NCG140392_DMR SW_20220329

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SrBMIT TO: CENTRAL OFFICE*
General Permit No. NCG140000
Calendar Year 2021
*Report ALL STORMINATER monitonrig'data on this form (include "No Flout.'/ No'Discharge" arid'Benchmark,:
E) ceedances) from, the preyious,calendar'year to the DEQ by MARCH.i of each year
Certificate of Coverage No. NCG14 0❑ 1 9❑ 20
Facility Name: Winston-Salem
County: Forsythe
Phone Number: 3( 36 ) 996-2841 Total no. of SDOs monitored �
Certified Laboratory Research & Analytical Lab Lab #
Lab #
Stormwater Discharge Outfall (SDO) No. 001 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 13
Yes, received approval from DEMLR to reduce monitoring frequency 13
Other ❑
Outfall IVo�
a
Total Rainfall,
mhes
:Suspeeided
Solids SS `�
)e
m it
s SU
�� r v ti
on polar
(EPA�Method
SGT HEM
sO
mgll (VMA)
Happlrca6le''
�r
� _ New Motor Oil
Usage (gaUmo )
�a x
? ' ti lfsappLcable ;
$tormWafer
Benchmarks,
indicate NO FLOW if
applicable '
Circle Benchmark
1 OOI5Q '
' _
s O 9.O
'15
-
>66 gaUmo average requires TsS and
Non -polar 0&G monitoring
Date Sample
Collected
�, . ;
:mo/tld/yr
'"f Y^4 d Qa
-y
?T*:.''R
8k 2� i4-..,... Yw
E'ki t'5"".""h
Y .a•. Ya ,�fi
'r' ya q wr .�` .
3/31/2021
NO FLOW
6/30/2021
NO FLOW
9/232021
NO FLOW
12/30/2021
NO FLOW
Permit Date 8/1/2017 — 6/30/2022
Last Revised 8-22-2015

Certificate of Coverage No. NCG14 ] fl 90 20
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 §122.2�]
Signature
Date 3
2z
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