NCG090031_MONITORING INFO_20170418

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
/V C� q 0 Q 3
DOC TYPE
❑HISTORICAL FILE
9, MONITORING REPORTS
DOC DATE
❑ C�a 17 I % .0 y I2
WYYMMDD

i�
STORMWATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT (DMR)1 SPPP Annual Update DATA REVIEW FORM
Calendar Year I-ot l
Individual NPDES Permit No. NCS❑❑❑❑❑❑ or� o�� / E��
Certificate of Coverage (COC) No. NCGO©®❑©® iD
/ O �( AIR 18
2017
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPIAENTRA!_ FILES
-� G L L C
R SECTION
Facility Name. t :k S V L- fl! rt 4riJ
County: � [ 6 #7n ow n
Phone Number: (gce) �9S =-.S? 7? Total no. of SDOs monitored
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 DWO to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
SWU-264 - Generic Annual DMR
Last revised 5Yl712013

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
Signature
Date
DWQ Renional Office Contact Information:
for knowing violations."
For questions, contact your local Regional Office:
OFFICE
2090 US Highway 70
Swannanoa, NC 28778
[phone]
RALEIGH REGIONAL OFFICE
3800 Barrett Drive
Raleigh, NC 27609
[phone]
585 Waughtown Street
Winston-Salem, NC 27107
[phone]
FAYETTEVILLE REGIONAL OFFICI
225 Green Street
Systel Building Suite 714
Fayetteville, NC 28301-5043
[phone]
WASHINGTON REGIONAL OFFICE
943 Washington Square Mall
Washington, NC 27889
[phone]
1617 Mail Service Center
Raleigh, NC 27699-1617
[phone]
610 East Center Avenue/Suite 301
Mooresville, NC 28115
[phone]
127 Cardinal Drive Extension
Wilmington, NC 28405-2845
[phone]
To plesenoe, protect
and enhance
AWM Gamfinals water..'
SWU-264 - Generic Annual DM
Last revised 5i17/1013