NCG030244_DMR_20200416 (2)

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calendar Year
Individual NPDES Permit No.
Certificate of Coverage (COC) No.
or
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name:
County: x-'Ac_4,
Phone Number:
Total no. of SDOs monitored
Outfall No. 2
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
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 DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No o
Parameter, (units)
Total
Rainfall,
inches
Benchmark N/A
Date Sample
Collected,
mmiddlyy
SW U-264 - Generic Annual DMR
Last revised 6/012018

Additional Outfall Attachment
Outfall No. 'L
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
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 DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No [
mm1dd/yyMMi"h=ill
SW U-264 - Generic Annual DMR
Last revised 6/01/2018

".1
" 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
For questions, contact your local Regional Office:
DEMLR Regional Office Contact Information:
Asi,evill
yLi
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
WINSTON-SALEM REGIONAL OFFICE ! CENTRAL OFFICE
450 Hanes Mill Rd, Suite 300 1617 Mail Service Center
Winston-Salem, NC 27105 Raleigh, NC 27699-1617
[phone] [phone]
MOORESVILLE REGIONAL OFFICE
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
SW U-264 - Generic Annual DMR
Last revised 610112018

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calendar Year -Uotc,
Individual NPDES Permit No.
Certificate of Coverage (COC) No.
or
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facility Name: OOnn w �IGbC
County:
Phone Number:
Total no. of SDOs monitored
Outfall No. �
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No [�
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 DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No [�
Parameter, (units)
Total
Rainfall,
inches
Benchmark N/A
Date Sample
Collected, _.
mm/dd/yy
SW U-264 - Generic Annual UMK
Last revised 6/012018

Additional Outfall Attachment
Outfall No. s
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No
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 DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
..rum=
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SWU-264 - Generic Annual DMR
Last revised 6/012018

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
For questions, contact your local Regional Office:
DEMLR Regional Office Contact Information:
A,bm.ii
ASHEVILLE REGIONAL OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
FAYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
WINSTON-SALEM REGIONAL OFFICE j CENTRAL OFFICE
450 Hanes Mill Rd, Suite 300 1617 Mail Service Center
Winston-Salem, NC 27105 Raleigh, NC 27699-1617
[phone] [phone]
MOORESVILLE REGIONAL OFFICE j
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WILMINGTON REGIONAL OFFICE
127 Cardinal Drive Extension '
Wilmington, NC 28405-2845
[phone] j
SWU-264 - Generic Annual DMR
Last revised 610112018