NCG140292_DMR_20210210

Individual NPDES Permit No.
Certificate of Coverage (COC) No.
STORMWATER DISCI ..±RGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar YearZ�0I
or
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name:
� .
County: V IL
Phone Number:
Total no. of SDOs monitored
Outfall No. Oa / /
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No U✓
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No
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 DWO to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
RECEIVED
FEB 2 8 20ZI
CENTRAL FILES
D►'yR SECTION
Parameter, (units)
Total
Rainfall,
inches
n _
J'
Benchmark
N/A
Date Sample
Collected,
mm/dd/yy
E
j6a 7-F_ 7%z wr
v
BkL cola
!t.
SW U-264-Generic-13Dec2012

"I certify, under penalty of law, that this document and all attachments w`eie" prepared under my direction or supervision in accordance Wit n 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 fins and jmprisonment for knowing violations."
Signature
Date
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ncxFvrra,F REGIONAL OFFICE
FAS ETTEVII LE:REGIOIVAL OFFICE
N—O0-RE4,YII.LE REGIONAL OFFICE
2090 US Highway 70
225 Green Street
610 East Center Avenue/Suite 301
Swannanoa, NC 28778
Systel Building Suite 714
Mooresville, NC 28115
[phone]
Fayetteville, NC 28301-5043
[phone]
[phone]
RALEIGH REGIONAL OFFICE
WASHINGTON:REGIQ1yOC,E
WWII MINGTON REGIONAL OFFICE
3800 Barrett Drive
943 Washington Square Mall
127 Cardinal Drive Extension
Raleigh, NC 27609
Washington, NC 27889
Wilmington, NC 28405-2845
[phone]
[phone]
[phone]
WINSTON•SALEM REGIONAL OFFICE
CENTRAL OFFI
585 Waughtown Street
1617 Mail Service Center
76 preserve, proleet
Winston-Salem, NC 27107
Raleigh, NC 27699-1617
andenhance
[phone]
[phone]
Norm Carolina's water-"
SW U-264-Generic-13Dec2012