NCG140478 DMR SW 20210405

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2021
'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
FBCIIIty Name: LANE TEMPORARY CONCRETE PLANT-STATESVILLE
County: IREDELL
Phone Number: 33( 6 )616-a671
Certified Laboratory Statesville Analytical
122 Court St, Statesville NC, 28687
Lab # DW 37755
Lab #
Total no. of SDOs monitored 1
Stormwater Discharge Outfall (SDO) No. 1 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?
Yes, enough consecutive samples below benchmarks to decrease frequency ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
Other ❑
Outfall No.
Total Rainfall,
inches
Total
Suspended
p
Solids (TSS),
m /I
p H
SU
Non -polar O&G
(EPA Method
1664 SGT-HEM ,
( ))
mg/I (VMA)
Ilapplicable
New Motor Oil
Usage (gal/mo.)
If applicable
Stormwater
Benchmarks
adicate NO FLOWir
applicable
Circle Benchmark
100/50
6.0-9.0
15
>55 gailmo. average requires TSS and
Non -polar O&G monitoring
Date Sample
Collected,
mo/dd/yr
3/31/2021
NO FLOW
CENTRAL
ILES
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG14 0❑®0®
CERTIFICATION
It 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 Kevin J. Sifford III
•�_�
Date 4/5/2021
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