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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IV Cc
DOC TYPE
❑HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑
YYWMMDD
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE'
General Permit No. NCG140000
Calendar Year 2019
Report ALL STORMWATER monitoring data on this form (include "No Flow")'"No Di bh®rge'�and=""Benchmark j
Exceedances) from the previous calendar year to the DEQ by MARCH 1'of each year. -_
Certificate of Coverage No. NCG 14 0416 Cah•rtw.\L I; ILES
Facility Name: Gobble Concrete DWR SECTION
County: Davidson
Phone Number: (336) 225-8235 Total no. of SDOs monitored 1
Certified Laboratory Prism Lab # 402
Lab #
Stormwater Discharge Outfall (SDO) No. 01 VMA Outfall? Yes ❑ No
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No
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
I
Outfall No:
i��rt
Total Rarnfal[;U
tis �
'^�
inches
, Totals r
,:
1, Ms06nded' `
�.�.
Solitls (TiSS),,.
s
.m 11 s
`"�� �i
� ► H, d
Pa a
�SU
n
J
`:v'Non -polar 0&G
w
(EPA Method
1664 (SGT-HEM))"
-��
mgli (VMA}r
F?;*
4�
NewMotor0il; -
Usage (gallmo) ;;.
� a�
rfapprroabla } , t F�.
1.
Stormwater
Indicate NO FLOW if
applicable
circle Benchmark
100150
6.0-9.0
c
15
r
>55 gallmo. average requires TSS and
Non -polar O&G monitoring
Date.Sample
Collected`3:
molddlyr.
5123/19
.15
29
9.4
N/A
NIA
10/16/19
.68
39
8.1
NIA
NIA
Permit Date 811/2017 — 6/3012022
Last Revised 8-22-2015
Certificate of Coverage No. NCG14 ❑❑❑❑
Additional Outfall Attachment (make 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 ❑
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 ❑
Outfall No.
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
mg/1
pH,
SU
Non -polar O&G
(EPA Method
1664 SGT-HEM
( ))'
mg/I (VMA)
if applicable
New Motor Oil
Usage (gallmo.)
It applicable
Stormwater
Benchmarks
Indicate NO FLOW it
applicable
Circle Benchmark
1 O V'JO
6. U-9.�
15
�55 g allma. avoraga requires T55 and
Non -polar 08G monitoring
Date Sample
Col lected,
molddl r
Permit Date 811/2017 — 6/30/2022
Last Revised 8-22-2015
Certificate of Coverage No
Additional Outfall Attachment (make copies as needed for additional outfalls)
NCG14 ❑❑❑❑
Stormwater Discharge Outfall (SDO) No. VMA Outfall? Yes ❑
Is this outfall currently in Tier 2 for any parameter? Yes ❑
Was this outfall ever in Tier 2 during the past year? Yes ❑
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
u
No ❑
No ❑
No ❑
Outfall No.
Total Rainfall
inches
Total
Suspended
Solids (TSS),
m II
pH,
SU
Non -polar O&G
(EPA Method
1664 (SGT-HEM)),
mg/1 (VMA)
New Motor Oil
Usage (gallmo.)
Stormwater
Benchmarks
Indicate NO FLOW if
applicable
Circle Benchmark
fyn150
� 0 V
6.0-9.0
'� 5
�55 g allmo. average requires T55 and
Non polar 08.G monitoring
Date Sample
Collected,
molddlyr
Permit Date 8/112017 — 6/30/2022
Last Revised 8-22-2015
Certificate of Coverage No. NCG14 ❑❑❑❑
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 §122.22]
Signature
Date /—
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 (919) 807-6300
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
(919) 707-9220
Permit Date 811/2017 — 6/30/2022
Last Revised 8-22-2015