NCG140354_DMR_20220221

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year -?nLt
'Report ALL STORMWATER monitoring data on this form (Include "No FlovVTNo Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARDJ-LjQf each year.
Certificate of Coverage No. NCG14 �)J[C)Jbjd MAR 01 20210
Facility Name: VC l 0A&, Abj j&eADj Miti� . CgNTRALF
County: t)lPAAissan DWR SECTION
Phone Number: (9L9 ) (oQl -%9 L t. Total no. of SDOs monitored 1
Certified Laborato W ga.SA& ��fl Lab # t4 9z
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 ❑
Other ❑
Outfall No.
Total Rainfall
inches
Total
Suspended
Solids (TSS),
m ll
pH,
SU
Non -polar O&G
(EPA Method
1664 SGT-HEM
( ))'
mg/l (VMA)
I/applicable
New Motor Oil
Usage (gal/mo.)
Ir applicable
Stormwater
Benchmarks
Indicate NO
applicable
Circle Benchmark
J
100/`0
6.0�9.0
15
>55 papmpolar Oe requires T56and
Non -paler GBG monitarinp
Date Sample
Collected,
mo/dd/yr
0 I ZA2t
o tr4AD
Jbivio
31
Ack Ck 40C
11 1 ­
RAL FILE
N
Permit Date 811/2017 — 613012022
Last Revised 8-22-2015

Certificate of Coverage No. NCG14 E2 QO R
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 S L'Law 'g. ju,
Date Vdaa a, 2t.2pzz
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 8/1 /2017 — 6/30/2022
Last Revised 8-22-2015