NCG200448_DMR_20200305

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2. D I `j MAR - 5 2020
General Permit No. NCG200000 Land I Jcc
Certificate of Coverage No. NCG20©Q©©[E l i,
This monitoring report summary is due to the DEMLR Regional Office no later than March 1s` of each
calendar year.
Facility Name: (==f� -
County: 2ji4'p
Phone Number: ala 3�i 1 �1A3
Total no. of SDOs monitored
Outfall No. 001
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No EA
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Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No u
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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SW U-250NCG20-01.28.15

Additional Outfall Attachment (make copies as needed for additional outfalls)
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 DEMLR to reduce monitoring frequency ❑
Other
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SW U-250NCG20-01.28.15

Additional Outfall Attachment (make copies as needed for additional ouffalls)
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 DEMLR to reduce monitoring frequency ❑
Other ❑
4 1
SW U-250NCG20-01.28.15

"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 knowin violations."
Signature
Date
MAR - 5 2020
Land ,c!_ion
Mail Annual DMR Summary Reports to Your Regional DEMLR Offie6'
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]
Central Office .........(919)
707-9220
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
FA_ YETTE P REGIQN,AL;OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
MOO]tESYILLE,REGION 1L.OFFIGE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
RALEIGH REGIONAL OFFICE
WASHINGTON REGIONAL OFFICE
WH MINGTON'RI GIONAL OFFICE
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINSTON-SALEM REGIONAL
CENTRAL OFFICE
OFFICE
1612 Mail Service Center
585 Waughtown Street
Raleigh, NC 27699-1612
Winston-Salem, NC 27107
[phone]
[phone]
SW U-250NCG20-01.28.15