NCG020285_DMR_20220128

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: 2 ZQZ? (all so les shall be reported within 30 days following monitoring period)
Certificate Of Coverage No. NCG02 U 9{t County of Facility
Facility Name CI.e u ✓ v n,c Name of Laboratory e `�—
Facility Contact S' eey -eL— Lab Certification 9
Facility Contact Phone No. ( 7v i- i 3?& 6 ct 3 7
Part B: Land Disturbance and Process Area Monitorine Reauirements
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Wa
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Date
5000
00530
00076
00545
�'ampte
C lie
0
Total
P16W -
Total
suspended
'S'urbidity
-Wei
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lif6
nivJ1
idTOs.1
=kzk
fy r
Lr
Part D: Storm Event Characteristics
Total Event Precipitation (inches): _
Event (Duration (hours):
Part E: Certification
'artC. Vehicle Maintenance MOnitorineReauirements
:.aLifall
.�
Aeceiving Stream
.
NptY(t
a
1a)e,i
OU50 .
00556
00330
00400
am st$u
p*
a elleore
'halal
0:.low
oil and
Grease
Tot.el
9nsperided
Selitis
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^'tdtl!•.+
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w'tl
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Unit
Event Precipitation (inches)* _
Event (Duration (hours):
(if a separate stone event is sampled)
REGElVF=r
FEB 0 7 2022
CENTRAL FILES
DWR SECTIor•
"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."
. �i� /�Z��� Z
(Signature of Pernnttee) 4DWK-)
Part F: Mailing Address
Attn: Central Files, DENIM, N.C. (Division of Water Quality, 1617 Mail Service Center, Raleigh, NC 27699-1617