HomeMy WebLinkAboutNCG020883_DMR_20210715STORMWATER DISCHARGE MONITORING REPORT (DMR)
Please Mail Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCGO20000
Part A: Facility Information
Samples Collected In Calendar Year: =Lj (all samples shall be reported within 30 days following monitoring period)
Certificate Of Coverage No. NCG02_,nQ 9 3_ County of Facility 'f'ot_ L ti
Facility Name 1 2 he 71 ,'ti Name of Laboratory 1WV
Facility Contact-���., Q Fr L �Lab Certification #
Facility Contact Phone No. (xi) -R 2g_ c1v q 7
Part B: Land Disturbance and Process Area Monitoriniz Reauirements
Date MOW 00536 90070 405a$
Outfall
Receivitlg Stream Total Settleable>:
Sample Total` Suspended ;Turbidity k No Name " CQltectetl plow;'nlids
Solitls
mo/dd/ r ; MG ` ingll N
Part D: Storm Event Characteristics
Total Event Precipitation (inches):
Event Duration (hours):
Part E: Certification
JUL 2 D 202,
L FILE
DmNR �C770mS
-art u: renicie maintenance monnorinztteautrernents
D ate'
S00s0
00556
00530'
0fJ400:
t�utfalk
Receingtreanl
Sampcle
l'otal
Oil and
Total'
No.
a n
Gull to
Flow
e
Suspended
pH
al`:.'.
souas
----
rtW/Eldlyr
MG
tMli
nze/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 Perrruttee) (Date)
/yl
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