NCG120066_DMR_20200331

STORMWATER L 1GE OUTFALL (SDO)
MONITORING REPORT
Permit Number; NCS /Vc-& I Z0000 — or
Certificate of Coverage Number: NCV. Z9 c9 6 (0
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FACHMNAME I/dkeS �tjadv
PERSON COLLECTING SAMIPL9(S) '
CERTIFIED LABORATORY(S)--S C411d /Ecy b li
—Lab
Part A: Speeffic Moultoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: ljzoz'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 Vl� I lie S
PHONE NO. (33& )-I�UL - 8 6 `7
(SIGNATURE OF PERMITTEE OR DESIGNEE)
By this signature, I certify that this report Is accurate
complete to the best of my knowledge.
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Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? — yes --W
(if yes, complete Part B)
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Form SWU-246-062310
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STORM EVENT CHARACTERISTICS:
Total Event Precipitation (inches):
Event Duration (hours): (ouly if APPuCabu —see POrm'L)
(if more than one storm event was samplod)
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 CenrOr
Raleigh, North Carolina 27699-1617
ender my direction or supervision in accordance with a
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I certify, under penalty of law, that this docuent and all attachments were prepared Based on nay inquiry of the person
ure
system designed to assthat quRIM d personnel pretty ia� and evaluate the information submitted.is,
e the system, or those persons directly responsible for gathering the information, the information submitted M to the beat
or persons who manage ties for submitting false Information,
of my Imowledge and belief, true, accurate, n �P �� awarevlolationsthat there
are sigamcant pew
including the possibility of flues and imp
(Signature of Permittee) (Date)
Form Svm-246-062310
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