NCG020178 DMR SW

t6S'��e 2., i .�� ��., i'� 4
General Permit No. NCG020000
Calendar Year �- D i S7
Report ALL STORt1fJ14ilATER monitoring data on this form (include "No Flow"I'No Discharge' and Benchmark
Exceedances) from the previouscalendar year to the DEO by IWAROF1,1 ofeach year.
Certificate of Coverage No.
Facility Name: Ni o'n5o n T - G f -I L�eS - izA i1 c," 50- v\j + is t'C. v(d
County: --- t -to. r o cn � W
Phone Number: (q I q ) 3 &n -P_`)`f Q Total no. of SDOs monitored --
Certified Laboratory Pc e_e_Ana1y+" ccvl lab# WW 4007
k_uLab# 53`72
Stormwater Discharge Outfall (SDO) No. N IA- VMA Outfall? Yes ® No
Is this outfall currently in iter 2 for any parameter? lies ❑ 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? RECEIVE
Yes, enough consecutive samples below benchmarks to decrease frequency ® 2 201
Yes, received approval from DEMLR to reduce monitoring frequency ® FEB
No, turbidity benchmark exceedances did not require monthly monitoring ® CENTRAL FILES
Other ® DIOR SECTION
Ouffall No.
Total
Rainfall,
inches
TSS,
mg/I
SS,
mill
Turbidity,
NTU
Upstream
(U) Turbidity,
NTLI
Downstream
(D) Turbidity,
NTU
Non -polar
O&G, rrtgll
(1/M,)
New
Motor Oil
Usage
allrr,+®.
:Be69c6deFiae �
linbcarelVo
FLOWS
a Grame
clale.
®eouhrrcs,k
1-®6/�0
®.1
- circle
Benchmark
�/2�/1®_
-
Waler 0-14
sla„dardappeles
-.
- N/�
Wak:r O,e,lity
sea,ae,�a�p�a
- -
I
>6B'gagma:
ayziageeequDaes
TSS eimi Noeapaler'
oaGma�lhxlr�
Date Sample =
Collected,
mo/dd/ r
i
5 ur
N
t
-`
eh etRr
1 k
Q�cm
I
i�t
Permit Date 1011/2015 - 9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCG02 QQ®®
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 §122.221
Signc-
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 — 9130/2020
Last Revised 10-2-2095