NCG020351_DMR_20240111

1
STORMWATER DISCHARGE OUTIFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT PIVIR)
Calendar Year- 20 2--
individual NPDES Permit No. NcsLJ _J""LJL_J or
Certificate of Coverage (COC) No. NCG O❑[LQ®O 0M
This monitoring report summary of the calendar year should be kept on file on -site with the facility SPPP.
Facilit Narne• C7Ck- W Pbr-
Y
County: �Y? u
Phone Number:
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Total no. of SDOs monitored
Outfall No. I____
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑ No (�
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑ No ES--""
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other
Was this SDO monitored because of vehicle maintenance activities? Yes ❑ No
Parameter, (units
Total
Rainfall,
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Inches
Benchmark
N/A
Date Sam !e
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Collected,
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SW U-264-Generic-13 Dec2012

STORMWWATER DISCHARGE MONITORING REPORT (I)MR)
Please Mail Original And One Copy To Mailing Address Below
GENERAL PERMIT NO. NCGO20000
Part A: Facility Information
Samples Collected In Calendar Year: 21-7) 2-0 2-0 (all samples shall be reported within 30 days following monitoring period)
Certificate Of Coverage No. NCG02_ 1 County of Facility
Facility Name o v- Name of Laboratory
Facility Contact 8 UL 4— Lab Certification #
Facility Contact Phone No. (ZW 3 2-0 D y 3
Part B: Land Disturbance and Process Area Monitorine Reauirements
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Part D: Storm Event Characteristics
Total Event Precipitation (inches):
Event Duration (hours):_
Part E: Certification
PA c: E
Part C. Vehicle Maintenance Monitorinir Reauirements
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Total Event Precipitation (inches):
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 ther are significant penalties for submitting false information,
Including the possibility of fines and imprisonment for knowing violations."
(Signature of P rmittee) (Date)
Part F: Mailing Address
Attn: Central Files, DENR, N.C. Division of Water Quality,1617 Mail Service Center, Raleigh, NC 27699-1617
Swv-243-01 MOS