NCG120066_DMR_20200430

STORMWATER L - IGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS �C—C- I'W60 0r SAMPLES COLLECTED DURING CALENDAR YEAR:
Certificate of Coverage Number: NCG 0 (This monitoring report shall be received by the Division no 17i;r than 30 days from
I the date the facility receives the sampling results from the laboratory.)
FACILITY NAME �1465 �,20LIn�V A&e1talL.11
PERSON COLLECTING SAMPLE(S).-
CERTIFIED LABORATORY(S) MT70m �F/, Ub
—Lab if
Put As. Specific Monitoring Requirements
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MAY 18 2020
(SIGNATURE OF PERMIME OR DESIGNEE)
CENTRAL FILES By this signature, I certify that this report Is accurate
DWR SECTION complete to the best of my Imowledge.
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Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of now motor Oil per month? — yes --W
(if yes, complete Pan B)
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Form SWU-246-062310
Page 1 of 2

STORM EVENT OURACTERLSTICS:
Date.. Z0zD
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable —see permit.)
(if more than one storm event was sampled)
Date
Tote! Event Preciotation (inches): --
Event Duration (hours): (may if applicable —see permit.)
Mail Orlghaal and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
an Hader my direction or supervision In accordance with a
"I certify, under penalty of law, that this document and rl at ow and were prepared Haled on my Inquiry of the person
to assure that qualified Personnel properly
Pam' and evaluate the Information aabontted.
�� or tboae persons directly responsible for gathering the tnformatbn, file information submitted is, to the best
or persona who manage the system, gUlt ea for snbmittin$ false Information,
of my imowledge and belie[, tree, accurate, and complete. I am aware that there are aiguM penalties
including the poseibUity of flna and Imprisonment for intowing violations.'
(Signature of Permittee) (Date)
Form SWU-246-062310
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