NCG020747 DMR SW (2)

STORMWATER DISCHARGE MONITORING REPORT (DMR)
Please Mail Original And One Copy To Mailing Address Below�����/�®/®��f®�
GENERAL PERMIT NO. NCG020000 JAN 2'2 2015
Part A: Facility. Information Wilier QUBIG�y
OPzrations as, gi1
Samples Collected In Calendar Year:20/ T all Samples shall be reported within 30 days following monitoring period)
Certificate Of Coverage No. NCG02 0 % County of Facility w LKeS
Facility Name /K 4TH /S Oij4oby% Name of Laboratory 5 N9 4 �*1'Lq-L .
Facility Contact ,,.5 _ Lab Certification # to
Facility Contact Phone No.
Part B: Land Disturbance and Process Area
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Part D. Storm Event Characteristics
Total Event Precipitation (inches): i
Event Duration (hours): / 2..
Part E: Certification
Part C: Vehicle Maintenance Monitorine Reauirementc
Total Event Precipitation (inches): A el
Event Duration (hours): od/Itar
(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."
(Signa re 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
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SWU-243-012005
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Total Event Precipitation (inches): A el
Event Duration (hours): od/Itar
(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."
(Signa re 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
v
SWU-243-012005

Pa t A Continued: Wastewater Monitor ng Re uirements
Outfall No.
Date Sample
Collected
50050 00530
Total Flow , Total Suspended
Solids'
00400
Turbidity,
00545
Settleable Solids
00400
pH
31616
Fecal Coliforms
-
mm/dd/yr
MG mg/1
NTU
n l
Standard
col/mP
74
MAEL ORIGINAL AND ONE COPY OF THIS ANNUAL SUNIIVIARY (INCLUDING ALL "NO FLOW"- "NO DISCHARGE" & LBUT
VIOLA IONS) BY MARCH 1 OF EACH YEAR TO:
DivisioA of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North. Carolina 27699-1617 -
YOUMUST SIGN THIS CERTIFICATION FOR ANYINFORMATIONREPORTED•
"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 responsiblp for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete.
I am aware that the a are sig • an enalties for submitting false information, including the possibility of fines and imprisonment for knowing violations."
(Sign)Vra of Permitte (Date)
Permit Date: 1/1!2010=12/31/2014 Last Revised 01-05-10
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