NCG020351_DMR_20230110

STORMWATER DISCHARGE MONITORING REPORT (DMR)
PIease Mail Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCG020000
Part A: Facility Information
Samples Collected In Calendar Year: ZhU Za 22 (all samples shall be reported within 30 days following monitoring period
Certificate Of Coverage No. NCG02 Q 3 51 )
Facility Name -- County of Facility m n ►- �
CIO � 6 0 V- CYI t r1Q Name of Laboratory
Facility Contact T L r •_ >-� --- •
h �a- e� r LQU %- tiltl AliV6l ff
Facility Contact Phone No. (7oYl-3Z19 Uy37
..•.•. —w—ruunce ana rl-OCeSS A?'
Date
Outfall Receiving Stream
Name Sample.
Nv. Collected
moldd/ r
Y%22.
Part D: Storm Event Characteristics
5005.0
00530 `.
00076
f105d5 ."
Total
F►ow '
Total
Sus ende,d;;
TurbidlY
le ;
SeStotlle►dabsSolids'
N ui
ml/l
Total Event Precipitation (inches): U
Event Duration (hours): 2_
Part E: Certification
REGEI\/P
jAN 2 3 202
Part C: Vehicle Maintenance Monitoring Requirements
CENTP\AL FILE -Total Event Precipitation (inches): —
OWR SECTIO�I 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 thei-A are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
6,
d Z3
(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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