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Home My WebLink AboutNCG020883_MONITORING INFO_20190115STORMWATER DIVISION CODING SHEET NCG PERMITS PERMIT N0. IV C( �V DOC TYPE ❑HISTORICAL FILE L� MONITORING REPORTS DOC DATE ❑ 0 t% 1 / b 1 l YYYYMMDD STORMWATER DISCHARGE MONITORING REPORT (I)MR) Please Mail Original And One Copy To Mailing Address Below GENERAL PERMIT NO. NCGO20000 Part A: Facility Information Samples Collected In Calendar Year: 26 i47 (all 5?t►�let sl:all be reported wfthln 30 days fellowing mentlerirg ge;tori) Certiticate Of Coverage No, NCG02 I County of Facility ��.'��•4-- S �, Facility Name E TA 8 A L kh /Ar Name of Laboratory Facility Contact €,a# Ceri iwation !l 50 Facility Contact Phone No. Part It.• Land Dkyturbrance and Process Area Monitoring Requirements Date:.. �0(J54. oti0 009E , ,bil 14 -f�uffatl ��e�.Ii'lgg. Str�iz� � � Stsrpj�lp: � }Tata`l � ; . Total; F � m-, � � + ! � 7 _1 � �• �: t+`eftl�}It+A: .i�.s 1 „ •,.' -CDlectedllb.!i ,e.F. _ '.a.4,., ��:+' +` i.+�.di I 1 f' ^T- 1, '�'$'•sl=.i .. 4y-. ci} ' 1`t-.: _ :.i%,}..a.• g= •• sW� a" 'Gtpi ` M� �!y, . .:7,{� W. �/12 �7•S 8.-7 �p.1 t Part D: Storm Event Characteristics Total Event Precipitation (inches): Event Duration (hours): 1 2- Part E. Certification Part C: Vehicle Maintenance Monitorinz Reauirements � V, I L h �, •�4 'i �ps1 �jqj /� w/� 'V�t�Y��' ''it��eMii�"�s}a�yµ�f�y�j'�'' .Z..V '��?-._y�+,•1;' i. :� �;=�":[��61�['�}�.£ .11.� l•,ti • •=FfiF.�� + ta"t �,,�r,Yyj�'�. a ' ��.� �' , 1�.,�� I 1;�` :::,� ._'f'6' i rl O 1��.• .7ir>',w• yri:�1�` �y f: •j, �, t � i�` 'y��. it '[j,Y_ +.� ,.� • �11�[2Cry([� ;.i',1 JUL 18 2019 CENTRAL FILES Total Event Precipitation (inch SECTION Event Duration (hours): (if a separate storm event is sampled) "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 th re are significant penalties for submitting false information, Including the possibility of fines and imprisonment for knowing violations." (Signature of ermittee) (Date) Part F.• Mailing Address Attn: Central Files, DENR, N.C. Division of Water Quality,1617 Mail Service Center, Raleigh, NC 27699-1617 swv' STORMWATER DISCHARGE MONITORING REPORT (DMR) Please Mail Original And One Copy To Mailing Address Below GENERAL, PERMIT NO. NCG020000 Part A: Facility Information Samples Collected In Calendar Year: Z o I? (all samples shall be reported within 30 days following monitoring period) Certificate Of Coverage No. NCG02. 02DB-S'3— • County of Facility Facility Name <:ATA-NigA C_t nx m/!vE Name of Laboratory Facility Contact per. " 4.0"- Lab Certification #E Facility Contact Phone No. 70V a o Y37 Part B: Land Disturbance and Process Area Monitoring Requirements Date 50454 OOS3i1 00076 Receiving Stream Total' Outfall:- .. No. !�!a`me Sample_ Collected .°. Total' 1♦low Suspended' �� y Turbidity SeEtleable k f Salids i 1' .L c •J-Salads ". f Fri` :!. f. :cnolddl r: MG`' ,., 1ii.. NTUs nal/l.,^ Part D: Storm Event Characteristics Total Event Precipitation (inches): O. Z Event Duration (hours): !Z Part E: Certification ECEIVED JAB! 15 2919 CENTRAL FILES DWR S,ECT1O!�i �119-T1 � IZFCH � R-!is Part C: Vehicle Maintenance Mn itoring Re uirements `Outfall' 1Va.. ' ltecelving Streams Nant , sr ; Date=0055E f10534 . 0.0404 ,Sampte'� _-� r gllec $e4 _ ; t otal ,� '`,Flow'{,' di�-[-x 5?:..a + 0ii aad Grease' `.. ,� Total Suspended t 0l1Els .. pH ' - ,mo/lid/'.� MCr `� m !1 M /l unit Total Event Precipitation (inches): Event Duration (hours): (if a separate storm event is sampled) "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 {Signature of Permittee) (Date) Part F: Mailing Address Attn: Central Files, DENR, N.C. Division of Water Quality,1617 Mail Service Center, Raleigh, NC 27699-1617 SWU-243-012005 STORMWATER DISCHARGE OUTFALL (SDO) ANNUAL SUMMARY DATA MONITORING REPORT (OMR)1 SPPP Annual Update DATA REVIEW FORM Calendar Year Z a/ Individual NPDES Permit No. 7 N Certificate of Coverage (COC) No. N or This monitoring report summa►y of the calendar year should be Inept on file on -site with the facility SPPP. Facility Name: „C�� _ M�Ng - County: Phone Number( 70 Y) 32 G -y `(3 7 Total no. of SDOs monitored i 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 Mow benchmarks to decrease frequency ❑ Received approval from DWO to reduce monitoring frequency ❑ Other ❑ Was this SDO monitored -because of vehicle maintenance activities? Yes ❑ No,j ------------- - r M J MRS s SWU-264 - Generic Annual DMR La.at ravicari _W17/"Jn19 STORMWATER DISCHARGE MONITORING REPORT (DMR) Please Mail Original And One Copy To Mailing Address Below GENERAL PERMIT NO. NCG020000 Part A: Facility Information Samples Collected In Calendar Year: 2-01�? (ail samples shall be reported within 30 days following monitoring period) Certificate Of Coverage No. NCG02 _ 6- 2 e- St County of Facility Facility Name '-E Name of Laboratory Facility Contact S Q..--, 8tC4 [W 6--Z-- Lab Certification # Facility Contact Phone No. 5- 2.0 O y3 7 Part B: Land Disturbance and Process Area Monitorin Requirements Qutfall No. Recelylgg Stream Name :Date Sl)OSO,: 00530 0007ti ,00545 Sample Collected Total`s PiowF Total - Suspended ,Tarbtdityallds Settleable> 'mold'd/ r `1.1VIG. Fm �:. N7i)s.°.' /17 tL-1� Part D: Storm Event Characteristics . Total Event Precipitation (inches): Event Duration (hours): Part E: Certification C/ t✓ ct ti Part C: Vehicle Maintenance Monitoring Reauirements RECEi '_ x 5015a'= YOQS56 D0400 . „ ,. , :µ tDate,�k� F: L00530,h Receiving;Sti eam ",Sample �' ;° Total filutfall Namek,; an 1 Qllec11bte Foial a •ail and,• T,, !S uspended, pH' Grease , ' SOIIdS.i 1J,'L11. _ ;m :unit JAN 16 20 Notal Event Precipitation (inches): Event Duration (hours): CENTRAL rlL;(if:a separate storm event is sampled) DWR Sr;CTIO! 2oir / "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 t ere are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."] r, , (Signature of Permittee) {Date) Part F: Mailing Address Attn: Central Files, DENR, N.C. Division of Water Quality, 1617 Mail Service Center, Raleigh, NC 27699-1617 SWU-243-012005 STORMWATER DISCHARGE MONITORING REPORT (DMR) Part A: Facility Information Samples Collected In Calendar Year: Certificate Of Coverage No. Facility Name Facility Contact Facility Contact Phone No. Please Mail Original And One Copy To Mailing Address Below GENERAL, PERMIT NO. NCG020000 2-0 /'� (ail samples shall be reported within 30 days following monitoring period) NCG02 A 2 ee- S County of Facility _ e Name of Laboratory 6Y-P_ Lab Certification # (2y) 3ZC.,O5t3-7 Part B: Land Disturbance and Process Area Monitoring Requirements Outfall No. . . Reeelving Stream Name ..Date' S4Q50 _ ,t11i53b 000?6 ` xr =OOS45 ; Sample;. ;.Gpllected` Total ltlaw Total Suspended` Sohds 't'arbidity Settleabie> � ,5olidsf inoldd/ s z MG r. JJ Part D: Storm Event Characteristics Total Event Precipitation (inches): Event Duration (hours): Part E: Certification e U c.- a ti Part C: Vehicle Maintenance Monitoring Reauirements f�D40ek44�Q5Qs UOSSG 00S3Q OQ4l}0 r 411ct ��t J,r i �j R. tt Flow . �Gre&Se Stilitls i5. w, o; it kn ; . n un►r Total Event Precipitation (inches): Event Duration (hours): (if a separate storm event is sampled) "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 tPere are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." , (Signature of Permittee) (Date) Part F: Mailing Address Attn: Central Files, DENR, N.C. Division of Water Quality, 1617 Mail Service Center, Raleigh, NC 27699-1617 SWU-243-012005 STORMWATER DISCHARGE MONITORING REPORT (DMR) 11 Please Mail Original And One Copy To Mailing Address Mpwr-, l- tx �c r� 11 GENERAL PERMIT NO. NCG020000 JUL 13 2018 Part A: Facility Information CENTRAL FILES DWR SECTIONS Samples Collected In Calendar Year: 2019 (all samples small be reported within 30 days following monitoring period) Certificate Of Coverage No. NCG02 d Z 9 9 S •3 County of Facility Facility Name CHTPrt.j B (q CLFri' fhtN f- Name of Laboratory tf, TF_ rz -Tr C I '-CBS Facility Contact STE-rl F— t3L /,40 K rt-f 6 G R Lab Certification # Facility Contact Phone No. 76 320 d 3"7 Part B: Land Disturbance and Process Area Monitoring Requirements Part C: Vehicle Maintenance Mo itoring Re uirements Outfall ': No.Fllected Receiving. Stiream Name$USpendedT. 50050"'.; ' �Q053�� 04595't Sample r�1'otal, Fiow;s= Total f I Turlaidity ' .$olids�r� cinoldd/ .r i MGx ? m' ,N i Us I sr- CP vi-- 9 Quiz z z S I-q/Nr-- "/Nft-CT/V i^ " Part D: Storm Event Characteristics Total Event Precipitation (inches): U. 3G Event Duration (hours): /2 Part E: Certification ' ;i€"Date'' r`K a IRA SQrad:OM355fi L ,k,roc _Y 00534 }` 004UD I o o h,Sus ended H,. Receiving;Str`cam t io�v ;,.G'rBase; ;:�F.11tLt7�h.�st.,f�r';��'Sbli�s .. rl a : "t; u tr m�/dcl/ r,� :e iV Am li. I Junit Total Event Precipitation (inches): Event Duration (hours): (if a separate storm event is sampled) "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 property 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." I j (Signkture of Permittee) (D Part F: Mailing Address Attn: Central Files, DENR, N.C. Division of Water Quality, 1617 Mail Service Center, Raleigh, NC 27699-1617 M 0.41J)I?nns 1Y STORMWATER DISCHARGE MONITORING REPORT (DMR) 1) Please Mail Original And One Copy To Mailing Address Below I Part A: Facility Information Samples Collected In Calendar Year: Certificate Of Coverage No. Facility Name Facility Contact Facility Contact Phone No. GENERAL PERMIT NO. NCG020000 (all samples shall be reported within 30 days following monitoring period NCG02 6 Z 0 fS S' 3 County of Facility C"q- 15Fi ecfj~Y_ r�uV E Name of Laboratory 5-r-r— VF (3 Lab Certification # 20 3 za - 01Y.3-7 Part B: Land Disturbance and Process Area Monitoring Requirements Outfail ��: No .. Receiving Stream Name Date 50050 00530 00076 00545 Sample Collected Total Flow Total Suspended Solids Turbidity Settleable Solids mo/dd/ r MG m n NTUs mill 1 5r: CArp-aa rz,u. 31 17 Z C.2 . 5 1. Z CO. i Part D: Storm Event Characteristics Total Event Precipitation (inches): �•2� Event Duration (hours): & Part E: Certification r,R\/FD JAN 0 a Z018 DVVR SECTION INFORMATION PROCESSING UNIT CA T4-w 6 /A Part C� Vehicle Maintenance Mo itoring Re uirements Outfall No. Receiving Stream Name it 50050 ` : 005.56: :-'00530l_-- -00400 , Sample' Collette d_ lotal : -Flow. Oil and Grease Total ,L. Suspended Solids;'r ' :PH..,. moldd/ r , : MG .: m l; " M I - unit. Total Event Precipitation (inches): Event Duration (hours): (if a separate storm event is sampled) "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." p r� 1?:Z a //%-7 (Signature of Permittee) (Date) Part F: Mailing Address Attn: Central Files, DENR, N.C. Division of Water Quality, 1617 Mail Service Center, Raleigh, NC 27699-1617 S W U-243-012005 STORMWATER DISCHARGE OUTFALL (SDO) ANNUAL SUMMARY DATA MONITORING REPORT (DMR)1 SPPP Annual Update DATA REVIEW FORM Calendar Year 20 � Individual NPDES Permit No. "7 NCSI Certificate of Coverage (COC) No. NCG or This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP. Facility Name: C /+TA" `'vJ3 County: C /�—T 4 w A Phone Number: ( 70Y l 3z a- 0 Y 3 7 Total no. of SDOs monitored I 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 DWQ to reduce monitoring frequency ❑ Other ❑ Was this SDO monitored because of vehicle maintenance activities? Yes ❑ Noll Total Rainfall, Inches Parameter, units (�G y 3o S S QDO 76 T.�,-h , d fr C�GSYS Benchmark Date Sample Collected, mm/ddl YJ{/ N/A S - •2 t 1.41-7 aS Z < Z.S Z 40, 1 SWU-264 - Generic Annual DMR Last revised 5/17/2013 is "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 possy)ility of fines and imprisonment for knowing violations." Signature ql U Date 1` 2 C Z/ / ( 7 For questions, contact your local Regional Office: DWQ Regional Office Contact Information: ASHEVILLE REGIONAL OFFICE 2090 US Highway 70 Swannanoa, NC 28778 (828) 296-4500 RALEIGH REGIONAL OFFICE 3800 Barrett Drive Raleigh, NC 27609 (919) 791-4200 FAYETTEVILLE'REGIONAL OFFICE 225 Green Street Systel Building Suite 714 Fayetteville, NC 28301-5043 (910) 433-3300 WASHINGTON REGIONAL OFFICE 943 Washington Square Mall Washington, NC 27889 (252) 946-6481 WINSTON-SALEM REGIONAL OFFICE CENTRAL OFFICE 585 Waughtown Street j 1617 Mail Service Center Winston-Salem, NC 27107 Raleigh, NC 27699-1617 (336) 771-5000 1 (919) 807-6300 MOORESVILLE REGIONAL OFFICI 610 East Center Avenue/Suite 301 Mooresville, NC 28115 (704) 663-1699 WILMINGTON REGIONAL OFFICE 127 Cardinal Drive Extension Wilmington, NC 28405-2845 (910) 796-7215 "Ta preserve, pr Xect and enhance WrM Carntina s water._." SWU-264 - Generic Annual DMR Last revised 5/1712013 STORMWATER DISCHARGE MONITORING REPORT (DMR) Please Mail Original And One Copy To Mailing Address Below K JAN GENERAL PERMIT NO. NCG020000 Part A: Facility Information Samples Collected In Calendar Year: ► ' 47— (all samples shall be reported within 30 days following monitoring period) Certificate Of Coverage No. NCG02. C; County of Facility Facility Name Name of Laboratory Facility Contact _ i L'� 2 n lr {,;e.vr��4 Y Lab Certification # Facility Contact Phone No. 2-c' e Part B; Land Disturbance and Process Area Monitorin Requirements Outfall : o Receiving Stream Name Date 50050 00530 00076 00545 Sample Collected Total Flow Total Suspended Solids Turbidity Settleable Solids molddl r MG m /l NTUs mill EIVED 0 8 Z016 ,:ENTRAL FILES WR SECTION Part C.• Vehicle Maintenance Monitoring Reauir•ements Outfall No. Receiving Stream Name . Date::.::: ;�•:.:_..;,. � ' S0050 ........ :. '.00556 . .,.. ' 00530: . 00 . Sample Gollecte dS Total:.. FIOW `.: Oii and; , Grease Total Suspended Solids.-,, 'pH' molddl yr''' '`-MG mg/Y. m i° unit. .��'C� r ►tic' -mot �� %.� W'CE' 7 i G+ is ti-C''`" - c;, 'r 5 Q., t.Z: +1 s,.� % i f `j 7 t� f,=�2 /�-C Part D: Storm Event Characteristics ;-el C) h r {i . f k r'r� v r �,1 Total Event Precipitation (inches); Total Event Precipitation (inches): Event Duration (hours): Event Duration (hours): (if a separate storm event is sampled) Part E: 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 tines and imprisonment for knowing violations." , (Sfg-naflure of Permittee) (Date) Part F.• Mailing Address Attn: Central Files, DENR, N.C. Division of Water Quality, 1611 Mail Service Center, Raleigh, NC 27699-1617 S WU-243-012005 STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT Permit Number NC 3 FACILITY NAME CAT1--tWd; A GC A- &1j fjF PERSON COLLECTING SAMPLE(S) _ S-&evszr._ CERTIFIED LABORATORY(S) _ N4-he.-"ci. Lab # � Lab # Part A: Specific Monitoring Requirements SAMPLES COLLECTED DURING CALENDAR YEAR: 6/ (This monitoring report shall be received by the Division no later than 30 days from the date the facility receives the sampling results from the laboratory.) COUNTY C 28:jp'GJ i3 6 PHONE NO. C200 326 jQ� SIGNATURE OF PERMITTEE OR DESIGNEE REQUIRED ON PAGE 2. Date Sample i . I Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes >60 (if yes, complete Part B) Part B: Vehicle Maintenance Activity Monitoring Requirements Outfall No. Date Sample Collected 50050 00556 00530 00400 Total Flow (if applicable) Total Rainfall Oil & Grease (if appl.) Non -polar O&G/TPH (Method 1664 SGT-HEM), if Repl. Total Suspended Solids pH New Motor Oil Usage mo/dd/ r MG inches m Me— unit al/mo Form SWU-247, last revised 21212012 Page 1 of 2 STORM EVENT CHARACTERISTICS: Date _ ttkM .7 Total Event Precipitation (inches): 6,20 Event Duration (hours): (only if applicable - see permit.) (if more than one storm event was sampled) Date Total Event Precipitation (inches): Event Duration (hours): (only if applicable - see permit.) Mail Original and one copy to: Division of Water Quality Attn: Central Files 1617 Mail Service Center Raleigh, North Carolina 27699-1617 "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, includinalthe possibility of fines and imprisonment for knowing violations." j7kp., A� �b -7 (Signature of Permittee) (D to e) T� Form SWU-247, last revised 21212012 Page 2 of 2 STORMWATER DISCHARGE MONITORING REPORT (DMR) 11 Please Mail Original And One Copy To Mailing Address Below ii GENERAL PERMIT NO. NCG020000 Parr A: Facility Information Samples Collected In Calendar Year: 2016 (all samples shall he reported within 30 days following monitoring period) Certificate Of Coverage No. NCG02_ -3 County of Facility Facility Name . _Cit W 6;q CC_ ; l PJF Name of Laboratory Facility Contact 51reverj Lab Certification 9 Facility Contact Plione No. ( 70 V) 3 zo- oy 37 Part B: Land Disturbance and Process Area Mnnitnring Regrrirernents Outfnl! No. .. Receiving Stream Name Date 50050 00530 D0076 00545 Sample Collected Fatal Flow Total Suspended Solids Turbidity Settleable Sollds moiddt r MG Mgt] NTUs mill _C Pr_'ft•w9A Pru•1 C: Vehicle Maintenance Monitoring Reatsirernents Outfall No. Receiving Stream Name Date:.:' S0050.1 00556 D0530 00400. Sample` 6.1lecte Total'.. Flbw • O11 and 'Grease Total Suspended Solids,. _ pll, mo/dd/ r' : `• 1NG . m 11 m 71! unit 5e0(MF_wr .6n-5I W0Pe_cFP VD-t; 6U6tf 1210ie T--o rrft-T /j0 b>>.SCtft�i26� Parr D: Storm Event Characteristics JAN 10 Z017 Total Event Precipitation (inches): CENTRAL FILES Total );vent Precipitation (inches): Event Duration (hours): D AIR SECTION Event Duration ()lours): (if a separate storm event is sampled) Part E: 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 qunliCed personnel properly gather and evaluate the information submitted. Based on any inquiry of the person or persons who manage the system, or those pet -sons 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." �-D. 6"J'� -y-r7 (Signature of Fermittee) (Date) Parr F., Mailing Address Attn: Central Files, DENR, N.C. Division of Water Quality, 1617 Mail Service Center, Raleigh, NC 27699-1617 SWU-243-012005 STORMWATER DISCHARGE MONITORING REPORT (DMR) 11 Please Mail Original And One Copy To Mailing Address Below u GENERAL PERMIT NO. NCG020000 Part A: Facitity Information Samples Collected In Calendar Year; G-O 1 (all samples shall be reported within 30 days following monitoring period) Certificate Of Coverage No. NCG02_ U_f3 R_�� County of Facility C .� t.v 4 Fi Facility Name Ct TPriv q __ CL ri ;' >n i hu a Name of Laboratory Facility Contact ---5j-t?y2rN_ /�ccz«, bc,e., 6c1s_e r Lab Certification # Facility Contact Phone No. ( 7) `1) 3 �—Icu U 1/1-7 TT Part B: Land Disturbance and Process Area Monitoring Requirements Part `G• Vehicle Maintenance Mo iforing Requirements pate'" . 50t150 00530:': , ; t#OD76 i}054 :' Outfalt Receiving Stream Name SasripYe Total Total .. ; Su§pegded,: Turblslitjrollds SettleabW. No. Collected' Flow ; Saltds inotddty r . MG; 1' NT1s. �nul Sr~DrMr_- fj f Part D: Storm Event Characteristics Total Event Precipitation (inches): Event Duration (hours): Part E: Certification B'ste 00556 O0530 004UI1 y !#ample � ...Taal �; Ua+and=; `; Total "� ` ,- Receiving Stream Uutfalf Min Gallecte t ' Suspended pH Na . d,' `Flow Grease Sblidg .,, ;inoiddl r .1ViG : m I: L unit` uivt7t=a COE�-;s'r-MUCr/Gt&_1 & /:.3C)/it, - r..�c Lr'1GNiTOP_/NC: Total Event Precipitation (inches): Event Duration (hours): (if a separate storm event is sampled) RECEIVED ,JUL 11 2Ut6 CENTRAL FILES DWR SECTION "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 here are significant penalties for submitting false information, Including the possibility of fines and imprisonment for knowing violations." -5 1 (S gnature of Permfttee) (Date) Part F: Mailing Address Attn: Central files, DENR, N.C. Division of Water Quality, 1617 Mail Service Center, Raleigh, NC 27699-1617 SWU-243_012005