NCG160172_Monitoring Report_20200121 (2)

Calendar Year
go A -
Revised 911712014
General Permit No. NCG160000
Certificate of Coverage No. NCG 16®©®3❑
00'� AFC
0o
41
This monitoring report summary is due to the DEMLR Regional Office no later than November 1 of
each year.
Facility Name: 6*
County: C.-A
Phone Number: 2 o - C>� � 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
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No`4
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
Duffel!
Total Rainfall,
inches
00630
TSS, mg/L
Benchmark
NIA
501100
Date Sample Collected,
mo/dd/yr
r
s `

."1 , 4'
Part B. On -Site Vehicle !Maintenance Outfall No.
No vnitctc
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
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 ❑
Outfall
Total Rainfall,
inches
00530
00556
TSS, mg/L
Non -polar Oil &
Grease, mg/L
Benchmark
NIA
501100
15
Date Sample Collected,
mo/dd/yr
�F� �
� �� �
tA6i
Yes ❑ No ❑
Yes ❑ No ❑
Page 12

"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 mans e the s stem, 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 I enalties for
submitting false information, including the possibility of fines and imprisonment for knowing violations."
Signs
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
... [phone]
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
ASHEVILLE REGIONAL OFFICE
FAYETTEVILLE REGIONAL OFFICE
MOORESVILLE REGIONAL OFFICE
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]
RALEIGH REGIONAL OFFICE
WASHINGTON REGIONAL OFFICE
WILMINGTON REGIONAL 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
OFFICE
585 Waughtown Street
Winston-Salem, NC 27107
[phone]

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year -90L9
Revised 911712014 pV
4IZ4
, f
General Permit No. NCG 160000
Certificate of Coverage No. NCG 1 6RO M17PIR
This monitoringreport summary is due to the DEMLR Regional Office n
each year. b�r 1 of
00.
arc
Facility Name:
County: L6FA2±>5
Phone Number: (22L L) --700- 0,9175 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 r-1 No
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes Fj NoR[
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency F-1
Received approval from DEMLR to reduce monitoring frequency 0 NIA
Other D
Outfall
Total Rainfall,
inches
00530
TSS, mg/L
Benchmark
NIA
50/100
Date Sample Collected,
moldd/yr
it I zlej
/to
64 1122 W 11,
C'.')
AIV -rulx"
Page I 1

Part B. On -Site Vehicle Maintenance Outfall No. N/A MO V A - PAN
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 ❑
Outfall
Total Rainfall,
inches
00630
00656
TSS, mg1L
Non -polar Oil &
Grease, mg/L
Benchmark
N/A `
501100
95
Date Sample Collected,
mo/dd/yr
a�
Page 12

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."
Signs
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]
ASHEVILLE REG10NAL OFFICE ; FAYETTEVILLE REGIONAL OFFICE
MOORESVILLEAREGIONAL OFFICE.
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]
_ ............
RALEIGH REGIONAL OFFICE
WAHINGTON REGIONAL OFFICE
WILMINGTON REGIONAL 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 REGIONAI
OFFICE
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
........... .. ................ ......... ...
..........................
Page 13