NCG140242_2021 DMR_20220221

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) I SPPP Annual Update DATA REVIEW FORM
Calendar Year 7 o Z 1
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG❑1 ©®©©❑7-
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP-
Facility Name: 14 ► 1 g1'k d al l e.. 1,10
_
County:yu 1+ k� _-
Phone Number: 11 211 q q 00 Total no. of SDOs monitored
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ["
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No [}
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No [;[-
Parameter, units
Total
Rainfall,'
Inches
Benchmark
NIA
> IDb IMI L--
_
Date Sample
Collected,
mmlddlyy
- -
-
JI
1
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Last revised 5922018

Additional Outfall Attachment
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No ❑
Parameter, urilfi)
Total
Rainfall,
inches
Benchmark N/A
Date Sample
Collected,
mmlddlyy
SWU-264 - Generic Annual DMR
Last revised 5/02/2018

"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."
Signature
Date 'Z
DM Regional Office Contact Information:
For questions, contact your local Regional Office:
.11
4St EV[1a.ItECL. t4A1 OFfU*
FAYFMYTLLEREGIONALOFFICE
2090 US Highway 70
225 Green Street
Swannanoa, NC 28778
Systel Building Suite 714
[phone]
Fayetteville, NC 28301-5043
[phone]
R.AI..FjiGH.RErIONQi ftRF7CE
IIIN.l,1 NIiiF;CJc AL [_ iei
3800 Barrett Drive
943 Washington Square Mall
Raleigh, NC 27609
Washington, NC 27889
[phone]
[phone]
1Y1 NSTON-SALENI REGIGNAL 0FFICE
CENT RAL
450 Hanes Mill Rd, Suite 300
1617 Mail Service Center
Winston-Salem, NC 27105
Raleigh, NC 27699-1617
[phone]
[phone]
AtQO 1AERE-�30N4Q MIC9
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
'To preserve, protect
and enhance
North Carolina's water:.."
SWU-264 - Generic Annual DMR
Last revised 5r02/2018