NCG200339 DMR SW (5)

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STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)
Calendar Year OILo
General Permit No. NCG200000
Certificate of Coverage No. NCeonnE
This monitoring report summary is due to the DEMLR Regional Office no later than March ft of each
calendar year.
Facility N [\AfJZL(
County: !'o}^n
Phone Number: (Q, R ) a- 'o/ 1' Total no. of SDOs monitored
/�� 1
Is this No. 0 U '�vl..`, Yes No
Is this outfall currently in Tier 2 (monitored monthly)? � ❑ ❑
Was this outfall ever in Tier 2 (monitored monthly) dura the past year? Yes ❑ No ❑
If this outfall was in Tier 2 last year, why was monthly moni o ' ' ontinued?
Enough consecutive samples below benchmarks to decrease frequency 0
Received approval from DEMLR to reduce monitoring frequency 0
Other 0
00530 00340 01119 01114 01094
Outfall - Total Non-polar Total Total Total
Rainfall, TSS, COD, oil&grease, Copper, Lead, Zinc,
inches mg/1 mg/1 mg/I mg/1 m' mg/1
Benchmarl�s' ?I Na 100/50 120E _ 1'5 0:010/0.0053: 0:075/0:21'0' 0.12'(/0'090- �t co Cl)z
�fresh/salt t fresh/salt fresh'/salt 11� o JO
-- _ _
Date Sample Y`> _ < y _ 0
Collected, = _ • _rpt.,.. ° 7-_ tI
mo/dd/yr ��s �•,�,.� . . k ��• _ C-) f-(r
L liJ W
o
0
( _)0_,l
SW U-250NCG20-01.28.15

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Additional Outfall Attachment (make copies as needed for additional outfalls)
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency 0
Received approval from DEMLR to reduce monitoring frequency 0
Other ❑
00530 00340 01119 01114 01094
Outfall Total Non-polar oil
Rainfall, T k, COD, &grease, Copper, Lead, Zinc,
inches_ mg/I\ mg/1 mg/1 mg/I mg/I mg/1
100/50 ''1\ 120 15 - 0.010/:005 _0:075/01:210 :0:126/0:090' -
Benc{am'ark N/A freshtsalt _I'_- fresWsalt. _fresli%salt`__
Date Sample . ; '
Collected, 447,
-
'no/cid/yr ;aPOrzrM:1
40,�
9 \
/I
SW U-250NCG20-01.28.15

"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 a.cf'complete. I am aware that there are significant penalties for
submitting fa = information, incl .' + the possibility of fines and imprisonment for knowing violations."
Signature
Date h -- 70 .
Mail Annual DMR Summary Reports to Your Regional DEMLR Office:
DEMLR Regional Office Contact Information:
, q
Asheville Office [phone] A ' "'-i <-
Fa etteville Office 910 ,-L loco,111 . z
Y ( )433-3300
Mooresville Office [phone] �,, ��,� .-+ °�'
Raleigh Office [phone] Ir1�e .-. �'
Washington Office ..[phone] �
AL
Wilmington Office [phone] y \ 1
Winston-Salem [phone] F• ett- 'll® �
Central Office .. [phone]
ngton
ASHEVILLE REGIONAL OFFICE FAYETT EVILLE REGIONAL OFFICE MOORESVILLE REGIONAL OFFICE
2090 US Highway 70 225 Green Street 610 East Center Avenue/Suite 301
Swannanoa,NC 28778 Systel Building Suite 714 Mooresville,NC 28115
[phone] Fayetteville,NC 28301-5043 [phone]
[phone]
RALEIGH REGIONAL OFFICE WASHINGTON REGIONAL OFFICE WILMINGTON REGIONAL OFFICE'
3800 Barrett Drive 943 Washington Square Mall 127 Cardinal Drive Extension
Raleigh,NC 27609 Washington,NC 27889 Wilmington,NC 28405-2845
[phone] [phone] [phone]
WINSTON-SALEM REGIONAL CENTRAL OFFICE
OFFICE 1612 Mail Service Center
585 Waughtown Street Raleigh,NC 27699-1612
Winston-Salem,NC 27107 [phone]
[phone]
SW U-250NCG20-01.28.15

t
Additional Outfall Attachment (make copies as needed for additional outfalls)
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No'❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DEMLR to reduce monitoring frequency 0
Other 0
00530 00340 01119 01114 01094
Outfall Total - Non-polar oil -
Rainfall, TSS, COD, &grease, Copper, Lead, - - Zinc,
inches mg/I mg/1N- mg/1 • mg/1mg/1 mg/I
' '��-`" 100/50 ,!, 120 ' 15 0.0107:005 0.07510:210'�� O:T26/0i090'
Benchmark N/A '
L,; :;•�.r_'.kfre
ee_smseh__/salt fre`-sms„hsy/sai
Date Sample ��s:.✓. w .v
e —%s„_
^_=i
_ft
,
C011eCtel, 7;-:4ig l Petiwaitp
mo/dd/Yl _ _
t1
f
SW U-250NCG20-01.28.15