NCG140126_DMR_20210302

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calendar Year Zo z0
Individual NPDES Permit No.
Certificate of Coverage (COC) No.
or
This monitoring report summary of the calendar year should be kept on rile on -site with the facility SPPP.
Facility Name: _Larr4or,,1Ck1.411
County: 0,-e, n G G
Phone Number: ( E i ) 4 11 03 SI
Total no. of SDOs monitored
Outfall No. i
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes ❑ No ❑■
Yes ❑ No ■❑
Yes ❑ No ❑�
R, F-cF.fv tom... D
MAR 0 8 2021
FNTiU\L
DWR StCTION
Parameter, (units)
Total
Rainfall,
inches
Total
Suspended
Solids MG/L
PH
Benchmark
N/A
100/50
6.0-9.0
Date Sample
Collected,
mmlddlyy
ZOLO
N�
SW U-264 - Generic Annual DMR
Last revised 5/02/2018

Additional Outfall Attachment
Outfall No. i.
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities?
Yes ❑ No
Yes ❑ No
Yes ❑ No
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SW U-264 - Generic Annual DMR
Last revised 5/02/2018

"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."
Signature
Date 3% zvz
For questions, contact your local Regional Office:
DWO Regional Office Contact Information:
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGIONAL OFFh
450 Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
[phone]
FAYETTEVILREGIONAL OFFICI LE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASAiNGTON AL REGIONOFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL O
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
900RESVILLEREGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFIt
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
"To preserve, protect
andenhance
North Carolina's water..."
SW U-264 - Generic Annual DMR
Last revised 5/02/2018