NCG020761 DMR SW (2)

STORMWATER DISCHARGE MONITORING REPORT (DMR)
II Please Mail Original And One Copy To Mailing Address Below II
GENERAL PERMIT NO. NCG020000
Part A: Facility Information
Samples Collected In Calendar Year: Q-16"(all samples shall be reported within 30 days following monitoring period)
Certificate Of.Coverage No. NCG020Z.0 76, /.. County of Facility �o
Facility Name'
-54,Ae 6 U Name of Laboratory q es ,�,q feJ
Facility Contact 5 4& C^4 M0a5 i3 Lab Certification # .
Facility Contact Phone No.
Part. B: Land Disturbance and Process Area Monitori ig Require ents Part C: vehicle Maintenance MY nitnrinv Remuiremontc
Part D: Storm Event Characteristics
Total Event Precipitation (inches):
Event Duration (hours): "
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Part D: Storm Event Characteristics
Total Event Precipitation (inches):
Event Duration (hours): "
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Part E: Certification
4018 BUFF
"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 violatio s."
O
(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 '

Sample Number Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
150325-23-01 Settleable Solids
OF#6
<0.1
ml/L
SM2540F-1997
03/26/2015
MD
150325-23-01 TSS
OF#6
4.667
mg/L
SM2540D-1997
03/26/2015
WL
150325-23-01 Turbidity
OF#6
8
NTLI
EPA 180.1
03/26%2015
MD
Respectfully
submitted,
Dena Myers.
NC Cert #440,
NCDW Cert #37755, -
EPA #NC00909 --
PO Box 228 • Statesville, NC 28687 • 704/872/4697
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