NCG020247DMR SW

ANNUAL SUMMARY DISCHARGE MONITORING
REPORT (DMR) — STORMWATER
1 _=- - -47-0, WWI TO CEiitTRm_0,010- * - 1
General Permit No. NCG020000
Calendar Year a 0/6,
Report-A'L2'S�TORMWATER monitoring tlata on this?form=♦Include WifairvytRur schar iti,(1:Benchmark
__ _ lExceedan e0fr,i5mO exprevio'usricafen`dar yeaiC tcah',®•EQl by g:40 1H:1•Cgfe4ch.;ygar. _ _ _ _
Certificate of CoveragetNo. NGGO2 a .a: AL 7 40
IJ
Facility Name: 51,b5& 0 C)0Ag'Z'.1
County: "5ACKSoal
Phone Number: (Sag ). say+-5455 Total no. of SDOs monitored
Certified Laboratory QAAC,E Lab# 140
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 ElNo [ RECEIVED
If this outfall was in Tier 2 last year, was monthly monitoring discontinued?
Yes,enough consecutive samples below benchmarks to decrease frequency ❑ JAN 26 2 01/
Yes,received approval from DEMLR to reduce monitoring frequency ❑ CENTRAL FILES
No,turbidity benchmark exceedances did not require monthly monitoring El DWR SECT ON
Other ❑
Upstream Downstream New
Total TSS, SS, Turbidity, (U)Turbidity, (D) Turbidity, Non-polar Motor Oil
Outfall No. Rainfall, mgll mil NTU NTU NTU O&G, mg/I Usage
inches (VMA) (gal/mo.)
Circle Circle N/A N/A - >55 gallmo
Stormwater Indicate NO Benchmark Benchmark average requires
Fcowir 100/50 0.1 . 50/25/10 s a�aa�d app es Standard applies -ater GuAty 15 TSS
08G m nitorihg Non-polar
Berl chmarks applicable
Date Sample ,
Collected, , - _
-SAN
-AN 1 /00 60vJ .
aut. /DCC- Al0 Fc J
Permit Date 10/1/2015-9/30/2020
Last Revised 10-2-2015

Certificate of Coverage No. NCGO2 nnnn
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 I.
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—9/3012020
Last Revised 10-2-2015