1
7.021
< 5.0
+/- 115
002
No discharge during this rainfall event
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 - 9.0
I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 Last revised April 11, 2013
Page I of 2
STORM EA CHARACTERISTICS: .0
0
Date 04 24 18 (first event sampled)
Total Event Precipitation (inches): 1.13"
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Trer 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 EXCEE DANCES 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 ANYONE OUTFALL? YES ❑ NO 21
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Moil an original and one copy of this DMR, including oil "No Discharge" reports, within 30 days of receipt if the lab results (or at end of monitoring period in
the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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."
(Date)
ditional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-250
Last revised April 11, 2013
Page 2 of 2
• •
Semi-annual Stormwater Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCGO80000
CERTIFICATE OF COVERAGE NO. NCG080928
FACILITY NAME Waste Industries - Stedman
COUNTY CUMBERLAND
PERSON COLLECTING SAMPLES J D FREI SwSG
LABORATORY Lab Cert. #
Comments on sample collection or analysis:
Date submitted January 15, 2018
0
SAMPLE COLLECTION YEAR 2017
SAMPLE PERIOD ❑ Jan -June Q July -Dec
RECEIVEn or ❑ Monthly' (month)
D SCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
JAN 2 5 2018 ❑Zero -flow ❑Water Supply ESA
CENTRAL FILES 2 Other C Sw
DWR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ✓ yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
15
-
001
No discharge during Year 5 Period 2
+/- 115
002
No discharge during Year 5 Period 2
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L.
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
1 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-2>0 Last rcN7iscd April 11. 2013
Page 1 of 2
•
STORM EVENT CHARACTERISTICS:
Date (first event sampled)
Total Event Precipitation (inches): `
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Ter 2, or Tier 3 responses. See General Permit text
FOR PART 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 it SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO Q
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results for at end of monitoring period in
the rase of "No_Dischame" reports) to:
Division of Water Resources
Attn: DWR 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."
(Signature(of Pe
! 8
4 ate
Additional copies of this form may be downloaded at: http:/Jportal.ncdenr.org/web/wg/ws/suLpdessw#tab-a
SWU-250 Last revised April 11, 2013
Page 2 of 2
Y
0 STORMWATER DISCHARGE OUTFALL (SDO) * 0
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)1 SPPP Annual Update DATA REVIEW FORM
Calendar Year 2017
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG 0 8 0 9 2 8
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: Waste Industries -- Stedman Garage _
County: Cumberland
Phone Number: (910 ) 423-4122 Total no. of SDOs monitored 2
Outfall No. 001
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No O
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No RI JAN 2 5 2018
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Outfall
No.
Date
Sample
Collected
mm/dd/ r
Rainfall
inches
00530
00400
00556
Total Suspended Solids,
mg/L
pH,
Standard Units
Oil and Grease,
mg/L
New Motor Oil Usage,
Annual average gaV'mo
Benchmark
-
100
Within 6.0 — 9.0
15
-
001
03/19/15
0.40
8.5
6.56
< 5.0
+1- 95
001
11 /09/15
0.77
50.7
6.79
< 5.0
+1- 95
001
09/29/16
2.56
9.7
6.85
< 5.0
+/- 95
001
03/31/17
1.61
13.2
1 6.70
1 < 5.0
+/- 115
001
No discharge during Year 5 Period 2
+/- 115
SWU-264 - Generic Annual DMR
Last revised 5/17/2013
• •
Additional.Outfall Attachment
Outfall No. 002
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No lI
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No R
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes 0 No ❑
Outfall
No.
- h
Date
Sample
Collected
mmldd/vr
Rainfall
inches
00530
06400
00556
-
Total Suspended Solids,
mg/L
pH,
Standard Units
Oil and Grease, .
inglL
New Motor Oil Usage,
Annual average gall ma
Benchmark
-
100
Within 6.0 — 9.0
15
-
002
03/19/15
0.40
4.5
6.87
< 5.0
+/- 95
002
11/09/15
0.77
No dis arpe this Perrod'due to re -construction of Detention Basin'
002
09/29/16
2.56
53.3
6.76 -
< 5.0
+/- 95
002
No discharge during Year 5 Period 1
+/- 115
002
No discharge during Year 5 Period 2
+/- 115
Faircloth Skimmer device originally installed at a lower invert nvas removed prior to this event.
SWU-264 - Generic Annual DMR
Last revised 511712013
0 0
Y"I certify, under enalt of law, that this document and all attachments were prepared under m direction or supervision in accordance w4th a
fY P Y P P Y P
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
Date
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
EVILLE REGIONAL OF:
2090 US Highway 70
Swannanoa, NC 28778
(828) 296-4500
3800 Barrett Drive
Raleigh, NC 27609
(919) 791-4200
585 Waughtown Street
Winston-Salem, NC 27107
(336) 771-5000
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
(910} 433-3300 _
kSHINGTON REGIONAL OFFI
943 Washington Square Mall
Washington, NC 27889
(252) 946-6481
1617 Mail Service Center
Raleigh, NC 27699-1617
(919) 807-6300
610 East Center Avenue/Suite 301
Mooresville, NC 28115
(704) 663-1699
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
(910) 796-7215
"To preserve, protect
and enhance
North Camfina s water.
SWU-264 - Generic Annual DMR
Last revised 5/1712013
0 Semi-annual Stormwater Aharge Monitorin Re ort
q
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted Aril 12 2017
CERTIFICATE OF COVERAGE NO. NCG080928
FACILITY NAME Waste Industries - Stedman
COUNTY CUMBERLAND
PERSON COLLECTING SAMPLES _ J D FREI/ SwSG
LABORATORY Pace Analytical Lab Cert. # 12/ 40
Comments on sample collection or analysis: pH measured in field by
SwSG Lab Cert No. 5054
•
SAMPLE COLLECTION YEAR 2017
SAMPLE PERIOD 0 Jan -June ❑ July -Dec
RECEIVAQ or ❑ Monthly' month
ARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
APR 28 2017 ❑Zero -flow [:]waterSupply ❑SA
CENTRAL FILES 0 Other C. Sw
DWR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ✓ yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0-9.0
15
-
001
1 03/31/17
13.2
6.70
1 < 5.0
+/- 115
002
03/31/17
No discharge this event
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfa Il
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
1 For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 Last revised April 1 1.2013
Page I of 2
STORM EVO CHARACTERISTICS: •
Date 03/31/17 Afirst event sampled)
Total Event Precipitation (inches): 1.61"
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: if you,report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier3 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 It SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO Q
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reworts within 30 day
s o1 receipt of the lab results (or at end_atmonitorina period in
the case of "No Discharge" reports) to:
Division of Water Resources
Attn: DWR 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 su itting false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Pe mittee)_ ( ate)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wg/ws/su/npdessw#tab-4
SWU-250 Last revised April 11, 2013
Page 2 of 2
'r STORMWATER DISCHARGE OUTFALL (SDO)
• ANNUAL SUMMARY DATA MONITORING REPORT (DMR)1 SPPP Annual Update DATA REVIEW FORM
Calendar Year 2016
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COG) No. NCG 0 8 0 9 2 8
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP. F E g - 2 2017
3
i
Facility Name: Waste Indus ries - Stedman Garage
County: Cumberland
Phone Number: (910 ) 423-4122 Total no. of SDOs monitored 2
Outfall No. 001
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No El
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No 0
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes Q No ❑
Outfall
No.
Date
Sample
Collected
mm/dd/ r
Rainfall
inches
00530
00400
00556
Total Suspended Solids,
mg/L
pH,
Standard Units
Oil and Crease,
mg/L
New Motor Oil Usage,
Annual average gall mo
Benchmark
-
100
Within 6.0 — 9.0
15
-
001
03/19/15
0.40
8.5
6.56
< 5.0
+/- 95
001
11/09/15
0.77
50.7
6.79
< 5.0
+/- 95
001
09/29/16
2.56
9.7
6.85
< 5.0
+/- 95
SWU-264 - Generic Annual DMR
Last revised 5/172013
Additional Outfall Attachment
Outfall No. 002
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No #�
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No 10
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes 0 No [—
Outfall
No.
Date
Sample
Collected
mm/dd/ r
Rainfall
inches
00530
00400
00556
Oil and Grease,
mg/L
Total Suspended Solids,
mg/L
pH,
Standard Units
New Motor Oil Usage,
Annual average gall mo
Benchmark
-
100
Within 6.0 -- 9.0
15
< 5.0
-
002
03/19/15
0.40
4.5
6.87
+/- 95
002
11/09/15
0.77
No disc har
e this Period due to re
-construction of Detention
< 5.0
Basin'
002
09/29/16
2.56
53.3
6.76
+/- 95
' Faircloth Skimmer device originally installed at a lower invert was removed prior to this event.
SWU-264 - Generic Annual DMR
Last revised 511712013
" I cer(fy, under penalty of law, that this documant and all attachments were prepared under my direction or supervisic)n in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based oh 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 4elief, true, accurate, and complete. I am aware that there are significant penalties for submitting false informatioh,
including the possibility of
Signature
Date
and imprisonment for knowing violations,"
For questions, contact your local Regional Office:
DWQ Regional Office Information:
WILLE REGIONAL OFF_
N90 US Highway 70
Swannanoa. NC 28778
(828) 296-4500
:IGH REGIONAL OF
3800 Barrett Drive
Raleigh, NC 27609
(919) 791-4200
585 Waughtown Street
Winston-Salem, NC 27107
(336) 771-5000
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
(910) 433-3300
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
(252)946-6481
1617 Mail Service Center
Raleigh, NC 27699-1617
(919) 807-6300
40ORESVILLE REGIONAL OFFICI
610 East Center Avenue/Suite 301
Mooresville, NC 28115
(704)663-1699
127 Cardinal Drive Extension
Wilmington, NC; 28405-2845
(910) 796-7215
"To preserve, protect
and'enhance
North Carolina's Ivater._."
SWU-264 - Generic Annual DMR
Last revised 5/17/2013
Semi-annual Stormwati
Reoort
for North Carolilna Division of Water Quality General Permit No. NCG080000
Date submitted
CERTIFICATE OF COVERAGE NO. NCGO80928
FACILITY NAME Waste Industries - Stedman
COUNTY CUMBERLAND
PERSON COLLECTING SAMPLES J D FREI( SwSG
LABORATORY- Pace Analytical Lab Cert. # 12/ 633__
Comments on sample collection or analysis: pH measured in field by
SwSG (Lab Cert No. 5054)
October 11, 2016
0
SAMPLE COLLECTION YEAR 2016
SAMPLE PERIOD ❑ Jan -June 0 July -Dec
or ❑ Monthly) (month)
DISCHARGING TO CLASS ❑ORW ❑HQW ❑Trout ❑PNA
❑Zero -flow ❑Water Supply ❑SA
0 Other C, Sw
PLEASE REMEMBER TO SIGN ON THE REVERSE ->
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ✓ yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (if applicable)
❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
005S6
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 —9.0
15
-
001
09/29/16
9.7
6.85
< 5.0
+/- 95
002
09/29/16
53.3
6.76
< 5.0
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfali
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH,EPA Method
1664 (SGT-HfM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 Last revised April 11, 2013
Page I of 2
STORM AT CHARACTERISTICS:
Date 09/29/16 (first event sampled)
Total Event Precipitation (inches): 2.56" i
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches): `
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 ANYONE OUTFALL? YES ❑ NO 0
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one conv of this DMR, includina all "No Discharae" reports, within 3D days of receipt of the lab results for at end of monitoring period in
the case of "No Discharae" reports) to:
Division of Water.Resources
Attn: DWR 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 submitt' g false information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee) (Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.orp,/web/wq/ws/su/npdessw#tab-4
SWU-250 Last revised April 11, 2013
Page 2 of 2
r
is
STORMWATER DISC GE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) l SPPP Annual Update DATA REVIEW FORM
Calendar Year 2015
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG 0 8 0 9 2 8
This monitoring report summary of the calendar year should be kept on rile on -site with the facility SPPP.
Facility Name: Waste Industries — Stedman Garage
County: Cumberland
Phone Number: (910 ) 423-4122 Total no. of SDOs monitored 2
Outfall No. 001 _
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No B i
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No 0
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued? J A N 3 2016
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ® No ❑
Outfall
No.
Date
Sample
Collected
mm/ddl r
00530
00400
00556
Total Suspended Solids,
mg/L
pH,
Standard Units
Oil and Grease,
mg/L
New Motor Oil Usage,
Annual average gall mo
Benchmark
-
100
Within 6.0-9.0
15
-
001
03/19/15
8.5
6.56
< 5.0
+1- 95
001
11/09/15
50.7
6.79
< 5.0
+/- 95
SWU-264 - Generic Annual DMR
Last revised 511712013
•
Additional Outfall Attachment
Outfall No. 002
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No Q
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No 0
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes a No ❑
Outfall
No.
Date
Sample
Collected
mm/ddlvr
00530
00400
00556
Total Suspended Solids,
mg/L
pH,
Standard Units
Oil and Grease,
mg/L
New Motor Oil Usage,
Annual average gaU mo
Benchmark
-
100
Within 6.0 — 9.0
15
-
002
03/19/15
4.5
6.87
< 5.0
+/- 95
002
11/09/15
No discharge this Period due to re -construction of Detention Basin
SWU-264 - Generic Annual DMR
Last revised 5/17/2013
'I certify,ter penalty of law, that this document and all attachments welprepared under my direction or supervision in accordance wiPa
stem 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 ipnprisonment for knowing violations."
Signature
Date
DWQ Regional Office Contact Information;
For questions, contact your local Regional Office:
u
ASH_ EVILLE REGIONAL OFFICE FAYETTEVILLE REGIONAL OFFICE MOORESVILLE REGIONAL OFFICE
2090 US Highway 70 i 225 Green Street 1 610 East Center Avenue/Suite 301
Swannanoa, NC 28778 Systel Building Suite 714 Mooresville, NC 28115
(828) 296-4500 Fayetteville, NC 28301-5043 (704) 663-1699
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
(919) 791-4200
WIN_ STON-SALEM REGIONAL OFFICE i
585 Waughtown Street
Winston-Salem, NC 27107
(336) 771-5000
_ (910) 433-3300 _
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
(252) 946-6481
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
(919) 807-6300
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
(910) 796-7215
"To preserve, Prolecl
and erTharice
Notlh Caroli:ta's ivalar
SWU-264 - Generic Annual DMR
Last revised 511712013
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEWFORM
Calendar Year 2014
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG 0 8 0 9 2 8
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name Waste Industries_— Stedman Garage
County: Cumberland
Phone Number: g( 1O) 423-4122 Total no. of SDOs monitored 2
Outfall No. 001
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No El
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No 0
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑ J A N 2 0 2015
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes 0 No ❑
Parameter, (units)
Total
Rainfall,
inches
Total
Suspended
Sroli L
pH
(Std. Units)
Oi_I & Grease
(mg/L)
New Motor
Oil Usage
(gals/ mo)
Benchmark
MIA
100
6.0 - 9.0
75
-
Date Sample
Collected,
mmlddlyy
,
,..
07/21/14
0.77"
16.7
6.83
t 5.0
+1-90
_
12/29/14
0.511,
23.8
9.72
¢ 5.0
+!- 95
SWU-264 - Generic Annual DMR
Last revised 511712013
Additional Outfall Attachment s
Outfall No. 002
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No 0
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No 0
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑ �.
Was this SDO monitored because of vehicle maintenance activities? Yes 0 No ❑
Total
Rainfall,
inches
Parameter, (units)
Total
Suspended
Solids
(mglL)
PH
(Std. Units)
Oil 8 Grease
(mgfL)
New Motor
age Oil Us
(gals! age
Benchmark
N/A
100
6.0.9.0
15
-
Date Sample
Collected,
mmlddlyy
07/21/14
0.77"
< 8.3
6.75
< 5.0
+1- 90
12/29/14
0.511,
10.6
6.60
<5.0
-F—
t
SVVU-264 - Generic Annual DMR
Last revised 511712013
"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 o nes nd imprisonment for knowing violations."
Signature
Date aXZS
For questions, contact your focal Regional Office: !
UWQ Regional Office Contact Information:
2090 US Highway 70
Swannanoa, NC 28778
(828)296-4500
RALEIGH REGIONAL OFFICE
80 30 Barrett Drive
Raleigh, NC 27609
(919)791-4200
INSTON-SALE_M REGIONAL OF_I
585 Waughtown Street
Winston-Salem, NC 27107
(336) 771-5000
+AYETTEVILLE REGIONAL OFFICt
225 Green Street W
Systel Building Suite 714
Fayetteville, NC 28301-5043
(910)_.433-3300
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
(252)946-6481
1617 Mail Service Center
Raleigh, NC 27699-1617
(919) 807-6300
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
(704) 663-1699
WILMINGTON REGIONAL OFFi(
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
(910) 796-7215
"To ye-esetve, protect
and enhance II
nloritl Carolina's water.-.^J
SWU-264 - Generic Annual DMR
Last revised 5/17/2013
® • •
Semi-annual Stormwat_er Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
Date submitted _ November 27, 2015
CERTIFICATE OF COVERAGE NO. NCG080928 SAMPLE COLLECTION YEAR 2015�
FACILITY NAME Waste Industries - Stedman SAMPLE PERIOD ❑ Jan -June 2 July-Dec
COUNTY CUMBERLAND or ❑ Monthly" '(month)
PERSON COLLECTING SAMPLES _ J D FREI/ SwSG RGING TO CLASS ❑ORW ❑HQW QTiouOPNA
LABORATORY Pace Analytical Lab Cert. # 12/633 RECEiih1� []Zero -flow ❑Water Supply ❑SA
Comments on sample collection or analysis: _pH measured in field by
�C O 4 �fl�5 Q Other C, Sw
SwSG Lab Cert No. 5054
CENTRAL FILES PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ✓ yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable)
❑ No discharge this period
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
i5
-
001
11/09/15
50.7
6.79
1 < 5.0
+/- 95
002
11/09/15
No flow today
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfal I
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0 — 9.0
For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 Last revised April 11, 2013
Pagel of 2
STORM EVENT CHARACTERISTICS:
Date _11/09/15 _ (first event sampled)
Total Event Precipitation (inches): 0.77"
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
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 11 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 ANYONE OLITFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
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 Resources T
Attn: DWR 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 pen Iti s for submitting false information, including the possibility of fines and imprisonment for knowing violations."
hp I., L
(Signature of Permittee) ( te)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/nodessw#tab-4
SWU-250 Last revised April 11. 2013
Page 2 of 2
® ® •
Semi-annual Stormwater_Discharge Monitoring Report
for North Carolina Division of Water Quality General Permit No. NCG080000
A14
Date submitted April 7, 2015
CERTIFICATE OF COVERAGE NO. UMQ.,80,P,28 SAMPLE COLLECTION YEAR 2015 ��A^
FACILITY NAME Waste Industries - Stedman SAMPLE PERIOD 0 Jan -June ❑ July -Dec
COUNTY CUMBERLAND or El monthly' (month)
PERSON COLLECTING SAMPLES J D FREI/ SwSG RECFAIVCHMG TO CLASS ❑ORW ❑HQW ❑Trout ,0?NAB
LABORATORY Pace Analytical Lab Cert. # 12/ 67 ai� ❑Zero -flow [:]water Supply ❑i
APB
Comments on sample collection or analysis: _pH measured in field by 0 Other C, Sw ik
SwSG (Lab Cert No. 5054) _^ CEN i W\L FILES
DWR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE -a
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ✓ yes _no
(if yes, report your analytical results in the table immediately below)
Part A: Vehicle Maintenance Areas Monitoring Requirements (If applicable) ❑ No discharge this period'
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00530
00400
00556
Total Suspended
Solids, mg/L
pH,
Standard units
Non -Polar Oil and Grease/TPH EPA
Method 1664 (SGT-HEM), mg/L
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
50 or 100 see permit
Within 6.0 — 9.0
15
-
001
03/19/15
8.5
6.56
< 5.0
+/- 95
002
03/19/15
4.5
6.87
< 5.0
Part B: Oil/water Separators and Secondary Containment Areas at Petroleum Bulk Stations and Terminals (If applicable)
Outfall
No.
Date
Sample Collected,
mo/dd/yr
00556
00530
00400
Non -Polar Oil and Grease/TPH EPA Method
1664 (SGT-HEM), mg/L
Total Suspended Solids,
mg/L
pH,
Standard units
Permit Limit
-
15
50 or 100 see permit
6.0-9.0
I For sampling periods with no discharge at any single outfall, you must still submit this discharge monitoring report with a checkmark here.
SWU-250 Last revised April 11, 2013
Page 1 of 2
0
STORM EVENT CHARACTERISTICS:
Date 03/19-20/15_ (first event sampled)
Total Event Precipitation (inches): 0.40"
Date (list each additional event sampled this reporting period, and rainfall amount)
Total Event Precipitation (inches):
Note: If you report a sample value in excess of the benchmark, you must implement Tier 1, Tier 2, or Tier 3 respanses. 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 ANYONE OUTFALL? YES ❑ NO 10
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oriainal and one copy of this DMR, including all "No Discharae" reports, within 30 dovs of receipt of the lab results for at end of monitorina period in
the case of "No Discharae" reports) to:
Division of Water Resources
Attn: DWR 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."
�1 }
1
(Signature of Permittee) (Dat
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-250 Last revised April 11, 2013
Page 2 of 2