NCG030707_2021 DMR_20211019

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR) / SPPP Annual Update DATA REVIEW FORM
Calendar Year 2 D 2
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or
Certificate of Coverage (COC) No. NCG©© [ d❑❑?
This monitoring report summary of the calendar year should be kept on rile on -site with the facility SPPP.
Facility Name: -TV 6S SP E c LA %-- l 5 00 M r '4-C1 y
County: x7a E 0 f-- I.%.
Phone Number: 7( Y3) 33,—;26,8j!i Total no. of SDOmonitored
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 ❑
Yes ❑ No ES
Yes ❑ No 59
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, units
Total
Rainfall, +
inches
Benchmark
N/A
i
Date Sample
Collected,
mmiddiyy
6 05 2l
SWU-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 possibilityof fines and imprisonment for knowing violations." A
Signature �.�[�{ _
Date 10-1 `1-2-f
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
ASHEVILLE REGIONAL O_FF_ _IC_ E
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE'
3800 Barrett Drive
Raleigh, NC 27609
[phone]
IWINSTON-SALEM REGIONAL OFFI_C_E
450 Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
[phone]
AYETTEVILLE REGIONAL OFFICE
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
W_ ASHINGTON _REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
MOORESVILLE REGIONAL OFFICE'
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
WH.MINGTON REGIONAL OFFICE
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
7o preserve, ptWed
and enhance
North Cardinals wafer_ "
SW U-264 - Generic Annual DMR
Last revised &02/2018