NCG160148_MONITORING INFO_20180627

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
w C& 16
DOC TYPE.
❑ HISTORICAL FILE
C MONITORING REPORTS
DOC DATE
❑ I 0.O .a
YYYYM M D D

STORMWATER DISCHARGE OUTFALL-(SDO) •,
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year .2o16
Revised 9/17/2014
General Permit No. NCG160000
Certificate of Coverage No. NCG16❑O ❑/ `�®❑
This monitoring report summary is due to the DEMLR Regional Office no later than November 1 of
each year.
Facility N
County:
Phone Number:
2..: 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 R
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No4F
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 ❑
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[)ate Sample Collected,
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NC Dept of Environmental Quality
JUN 2 7 2m
Raleigh Regional Office
Pagel

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Part B. On -Site Vehicle Maintenance Outfall No.
Is this outfall currently in Tier 2.(monitored monthly)? Yes ❑ NoE]
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes El No C]
If this outfall was in Tier 2 last year, whywas monthly mioinitoring'cliscontinued?
Enough consecutive.samples below benchmarks to decrease frequency ❑
Received approval from DEMLR to reduce monitoring frequency,
Other ❑
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Page 12

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" 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 falsp�rmation, *luding 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 ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
ASHFy,IL'liE,RFGIONAL'OFFICE
FAYET,TEUILLE KFGIONAL OFFICE
MOORESVILL1i:RPGIONA'L,oFrIC-F
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
RALEI6HORFGIONAL?01771gF
WASIIINGTONtRGG10NAL'`OfFICF
943-Washington Squarc Mall—
WILMINGTON REGIONAL;OFFICE
- 3800-BurDrive
—127-Cardinal"Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINST__ON SALEM-REGIONAL
ws
OFFICE
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
Page 13