NCG240004_DMR_20210217

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT tDMRI — STORMWATER
SUBMIT TO CENTRAL OFFICE* m r klr-
General Permit No. NCG240000
Calendar Year RO PC CENTRAL FILES
DWR SECTION
*Report ALL STORMWATER monitoring data on this form (include "No Flow"1" No Discharge" and Benchmark Exceedances) from the previous calendar year to the
DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG24 ®©©® Facility Name: s Q NC (-CCrI, .
County: Sa xnapst n Phone Number: 9( !aTotal no. of SDOs monitored c�
Certified Laboratory: Lab # Lab #
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 vio/
r 1— f
Signature
ons." [Required by 40 CFR §122.221
1 r
Mail this DIVIR to the NCDEQ Central Office:
Note: the address is correct - Central Files is housed in DWR (not DEMLR)
Central Files Telephone [phone]
Date -7 0,7�1
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Questions? Contact DEMLR Stormwater Staff in the Central Office at: [phone]
Permit Date 10/2/2017 — 9/30/2022
Last Revised 9/29/2017

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Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. I VIVIA Outfall? Yes ❑ No ❑
Certificate of Coverage No. NCG24 FU 0F4
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 DEMi_R to reduce monitoring frequency ❑
Other ❑
Outfall No.
Total
Rainfall,
inches
TSS,
mgll
COD,
mgll
Fecal
Coliform,
Col/100mL
TN,
mgll
TP,
mg/1
Cu, mgll
Pb, mgll
Zn, mgll
pH,
Su
Non-polar
11
(VMAj
frapplicable
New Motor Oil
Usage (gallmo.j
If applicable
S[ormwater
Benchmarks
lnucatel
a !!cable
100
120
1000
30
2
0.010
0.075
0.126
6.0-9.0
15
requires TSSavee
andrNon-
ofar O&G monitoring
Date Sample
Collected,
molddl r
Permit Date 10/2/2017 - 9130/2022
Last Revised 912912017

Outfall Attachment (make copies as needed for additional ouffalls)
Stormwater Discharge Outfall (SDO) No. —�— VMA Outfall? Yes ❑ No ❑
coo+
Certificate of Coverage No. NCG24 ❑❑[
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑ Was this outfall ever in Tier 2 during the past year? Yes ❑ I
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
Other
Outfall No.
Total
Rainfall,
inches
TSS,
mg/1
COD,
mgll
Fecal
Coliform,
Col/100mL.
TN,
mgll
TP,
mgll
Cu, mgll
Pb, mgll
Zn, mgll
pH,
Su
Non -polar
O&G, mg/1
(VMA)
Ifappflcable
Usage 9M '
If Opp,
Benchmark
Benchmarks
lnFLOWNO
applicable
100
120
1000
30
2
0.010
0.075
0.126
6.0-9.0
15
requimsTS
polarO&G
Date Sample
Collected,
mold dl r
l
K�b) _ tj
Permit Date 10/2/2017 - 9/30/2022
Last Revised 9/2912017

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