NCG020267 DMR SW (3)

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: ,A,W —____ s,(all samples shall be reported within 30 days following'motiltoring period)
Certificate Of Coverage No. Nl; tfZ ' t� ". County of Facility , ' .,L/,c ifp €11 ,C '0,1/ in, e
Facility Name e e 1 J L , l C Name of Laboratory '54/4–.1.— -s r✓ .'.J)c ' /t,.L-,,,./�,741 c�,�
' Facility Contact • - - c L U ✓YJ.06 5 Lab Certification ii vw cO ,3 '-j'>''S S— , •
Facility Contact Phone No. (7041 1-7Z,'_.--4-1112--5 •
Part B:Land Disturbance and Process Area Monitoring Requirements Part C: Vehicle Maintenthice Mdnitoring Requirements
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OCT 1F216,
Poi t D:Storm Event Chn�acteristics
DE SELCTION
Total Event Precipitation(inches): 0, Total Event Precipitation(inches): •
,- - Event Duration(hours): -y S,, n•;„ ,,d - Event Duration(hours): ' 1
_ (if a separate storm event is sampled) ' • ,
Part E: Certification ” ' ' -
• , , - "I certify,under penalty of law,that Ulla'document and ail 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. Baed on my inquiry of the person
or persons who manage the'system,or those persons directly responsible for gathering the information,the m
inforation 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 j - ` ,
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`"',',:„,t4--,.. 6 D-o a ‘7 STATESVILLE ,
Parameter Sample ID Result Ul_____:ljL___________----------Method Analyzed Analyst
t*:-..4.",--' 160930-08-01 Settleable Solids Outfall#1 <0.1 ml/L SM2540E-1997 09/30/2016 MD
l'6-';'-f, 160930-08-01 TSS Outfall#1 7.093 mg/L SM2540D-1997 09/30/2016 CR
Turbidity 1
Outfall#1 12 NTU EPA 180.1 09/30/2016 MD
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NCDW Cert#37755,
EPA#NC00909
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1 PO Box 228 ° Statesville, Z8G87 NC ° 704/872/4697
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