NCG020285_DMR_20210715

STORMWATER DISCHARGE MONITORING REPORT (I)MR)
Please Mail Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCG020000
Par? A: Facility Information
Samples Collected In Calendar Year: & (all samples shall be reported within 30 days following monitoring period
Certificate Of Coverage No. NCG92 � County of Facility
Facility Name 1 y ✓ -� .7_7W ,h;._ Name of Laboratory
Facility Contact _ ¢N c r. , f , , i ! Lab Certification #
Facility Contact Phone No. Q
,Part H: Gantt Disturbance and Process Area Monitoring Reauirements
Date ` 500% 00530 �007 00545
Outfalt Recei►�itig Stream Ss#rnple Total, Total Seftle�blC:
IVo:. Name Cgllectetl`, , ` Fiore Six§pe�aded .Turbidity
Snhds+
na©Idd/ r X..::;
Part D: Storm Event Characteristics
Total Event Precipitation (inches):
Event Duration (hours):
Part E: Certification
JUL 2 0 2021
CENTRAL FILEn,
DWR SECT101�
Part C: Vehich- Mainfonnnrc MnnifeWinv Roinfiromonic
Outfail .:
,: iVo
-77
12ecelving Stream
'Name s4
a4illect+.4
Daze _`sue
SQ00'
00556
0053t11
00400
Satnpld
atdl
Fllfw'
ail sisd
Crease
' Total.
Suspended
pH
mg,
talit.
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 th a are significant penalties for submitting false information,
including the possibility of 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