NCG140354_DMR_20210315

- - ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2 0 -2 v
"Report ALL STORMWATER monitoring data on this form (include "No Flow'T No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 9 of each year.
Certificate of Coverage No. NCG14 0[E[ 91 (�f� (r J!/ C� O3
Facility Name: �t f
County:
Phone Number: foq-1- 9(cro Total no, of SDOs monitored
Certified Laboratory ( ab # !4!2)�
Lab #
Stormwater Discharge Outfall (SDO) No. I VMA Outfall? Yes ❑ No ❑
Is this outfall currently in Tier 2 for any parameter? Yes [✓] No ❑
Was this outfall ever in Tier 2 during the past year? Yes No ❑
If this outfall was in Tier 2 last year, was monthly monitoring discontinued? ft jEIVED
Yes, enough consecutive samples below benchmarks to decrease frequency
Yes, received approval from DEMLR to reduce monitoring frequency ❑��� 2ZQz�
Other ❑ CENTRAL, FILES
.. rl5 A •.y ....
Outfall No. �
t
Total Rainfall,
inches
Total
Suspended
p
Solids (TSS),
mu/1
H
p �
SU
Non -polar O&G
(EPA Method
1664 ,
(SGT-HEM)),
mgll (VMA)
Ifappllcablo
New Motor Oil
Usage allmo,
g (g )
frapprrcable
Stormwater
Benchmarks
Indicate ND FLOW ff
appffcabfe
Circle Benchmark
1 oI]I,CO
�,�"9 �Q
15
�55 gaumo. average requires TSS and
Non -Polar 080 manitoring
Date Sample
Collected,
molddl r`'
Y
Emil
-
(D o
Ls
Permit Date 8/1/2017 — 6/30/2022
Last Revised 5-22-2015

--' Certificate of Coverage No. NCG14 ®©®®
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 LLdazi C . t.--
Date 31- K- ?D Z t
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