NCG020245_2021 DMR_20220121

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year a 0 a 1
"Report ALL STORMWATER monitoring data on this form (include "No Flow"f'No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. N0002
Facility Name: F?-NNY. LZN &V
County: M AGO IV
Phone Number: (5 2 %) 524 - 54 5 5 Total no. of SDOs monitored
Certified Laboratory PA Lab # . 4o
Lab #
Stormwater Discharge Outfall (SDO) No.. 00 1_ VMA Outfall? Yes ❑ No Q�
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No [✓7
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 DDMLR to reduce monitoring frequency ❑
No, turbidity benchmark exceedances did not require monthly monitoring ❑
Other El
Upstream
Downstream
New
Total
TSS,
SS,
Turbidity,
(U) Turbidity,
(D) Turbidity,
Non -polar
Motor Oil
Outfall No.
Rainfall,
mgfl
mill
NTU
NTU
NTU
O&G, mgfl
Usage
OCR
00
inches
(VMA)
allmo.
Stormwater
IndicaleNo
circle
BenchmIUS
circle
Benchmark
NIA
NIA
>56 gaUmo.
average requires
Benchmarks
FLOWiI
a Iiceble
� 0O 0
0.1
501260
standard applies
Standard applies
15
TSS and Oso monitoriolar
ng
Date Sample
_
Collected,
mofdd! r
&laA)al
0.(
4A.5
40. t
t1
NIA
NIA
nf/A
/Q A.
4) i /ax I I.-� I e-2.5 I L0.1 1 t .4 1 NfH I NIA I \)/A I IVIA1
- D Er. I No
Permit Date 10/1/2015—9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. N0002 ©®5❑ 3❑
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. 00 a 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 [7J
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 ❑
No, turbidity benchmark exceedances did not require monthly monitoring ❑
Other ❑
Upstream
Downstream
New
Total
TSS,
SS,
Turbidity,
(U) Turbidity,
(D) Turbidity,
Non -polar
Motor Oil
Outfall No.
Rainfall,
mgll
mill
NTU
NTU
NTU
O&G, mg/l
Usage
Do. P
Inches
(VMA)
allmo.
Stormwater
lndicateNo
Circle
Benchmark
circle
Benchmark
N/A
NIA
>66 gallmo.
averagerequlres
Benchmarks
FZ°WH
a reaare
100150
0.1
50/26/10
WaterQualit
Standard applies
Water
Standard applies
15
TRsa m nSS and /torri�iar
Date Sample
Collected,
molddlyr
i
tin/22Ia1
0.
Z 2 5[
o. I
1 g
N rA
n1 A..
NIA
_ N
I A I I /a % I I.'3 Ie-a.5 IZO,I 14 1.0 1 /V['A I NIA I N/A I AJIA
Permit Date 10/112015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCGU I ®®©
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 C✓'R § 122.22)
Signature
Date I I as I a a,
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct — Central Files is housed in DWR (not Dt~MGR)
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 1011/2015 — 9130/2020
Last Revised 10-2-2015