NCG140050_DMR_20210301 (2)

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2019
'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. NCG14
Facility Name: Shelby
County: Cleveland
Phone Number: 70( 4 ) 529-6364
Certified Laboratory Waypoint Analytical
Lab # 402
Lab #
Total no. of SDOs monitored 1
Stormwater Discharge Outfall (SDO) No. 001 VMA Outfall? Yes Cl No ❑✓
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No ❑v
Was this outfall ever in Tier 2 during the past year? Yes ❑ No 0 p ja or-- d y
If this outfall was in Tier 2 last year, was monthly monitoring discontinued? RE at'_. er:
Yes, enough consecutive samples below benchmarks to decrease frequency ❑ MAR 15 2021
Yes, received approval from DEMLR to reduce monitoring frequency ❑ CENTP,1\1- FILE
Other ❑ DWR 3LC ; n �
Outfall No.
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
mg/1
pH,
SU
Non -polar O&G
(EPA Method
1664 (SGT-HEM)),
mgll (VMA)
Irappuuore
New Motor Oil
Usage (gal/mo.)
aappffcable
Stormwater
Benchmarks
lnrlicafe NO FLOW0
applicable
circle Benchmark
100150
6.0-9.0
15
>&a gagmo. average requires TSS and
Non -polar O&G monitoring
Date Sample
Collected,
mo/dd/yr
3/25/2020
NO FLOW
8/1912020
NO FLOW
12/3/2020
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG 14 0❑ 0❑ 50 0�
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 ✓ /iV�utC1J f ��
Date 3 /—zf /vI C,
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