NCG210353 DMR SW (2)

STORMWATER DISL—A.,..E OUTFALL (SDO)
Permit Number: NCS MONITORING REPORT
Certificate of Coverage Number: NC X10 S or
FACILITY NAME Ca et i c,
PERSON COLLECTING SAMPLE(S)
CERTIFIED LAB_ ORATORY(S) _da,
el Lab* 2 D
ab #�—
Part A: Specific Monitoring Requirements
No. a
Sample
S P
�uuZU
SrI nom.} .CRE.3
Total_
Collected' '
..
tii-,-To
Flow, �,i6_ •_
(if aPP•), Rainfa11�
Od gt Gre as�
..
mo/0d/
�"
t j• e4�-.: ,i _. � •.,2'�_=�a=�''�.�
�?
.'���_ �' �-€ kms; S
,1
7_N_7nn-�_
M - _
Gmat
SAMPLES COLLECTED DURING CALENDAR YEAR: .
(This monitoring report shall be received'
the date the facility receives the sampling re the Division no later than 30 days from
. P • b results from the laboratory.)
COc,bC, Y
7=U y s s 6
I(SIGIW4--
siF PERmn
bure, I certify that this report is accurate
complete to the best of my imowleda
Does this facility perform vehicle Maintenance Activities using more than Sg e
(if yes, complete Part B)
ballons of new rn, t, _
Form SWU_246_112608
Page 1 of 2
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77
Form SWU_246_112608
Page 1 of 2

STORM E �—'qT CHARACTERISTICS:
mate
Total _Ev the P • —Precipitation (inches); _
Event Duration (hours): —
(0131y if applicable – see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours);
(only if applicable – see permit,)
Mail Original and one copy to:
Division of Water Quality
Attu: Central Files
1617 Mail Service Center
RaIei;h, North Carolina 27699-1617
"I certify, under penalty of law, that this document and
system designed to assure that qualified all attachments were re
or persons who manaa t , or
personnel properly prepared under my direction or su ervision in accordance with a
of my knowledge se the system, or those persons directI brther and evaluate the ' P
ae and belief, true, Y responsible for informahOnbrted- Sased on m
indud' ossibili accurate, and complete• I am aware that there are Danii`icant penalties for sub Y inquiry of the person
t3' of fuses and • b the information, the information submitted is, to the best
for lmowfng violations.^
nutting; false information,
( gnature o ermitteq
lJ
(Da e)
Form SWU-246-112608
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