NCG020285_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
Samples Collected In Calendar Year: 15L Z020 (all samples shall be reported within 30 days following monitoring period)
Certificate Of Coverage No. NCG02 O 2- 0 County of Facility
Facility Name -e-Cc Ewa �- M %.,e Name of Laboratory
Facility Contact .Qve" 6,- Lab Certification#
Facility Contact Phone No. 7( ar) 9 Zo 6Dy3 7
Part B: Land Disturbance and Process Area Monitoring Requirements
Outfall
No.
Receiving Stream
Name
Date`
50051)
00$30 ..
00076 ;;
,`00545s'
simple
Collected
Total
Flow
Total.
Suspended.
Solids. ;
Turbidity:...
Settleable
Solids
mo/dd/ r
MG
moll -
NTUs ;
ml/1
wa -Le
-AL 5-0
Outfall
ltecelviog Stream
Date
•90054
00556.
00530
, $ample
Total
Oil aid-
Total
No
Name ;
CoIleete•
. Flaw'
Grease'
Susped0e
dC ,
, Solids,
..
maldd/ve
' MG-.�
ma/t
mvtf
Part D: Storm Event Characteristics RECEIVED
Total Event Precipitation (inches): JUL 06 2020 Total Event Precipitation (inches):
Event Duration (hours): Event Duration (hours):
CENTRAL FILES (if a separate storm event is sampled)
DWR SECTION
Part E: Certification
"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 the a are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
4Z2-2Zzj
(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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