NCG080794_DMR_20211220

(
STORMWATER DISCHARGE MONITORING REPORT (DMR)
Please Mail Original And One Copy To Mailing Address On Back Of This Form
GENERAL PERMIT NO. NCG080000
Part A: Facility Information
Samples Collected in Calendar Yea r: 2021 (all samples shall be reported following receipt from lab, but no later than January 31 of the following year)
Certificate of Coverage No.
Facility Name
Facility Contact
Facility Contact Phone No.
NCG08 0794
YRC Inc. (Wilson 650)
BURKE DANIELS DEC 2 8 2021
[phone] CEPdI KAL FILES
DWR SECTION
Part B: Vehicle Maintenance Activity Monitoring Requirements
County of Facility NASH
Name of Laboratories
Lab Certification #'s
Outfall
No.
Date
Sample
Collected
50050
00400
00545
00556
Total
Flow
pH
Total Suspended
Solids
Oil and Grease
I
New Motor Oil
Usage
mm/dd/ r
MG
units
nign
I mgal/month
001
No samples this period — new motor oil usage is less than 55 gallons
+/- 25
002
Represented by SOO-001
Part C: Oil Water Separators and Secondary Containment Areas at Petroleum Bulk Station and Terminals
Outfan
No.
Date
Sample
Collected
50050
00400
00545
00556
Total
Flow
pH
Total Suspended
Solids
Oil and Grease
mm/dd/ r
MG
units
MWI
myfl
Form SWU-250-071400
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STORMWATER DISCHARGE MONITORING REPORT (DMR)
Part D: Storm Event Characteristics
s�
Total Event Precipitation (inches):
Event Duration (hours):
(if more than one storm event was sampled)
Total Event Precipitation (inches):
Event Duration (hours):
"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 there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
_30AW D4MICIs -1212012
(Signature of Permittee (Date)
MAILING ADDRESS:
Attn: Central Files
NCDEQ / DWR
1617 Mail Service Center
Raleigh, NC 27699-1617
Form SWU-250-071400
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