NCG020285 DMR SW (2)

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: 0"r/ (all samples shall be reported within 30 days following monitoring period)
Certificate Of Coverage No. NCG02 G . County of Facility
Facility Name - 11W Name of Laboratory
Facility Contact +e7.� hocy'r yr 4,z Lab Certification #
Facility Contact Phone No. (wj
,
n__., n. r _._J n:..,....t.,. ,.l D.... � d.•nn AAnnifnrian Rnmiirnmmf/c
Outfall
No...:
Receiving Stream
` Name
Date
50050
00530
00076
00545
Sample
Collected
Total
Flow
Total
Suspended
Solids
Turbidity
Settleable
S,ollds
mo/dd/ r
MG
mg/1
NTUs
mill
unit. .
f�)" c;
Part D: Storm Event Characteristics
Total Event Precipitation (inches):
Event Duration (hours):
Part E: Certification
rl ffi� � �14 7r�
Part C: Vehicle Maintenance
OutfallI Receiving Stream
No. Name
t G� -c tbn
.11 . 21,�
Total Event Precipitation (inches): —
Event Duration (hours):
(if a separate storm event is sampled)
uirements
50050
0556,;:
0053,0
00400..
Total
and:
Toful
1.Oil
!„Grease
Suspended
pH .
Solids ::.'
MG
aiell..
unit. .
Guff 1 6)
"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.”
(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
SWU-243-012005