NCG140075_DMR_20191016

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER _
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG940000
Calendar Year Lo(q
*Report ALL STORMWATER monitoring data on this form (include"No Flow"P'No Discharge"and Benchmark
Exceedances)from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG 14 f]n(T 5n
Facility Name: Cw+y # 0.3
County: W
Phone Number. ( ) -c1c1I\ Total no. of SDOs monitored I
Certified Laboratory P Rut_ Lab# 1
Lab#
Stormwater Discharge Outfall (SDO) No. l VMA Outfall? Yes ❑ No
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No g
Was this outfall ever in Tier 2 during the past year? Yes ❑ No® RCFIvCIGD
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes,enough consecutive samples below benchmarks to decrease frequency 0 MAR 0 2 2020
Yes, received approval from DEMLR to reduce monitoring frequency ❑
CENIKALFILES
Other ❑ DWR SECTION
Non-polar O&G
Total (EPA Method New Motor Oil
Total (gal/mo.)
Suspended pH, Usage .
Outfall No. inches 1664(SGT-HEM)), 9 (9 )
Solids(TSS), SU mg/1(VMA) Happikae/a
mg/1 if applicable
Stormwater Circle Benchmark
indicate a 100/50 6.0-9.0 15 'ss°��avengerequires —'
Benchmarks
Date Sample
Collected,
mo/dd/yr
lollb�l°L ZS 11 .3 6 .
t. /t- . t 5 Zo 6•
Permit Date 8/1/2017—6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG1 4 [IL
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 information, including the possibility of fines and imprisonment for knowing violations."
(Required by 40 CFR§122.22)
Signature t s,
Date ich( fi
Mail Annual Summary Stormwater 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 8/1/2017—6/30/2022
Last Revised 8-22-2015