NCG140443_DMR_20210210

STORMWATER DISCI .,;RGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MO TI�I, ORING REPORT (DMR)
Calendar Year Ozo
Individual NPDES Permit No. NCSLLjY ULUJLUlVI or
Certificate of Coverage (COC) No. NCGV1©®m®
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: 6A6-Lf R0CY— CQ)qeW7 _ r MAIF
County: l
Phone Number: ( l ) Vb - 70 77 Total no. of SDOs monitored
Outfall No. 00I �,( /
Is this outfall currently in Tier 2 (monitored monthly)? Yes El No E�
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No RECEIVED
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑ FEB 2 3 2Q21
Received approval from DWO to reduce monitoring frequency ❑ CENTRAL FILES
Other ❑ DWR SECTION
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No 2'/
�11.l11.T,�ldl
SW U-264-Generic-13Dec2012

I certify under penalty of law, that this document and all attachments werdprepared under my direction or supervision in accordance wrifi 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 fineq,9nd imprisonment for knowing violations."
Signature
Date
For questions, contact your local Regional Office:
DWQ Reqional Office Contact Information:
ASHEYII.LE REGIONAL OFFICE
FAYETTEVILLEREGIONAL OFFICE
MOORESVILLE REGIONAL OFFICE
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
RALEIGH REGIONAL OFFICE
WASHINGTON REGIONAL OFFICE
WILMINGTON REGIONAL OFFICE
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINSTON-SALEM REGIONAL OFFICE
CENTRAL OFFICE
585 Waughtown Street
1617 Mail Service Center
"To ptr serve ed
Winston-Salem, NC 27107
Raleigh, NC 27699-1617
j ll� and enhai
[phone]
[phone]
^� NORh Camfinas water..'
SW U-264-Generic-13Dec2012