NCG160031_2021 DMR_20220114

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year aoak
Revised 911712014
General Permit No. NCG160000
Certificate of Coverage No. NCG161U� 0❑I ❑
This monitoring report summary is due to the DEMLR Regional Office no later than November 9 of
each year.
Facility Name: Q %A G
County: 3 nc lcsoN
Phone Number:
Total no. of SDOs monitored i
Part A. Outfall No. 0n I (use multiple sheets for multiple outfalis)
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ff
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 DEMLR to reduce monitoring frequency ❑
Other ❑
Outfall 01
Total Rainfall,
Inches
00530
TSS, mgltw
Benchmark
N/A
W 0
Date Sample Collected,
molddlyr
('a as
G
5 a
-3v4— psc
o FLow
Page I 1

Part B. On -Site Vehicle Maintenance 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 DEMLR to reduce monitoring frequency ❑
Other ❑
00630 00556
Total Rainfall, Non -polar Oil &
Outfall inches TSS, mglL Grease, mglL
Benchmark NIA 501100 15
Date Sample Collected,
molddlyr
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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 1 l r 4l a s
Mail Annual DMR Summary Reports to:
DEMLR Regional Office Contact Information:
Asheville Office ......
[phone]
Fayetteville Office ...
[phone]
Mooresville Office ...
[phone]
Raleigh Office ........
[phone]
Washington Office ...(252)
946-6481
Wilmington Office ...
[phone]
Winston-Salem ......
[phone]
ASHEVILLE REGIONAL OFFICE FAYETTEVILLE REGIONAL OFFICE MOORESVILLE 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 REGIONAL OFFICE WILMINGTON 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
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
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