NCG020097 DMR SW

ANNUAL SUMMARY DMR - STORMWATER RECEIVED
SEND TO CENTRAL OFFICE ... FEB 16 2015
STORMWATER DISCHARGE OUTFALLS (SDO) CENTRAL TES
GENERAL PERMIT NO. NCG020000 DWR SECTION
*Report ALL STORMWATER Monitoring Data on this form (including No Flow and No Discharge.and Permit Limit Violations) by MARCH 1 of each year.
CERTIFICATE OF COVERAGE INo. NCG02 0 t, q Z
FACILITY NAME: 44W)Z A4,01,44441 Xj, J4 KIK
PERSON COLLECTING SAMPLES' X7-17 iz ✓I�a✓1S
CERTIFIED LABORATORY Lab # qP
Lab #
Part A: Stormwater Monitorine Requirements
SAMPLE COLLECTION YEAR:
COUNTY L ii✓GrZs�/
PHONE NO. 9.2- V6 - 3 T V j
ADD TO LISTSERVE? YES ❑ NO ❑ EMAIL:
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' If "NO FLOW" or "NO DISCHARGE, Enter "NO FLOW" or "NO DISCHARGE" for each outfall here and the Date Range.
2 Per NCG02: Tier 2 Monthly sampling shall be done until 3 consecutive samples are below the benchmark or within the benchmark range
3 If a value is in excess of the benchmark, or outside the benchmark range (for pH), you must implement the Tier 1 or Tier 2 responses in the General Permit.
TSS benchmark values are 100 mg/l except in ORW, HWQ, trout, and PNA waters where they are 50 mg/1.
'The discharge shall not cause an instantaneous measurement of the turbidity of the receiving water to exceed: 10 NTU for freshwater streams, lakes, and reservoirs designated
as trout waters; 25 NTU for all lakes and reservoirs, and all salt waters; 50 NTU for all other streams and surface waters. Turbidity may be monitored at the SDO.
Alternatively, the permittee may choose to monitor turbidity in the receiving water, directly upstream and downstream of the SDO.
Permit Date: 1/1/2010-12/31/2014 Last Revised 0 1 -21 -11
Page 1 of 2

Part B: Vehicle Maintenance Activity Mo itoring Re, uirements for facilities using > 55 gal of new motor off/month on avera e
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HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES
AT ANY ONE OUTFALL (INCLUDING VEHICLE MAINTENANCE)? YES [:]NO
HAVE YOU CONTACTED THE REGION? YES ❑ NO ]
WHO AT THE REGION HAVE YOU SPOKEN WITH?
MAIL ORIGINAL AND ONE COPY OF THIS ANNUAL SUMMARY (INCLUDING ALL "NO FLOW", "NO DISCHARGE" & LIMIT
VIOLATIONS) BY MARCH I OF EACH YEAR TO:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
[phone]
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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."
(Signatu�eof Permittee)
Permit Date: 1/1/2010-12/31/2014
,7-/11/1-4
(Date)
Last Revised 0 1 -2 1 -11
Page 2 of 2