NCG020842 DMR SW

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4 ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit Mo. A&R12020000
Calendar Year
o
*Report ALL STORMWATER monitoring data on this form (include "No Flow"/"No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NAMMMIS"1�21 _
Facility Name: Rj dve,7Dy/ 5-6/
I
County: L17ifCtl/.tT/ APR 0 5 2016
Phone Number: (Z S2) 2 2 9 <16;>_0 Total no. of SDOs monitored /Uo 14 G-a4L)
CENT AL PILES
Certified Laboratory Lab #
Lab #
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 Ffl
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 / Z d 0,0 /V / ,5 FAM H,9iPzA,, l' l .W#1 G1) ❑
Permit Date 10/1/2015 - 9/30/2020
Last Revised 10-2-2015
Upstream
Downstream
New
Total
TSS
SS
Turbidity,
(U) Turbidity,
(D) Turbidity,
Non -polar
Motor Oil
Outfall No.
Ji
Rainfall,
mg/I
MIANTU
NTU
NTU
O&G, mg/I
Usage
inches
(VMA)
gal/mo.)
Stormwater
Indicate NO
Circle
Benchmark
Benchmark
Benchmark
N/A
N/A
eraCircle gaequi
average requires
Benchmarks
FLOW if
app/rcable
100/50
0.1
50/25/10
Water Quality
Standard applies
Water Quality
Standard applies
15
TSS and Nonpolar
O&G monitoring
Date Sample
Collected,-
mo/dd/yr
f
J_
U
L�
�j%
Loth
i
t` i
jE5
, Ur;
, = a
o45
Permit Date 10/1/2015 - 9/30/2020
Last Revised 10-2-2015

t.
Certificate of Coverage No. NCG02 ©®®I�-.,1
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. 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•yea"r--?_ 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 ❑
No, turbidity benchmark exceedances did not require monthly monitbnng - , •
Other ❑
Permit Date 10/1/2015 — 9/30/2020
Last Revised 90-2-2095

1
Certificate of Coverage No. NCG02 00®®©
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. N/'/4- 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?
New
Non -polar Motor Oil
O&G, mg/I Usage
(VMA) gal/mo.
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
❑
Outfall No.
Total
Rainfall,
inches
TSS,
mg/I
SS,
ml/I
Turbidity,
NTU
-
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
New
Non -polar Motor Oil
O&G, mg/I Usage
(VMA) gal/mo.
Stormwater
Benchmarks
Indicate NO
ap, a f
Circle
Benchmark
100/50
0.1
Circle
Benchmark
50/25/10
N/A
S andard appWater lies
N/A
Standard applies Water
llmo
average requires
era a requires
Non -polar
1 5 TSS and O&G monitoring
Date Sample$c.,
Collected,P"44,
molddlyr
�
�p�, ,�1 w , �; M urs
lJs S s"i�u ` a"J�—^ ffi�Yw, 4 g
�:���f •;� �
-u w- a x"w„
N.. ^r',j'�ri � e��F
`".;�;:��.,• .� �.
d*-'.,�a„-�
flet C',Tsk `�i5
„n h' �
��. rV r�i ���" rx.f
�.
�-� � �.:, ,��; � ;
, �k & ro- ^�; 'As'• > -
MnKs f�f 1"�, TY•. 3V.r �S+'
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ©B NW Qa
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 §1
Signature
Date1 Lei
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 10/1/2015 — 9/30/2020
Last Revised 10-2-2015