NCG160019_MONITORING INFO_20180627

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
�v �� I p p I �J
DOC TYPE
HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ a i b a
YYYYMMDD

'STORMWATER DISCHARGE OUTFALL•(SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year .26/8
Revised 9/17/2014
General Permit No. NCG160000
Certificate of Coverage No. NCG 16❑o ❑O I®❑
This monitoring report summary, is due to the DEMLR Regional Office no later than November 1 of
each year.
Facility N
County:
Phone Number:
( �qs;L) .290- .5-9/ .,, Total no. of SDOs monitored
Part A. Outfall No. (use multiple sheets for multiple outfalls)
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 DEMLR to reduce monitoring frequency ❑
Other ❑
` Outfall �trt
$
TotalRainfal�
mles ,
yc{�h[
�7a00530ii;
9
Benchmark
N/A
j 50/100 :I
Date Sample
Imo/dd/yr
Collected,"
NC_Dept of Environmental Quality
JUN 21 2018
Raleigh Regional Office
Page I I

Part B. On -Site Vehicle Maintenance Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) nthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency El
ReceivedEl
' approval from DEMLR to reduce monitoring frequency,
Other ❑
I- 1� - I I?
1-M
gN
rarn-A1T7
0 an all
'U!�'00539 X;
ai
E�MRRpolNuoH&
1AAIM121INRR
k `005 6 0
,
U91
resm/
jF13 enchtnark
WA
15'
Date Sample C lected,
molddd//yr
j
'.
I
Yes ❑ No]E]
Yes E:1 No F]
Page 12

"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."
Signature _
Date
Mail Annual DMR Summary Reports to:
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...
[phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
ASIIEVILliEREGIONAL'�'OFFICE
iFAY&XEVILL+E'RC' 'ION ILOF.FICE
225 Green Street
MOORRSV,ILL'EsREG10NAL"_OFFICE
2090 US Highway 70
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
I Systel Building Suite 714
Mooresville, NC 28115
[phone]
I Fayetteville, NC 28301-5043
[phone]
[phone]
RAI,,EIGWREGIONALOFFlCE
WASHINGTON!REGIONALiOrF,ICE
WIli1NINGTON:12EGlONALuOFFICE
--3800 Bazrett Drivn _
—943 Washington Square Mall—_
— I'27 Cardinal'Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WW NST,_,TONWSALC NuREG10NAL
I
OrFFIN
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
i
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