NCG140392_MONITORING INFO_20200224

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V
DOC TYPE
p HISTORICAL FILE
C�7, MONITORING REPORTS
DOC DATE
❑ �C)Qw UaQw
YYYYMMDD

I
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) - WASTEWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2019
*Report ALL WASTEWATER monitoring data on this form (include "No FlovVY'No Discharge" and Limit Violations) from
the previous calendar year to the DEQ by MARCH 1 of each year,
Certificate of Coverage No. NCG14 ®3❑
Facility Name: Winston-Salem
County: Forsyth
Phone Number: 3( 36 ) 996-2841
Certified Laboratory Research & Analytical Lab
Lab #
Lab #
Total no. of outfalls monitored 1
Wastewater (WW) Discharge Outfall No. 001
Does this outfall discharge WW to SA waters? Yes ❑ No ❑✓
Does this outfall discharge WW to SIB or PNA waters? Yes ❑ No ❑✓
Does this outfall discharge WW to HQW or ORW waters? Yes ❑ No ❑✓
If so, what is the 7Q10 flow rate? or Tidally influenced waters, 7Q10 not available ❑
Does this outfall discharge WW to Trout (Tr) designated waters? Yes ❑ No ❑✓
Were there any limit violations in the calendar year? Yes ❑ No 0
Outfall No.
001
Daily Flow Rate,
cfs
pH,
Su
TSS,
mgll
SS,
mill
it applicable
Non -Polar O&G (EPA Method 1664
(SGT-HEM)), mgll
Effluent
Limitations
Daily Marlmum
HQW or ORW
50% of 7Q10
indicate NO FLOWlI
applicable
freshwater
6.0-9.0
aattwrwr
6.8-8.5
Standard
30
HOW
0n
� V
HQW 1 ORIN and Tr, or
PNA
10
HOW, ORW, SA,
SB, PNA, or any
Trot
$
No Limit
Samples above Benchmark
subject to Tiered Responses
15
Date
Sample
Collected,'
moldd! r
,
3/29/2019
NO FLOW
6/27/2019
NO FLOW
9/27/2019
NO FLOW
10/30/2019
NO FLOW
Permit Date 8I112017 — 6/3012022
Last Revised 8-22-2017

Certificate of Coverage No. NCG14 OIL -91a]
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 informati n, including the possibility of fines and imprisonment for knowing violations."
(Required 6y 40 CFR §122.22( _
Signature /
Date 1 'Li 2 K
2, oze)
Mail Annual Summary Wastewater 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 811/2017 — 6/30/2022
Last Revised 8-22-2017