NCS000562 DMR SW (2)

STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year 2. 01 '5
Individual NPDES Permit No.NCS❑O O❑❑O 5❑®❑Z or
Certificate of Coverage (COC) No. NCG❑❑❑❑❑❑
This monitoring report summary of the calendar year should be kept on file on-site with the facility SPPP.
Facility Name: gorSehG4d /Nf,fa ( Pr -d -c-6 lame-.
County: oQa-�r-rIed
Phone Number: (8? -3 4111- 31 3 G Total no. of SDOs monitored
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)?
Was this outfall ever in Tier 2 (monitored monthly) during the past year?
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 ❑
LR��O ROWIN
FEB 0 L 7014
* "f kerq- WtI vlc>
Yes ❑ No N ;Ad S'tAw 't4l-v4 (
Yes ❑ No
l�A 4(Arrl� -f l t, Zof3
Yee -r.
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
SW U-264-Generic-Mec2012
Parameter,((units)
Total
Rainfall,
inches
Benchmark
Date Sample
Collected,
mm/dd/yy
N/A
- Yio ,n i LivZo
Nor) e-
SW U-264-Generic-Mec2012

Additional Outfall Attachment
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 DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No ❑
Parameter, (units)
Total
Date Sampl
1
SW U-264-Generic-13Dec2012

"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 I - A
For questions, contact your local Regional Office:
DWO Reaional Office Contact Information:
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
CENTRAL OFFICE
585 Waughtown Street
1617 Mail Service Center I 70 preserve, protect
Winston-Salem, NC 27107
Raleigh, NC 27699-1617 and enhance
[phone] 1
[phone] �- Nonh Carol+na's water..."
SW U-264-Generic-13Dec2012