NCG140138_MONITORING INFO_20190426

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV �& No 13
DOC TYPE
❑ HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ of b a
YYYYM M D D

STORMWATER DISCHARGE OUTFALL (SDO) - MONITORING FORM
REC% N,,@& PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140138. APR H19 SAMPLE COLLECTION YEAR:
FACILITY NAME: Gre stone Concrete Products Inc.. SAMPLING PERIOD: ❑July -December January -June
SAMPLE COLLECTOR: r�I`� ,{�%Y1Y1�11 ��ALILE SAMPLING FREQUENCY: Quarter) Semi-annual)
CERTIFIED LABORATORY _ Lab # COUNTY Vance
Lab # PHONE N0. 252-438-5144
OPTIONAL INFO: ADD TO LISTSERVE? []YES []NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout [:]Other G
Part A: Stormwater Monitoring Requirements
Outfall No.
Date Sample
Collected
(mm/dd/yr OR
NO FLOW]
pH
(Standard Units)
TSS
(mg/L)
Total
Rainfall'
(in)
In Tier 2
Monthly Monitoring?
(y/n)
# of Months in Tier 2
Sampling'
-
-
6-91
1002,3
Loa
%n -
�---
' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the Sample period above.
If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
° For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 8/1/2017-6/30/2022 Last Revised 8/09/17
Page 1 of 2

V � �
Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using,> 55 gal of new motor oil/month — averaged over a calendar year.
Outfali
No.
Date Sample
Collected
(mo/dd/yr)l
PH
(Standard
Units)
Non -Polar
Oil & Grease using
method1664
SGT-HEM
(mg/L)
Iota!
Suspended
Solids
(mg/L)
Total
Rainfall'
(in)
New Motor Oii Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
II of Months in Tier 2
Sampling'
6-9'
15'
1001"
-
-
-
-
_—�-_
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCFS AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO [
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this_DMR including all "No Flow" & "No Discharee" reports) within 30 days of receipt of sample for at end of monitoring period
in case of "No Flow") to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUSTSIGN 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
am aware tLaj_thnr�e. are sign rant penalt�6 for submitting false information, including the possibility of fines and imprisonment for knowing violations."
I
(Signature o Permittee) / (D�te)
Permit Date: 8/1/2017-6/30/2022 Last Revised 8/09/17
Page 2 of 2

PROCESS WASTEWATER —Discharge Monitoring Report
r-...g. _�gwiign
GENERAL -PERMIT No. NCG140000
APR 0 3 2019
CERTIFICATE OF COVERAGE NO. NCG140138 CENTRAL FlLr_ SAMPLE COLLECTION YEAR: �OIy
FACILITY NAME: Gemstone Concrete Products, Inc. UPIR SEC T10' SAMPLE PERIOD: ❑July -December January -June
SAMPLE COLLECTOR: SAMPLE FREQUENCY: Quarterly �q Semi-annually ❑
CERTIFIED LABORATORY: Lab # COUNTY: Vance
Lab # z%- PHONE NO.: 252-438-5144
ADDTO LISTSERVE? ❑YES ONO EMAIL: ,.
LIMIT VIOLATIONS? YES ❑ NO ❑ DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout Other G
OPTIONAL INFO:
Part A. Wastewater Monitoring Requirements
Outfall No.
Date Sample
Collected �
dd r
(mm / /y)
Type of Wastewater
[VE, RM, MD)z
pH
(standard]
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
Non -Polar
Oil & Grease
using method
1664 SGT-HEM c
(mg/L)
Discharge
Duration
(minutes)
Total Flow
(gallons/day]
-
-
-
,-93,4
303.s
53
(15)6
-
I
~~
i
If wastewater systems have not discharged in this quarter— report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff
notifies you to continue monitoring.
Permit Date: 8/1/2017-06/30/2022
Last Revised 08/09/17
Page 1 of 2

V
pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
' Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall beset to 50% of the Summer 70.10 Flow as per 15A
NCAC 029 .0224. Permittees who discharge wastewater.to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD 1N CASE OF "NO FLOW") TO:
Division of Water Resources ^
Attn: DWR 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."
re of Perm
Permit Date:8/1/2017-06/30/2022
ate)
Last Revised 08/09/17
Page 2 of 2

C
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) -- WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year �ZO/it
`Report ALL WASTEWATER monitoring data on this form (include"No Flow"rNo Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 9 of each year. I
Certificate of Coverage No, NCG140138
Facility Name: Greystone Concrete Products, Inc.
County: Vance
Phone Number: 252-438-5144 Total no. of outfalls monitored l
Certified LaboratoryG Lab #
Lab #
Wastewater (WW) Discharge Outfall No. e.41
Does this outfall discharge WW to SA waters? Yes ❑ No
Does this outfall discharge WW to SB or PNA waters? Yes ❑ No
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ NoI
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No (X
Were there any limit violations in the calendar year? Yes No ❑
Outfaf] No.
Daily Flow Rate,
cfs
pH,
SU
TSS,
mgll
SS,
mill
if applicable
Non -Polar O&G (EPA Method
1664 (SGT-HEM)), mgll
Effluent
Limitations
Daily Maximum
HQW or ORW
50% of 7Q10
Indicate NO FLOW if
applicable
freshwater
6.0-9.0
saltwater
6.8-8.5
Standard
3�
HQW
20
0
HQW I ORIN and Tr, or
PNA
10
HQW, ORW, SA, SB, PNA,
orany'rrout
�
No Limit
Samples above Benchmark Sam
P
subject to Tiered Responses
15
Date
Sample
Collected,
molddlyr
`;Nbt'Applidable'
_
for"Greystonew
4
E �F
;i,
_
j -r�`'
-, .
-- .
Not Applicable
for Greystone'
-�. '' l
.Y` s ..'.r ti
E� r.
nntn
l
lv AR 0 7 6V J
CENTRAL FILES
DWR 5EL I IUN
i
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

4k
1814 A 9 12 K-A 110101
Certificate of Coverage No. NCG140138
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."
[Required by 40 CFR §122.221
Signature
Date , s /% -?ic>
Mail Annual Summary Wastewater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in DWR (not DEMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
CAttn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

r- . ";a
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE`
General Permit No. NCG140000
Calendar Year '
"Report ALL STORMWATER monitoring data on this form (include "No Flow" P`No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 9 of each year.
Certificate of Coverage No. NCG140138 -�~"_' "
Facility Name: Greystone Concrete Products, Inc. MAR 0 7 20!�
County: Vance CENTRAL FILE ;
CWR Lq;=,- C�Ir -
Phone Number: 252-438-5144 Total no. of SDOs monit&ed_
Certified Laboratory �( i✓�/_l�%t�,F�f_ Lab # rT
Lab #
Stormwater Discharge Outfall (SDO) No. /969VMA Outfall? Yes ❑ No
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No l
Was this outfall ever in Tier 2 during the past year? Yes ❑ No
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
Other ❑
..0
Outfall No.
Total Rainfall,
inches
-
Total
Suspended
Solids ( 1,
Mg/1
pH,
SU
Non -polar O&G
(EPA Method
1664TSS (SGT-HEM)),
mgll (VMA)
lrappBuablo
New Motor Oil
Usage (gallmo.)
If applicable
Stormwater
Benchmarks
ladlcaftr NO FLOW if
applicable
ci nchmark
� Q Q
6. U-9. a
1 �
>55 gaUmo. average requires T55 and
Non•polarO&Gmonitoring
Date Sample
Collected,
Iddlyr
;
'
f�
l
i
IWIF
LF—
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

C
Certificate of Coverage No. NCG 140138
Additional Outfall Attachment (rnake copies as needed for additional outfalls)
)Stormwater Discharge Outfall (SDO) No. _ VMA Outfall? Yes` No ❑
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No`W
Was this outfall ever in Tier 2 during the past year? Yes ❑ No�
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
Other
J
Outfall No.
Total Rainfall,
inches
.
Total
Suspended
Solids ( ),
mgll
pH,
SU
Non -polar O&G
(EPA Method
1664TSS (SGT-HEM)),
mgll (VMA)
It applicable
New Motor Oil
Usage (gal/mo.)
It applicable
-
Sformwafer
Benchmarks
Indicate NO FLOW IF
applicable
carch mark
(q n(�XO
105
6.0-9, 0
1 CJ
>55 gallmo. average requires T55 and
Non -polar 08G monitoring
Date Sample
Collected,
molddlyr
:r
i
Permit Date 8/1/2017 — 6130/2022
Last Revised 8-22-2015.

Certificate of Coverage No. NCG 140138
CERTIFICATION
"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."
[Required by 40 CFR §122.221
Signature
Date J'�
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in DWR (not DEMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

PROCESS WASTEWATER —Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
RECEIVED
CERTIFICATE OF COVERAGE NO. NCG140138 JAN 2 2 20�MPLE COLLECTION YEAR: �i^v%�
FACILITY NAME: Gre stone Concrete Products Inc. SAMPLE PERIOD: uly-December []January
SAMPLE COLLECTOR:r �T Y /�//�� y CENTRAL FltsAMPLE FREQUEN Y: QuarterlyV Semi-annually ❑
CERTIFIED LABORATORY:
l �� Lab # DWR SECTIQCOUNTY: Vance
Lab # err PHONE NO.: 252-438-5144
LIMIT VIOLATIONS? YES ❑ NO ❑
Part A: Wastewater Monitoring Requirements
ADD TO LISTSERVE? ❑YES "NO EMAIL: 11 ,
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trou them L�
OPTIONAL INFO:
Outfall No.
Date Sample
Collected 1
(mm/dd/yr)
Type of Wastewater
(VE, RM, MDjZ
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
Non -Polar
Oil & Grease
using method
1664 SGT-HFM6
(mg/L)
Discharge
Duration
(minutes)
Total Flow
gallons/day)'
-
-
-
6-93•4
3035
53
(15)G
-
-
1 If wastewater systems have not discharged in this quarter— report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
31f an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff
notifies you to continue monitoring.
Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17
Page 1 of 2

4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters,10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
' Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY INCLUDING ALL "NO FLOW" "NO DISCHARGE" WITHIN 30 DAYS OF RECEIPT OF SAMPLE OR
AT END OF MONITORING_ PERIOD IN CASE OF F "NO FLOW"] TO:
Division of Water Resources
Attn: DWR 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."
ature
( te]
Permit Date: 8/1/2017-06/30/202A1 / Last Revised 08/09/17
Page 2 of 2

�+r
STORMIMATER DISCHARGE OUTFALL (SDO) - MONITORING FORM
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140138 SAMPLE COLLECTION YEAR:
FACILITY NAME: Gre stone Concrete Products Inc. SAMPLING PERIOD: 0July-December ❑ January -June
SAMPLE COLLECTOR:y SAMPLING FREQUENCY: Quarterly: ❑ Semi-annually
�,1�/ %
CERTIFIED LABORATORY Lab # COUNTY Vance
12e- {jam Lab # PHONE NO. 252-438-5144
OPTIONAL INFO: ADD TO LISTSERVE? ❑YES ❑NO EMAIL:
�r
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Others G
Part A: Stormwater Monitoring Requirements
Outfall No.
Date Sample
Collected
(mm/dd/yr OR
NO FLOW)'
pH
(Standard Units)
TSS
(mg/L)
Total
Rainfall"
(in)
In Tier 2
Monthly Monitoring?
(y/n)
# of Months in Tier 2
Sampling
-
6-92
1002.3
-
-
IV
RECEIVED
nP
r)%AIDi
Cf 1 �I
If "NO FLAW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
z If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range,
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
"For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date: 8/1/2017-5/30/2022 Last Revised 8/09/17
Page 1 of 2

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year,
Outfall
No.
Date Sample
Collected
(mo/dd/yr)1
pH
(Standard
Units)
Non -Polar
Oil & Grease using
method 1664
SGT--HEM
(mg/L)
Total
Suspended
Solids
(mg/L)
Total
a
Rainfall
(in)
New Motor Oil Usage
(gal/month)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier 2
Sampling'
6_9'
15'
1002,3
_
_
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO'I
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Orieinal and one coov of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample for at end of monitoring period
in case of "No Flow") to:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST S1GN TH15 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 t e•information the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware that there are 'gni#ieant penalti ,submitting f se information, including the possibility of fines and imprisonment for knowing violations."
ke
(Signature of ter ' ,(0 e
Permit Date: 8/1/2017-6/30/2022 Last Revised 8/09/17
Page 2 of 2

PROCESS WASTEWATER --Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG140138 SAMPLE COLLECTION YEAR:
FACILITY NAME: Gre stone Concrete Products Inc. SAMPLE PERIOD: July -December ❑January -June
SAMPLE COLLECTOR:i� SAMPLE FREQUEN Y: Quarterly LA Semi-annually ❑
CERTIFIED LABORATORY: Lab # COUNTY: Vance
i= Lab # PHONE NO.: 252-438-5144
r! r ADD TO LISTSERVE? []YES [:]NO EMAIL:
LIMIT VIOLATIONS? YES ❑ NO ❑ DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other(
OPTIONAL INFO:
Part A: Wastewater Monitoring Requirements
Outfall No.
Date Sample
Collected'
(mm/dd/yr)
Type of Wastewater
{VE, RM, MD} Z
pH
{standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
Non -Polar
Oil & Grease
using method
1664 SGT-HEM6
(mg/L)
Discharge
Duration
(minutes)
Total Flow
,
(gallons/day}
-
-
-
6-93'4
3035
53
(15)6
-
-
LID
_
1 `
T I
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff
notifies you to continue monitoring.
Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17
Page 1 of 2

pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
s TS5 limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
e Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas, TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
' Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY INCLUDING ALL "NO FLOW" "NO DISCHARGE" WITHIN 30 DAYS OF RECEIPT OF SAMPLE OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Resources
Attn: DWR 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." - , IV'.. A
ature
Permit Date:8/1/2017-06/30/2022
( te}
Last Revised 08/09/17
Page 2 of 2

PROCESS WASTEWATER —Discharge Monitoring Report RECEIVED
GENhRAL PERMIT NO. IVCG140000
CERTIFICATE OF COVERAGE NO. NCG140138
FACILITY NAME: Gre stone Concrete Products Inc.
SAMPLE COLLECTOR:
CERTIFIED LABORATORY: Lab #
Lab # _i2X,--_
LIMIT VIOLATIONS? YES ❑ NO X
Part A: Wastewater Monitoring Requirements
JUN 21 2o18
CENTRAL FILES
SAMPLE COLLECTION YEAR: DWR SECTION
SAMPLE PERIOD: []July -December. XJanuary-June
SAMPLE FREQUENCY: Quarterly A
5erbi-annually ❑
COUNTY: Vance
PHONE NO.: 252-438-5144
ADD TO LISTSERVE? ❑YES []NO EMAIL:
DISCHARGING TO CLASS: [—]SA ❑HQW ❑PNA ❑Trout ❑Other;L'
OPTIONAL INFO:
Outfall No.
Date Sample
Collected x
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD) x
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
Non -Polar
Oil & Grease
using method
1664 SGT-MEM6
(mg/L)
Discharge
Duration
(minutes)
Total Flow
7
�gallans/day}
-
-
6-93,4
303.s
53
(15)1
-
-
1 If wastewater systems have not discharged in this quarter— report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD), Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff
notifies you to continue monitoring.
Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17
Page 1 of 2

° pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action,
7 Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall beset to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
1 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." / 6% %
N- �fiature of Peirmittee)
Permit Date:8/1/2017-06/30/2022
■�/�7/ i _
Last Revised 08/09/17
Page 2 of 2

PROCESS WASTEWATER —Discharge Monitoring Report
GENERACPERMIT NO. NCG140000
APR 10 2018
CERTIFICATE OF COVERAGE NO. NCG140138 SAMPLE COLLECTION YEAR: S'
CENTRAL FILE5AMPLE PERIOD: []July -December January -June
FACILITY NAME: Gre stone Concrete Products Inc. UWrR SECTIQA'
SAMPLE COLLECTOR:. SAMPLE FREQUENCY: Quarterly iemi-annually ❑
CERTIFIED LABORATOR Lab # COUNTY: Vance
Lab # /� K,5' PHONE NO.: 252-438-5144
ADD TO LISTSERVE? ❑YES []NO EMAIL:
LIMIT VIOLATIONS? YES NO ❑ DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other G/
TC OPTIONAL INFO:
Part A: Wastewater Monitoring Requirements
Outfail No.
Date Sample
Collected 1
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD}Z
pH
(standard}
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
Non -Polar
Oil & Grease
using method
1664SGT-HEM6
(mg/L)
Discharge
Duration
(minutes)
Total Flow
,
(gallons/day}
-
-
-
6-93,a
303.5
53
(15)6
-
-
r
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled,
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DEMLR RO staff
notifies you to continue monitoring.
Permit Date: 8/1/2017-05/30/2022 Last Revised 08/09/17
Page 1 of 2

4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
s TSS limits are 20 mg/L for wastewater discharges to HQW waters,10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
s Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
' Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DEMLR. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DEMLR, and the DEMLR Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Resources
Attn: DWR 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
(Signature of ermittee) [ ej
Permit Date: 8/1/2017-06/30/2022 Last Revised 08/09/17
Page 2 of 2

I
e
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year
Report ALL WASTEWATER monitoring data on this form (include "No Floe+!'/"No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year. J
Certificate of Coverage No. NCG140138
Facility Name: Greystone Concrete Products, Inc.
County: Vance
Phone Number: 252-438-5144 Total no. of outfalls monitored
Certified Laboratory[ lam, Lab # D
Lab #
Wastewater (WW) Discharge Outfall No. d2O
Does this outfall discharge WW to SA waters?
Yes ❑
Nog
Does this outfall discharge WW to SB or PNA waters?
Yes ❑
No to
Does this outfall discharge WW to HQW or ORW waters?
Yes ❑
No Dq
If so, what is the 7Q10 flow rate? or Tidally influenced waters,
7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters?
Yes ❑
No %
Were there any limit violations in the calendar year?
Yes
No ❑
Outfall No.
Daily Flow Rate,
pH,
TSS,
SS,
Non -Polar O&G (EPA Method
cfs
SU
mg/I
mlll
j 1664 (SGT-HEM)), mg/I
!f applicable
Standard
Effluent
HOW or ORW
50% of 7Q10
freshwater
6.0-9.0
30
W HOW, OR, SA, SB, PNA,
No Limit
Limitations
HOW
20
or any Trout
5
frtdlcafe NO FLOW if
saltwater
SamplesaboveBenchmark
applicable
6.$—$.
HOW I ORW and Tr, or
subject to Tiered Responses
Dally Maximum
PNA
15
10
Date
'No#:Applicable
`"
'Not Applicahle:
Sample
for=Geeystorie
u
r
for Greystone
?' 5
Collected,
mo/ddl r
17
SPH
AJ
g
`ter o
� o
c
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2017

d
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT [DMR] -- WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year
*Report ALL WASTEWATER monitoring data on this form (include "No Flow"/"No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH i of each year.
Certificate of Coverage No. N CG 140138
Facility Name: Greystone Concrete Products, Inc.
County: Vance
Phone Number: 252-438-5144 Total no. of outfalls monitored
Certified LaboratorygJ y�/i j� Lab #
Lab #
Wastewater (WW) Discharge Outfall No. O�2 /
Does this outfall discharge WW to SA waters? Yes ❑ Nog
Does this outfall discharge WW to S13 or PNA waters? Yes ❑ No
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No m
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ Nolte
Were there any limit violations in the calendar year? - Yes No ❑
Outfall No.
Daily Flow Rate,
cfs
pH,
SU
TSS,
mgli
SS,
mill
if applicable
Non -Polar O&G (EPA Method
1664 (SGT-HEM)), mg/1
Effluent
Limitations
Daily Maximum
o OW or ORW
50 /o of 7Q10
Indicate NO FLOW if
applicable
freshwater
6.0-9.0
saltwater
6.8-8.5
Standard
30
HOW
20
HOW I ORW and Tr, or
PNA
10
HOW, ORW, SA, SB, PNA
oranyTrout
5
No Limit
Samples above Benchmark
subject to Tiered Responses
15
Date
Sample
Collected
mo/ddl r
Y
Not �Applicable�
-
for,�,Greystone
7.J"y
rI t �5. �,, �1
"G !a s- 2
Yfi
" a" r
hR. i"l
gUV
r, '}r`:_S'i_//.
��
J„a�^.`1- J`
r '
rF - ­'°
.m2�T✓..'G Yl'YfF
Not Applicable
s7- - �`fi f
for;Greystone�
za y ? rv� v �
1 Y4.
I -z �y{
- �l.i. r "v
r��
} r t 'c 51 "` r
y t ,
I£ ly'i� ^t- j.L �..,T-�
r?3�. C F« c t �wxuc3C
/
�H[i�/3�r
/
f—)
/7
g
r
Permit Date 811i2017 — 6/30/2022
Last Revised 8-22-2017

Certificate of Coverage No. N CG 140138
C,
CERTIFICATION
"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."
(Reorfirrd by 41) ('.FR 8122 221
Sig
Dal
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct - Central Files is housed in DWR (not DEMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
C Raleigh, NC 27699-1617
Central Files Telephone [phone]J
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

t)
PROCESS V4/ASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG141,1a2IE?
FACILITY NAME: �' J
PERSON COLLECTING 5 MPLES:;
CERTIFIED LABORATORY: LA #
.: Lab # +
LIMIT VIOLATIONS? YES F1 NO ❑
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLE QUARTER: Jul-SeptOct-Dec ❑Jan-MarcF
COUNTY: G
PHONE NO. ()
ADD TO LISTSERVE? 7YEs Flho EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA [—]Trout
OPTIONAL INFO:
❑April -June
11 []Other Ci G rI
Outfall No,
Date Sample
Collected'
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)'
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SG
(mg/L) g/Lj
Duration
(minutes)
Total Flow
(gallons/day)
-
-
-
6-93,4
303.5
53-
rlk90
��d'�I1/CIS
JAII
Z018
h�I'•f1F7AAAT11'
t� Oprnrnnn.., ...
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 T5S limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Datp- 7/1/2010-06/30/2015 Last Revised 07/13/11
,ge 1 of 2

G Process —tewater discharges shall only be monitored for TPH w+�., , hen commingled stormwater discharges from VMA areas. TPH does not have a limit for. cewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
' Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DINQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY INCLUDING ALL "NO FLOW" "NO DISCHARGE" WITHIN 30 DAYS OF RECEIPT OF SAMPLE OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN n41S 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." /. /l / r
ure of Pe
Permit Date: 7/1/2010-06/30/2015
(Daeej
Last Revised 07/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14/9 4_IL
FACILITY NAME:('
PERSON COLLECTINGAMPLES
CERTIFIED LABORATORY Lab #
P Lab # /5�7
OPTIONAL INFO:
Part A: Stormwater Monitoring Reauirements
SAMPLE COLLECTION YEAR: ZO%,7
SAMPLING PERIOD: ly-December ❑ January -June
COUNTY i
PHONE NO. ('�]
ADD TO LIST ERVE? [:]YES NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout []Other
Outfall No. •
Date Sample Collected
(mo/dd/yr OR
NO FLOW)1
PH
(Standard
Units
TS5
(mg/L)
Event
Duration
(minutes)
Total 4
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2 SamplingZ
-
6-9
10021
-
i r
AN 0 3 10i8
a
v V1>
IiY'd{idLUi.v.
r nm PPOCESSING UNR
I 0
�
I
V
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
° For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Date• 711/2011-50/30/2015 Last Revisers 7/13/11
Page 1 of

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfail
No.
Date sample
p
Collected i
(mo/dd/yr)
pH
(Standard
Units)
TPH using method
.1664A5GT-HEM
(mg/L)
Total Suspended
Solids
(mg/L)
Event
Duration
(minutes)
Total
Rainfa114
(in)
New Motor Oil
Usage
(gal/month)
In Tier 2
Month,ly
Monitoring?
(y/n)
# of Months
in Tier 2
Sampling2
6-4
15
1002'
-
-
-
-
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO'❑
HAVE YOU CONTACTED THE REGION? YES ❑ No ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring period
in case of "No Flow") to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
YOU MUST SIGN T141S 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
am aware that there penalti • fo 5mitting Ise information, including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee) �(6afei
t
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2 of

0
PROCESS ASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14.L�) 1.SAMPLE COLLECTION YEAR; 1-0/1
FACILITYNAME:�yrr �7/a�rRr7/1�II17; atUARTER: I -Sept ❑Oct -Dec [JJan-March []April -June
PERSON COLLECTING SA PLES: O, A
CERTIFIED LABORATORY: La # OCT 2 SHAN� NO. ice)
Lab # GEN ADD TO LISTSERVE? YES NO EMAIL:
❑ ❑ DWR SEj ❑ ❑ ❑ ❑�G�,
LIMIT VIOLATIONS? YES NO GiNG TO CLASS: SA HQW PNA Trout OtherG
OPAIINAL INFO:
Part A: Wastewater Monitoring Requirements
Outfall No.
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
Z
RMMD)
(VE, ,
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 1664A
6
SGT HEM
(mg/L)
Discharge
Duration
(minutes)
Total Flow
7
(gallons/day]
-
-
-
6-93'4
303.5
53
(15)6
-
UZaly
C L/
1 If wastewater systems have not discharged in this quarter— report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
" pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Data• 7/1/2010-06/30/2015
Last Revised 07/13/11
,ge1of2

J
Process .._tewater discharges shall only be monitored for TPH when commingled \,.. _, stormwater discharges from VMA areas. TPH does not have a limit for. cewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW" "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, Borth Carolina 27699-1617
[phone]
YOU MUST SIGN T141S 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." _W ____ r-, / f i
re of Permitted) {
Permit Date: 7/1/2010-06/30/2015
14 // 11/ �) z / z
(D te)
Last Revised 07/13/11
Page 2 of

WX
PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE N0. NCGI40 /
FACILITY NAME: -
PERSON COLLECTING AMPLES: (�jy%}�/y�J%
CERTIFIED LABORATORY: _ LA #
Lab #t _jna�_
LIMIT VIOLATIONS? YES ❑ NO ❑
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLE QUARTER: ❑Jul-S pt Oct -Dec ❑Jan -March *ril-June
COUNTY:
PHONE NO.
ADD TO LISTSERVE? ❑YES ONO EMAIL:
DISCHARGING TO CLASS: [:]SA ❑HQW ❑PNA ❑Trout �therc./,� c
OPTIONAL INFO:
Outfall No.
Date Sample
i
Collected
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)'
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SG7-HEM'
(mg/L)
Duration
(minutes)
Total Flow
7
(gallons/day)
-
-
6-93'4
303,5
53
(15)6
-
/'9 cs o • two
VC
-Li
I 1: nl�
GlEniq i RAL FILE
S
If wastewater systems have not discharged in this quarter— report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit DatP-7/1/2010-06/30/2015
Last Revised 07/13/11
�ge 1 of 2

6 Process —. tewater discharges shall only be monitored for TPH when commingled i,. stormwater discharges from VMA areas. TPH does not have a limit for .cewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 026.0224. Permittees who discharge wastewater to HQW waters.shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING_ PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN T141S 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."----�- &/ /—
Pe
Permit Date:7/1/2010-06/30/2015
(D ej
Last Revised 07/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE No. NCG14 0L a
FACILITY NAME: y'
PERSON COLLECTING S MPLE
CERTIFIED LABORATORY Lab #
pgl I]I�Lyi1/_ Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLING PERIOD: ❑ July -December nuary-June
COUNTY.
PHONE NO. lz ., )
ADD TO LISTSERVE? YES ❑NO EMAIL:
DISCHARGING TO CLASS: [—].SA ❑HQW ❑PNA [-]Trout gothere G
iOutfall No
•
Date Sample
Collected
-.
(mo/dd/yr OR.—..
i
=, NO FLOW]
pH
„ -,.(Standard',
nits)
TSS
;(mg/Lj
Event.
Duration .
{minutes)
Total d
Rainfall
... -
(in).`
In Tier 2
Monthly
Monitoring?
{Y/n)
# of Months .In Tier
2
.z Sampling•.
=9
,1a0
'
�
(21
1
If41
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
° For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Dar__�(1/2011-60/30/2015 Last Revisr`3 13/11
Page 1 of )

r�
Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
+Outfall ,'
:No ..:,
yt. �� ��
NI]ate!Sam IeAT
p '= t
._; . Collected Fr
".i.t4 �.� 4f r 'x �f•:.+.
w
r!
. p H s
f. ,, ;:,
�.3 5tandard
�.°� , ,
;.Units]
�1... � x �,i�--�
TPH usin +method
9i,
y ;4•t ..,,,._ -
1664A SGT HEM'Solid
x.R `� : +'
�r-, ��.�4 nw r:
To4aI Sus entled
L - p
-
.
fmg/L)
' ;u, yf_�. �t! A-
;.
Event
k s
puration
r i
- 1 minutes}
'`
Total
r a
cRainfall
t.-. :
F (ini
F
New4Motor<Oill�
Usa a
!., gal/monthj
'In:Tier 2
_ Monthly
Momtormg? _.
-
�r �., r
{(Y./n)
#I of•Montfis'-1:
to lie+ 2,
�' Samphngz
rwr
'�
15? c
3
100
-
r
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR fincludiniz all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample for at end of monitoriniz period
in case of "No Flow"] 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:
9 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 f r gathering t e information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am awaroattat-thgr a e signif' nalties f submitting false information, including the possibility of fi es and imprisonment for knowing violations."'
(Signature o ermittee)/ (ate
Permit r'-`,: 7/1/2011-60/30/2015 Last Revised 7/13/11
Page 2

N
PROCESS WASTEWATER -- Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000 RECEIVED
CERTIFICATE OF COVERAGE NO. NCG14-Q,La_
FACILITY NAME: - 2 V =
PERSON COLLECTING 5 MPLES:
CERTIFIED LABORATORY: ab #
% G ' Lab ft
LIMIT VIOLATIONS? YES ❑ NO ❑
Part A: Wastewater Monitoring Requirements
MAR 2 2 20?7
SAMPLE COLLECTION YEAR: CENTRAL FILES
SAMPLE QUARTER: _❑Jul -Sept ❑Oct -Dec an`-'I+/lai� ON❑April-June
COUNTY: (/�%�G�
PHONE NO. (j
ADD TO LISTSERVE? 11YES NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout ❑Other�C
OPTIONAL INFO:
Outfall No.
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
z
(VE, RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Set lable
e
.solids
(mL/L)
TPH using
method 1664A
5GT-HEIW
(mg/L)
Discharge
Duration
(minutes)
Total Flow
7
(gallons/day)
-
-
-
6-93,4
303's
531
(15)6
-
-
i
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Datp: 7/1/2010-06/30/2015
Last Revised 07/13/11
,ge1of2

r
s Process wastewater discharges shall only be monitored for TPH when commingled � stormwater discharges from VMA areas. TPH does not have a limit for .—cewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
7 Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 70.10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") 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." �.
nature. o rmittee] ( te)
Permit Date: 7/1/2010-06/30/2015
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERA. PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14_0
FACILITY NAME:
PERSON COLLECTING S PLES:
CERTIFIED LABORATORY: Lab
Lab #�
LIMIT VIOLATIONS? YES ❑ NO ❑
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR: 16
SAMPLE QUARTER: ❑Jul -Sept ct-Dec ❑Jan -March []April -June
COUNTY: 6y
PHONE NO. (X�) - n
ADD TO LISTSERVE? OYES NO EMAIL: Olt
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other
OPTIONAL INFO:
Outfall No.
Date Sample
Collected
(mm/dd/yr)
Type of Wastewater
z
(VERMMD)
, ,
pH
{standard]
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L) ..
TPH usingDischarge
method 1664A
6
SG
/L)T-HEM
{mg/L]
Duration
(minutes)
Total Flow
7
(gallons/day]
-
-
-
6-93,4
303,5
S3
(15)6
-
-
Frnnn 1�
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Pt
Permit Date• 7/1/2010-06/30/2015
Last Revised 07/13/11
;e 1of2

s Process wastewater discharges shall only be monitored for TPH when commingled wiw stormwater discharges from VMA areas. TPH does not have a limit for w_ _dwater,
but instead is subject to benchmarks and provisions of Part 1V, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
-obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a rase -by -case basis.
MAIL ORIGINAL AIVD ONE COPY OF THIS ANNUAL SUMMARY I INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") 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 . /// 1. /1
al J147"
(Signature of Permittee)_ (Date)
Permit Date: 7/1/2010-06/30/2015 v Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000 -
CERTIFICATE OF COVERAGE NO. NCG14� SAMPLE COLLECTIO3YR:
FACILITY NAME:: n SAMPLE QUARTER:I-Sept ❑Oct -Dec ❑JanZMarche❑April-June
PERSON COLLECTING S PL S: COUNTY: t
CERTIFIED LABORATORY: b # \\ PHONE NO. ( j -
ab # \\ ADD TO LISTEVE? YES ❑ EMAIL:
r
LIMIT VIOLATIONS? YES [—]NO ❑ v DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Otheq�
OPTIONAL INFO:
Part A►: Wastewater Monitoring Requirements
Outfall No.
Date Sample
i
Collected
(mm/dd/yr)
Type of Wastewater
2
(VE, RM, MD)
pH
{standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
6
(SG rrtg/�) g/L)
Duration
(minutes)
Total Flow
7
{gallons/day)
-
-
-
6-93'4
303,5
53
(15)6
-
-
v
RECEIVED
CENTRAL FILES
UWR SECTION
1 If wastewater systems have not discharged in this quarter— report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Data- 7/1/2010-06/30/2015
Last Revised 07/13/11
,ge 1 of 2

r
e Process--cewater discharges shall only be monitored for TPH when commingled e. _., stormwater discharges from VMA areas. TPH does not have a limit for .. _,iewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer '7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY IINCLUDING ALL "NO FLOW" "NO DISCHARGE" WITHIN 30 DAYS OF RECEIPT OF SAMPLE OR
AT END OF MONITORING PERIOD #N CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, Borth 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. 1 am aware that there are signif!cant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
(Date)
Permit Date: 7/1/2010-06/30/2015
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG1401�5_Z
FACILITY NAME:
PERSON COLLECTING!SAMPLES}� � 0Nff402Y_
CERTIFIED LABORATORY: Lab #
=~ Lab # 1Q(5_
LIMIT VIOLATIONS? YES NOFJ
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR: �&
SAMPLE QUARTER: ❑Jul -Sept []Oct -Dec []Jan -March Oxpril-June
COUNTY:
PHONE NO.
ADD TO LISTSERVE? []YES ffNO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑Other�rG-
OPTIONAL INFO:
Outfall No.
Date Sample
Collected)
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)
pH
(standard}
Total Suspended
Solids
(mg/L}
Settleable
Solids
[mL/L}
TPli usingDischarge
method 1664A
SGT-H M
(mg/L)
Duration
{minutes}
Total Flow 7
(gallons/day)
-
-
-
6-93.4
303.5
53
(15)6
-
-
c
I K
1jj 1
!b'
c
nrr
' If wastewater systems have not discharged in this quarter -- report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
° pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
r1
Permit Date- 7/1/2010-06/30/2015 Last Revised 07/13/11
,e 1 of 2

6 Process wastewater discharges shall only be monitored for TPH when commingled A. stormwater discharges from VMA areas. TPH does not have a limit for w. .-,water,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AIVD ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW". "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING_ PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
0
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." %i z
re of itteej ( atej
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
Page 2 of 2

STORMI&ATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14_�2 4 4,3 5�)
FACILITY NAME:
PERSON COLLECTING S MPLES' D'
CERTIFIED LABORATORY ab #
Lii�f (j�AL1�7�f7�G Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLING PERIOD: ❑ July -December anuary-June
COUNTY
PHONE NO. { y
ADD TO LISTSERVE? YES "NO EMAIL:
DISCHARGING TO CLASS: [_]SA ❑HQW ❑PNA ❑Trout
❑Other G
Outfall No
Date Sample
- Collected .
F ( m_o/dd/yr OR
NO FLOW) -
PH
(Standard _
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total 4 -
Rainfall
(in),
In Tier 2
Monthly
Monitoring?:.,
(y/n)
# of Months in Tier
Z
2 Sampling
_ .
6-9
100
��
i� II
r► i'
I
I r
!'ALi
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here, Please make sure to mark the sample period above.
Z If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range,
3 TSS benchmark values are 100 mg/l, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/l,
"For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
V1 ®
2016
`ILES
ION
Permit Da '1/2011-60/30/2015 Last Revis--113/11
Page 1 of

Part 13: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
" No �'
Date Samples
F
i3= Collected I '
1
[mo/dd/yr]
P.
(Standard-
',"''
mt }
+U s
L
TPH;usmg"method'
1664A SGT=HEM
( mg/L]
TotalSuspended
solids",.
{mg/L}.
r
,
' Event
Duration•
inu.
(m sj
{ Total
a
Rainfall
`-
{i'nj
New Motor Oil
? Usage
ont
[gal/m h]
In Tier42
Monthly
Monitoring?
{y/n],
# of Months,
,
in Tier 2 ,
2,
5a milling
f,
59
s 15
1
i
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL {INCLUDING VEHICLE MAINTENANCE}? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one copy of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring period
in case of "No Flow") 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 gathBring th 'nformation, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aware.th there -are signif' nalties for bmitting false information, including the possibility of fines and imprisonment for knowing violations."
(Signs ermittee)/ l' ( te]
Permit Date: 7/1/2011-60/30/2015 v Last Revised 7/13/11
Page 2 of 2

STORMWATER DISCIIARGE OUTFA_LL (SDO)
MONITORING REPORT
GENERAL. PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE NO. NCC06 O 1$5
FACILITY NAMES ,oe
PEIISON COLLECTINCFSAMPLES ` f M
CERTIFIED LABORATORY _(+�er,rc Lab #
Lab #
Part A: Specific Monitoring Requirements
ftP_ttWEb
JUN 22 201b
CENTRAL FILES
SAMPLES COLLECTED DURING CAL'E�U fgW. 04-.
(This monitoring report is due at the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY 3vrr.1 _ r
lll[ONE NO. (33&
PLEASE SIGN ON TIIE REVERSE 4
O.utfiiU. ,
No
y'i:: ..• .. -.
Tlate
r SAmpie
r Col!lected`+
: •- '
[t!o'/d[II' IC :. �i
Q0530
�; QQ440
00340 , ;•
5��i,„
N `Total 5uspendgd rf
:. S..
olds �,
:1.r
to
�pli,
�S A _
t s
r n untt
a
y third.
ChGmtcal Oxygen
,, Dem r
an
d' ,x-
pn r :�
,Otl;anc��Greasef ,
mg
it F 'i, �,
r4 a
; Feeal Eoliform,' :
I
Co oiites per 140 nil
r
Iienchmiirk
L00 •
;Within
2Q r�.,
`''�30 • .:u. i +
;1000
oCe.
0
i�
<
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pl-I, you must implement Tier I or Tier 2 responses.
See General Permit text.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity onitoring 11e uirements
Outfall.
No: ` .
:., Date'
Sumple'Cotlected
makld/' r , •.....
.: 00556:.,,.
00530:::.:.:::.::.
0040U'
Oil and Crease,
in /[ .f ':; ..:
7-Total SU§pellded'SOlydb, :
m /L. ''
ply;
SCand'ard"units .
:New Mkdr 0I1.Usage'
Annual"avers a allmo
30.'
100
Note: If you report a sampled value in excess of the benchmark value, or outside the benchmark range for pH, you must implement Tier 1 or Tier 2 responses.
See General Permit text.
STORM EVENT CIIARACTERISTICS:
Date S-17-rl. (first event sampled)
Total Event Precipitation (inches): i s
Date (list each additional event sampled this reporting period, and rainfall amount)
Mats Original and one copy to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Total Event Precipitation (inches):
QNurT 9nn 1ng1n-e

"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 fiixes and imprisonment for knowing violations."
(Signature of ermittee) (Date
rj
SWU-249-102107
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report RECEIVED
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 0 g
FACILITY NAME: "
PERSON COLLECTING SAMPLES: 6 �f�/j2 y
CERTIFIED LABORATORY: Lab #
Lab #
LIMIT VIOLATIONS? YES n NO
Part A: Wastewater Monitoring Requirements
MAR 1 1 2016
CENTRAL FILES
SAMPLE COLLECTION YEAR:
DWR SECTION
SAMPLE QUARTER: []Jul -Sept Oct -Dec %Jan -March ❑April -June
COUNTY:
PHONE NO.
ADD TO LISTSERVE? []YES NO EMA L:
r
DISCHARGING TO CLASS: []SA ❑IiQW ❑PNA ❑Trout XjOther4�461 C
OPTIONAL INFO:
Outfail No.
Date Sample
i
Collected
(mm/dd/yr)
Type of Wastewater
z
(VE, RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
SGT-NEM6
(mg/L)
Duration
(minutes)
Total Flow
7
(gallons/day)
-
-
-
6-93,4
303,5
53
(15)6
-
-
i
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters,
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date:7/1/2010-06/30/2015
Last Revised 07/13/11
e 1 of 2

6 Process wastewater discharges shall only be monitored for TPH when commingled wiw stormwater discharges from VMA areas. TPH does not have a limit for v�_.._- ,water,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 1SA
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AIVD ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING_ PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THfS 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
Hermit uate: //l/Lulu-ub/iu/Lul5
3
!(Dat
Last Revised 07/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000.
CERTIFICATE OF COVERAGE NO. NCG14
FACILITY NAME: Gr
PERSON COLLECTING S MPLE
CERTIFIED LABORATORY Lab #
4&f 2�71�GqZ, Lab # D6
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLING PERIOD: uly-December ❑ January -June
COUNTY
PHONE NO. {� r
ADD TO LISTSERVE? YES [:]NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ther�� G
• Outfall No
:.Date Sample
-, Collected
mo/dd/yr
(. OR
NO FLOW):'
pH
(Standard
Units)
TSS
(mg/L)
Event
Duration
(minutes)
Total
n
Rainfall
(in)
In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
2
2 Sampling
-
6-13
100.=o
•'
%J �I
f P //
REC
IAN
lr s=1 4 11"t
mAIR E
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above,
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier I or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/i, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
° For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
aid
E-r—,
=IVED
) 6 2016
qL FILES
ECTION
Permit Da '1/2011-60/30/2015 Last Revis
Page 1 of
'13/11

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No
• -
Date_Sample"
r- Collected `'`
% _ /Y) :,
mo dd r 1
p H ;,
(Standard-
�-Units _.
�. 1
: TPHxusrn method
g,
1664A SG_T:HEM
m L
f mg }
,.
Tot: ;
al Suspended
u
Solids: ;
m' L
( g/ }•
Event
Duration
minutes
�... )
o „
Total
a
Rainfall
�n
( 1
.. .
New•Motor'Oil
Usage
al month
(g / 1,
r
In Tier 2.
Monthly
. Monitoring.
.(YLn1
# of Months:
in Tier 2 "
Sam Em z
P g
17
r
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ N00
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑ "^
REGIONAL OFFICE CONTACT NAME:
Mail Original and one coov of this DMR (including all "No Flaw" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitoring period
in case of "No Flow") to:
Division of Water Quality x ''
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 fo gath ing the M formation, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware that there are signifi pe ties for sub6tting false information, including the possibility of fines and imprisonment for knowing violations."
'41C, ,11 %
(Signature o ermittee) % (ur
atej
Permit Date: 7/1/2011-60/30/2015 t._­1 Last Revised 7/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring RepoRECEIVED
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 QL E
FACILITY NAME: y N
PERSON COLLECTING AMPLEST
CERTIFIED LABORATORY: La #
/ Lab #�
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitoring Requirements
NOV 0 4 2015
CENTRAL FILES
DWR SECTION
SAMPLE COLLECTION YEAR:
SAMPLE QUARTER: ❑Ju1-Sept Oct -Dec ❑Jan -March
COUNTY: �fYG�
PHONE IJO. ( j —
ADD TO LISTSERVE? ❑YE ❑NO. EM IL:
DISCHARGING TO CLASS: []SA ❑HQW ❑PNA []Trout
OPTIONAL INFO:
[]April -June
reG-
WOther
Outfall No.
Date Sample
i
Collected
(mm/dd/yr}
Type of Wastewater
(VE, RM, MD)z
pH
{standard}
Total Suspended
Solids
[mg/L}
Settleable
Solids
(mL/L}
TPH using
method 1664A
SG /L)ls
(mg/L}
Discharge
Duration
(minutes)
Total Flow
7
(gallons/day}
-
-
-
6-93.4
303,5
53
(15)6
-
-
A
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles {RM}, Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the perrnittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
?e 1 of 2

6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL. SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") 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."
re of Pe
Permit Date: 7/1/2010-06/30/2015
(te)
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring RePORECEIVED
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 t02_
FACILITY NAME: 1%
PERSON COLLECTING SAMPLES: r
CERTIFIED LABORATORY: Lab #
Zffl f1 _ Lab # —
LIMIT VIOLATIONS? YES ❑ NO ❑
Part A: Wastewater Monitoring Requirements
AU6 u b Lt; l5
CENTRAL FILES
-r' OWR SECTION
SAMPLE COLLECTION YEAR:
SAMPLE QUARTER: Jul -Sept ❑Oct -Dec ❑Jan -March []April -June
COUNTY:
PHONE 140.
ADD TO LISTSERVE? YES NO EM IL:
DISCHARGING TO CLASS: []SA ❑WQW ❑PNA ❑TroutOther G s
OPTIONAL INFO:
Outfall No.
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
Z
(VE,.RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(ml/L}
TPH usingDischarge
method 1664A
SGT HEM6
(mg/L)
Duration
(minutes}
Total Flow
7
(gallons/day)
-
-
-
6-93'4
303.5
53
(15)6
AdG4
AL
=1LES
DWR SEC
TIO
1 if wastewater systems have not discharged in this quarter— report "No.Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
31f an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
h pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015
Last Revised 07/13/11
_,aeIof2

6 Process wastewater discharges shall only be monitored for TPH when commingled wit,, .._ormwater discharges from VMA areas. TPH does not have a limit for wa- rater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
7 Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224, Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. if the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOWI_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
violation,.-" r
(Signature of
Permit Date:7/1/2010-06/30/2015
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER —Quarterly Discharge Monitoring
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 D
FACILITY NAME: YGr
PERSON COLLECTING MPLES: 6,/4W /7y
CERTIFIED LABORATORY: Lab #
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitoring Requirements
Report
SAMPLE COLLECTION YEAR. -
SAMPLE QUARTER: ❑Jul -Sept ❑Oct -Dec ❑Jan -March gAprif-June
COUNTY:
PHONE IJO.
ADD TO LISTSERVE?T❑YES ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout ❑OtherrL�r
OPTIONAL INFO:
Outfall No.
Date Sample
Collected'
(mm/dd/yr)
Type of Wastewater
Z
(VE, RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH using
method 166gA
6
SGT-HEM
(mg/L)
Discharge
Duration
(minutes)
Total Flow
7
(gallons/day)
-
-
-
6-93 a
303 s
53
(15)6
-
-
.'
' !
INFORW T Il
IN PROCRYqft
;1 I,\IIT
If wastewater systems have not discharged in this quarter,— report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
Z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
G pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date:7/1/2010-06/30/2015
Last Revised 07/13/11
-1l ge 1 of 2

6 Process wastewater discharges shall only be monitored for TPH when commingled wi h -�cormwater discharges from VMA areas. TPH does not have a limit for was��, Water,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 0213.0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUSTSIGN 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. 1 am aware that there,are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing
ature
Permit Date:7/1/2010-06/30/2015
{ atej
Last Revised 07/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 0 /� rL
FACILITY NAME:
PERSON COLLECTING AMPLES
CERTIFIED LABORATORY Lai #
Pd44, )-_)A1&X Lab # "
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION YEAR: %
SAMPLING P RIOD: ❑ July- ecember anuary-June
COUNTY LYt;� _.
PHONE N0. ()
ADD TO LISTSERVE?FIYES MN6 EMAIL: (r i
DISCHARGING TO CLASS: []SA ❑HQW ❑PNA ❑Trou thery("i,
Outfall No. �
:Date Sample
Collected
� �
. (mo/dd/yr OR
NO FLOW]
PH
(Standard
Units)
,(mg/L)
Event
Duration
(minutes)
Total
Rainfall' a
(m)
In Tier 2
Monthly
-
Monitoring?
(y/n)
#i � z of Months in Tier
2 Sampling
- .
&9
15
_CTION
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfail here. Please make sure to mark the sample period above.
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit, Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
'For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Dal '/l/2011-60/30/2015 Last Revise'-7/13/11
Page 1 of

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
x
Ou !I=
tfa
t
+ No
`
Date'SampleT,$
x Collected
i'a
(mo dd yr]
l 1 �
,OH
,xi tan d
;Unitsi
-
TPH using method
1664A SG:T NEM
: L
(mg/ ] r
' Total Suspended „
Solids`
{mg/L]
Event
Duration
{minutes]
Total
a
Rainfall
(in}
Ne►nr;Motor Oil
sage
g
(gal/month)
In Tier 2
Monthly
~Monitormg7
=;s ,t,.
n
# of. Months -
in Tier.2%
Z°
Sampling,
t '
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑ R
REGIONAL OFFICE CONTACT NAME:
iUb'R:4,di
i,-4 4
Mail Original and one coov of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample (or at end of monitorins period
in case of "No Flow") 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 g t ering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware thaLtberd_a.ra-significant e alties,for submitting false information, including the possibility of fines and imprisonment for knowing violations."
r
1 f �;' l(G<
{Signature o ermittee} ,f� . :'" f (D, te]/
Permit Date: 7/1/2011-60/30/2015 `' Last Revised 7/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 �(� 4_�.�
FACILITY NAME: ��� y '
PERSON COLLECTING A PLES: y
CERTIFIED LABORATORY: Cab #
.� Lab #
LIMIT VIOLATIONS? YE r NO ❑
Part A: Wastewater Monitorine Requirements
Report er,�-p
49
SAMPLE COLLECTION YEAR: 92 L
SAMPLE QUARTER: ❑Jul -Sept ❑Ott -Dec Jan -March ]�A' I -June
COUNTY:
PHONE 140. j
ADD TO LISTSERVE? niES EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA []Trout 'POthera&5j
OPTIONAL INFO:
Outfall No.
Date Sample
Collected
(mm/dd/yr)
Type of Wastewater
2
(VE, RM, MD)'
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TpH usingDischarge
method 1664A
6
SGT
(mgL) /L)HEM
Duration
(minutes)
Total Flow
(gallons/day)
-
-
6-93.4
303,5
53
(15)6
-
-
CENTRAL FILES
SECTIONDWR
E-
w.
I-=::
$NTft4k
'€1 N
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/2015 Last Revised 07/13/11
-,-e 1 of 2

e Process wastewater discharges shall only be monitored for TPH when commingled withoormwater discharges from VMA areas. TPH does not have a limit for wa- .dater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality. ," •'
Attn: DWQ Central Flles F I
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"1 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 sjg ifica enaltiesf r submitting false information, including the possibility of fines and imprisonment for knowing
violations." /
re of
Permit Date: 7/1/2010-06/30/2015
1
ate
Last -,Revised 07/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NC6140000
CERTIFICATE OF COVERAGE NO. NCG14
FACILITY NAME: /
PERSON COLLECTING A PLES r
CERTIFIED LABORATORY La #
J1= � 422;�& Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION Y SAMPLING PERIOD: July -December ❑ January -June
COUNTY
PHONE NO. [)
ADD TO LISTSERVE? YES L_jN0 EMAIL:
DISCHARGING TO CLASS: []SA ❑HQW ❑PNA [E]Trout them% �S G
Outfall No
--
,R Qate Sample
Collected •
(mo/dd/yr OR
NO FLOW)1.
pH
(standard
Units)
TSS
(mg/L)
Event .
Duration
(minutes)
Total
a
Rainfall
(in)
-.In Tier 2
Monthly
Monitoring?
(y/n)
# of Months in Tier
z
2 Sampling
_:..
6-9
100
-
-
-
2014
ENT
WR SECTION
1 If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 T55 benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
° For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge,
Permit Do '1/2011-60/30/2015 r Last ReviS 113/11
Page 1 of

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
'Outfall
i No
-V
.
} Date15ample;"
„_k(5tandard
Collected
ma%dd/ r 1 '
- yi)
6
u pH
"Units =�
Z
TPH'us�ng:methad`
E..
°1664A SGT-HEM
(mg/L)
Total Suspended
s Solids'°.
ling/L).
•r
Event
Duration
(minutes)
Total
a ,
Rainfall
- r
(rn)
-
'New -Motor Oil
Usage
(gal/monthj!!
.'. Monthly.
r
Monitoring?
�a(Y/n)'.
# of Months °.
in Tier 2
5amplingZ
-
-
-
HAS YOUR FACILITY HAD 4; OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUT FALL (INCLUDING VEHICLE MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED TWREGION? YE5`❑•NO ❑ �-
REGIONAL OFFICE CONTACT NAME:
Mail 0dizinal and one copy of this DMR fincludina all "No Flow" & "No Discharge" reports) within 30_days of receipt of sample for at end of monitoring period
in case of "No Flow") 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 respons le for gatherin the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete
am aware ere ar i penaltie or submitting false information, including the possibility of fines and imprisonment for knowing violations."
/ %�/
ature of Per ' ee) (D e)
Permit Date: 7/1/2011-60/30/2015 Last Revised 7/13/11
�� Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING FORM
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14
FACILITY NAME:
PERSON COLLECTING A PLES
CERTIFIED LABORATORY La #
Lab # '
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
SAMPLE COLLECTION Y R:
SAMPLING PERIOD: July -December ❑January -June
COUNTY
PHONE NO.
ADD TO LISTSERVE?' YES ❑IV EMAIL: fi
DISCHARGING TO CLASS: [_]SA ❑HQW ❑PNA ❑Trout other �5 L
-
Outfall No
Date Sample
`Collected
[mo/dd/yr.,OR
NO FLOW)z
pH
(Standard
Units)
TSS
(mg/G)
Event
Duration
(minutes)
Total 4
Rainfall-
(in)
In Tier 2 _
Monthly
Monitoring?-
(y/n)
# of Months,in Tier
z
2:Sampling
100
�+
9
oll
/
if ,Nn FI OW" nr "NO DISCHARGE. Enter "NO
FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark
the sample period above.
2 if a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
'TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Da" `11/2011-60/30/2015 i r 1 Last Revise`7113/11
Page 1 of !

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month -- averaged over a calendar year.
r
-
7
2:
,-
,fp
� H
TPH usm 'meihod
.'sTotahSus erided
p
; `Event.
'iotal
zNew_.Motor.0il
r
#I of Months
lOutfall `
Date,Sam lei
,F=, ,.i
.P•_
�� ,-��,gi_ �
1664A:SGT-HEM
.r `f
:Duration
nr
RRai
� F=
s
erzZ
x
.: ;..
Callected�'r,
r Standard9
[
; a r -+::
�• _ ! ,,, 3
�. ,Solids:
.' �.
ref
sage
,.:V�k
.Monitorin 7:
in
,
m y
: (Mg/L), +
r :,. m L :
Z �,.(, g/ ),
(minutes)
a (inj
r :(gal/month)
.: t'/
Sam' hn
P g
e
,(mo%dd/y
' D
_ ram,
'� z M a -
2
- '4, �
L-,�
dJxrf
�
l
,, Yln �y �
�
r �
.,`
r ,.1". `�
- i'
�:': �..:• �
-C' `
i L t
; :+-� -
i�
;�[` :.
Y- .y ?• 7 4 x
•d"' y 1 - -._-F
L - }-
, .-ni
L .. .^li 1�.
- .�57 rr� Y.}
ri7
r'
15Z
S
HAS YOUR FACILITY HAD .4 OR MORE BENCHMARK EXCEEDENCES AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES El NO ❑
HAVE YOU CONTACTED THE REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Orisinal and one coov of this DMR (including all "No Flow" & "No Discharge" reports) within 30-days of receipt of sample (or at end of monitoring period
in case of "No Flow") 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:
it, 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 respon.sjble for gatherin the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am aware ere ar scant penaltie or submitting false information, including the possibility of fines and imprisonment for knowing violations."
JS_igd
ature of Per ee) z (D e)
Permit Late: 7/1/2011-60/30/2015 Last Revised 7/13/11
- Page 2 of 2

,7
PROCESS.WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14_ 4Gli �n
FACILITY NAME:
PERSON COLLECTING SAMPLES:
CERTIFIED LABORATORY: La #
P Lab#ZO
LIMIT VIOLATIONS? YES ❑ N ❑ .
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLE QUARTER: []Jul -Sept NOct-Dec ❑Jan -March ❑April -June
COUNTY:
PHONE NO. ]
ADD TO LISTSERVE? ❑YES NO EMAIL-
%/ iI
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout %Otherl��
OPTIONAL INFO:
Outfa!! No.
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
z
(VE RM, MD)
pH
(standard)
Total Suspended
Solids
(mg/L)
SettleableTPH
Solids
(mL/L)
usingDischarge
method 1664A
6
SGT-HEM
(mg/L)
Duration
(minutes)
Total Flow
-r
(gallons/day)
-
-
6-93'4
303,5
53
(15)6
-
-
ng
ENT
L FIL
ION
' If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here, Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date:7/1/2010-05/30/2015
Last Revised 07/13/11
.age 1 of 2
U

i % ! G Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VIVA areas. TPH does not have a limit for was-,,4ter,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 028 .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY 1INCLUDING ALL "NO FLOW" "NO DISCHARGE" WITHIN 30 DAYS OF RECEIPT OF SAMPLE 10R
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW"] 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 signif}'canntt penalties r submitting false information, including the possibility of fines and imprisonment for knowing
violations."
of
Permit Date: 7/1/2010-06/30/2015
A-, A7191z-1
(Da 1
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14,0 SAMPLE COLLECTION YEAR:
FACILITY NAME: /' SAMPLE QUARTER: ❑Jul -Sept Oct -Dec []Jan -March ❑April -June rF
PERSON COLLECTING SAMPLES: COUNTY:
CERTIFIED LABORATORY: 6-bi PHONE hIO. Yam}
liT Lab #1 ADD TO LISTSERVE? ❑YES CVO EMAIL:
LIMIT VIOLATIONS? YES ❑ IV ❑ DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout KOther6_z
OPTIONAL INFO:
Part A: Wastewater Monitoring Requirements
Outfall No.
Date Sample
collected
(mm/dd/yr)
Type of Wastewater
z
(VERMMD}
, ,
pH
(standard}
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
a
5G7 HEM
{mg/L}
Duration
(minutes)
Total Flow
(gallons/day}
-
-
-
6-93.4
303,5
53
(15)8
1 If wastewater systems have not discharged in this quarter— report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
s TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/201S Last Revised 07/13/11
-e1of2

a Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wa- .rater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
' Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW" 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 signif'cant penalties r submitting false information, including the possibility of fines and imprisonment for knowing
violations."r��
ature of Perm
Permit Date:7/1/2010-06/30/2015
'.
Last Revised 07/13/11
Page 2 of 2

PROCESS WASTEWATER —Quarterly Discharge Monitoring Report
GENERAL PERMIT NO. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14�L/ L 3
FACILITY NAME: i,�EVS7DA/£ 6D1vCjc_1TT_ /2l�DlCGT'
PERSON COLLECTING SAMPLES: e,44141,42)Y _
CERTIFIED LABORATORY: Lab #
/ace-,¢AyyLyTi�4L- Lab# 6767
LIMIT VIOLATIONS? YES ❑ NO ❑
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION R: .:2 y/y
SAMPLE QUARTER I -Sept ❑Oct -Dec ❑Jan -March ❑April -June
COUNTY: VgA
PHONE IdO. r�z s�-j1
139
ADO TO LISTSERVE? []YES. ❑NO EMAIL:
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout 16 the
OPTIONAL INFO:
Outfall No.
Date Sample
i
Collected
(mm/dd/yr)
Type of Wastewater
z
(VE, RM, MD}
pH
(standard]
Total Suspended
Solids
(m
Settleable
Solids
(mL/L)
TPH usingDischarge
method 1664A
F
SG
(mg/L}g/L)
/L)
Duration
(minutes)
Total Flow
(gallons/day}
-
-
6-93.a
303'S
53
(15)6
-
-
4 /l D/
/• S
4, /D
7D/4
REILLIVED
T
CENTF
At c
DWR ,SECTION
1 If wastewater systems have not discharged in this quarter— report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
3 if an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
4 pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date: 7/1/2010-06/30/201S
Last Revised 07/13/11
`,e1of2

6 Process wastewater discharges shall only be monitored for TPH when commingled with ttormwater discharges from VMA areas. TPH does not have a limit for way. -Water,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY INCLUDING ALL "NO FLOW" "NO DISCHARGE" WITHIN 30 DAYS OF RECEIPT OF SAMPLE OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") TO:
Division of Water Quality
Attn: DWQCentral 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: 7/1/2010-06/30/2015
!o - D�
(pate)
Last Revised 07/13/11
Page 2 of 2

0
PROCESS WASTEWATER -- Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG140000
CERTIFICATE OF COVERAGE NO. NCG14 01g
FACILITY NAME: l "'
PERSON COLLECTING S MPLES:
CERTIFIED LABORATORY: La
LIMIT VIOLATIONS? YES ❑ NO
Part A: Wastewater Monitoring Requirements
1 If wastewater systems have not discharged in this quarter — report "No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
2 Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report more than one type if the waste -stream is commingled.
31f an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
SAMPLE COLLECTION YEAR: Z lh
SAMPLE QUARTER: ❑Jul -Sept ❑Oct -Dec ❑tan -March 6ppril-June
COUNTY: lll���"'
PHONE 140.1[)ZI
ADD TO LISTSERVE? UYES NO EMAIL:
DISCHARGING TO CLASS: ESA ❑HQW ❑PNA ❑Trout other
OPTIONAL INFO:
Outfall No.
Date Sample
1
Collected
(mm/dd/yr)
Type of Wastewater
(VE, RM, MD)'
pH
(standard)
Total Suspended
Solids
(mg/L)
Settleable
Solids
(mL/L)
TPW using
method 1664A
SGT-NEM6
(mg/L)
Discharge
Duration
(minutes)
Total Flow
�
(gallons/day)
-
-
-
6-93,4
303'5
53
(15)6
-
-
r
- i L --_ PN
Jilt_
tv+
.Y
+
notifies you to continue monitoring.
° pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Date:7/1/2010-06/30/2015
Last Revised 07/13/11
—,Re 1 of 2

e Process wastewater discharges shall only be monitored for TPH when commingled with cormwater discharges from VMA areas. TPH does not have a limit for wa—water,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered Response Action.
Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ and the DWQ Regional Office may require an annual flow
report on a case -by -case basis. '
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW" TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUSTSIGN 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 f9r submitting false information, including the possibility of fines and imprisonment for knowing
violations." /Av�-
(Signature of
Permit Date: 7/1/2010-06/30/2015
Last Revised 07/13/11
Page 2 of 2

STORMWATER DISCHARGE OUTFALL (SDO) - Semi -Annual MONITORING O,R, ._
GENERAL PERMIT NO. NCG140000 NECEIVED
CERTIFICATE OF COVERAGE NO. NCG14 O 1 a
FACILITY NAME:
PERSON COLLECTING SAA PLES
CERTIFIED LABORATORY L aX#
Lab #
OPTIONAL INFO:
Part A: Stormwater Monitoring Requirements
JUL 0 9 2014
SAMPLE COLLECTION YEAR: CENTRAL FILES
SAMPLING PERIOD: ❑ July -December anuary-June ❑WO/BOG
COUNTY
PHONE NO. )
ADD TO LISTSERVE? FrYES NO EMAIL:
DISCHARGING TO CLASS: ESA ❑HQW ❑PNA ❑Trou ther� G
•Outfall�Na
._,Date Sample
Collected.
[mo/dd/yr OR
N0 FLOW).'
pH
{Standard
Units}
TSS
(mg/L)
Event
Duration
(minutes)
Total a
Rainfall
[in}
In Tier 2
Monthly
Monitoring?
(y/n) .`
# of Months in,Tier.
2
2 Sampling•
_
-6.9
1o0 , -
' if "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here. Please make sure to mark the sample period above.
2 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit. Tier 2
Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range.
3 TSS benchmark values are 100 mg/I, except when discharging to ORW, HQW, Trout, and PNA waters where they are 50 mg/I.
4 For each sampled measurable storm event the total precipitation must be recorded using data from an on -site rain gauge.
Permit Da 11/2011-60/30/2015 Last Revis, '113/11
Page 1 of

Part B: Vehicle Maintenance Activity Monitoring Requirements for facilities using > 55 gal of new motor oil/month — averaged over a calendar year.
Outfall
No
x
Date Sample
.
f Collected
d/y�}1
pH
Standard;
'T..
ti• U nits}
TPH usrng;inethod
, _ . 4
1664A SG7;NEM
�, , :.
_ mg/L}
(
,Total Suspended
r
Solids;.-
r [mg/L)
1
Event
Duration
(minute
s�. ;z
';Total-'-
'.
> Rainfall ;°
in
3
.' New:Motor'Oil
-.,-Usage
g
{gal/month]
In Tier`2
Month) y
Monitormga ,
d-
fylnJ -
""# of Mor>Iths>:
;", in Tier2 "
Z=. .
Sa mpling
�
679
15
100
-
_
-
HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES AT ANYONE OUTFALL (_INCLUDING VEHICLE: MAINTENANCE)? YES ❑ NO ❑
HAVE YOU CONTACTED'THE,REGION? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail Original and one coin of this DMR (including all "No Flow" & "No Discharge" reports) within 30 days of receipt of sample for at end of monitoring period
in case of "No Flow") 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 responsib je for atthh7ering the in ormation, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
am awa7that-there are signifi real ies for su itting false information, including the possibility of fine and imprisonment for knowing violations."
{Si of Pe ittee�/ /l (IgteV
Permit Date: 7/1/2011-60/30/2015 [% Last Revised 7/13/11
Page 2 of 2

PROCESS WASTEWATER — Quarterly Discharge Monitoring Report
GENERAL PERMIT No. NCG146000
\V,
CERTIFICATE OF COVERAGE NO. NCG14 D-1— ,68—
FACILITY NAME:
PERSON COLLECTING S PLES:
` CERTIFIED LABORATORY: La
Lab#CK,_
LIMIT VIOLATIONS? YES NO
Part A: Wastewater Monitoring Requirements
SAMPLE COLLECTION YEAR:
SAMPLE QUARTER: []Jul -Sept Oct -Dec an -March ❑April -June
COUNTY: `1�r
PHONE 140. [ ) �' r'
ADD TO LISTSERVE? MYES flNO E AI :
DISCHARGING TO CLASS: ❑SA ❑HQW ❑PNA ❑Trout Ml]ther 5 G
OPTIONAL INFO:
0utfa11 No..,.Collected
'.Date Sample'
1
(mm/dd/yr)A
—Type of Wastewater
(V£, RM, MD 2
),
pH
stands
(standard) .
Total Suspended
Solids
(mg/L)
Settleable
Solids . '
(mL/L).
TP.H using
method 1664A
e
SG7-HEM:..
(mg/L)
Discharge .
Duiation .
(minutes)
. ' Total Flow"
'
(gallons/day)
6-93,a
303'5.
' 53
(15)6
MAh
19 201,d
r~
S
1 If wastewater systems have not discharged in this quarter— report"No Flow" or "No Discharge" here. Please make sure to mark the sample quarter above.
z Report the abbreviation for the type of Authorized Wastewater Discharges here: Vehicle and Equipment Cleaning (VE), Raw Material Stockpiles (RM), Mixing Drum
Cleanout (MD). Report' more than one type if the waste -stream is commingled.
3If an effluent limit is exceeded twice in a row, the permittee is required to institute monthly monitoring for that parameter for six months, unless DWQ RO staff
notifies you to continue monitoring.
° pH limits are 6-9 S.U. for wastewater discharges to freshwaters, and 6.8-8.5 S.U. for discharges to saltwaters.
5 TSS limits are 20 mg/L for wastewater discharges to HQW waters, 10 mg/L for Trout and PNA waters, and 30 mg/L for all other water classifications.
Permit Da* "/1/2010-06/30/2015 Last Revisers 07/13/11
geIof2

6 Process wastewater discharges shall only be monitored for TPH when commingled with stormwater discharges from VMA areas. TPH does not have a limit for wastewater,
but instead is subject to benchmarks and provisions of Part IV, Section A, including the Tiered.Response Action.
' Flow rate can be measured continuously or calculated. Flow limits for wastewater discharges to HQW waters shall be set to 50% of the Summer 7Q10 Flow as per 15A
NCAC 02B .0224. Permittees who discharge wastewater to HQW waters shall obtain a Summer 7Q10 flow and report this information to DWQ. If the permittee cannot
obtain a Summer 7Q10 flow for the receiving waters at the discharge location, the permittee shall notify DWQ, and the DWQ Regional Office may require an annual flow
report on a case -by -case basis.
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW"; "NO DISCHARGE") WITHIN 30 DAYS OF RECEIPT OF SAMPLE (OR
AT END OF MONITORING PERIOD IN CASE OF "NO FLOW") 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 REPO'RTED:,
N 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 any knowledge and belief, true, accurate, and
ti
complete. 1 am aware that there are sin c nt penalties fors bmitting false information, including the possibility of fines and imprisonment for knowing
violations."//�l
(Signature of
Permit Date:7/1/2010-06/30/2015
Last Revised 07/13/11
Page 2 of 2