NCG160054_MONITORING INFO_20180627

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v u& I
DOC TYPE
❑ HISTORICAL FILE
E� MONITORING REPORTS
DOC DATE
❑ QM q
YYYYM M D D

STORMWATER DISCHARGE OUTFALL•(SDO) ',
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2wS
Revised 9/172014
General Permit No. NCG160000
Certificate of Coverage No. NCG 16❑O o1 ©❑
This monitoring report summary, is due to the DEMLR Regional Office no later than November 1 of
each year.
Facility N
County:
Phone Number:
S2 ,296 59/2-; , .Total no. of SDOs monitored
Part A. Outfall No. 1 (use multiple sheets for multiple oiitfalls)
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 N
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 ❑
(IF ' f �Oyu^Ytifallpy rs''`4
f�
otaRinall
iqhy esw
mc
+p��TaS0S05�m30I
+ i7)
Benchmark
I.-' N/AL I
i;I50/100
Date Sample Collected,
mnolddlyr
Milo".
NC Dept ofEnvironmmal Quality
JUN 2 7 2018
— -------- -------------Raleigh-Rcgional`()1'l ce - _ -
Pagel

Part B. On -Site Vehicle Maintenance Outfall No.
Is this outfall currently in Tier 2.(monitored monthly)? Yes E] N E]
Was this outfall.ever in Tier 2 (monitored monthly) during the past year? Yes Ej No El
If this outfall was in Tier 2 last year, why was monthly ro'nitoring'discontinued?
Enough consecutive samples below benchmarks to decrease frequency El
Received approval from DEMLR to reduce monitoring frequency, ❑
Other El
Outfall
2iF
Total Rainfall
k j
�men
MIQ0530�OAJ%R��KTQ
�.riAM
IE
5kr6.M1&%
gff
t 1 p;
Benchmark
N/A
Wi 06
415
Date Sample�Collected,
. I'm
yn
Page 12

"i cerVr , 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, ingluding the possibility of fines and imprisonment for knowing violations."
Signature
Date 1v
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]
ASHE V.ILEVREGIONALi'OFFICE
T-IREGIONAL",but@G
MOORGSV.ItiLE;RE6IONALFOFI ICE
2090 US Highway 70
,FAYETTEVIE
225 Green Street
610 Bast Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
kXLEIGH�REG10NALIOF,FIGE
j WASHINGTOMkEGIONAI'OFFICE
WILMINCTON�IZEGIONAL'.OFFICC
--�3800 BairetfDiive
--are-Washington Square Mall—
l27-Cardinal-Drive Extension--
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
W� INS� WSALGM�RECIQNAL
OFFICE
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
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