NCG140073_2021 DMR_20220427

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)1 SPPP Annual Update DATA REVIEW FORM
Calendar Year -_.b 2- l
Individual NPDES Permit No.
Certificate of Coverage (COC) No.
NCS❑❑❑❑❑❑ or
NCGOWK] O❑®M
This monitoring report summary of the calendar year should be kept on rile on -site with the facility SPPP.
Facility Name:
County: t;
Phone Number: Total no. of SDOs monitored
Outfall No. J_
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No H
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
Total
Suspended
Solids MG/L
PH
Benchmark
N/A
100/50
6.0-9.0
Date Sample
Collected,
mmlddlyy
Z t
S.2
11
ij
SW u-zb4 - heneric Annual UMt<
Last revised 5/02/2018

Additional Outfall Attachment
Outfall No. 1.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑
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 ❑
Total
Rainfall,
inches
Parameter, (units)
i5 L
1 7
Benchmark
N/A
Date Sample
Collected,
mmiddlyy
SWU-264 - Generic Annual DMR
Last revised Y02/2018

"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 possibility of fines and imprisonment for knowing violations."
Signature ^--
Date Z7 Z
For questions, contact your local Regional Office:
DWQ Regional Office Contact Information:
' Winatosr5nlem -
. RniOgh/ '-
w.iminyfan
asFtf�v � D�F�'1Cli+
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RAt_PIG1I R1.cj0,&AL=OFFg_CE_
3800 Barrett Drive
Raleigh, NC 27609
[phone]
WINSTON-SALEM REGIONAL OFFICE
450 Hanes Mill Rd, Suite 300
Winston-Salem, NC 27105
[phone]
FXY
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
HASHI1VG fJN REC1IOXA.L OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
CENTRAL OFFICE
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
i3t➢�➢,I�S�T.�� R��s01 ��'A�1E
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
�'ILMYN�7Clr➢�,Y I3EGIID�,'Ai.,(�k_'kT�F
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
"To preserve, protect
r and enhance
North Carolina's water._."
SWU-264 - Generic Annual DMR
Lastrevised 510212018