NCG020247 DMR SW

i
ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) - STORMWATER
SUBMITTO CE -NT -RAL OFFICE*
General Permit No. NCG'020000
Calendar Year. bl5
*Report ALL STORMVVATER mon.ito.ring.data on'ahis form (include "No Flow"/'No Discharge" and'Benchmark
Exceedances) from the previous'calentlar year' to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG02 ❑D ®©R
Facility Name: DuLszorn 00AKIZA
County: IA LWN
Phone Number: (2) 5 314 6465 Total no. of SDOs monitored
Certified Laboratory PAcE -Lab # 46
Lab #
Stormwater Discharge Outfall (6130) No. VMA Outfall? Yes ❑ No Rf
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 ❑
Yes, received approval from DEMLR to reduce monitoring frequency ❑
No, turbidity benchmark exceedances did not require monthly monitoring ❑
Other n
Outfall No.
I
Total
Rainfall;
inches
TSS,
mg/I
SS,
mill
Turbidity,Non-polar
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
O&G, mg/I
(VMA)
New
Motor Oil
Usage
al/mo.)
Stormwater
Benchmarks
Indicate NO
FLOW, if
a flc'able
Circle -
mark:
50
0:�
•Circle.
cams*.
25110
- -
NIA
Wate?Qoaiity,
standard applies
I NIA
waterduaRty
Standard appllea
`5
�b5gallmo.
average requires
TSS and Nompolar
08G rnonitodn
Date Sample
Collected
mo/dd/ r
r�M�fSr3giL
'
E TY `sL, i •,r ??])
'j.� yr
r---------
j1,•
,g�•
}r�:r%�o ,
r-
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--
ti
I
q
14. G
ZO.1
.7
NJA
AJIA
NIA
N A
I
t
I
1
1
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 ❑O ®©?❑ .
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 §122.22]
Signe
Date
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 10/1/2015 —9130/2020 .
Last Revised 10-2-2015