NCG020245 DMR SW

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT DMR—STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year
'Report ALL STORMWATER monitoring data on this form (include "No Flow'T'No Discharge" and Benchmark
Exceedances) from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCG02 0®©0
Facility Name: Af-AA) GIN Q UARCY
County: A CON
Phone Number: (W ) 5a4 5455 Total no. of SDOs monitored
Certified Laboratory PAC E Lab # 46
Lab #
Stormwater Discharge Outfall (SDO) No.. I ' 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 . ❑
Yes,, received approval from DEMLR to reduce monitoring frequency ❑
No, turbidity benchmark exceedances did not require monthly monitoring ❑
Other ❑
Outfall No.
Total
Rainfall,
inches
TSS,'
mg/I
SS,
-ml/l
Turbidity,
NTU
Upstream
(U) Turbidity,
NTU
Downstream
(D) Turbidity,
NTU
Non -polar
O&G, mg/I
(VMA)
New
Motor Oil'
Usage
(al/mo.)
Stormwater
BenchmarksFLOWN
Indicate NO
applicable
circle
Bench
100
0.1
Circle
Benchma
50/25/
N/A
Water Quality
Standard applies
N/A
Water Quality
Standard applies
15
era a requires
average requires
TSS and Nonpolar
O&G monitoring
Date Sample
Collected,
mo/d4/yr
z a.
5
q
n�
Permit Date 1011/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. �VMA Outfall? Yes ❑
Is this outfall currently in Tier 2 for any parameter?' Yes ❑
Was this outfall ever in Tier 2 during the past year? Yes ❑
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 C G 0 2 ©®©5❑
IMA
Outfall No.
�—
Total
Rainfall,
inches
TSS,
mg/I
SS,
ml/I
Turbidity,
,
NTU
Upstream
U Turbidity,
( )
NTU
Downstream
(D) Turbidity,
NTU
Non -polar
O&G, mg/I
(VMA)
New
Motor Oil
Usage
al/mo.
Stormwater
Benchmarks
Indicate NO
applliicab
Circe
Benchm
100
0.1
circle
Benchma
50/25/ 0
N/A
Standard applies
N/A
WaterQuality
Standard applies
15
>55 gal/mo.
average requires
TSSlar
08G monitoring
Date Sample
Collected,
mo/dd/yr
1 A116
1.16
36, R
L.I
5,
q7.6
A)A
Permit Date 10/1/2015 — 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. N0002 a®0©
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 10/112015 — 9/30/2020
Last Revised 10-2-2015