NCG020096_2021 DMR_20211028

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year 2021
*Report ALL STORMWATER monitoring data on this form (include "No Flow'T No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG020096
Facility Name: Salem Stone Quarry
County: Forsyth
Phone Number: 336-375-7584 Total No. of SDOs Monitored
Certified Laboratory Pace Analytical Lab # 40
Lab #
Stormwater Discharge Outfall (SDO) No. 1 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
No, turbidity benchmark exceedances did not require monthly monitoring
Outfall No.
Total Rainfall,
inches
TSS, mg/l
SS, ml/l
Turbidity,
NTU
Upstream (U)
Turbidity, NTU
Downstream (D)
Turbidity, NTU
Non -polar O&G,
mg/l (VMA)
New Motor Oil
Usage
(gal/mo.)
Stormwater
Benchmarks
Mdk..NOFLOWi/
appiic.bi.
"m'e
Benchmark
100/50
0 1
Benchmark
50/25/10
N/A
Water Quality
Stands applies
NIA
Wa NQuality
Stand.N applies
15
av>55gal1—
emge requires
TSS and Non clar
O&G monitorin
Date Sample
Collected,
mo/dd/yr
Basin 30
20213rd Quarter
No Discharge
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG020096
CERTIFICATION
"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."
[Required by 40 CFR §122.22]
Signature:
Date: 10/28/2021
Mail Annual Summary Stormwater DMR to the NCDEQ Central Office:
Note the address is correct - Central Files is housed in DWR (not DEMLR)
N.C. Department of Environmental Quality (DEQ)
Division of Water Resources
Attn: DWR Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Central Files Telephone [phone]
Questions? Contact DEMLR Stormwater Permitting Staff in the Central Office at:
[phone]
Permit Date 10/1/2015 - 9/30/2020
Last Revised 10-2-2015