NCG020351_MONITORING INFO_20190730

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCG O)o 361
DOC TYPE
❑ HISTORICAL FILE
i)( MONITORING REPORTS
DOC DATE
❑ U 0
YYYYMMDD

STORMWATER DISCHARGE MONITORING REPORT (DMR)
Please Mail Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCG020000
Part A: Facility Information
Li tyiy���� ��t VED
Samples Collected In Calendar Year: 2 D ! (all samples shall be reportedwtliln 3 days following monitoring period)
Certificate Of Coverage No. NCG02 10 3 61 JUL 9 0 goy_bty of Facility MUK e) -.o nz
Facility Name K Name of Laboratory w e
Facility Contact 13 1 a-% La h /a2lieeENTRAL UjW-Gertification 0 O
Facility Contact Phone No. ( 7 6`01 3 a r) y 3 7 DWR SECTION
Part B: Land Disturbance and Process Area Monitoring Requirements
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Outfall'
Receivin Stream
g
Sarople .
Total
Total*:
Settleable
No..,
Name
Collected'
Flow
Suspended
Turbldltyy
Solids r
,;;
qyt
mo/dd/r:
MG t`*
m t' ::
NTUs,"
tnl/1'=;`r
Part D: Storm Event Characteristics
Total Event Precipitation (inches):
Event Duration (hours): %
Part E: Certification
Part C: Vehicle Maintenance Monitoring Requirements
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/ Deie' �`'
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00556i
00530'.:
f am le r
,P
r
Total 4
Oii and
Total's
Outfal(
ReColvin Stream+ ,
No
Name G ° z
rCollecte`
} „s
,s Flow
Grease
Suspende
y
Solids::
trail dd/
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 fo 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. A lsf
7123
( ignature 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