NCG120066_DMR_20210206

Permit Number: NCS 12 DO 00 or
Certificate of Coverage Number: NCG 1 :2- 06 L- to
STORMWATER 1. tGE OUTFALL (SDO)
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR: ) w' � 2 021
CM monitoring report shall be recelved by the Division no Cater than 30 days from
the date the facility receives the sampling results from the laboratory.)
FACILITY NAME � � � RECEIVED COUNTY �(s
PERSON COLLECTING SAMPLE(S) } PHONE I O.
CERTIFIED LABORATORY(S) Lab # P E3 J 8 2021 �n u
Lab *----CENTRAL
OF PERMITTEE OR DESIGNEE)
—CENTRAL FILES By this signature, I certify that this report is accurate
DW R SECTION complete to the best of my knowledge.
Part A: Specific Monitoring Requirements
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of now motor oil per month? —yes _no
(if yes, complete Part B)
Part tt: Vehicle
Maintenance
Activity Momto
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Form SWU-246-062310
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