NCG020351_DMR_20200627

STORMWATER DISCHARGE MONITORING REPORT (DMR)
Please Mail Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCG020000
Part A: Facility Information
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Samples Collected In Calendar Year: (all samples shall be reported within 30 days following monitoring period)
Certificate Of Coverage No. NCG02 O 3 5-1 County of Facility
Facility Name CA AJ Dog Name of Laboratory
Facility Contact S-1-eve-S, 1, t,L l4Q" ,i I a' Cer"Cation
Facility Contact Phone No. 20 3 Zy U y 37
-cart o: Lana visturoance and Process Area Monitoringe Requirements
O.utfall'
No.
Receiving Stream
Name
:Date'
5005.0
00530 ;.
•00076
9-054 S.' ,'
Sample
Collected'
'fdfal
Flow
Totat
Suspen(led
Shcfds:
Turbiiiiy
Settleslbie
:Solids
mo/ddl.r
MG,
m 1
N'fjs
iuUl,
516120
�.S
(o
I,j
<6
Part D: Storm Event Characteristics RECEIVED
020
Total Event Precipitation (inches): O. /7 JUL 0 6 ?
Event Duration (hours): 3
CENTRAL FILES
Part E: Certification DWR SECTION
urns-e rt�--e h
Part C: Vehicle Maintenance Monitoring Requirements
Date> ' , ' �11�50 Q05S6. 0053:0`
WWI` Receiving StreamF earn 1e ^
'final Oxl and rCotal'.:
Nu Name Go11�Cte' Sgspende
Flijw grease
�" lno/dd%vr. IYIG nrati _ mail
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 t
including the possibility of ere are significant penalties for submitting false information,
fines and imprisonment for knowing violations."
(Signature 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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