NCG140066_DMR SW_20220329

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) - STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2021
"Report ALL STORMWATER monitoring data on this form (include "No FloW/'No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG14 OQ 0❑I
Facility Name: Thomasville
CountV: Davidson
Phone Number: 33( 6 ) 983-2181
Certified Laboratory Prism Lab
Lab # 402
Lab #
Total no. of SDOs monitored 1
Stormwater Discharge Outfall (SDO) No. 001 VMA Outfall? Yes ❑ No ❑✓
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No El
Was this outfall ever in Tier 2 during the past year? Yes ❑ No ❑v
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes, enough consecutive samples below benchmarks to decrease frequency 0
Yes, received approval from DEMLR to reduce monitoring frequency 13
Other ❑
Outfali No.
007
Total Rainfall,
inches
Total
Suspended
Solids (TSS),
m /I
pH,
SU
Non -polar O&G
(EPA Method
1664 SGT-HEM ,
( ))
mg/I (VMA)
I/applicable
New Motor Oil
Usage (gal/mo.)
Mopprcable
Stormwater
Benchmarks
Indicate NO FLOWS
applicable
Circle Benchmark
100/50
6.0-9.0
15
>55 gallmo. average requires T55 and
Non -polar O&G monitoring
Date Sample
Collected,
mo/dd/yr
3/1212021
NO FLOW
6/29/2021
NO FLOW
r --
APR 0 '
9/29/2021
NO FLOW
CENTRAL PiLizo
12/16/2021
NO FLOW
wilm Z>tUTION
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG14 KERN]
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.
Signature _. ►,,
Date e1bKk 11
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