NCG020747 DMR SW (4)

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
SUBMIT TO CENTRAL OFFICE*
General Permit No. NCG020000
Calendar Year 20/
*Report ALL STORMWATER monitoring data on this form (include"No Flow"/"No Discharge" and Benchmark
Exceedances)from the previous calendar year to the DEQ by MARCH 1 of each year.
Certificate of Coverage No. NCGO2 0 1 n'?
Facility Name: A r/f/S QtM,Zv7
County: woi-K6-S
Phone Number: ($ . ) ' f - ft/® Total no. of SDOs monitored 3
Certified Laboratory Srx5i1.10 AfAmg_vr11i.L Lab# 410
Lab#
Stormwater Discharge Outfall (SDO) No. 1 VMA Outfall? Yes ❑ No E"
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 E r- -�
If this outfall was in Tier 2 last year, was monthly monitoring discontinued? ' � s D
Yes,enough consecutive samples below benchmarks to decrease frequency ❑ JAN
Yes,received approval from DEMLR to reduce monitoring frequency ❑ C , TF
�r,_ (=ICES
No,turbidity benchmark exceedances did not require monthly monitoring DVVR rE,-Tioi l
Other ❑
Upstream Downstream New
Total TSS, ss, Turbidity, (U) Turbidity, (D) Turbidity, Non-polar Motor Oil
Ouffall
I No. Rainfall, mg/I mill NTU NTU NTU O&G, mg/I Usage
inches (VMA) (gal/mo.)
Circle Circle >55 gallmo.
Stormwater Indicate NOBenchmark Benchmark N/A N/A
Benchmarks 10 50 0.1 Water Ouali Water Quality15 average requires
FLOW if tY TSS and Non-polar
applicable 50 25/10 Standard applies Standard applies
08G monitoring
®ate Sample ,R;'�� � � �r� ° �:��� _M1�9 ����=�_1����' � -r�_ __
Collected, R�y�',,," ,y�'Via's1,U:•,��,d�`�' �,t. tz- sG"w,'^�-k".,.""','
✓*y""a
mo/dd/ r
,91//2//4 , 2 9s,3 zos f 4o, 5 RE ' 1\IP ri
JAN k 8 .,/
CENTRr L z,LE:11
l2OdB , 3 4,?.5 LO, I 5 n
Permit Date 10/1/2015—9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCGO2 b ' 1 7
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. L VMA Outfall? Yes ❑ No ff.
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No L 1
Was this outfall ever in Tier 2 during the past year? Yes ❑ No II
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 ❑
Upstream Downstream New
Outfall No. Total TSS, SS, Turbidity, (U)Turbidity, (D) Turbidity, Non-polar Motor Oil
2_ Rainfall, mg/I min NTU NTU NTU O&G, mg/1 Usage
inches (VMA) (gal/mo.)
Stormwater circle Circle N/A N/A >55 gailmo.
indicate NO - • mark Benchmark average requires
FLOW if Water Quality Water Quality TSS and Non-polar
Benchmarks 50 0.1 5/10 15
applicable Standard applies Standard applies O&G monitoring
Date Sample i1d - , , . . '° .
Collected, =: ,:o,'4:' .r ,,114-,; , v ,:, :a
mo/dd/yr ', °_,a a a , ��` "tea qs' r s e x.' _ r _,�T )`:,.,
0 4( t'2/ (, . 2. it.4 fO. I /0
i2 / ®i//L . 3 1,08 LD,I /0,5
I
Permit Date 10/1/2015—9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCGO2 1 Irl 2
Additional Outfall Attachment (make copies as needed for additional outfalls)
Stormwater Discharge Outfall (SDO) No. .3 VMA Outfall? Yes ❑ No I
Is this outfall currently in Tier 2 for any parameter? Yes ❑ No L1
Was this outfall ever in Tier 2 during the past year? Yes ❑ No 0'
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 ❑
Upstream Downstream „ New
Total TSS, SS, Turbidity, (U)Turbidity, (D) Turbidity, Non-polar Motor Oil
Outfall No.
.3 Rainfall, mg/ ml/1 NTU NTU NTUO&G, mg/l Usage
, •
-
inches (VMA) (gal/mo.)
Circle Circle N/A >55 gallmo.
Stormwater Indicate NO B-. hmark enchmark N//i N/A average requires
FLOW if 50 25/10 Water Quality Water Quality 15 TSS and Non-polar
Benchmarks pp ( . 50 ®.1 Standard applies Standard applies O&G monitoring
a llcable
DateSample ,3ag '° ;, LM ,! $. l3z . 'K en.r__ . ..9„
mp a ws 3& c , , : : '.,'r'S"n' a'r.'; ,',,5 ,°.` ' ''6 Q'-'a c''t 3
'' t,9_�Cix4;�' ,cA3�f�td,Y wr '���.. .� �— _ •"��l'�33�d ,ti r, r;�'« a ;*'fie*:
Collected, "fin«; ,,! ro, F',,7,` �. P1 e , x.%s":- »L ,4,-a is:' }- ,, ;m,— .a
�.� .'_ �-:mx� „,c a -:', ,::':',!,":,,,WP,
'�•z;o«°Rl,��. ,3"��,� «.�'"`£_`, l�r?,&p�l L"<c=,M„>* � �,�.�,?
,k4 >Nef ",ii ' ‘,.,:::,,,,,4; ',tilb �'t: -,-;- ,, ,Y::,;:', :dit'Iii 5nif ",=;' ,:SIiti»,�, ,'/
mold d/yr �9mt�'N��l 3�P;,k�r�f,w,,; f f�;, �,�`�� ',Y),41,0::, „, � ;t ”%�-.�'.�''-'>r,�, '� ,r� �`�%w � ,.,r "i&d'i,,„..
0024 . 2 2.9 e°. I 3
/2 /0//4 , 3 42,13k4O,/ C1
Permit Date 10/1/2015—9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCGO2 Finn ?
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]
, %
Signature
Date 1-12
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—9/30/2020
Last Revised 10-2-2015