NCG140147_DMR_20210805

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE`
General Permit No. NCG140000
Calendar Year obi
`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
Facility Name
County:
Phone Number: (Z
Certified Laboratory
No. NCG14
Lab # 1—
Lab #
Total no. of SDOs monitored J_
Stormwater Discharge Ouffall (SDO) No. 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
:Solids (TSS),
m II. ...
pH,
Sfl„
Non -polar O&G
(EP..A Method
1664 (SGT HEM));
mgll (VMA) "
.. Irappllcabl{
New Motor Oil
Usage (gal/mo.)
aPPlicab/e
.
Stormwater
Benchmarks
Indicate NO FLOWN
applicable
Cind. Benehmark
100160
6.0-9.0
15
>65 gNonm iar O&rmonitoingg and
Nono. average
moues ng
Date Sample
Collected,
mo/dd/yr
•"
46
AUG
R2i
.:ENTRAL
FILES
DWR SECTION
I
Permit Date 811/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG 14 RORF]
CERTIFICATION
" l 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 info ' n, including the possibility of fines and imprisonment for knowing violations."
[Required by 40 CFR §1 J /
Signature_ —
Date J�%&,z(
11lllail Annual Summary Stormwater DMR to the HCDEQ Central Office:
Note the address is correct -- Central Files is housed in DWR (not DEMLR)
I.C. Department of Environmental Quality (DEQ)
Division of Dater Resources
Attn: DWR Central Files
1617 Flail Service Center
Raleigh, IBC 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