NCG020022_DMR_20210301 (2)

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. ACG0020000
Calendar Year ©.0
"Report ALL STORMWATER monitoring data,on this form (include "No Flow"/"No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG02 EEU[;4
Facility Name: I % 'A , b; I i A Qf-a-1 S <--
County: _(!A& t Lei
Phone Number: (�fD-) - 6 Total no. of SDOs monitored_
Certified Laboratory pn Lab # &.E /V
Lab #
Stormwater Discharge Outfall (SDO) No."5a 1 VMA Outfall?
Yes ❑ NoXI
Is this outfall currently in Tier 2 for any parameter?
Yes ❑ No NEr
Was this outfall ever In Tier 2 during the past year?
Yes ❑ Nok",
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency
❑
Yes, received approval from DEMLR to reduce monitoring frequency
❑
No, turbidity benchmark exceedances did not require monthly monitoring
❑
Other
❑
Upstream
Downstream
New
Total
TSS
SS,
Turbidity,
(U) Turbidity,
(D) Turbidity,
Non -polar
Motor Oil
Outfalo.
�?—
Rainfall,
mg/I
mI/I
NTU
NTU
NTU
O&G, mg/I
Usage
inches
(VMA)-
al/mo.
Stormwafer
Idahoan. NO
""'°
Benchmark
c""°
Banehmerk
N/A
N/A
ev.r.po req, Ins
s ogpt
Benchmarks
FoOWI/
• IkeWa
100/50
0.1
50/25/10
Banderd appll s
Standard applies
15
Todand oNon-polar,
Data Sample?
Collected, ,
mo/dd/ r .
!,r-
�- O
cUl7.
o.o
o
D
Lc• 00
L`
o F ow
-a
-
o.loo
F
il
��.
Ol1i
- 20
0 Fkt
- o-
-Al30
•
o•loo
V73-
0-7
. eo
<o• o
Permit Date 10/1/2015 — 9/30/2020 CENTRAL FILL,
DWR SECTION
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 Q❑Rfl©a
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. 5 4i 3 VMA Outfall?
Yes ❑
No
Is this outfall currently in Tier 2 for any parameter?
Yes ❑
Nod!v—
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?
Yes, enough consecutive samples below benchmarks to decrease frequency
❑
Yes, received approval from DEMLR to reduce monitoring frequency
❑
No, turbidity benchmark exceedanoes did not require monthly monitoring
❑
Other
❑
•
•-
..
•.ew
• ..
•-
.eil
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• •
• • •
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+ _ +
ILL1W
ARTIM
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 �O©©
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. , II (is k\VMA Outfall?
Yes ❑
No"R'
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?
Yes, enough consecutive samples below benchmarks to decrease frequency
❑
Yes, received approval from DEMLR to reduce monitoring frequency
❑
No, turbidity benchmark exceedances did not require monthly monitoring
❑
Other
91
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e�
• r r
r r
NIA
®
.. 1.
>? .
is,
Iiq°P
Wit .�if^'•��ll+l1['l!•J__-----
> .. - •
5�15"V
�SM�----
Permit Date 10/1 /2015 — 9130/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 a 91;&
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 §122.221
Signature
Date o S • ok - z�
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 10/1/2015 — 9/30/2020
Last Revised 10-2-2015