NCS000289_MONITORING INFO_20190516

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STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
j�f �S b Ob
1'
DOC TYPE
❑FINAL PERMIT
b� MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ 80t �
YYYYMMDD

STORviWATER DLC�RGE OL'I'FAC_i. (SDO;
MONT70R NG REPORT
a
Permit tit=ber:.NCS �* ` Or
Cert;f:"€e of Coverage Number; N,CG
F A C T ITY NAME S mtr�joci
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PERSON' COLLECTLtiG SAMTLErC ,
CERTIFCED LABORATORY(S) Lab ;; '�7;
Lab 4
Part A. Specific .Mlot:iteriag Requirements
SAMPLES COLLECTED DURING CALE:``DAR YEAR:
('rhi_s mertitorirg report sbafi be received by the Divu:oa no Eater than 30 days from
the date'the facility receives tfie sampling restJ- t_s From the [aboraic• v.)�r—�
REG�I ,�- c
o u-N—ry O -i i
MAY 2019 P- -E .N-O- ( i, �
CEN`fRAL FILF--(SIGtiATURE OF PE FOR DESIGNEE)
pWR SEGTiONB this sign a„ rre, I cert♦.v that this report is accur'a:e
complete to 4 e best of t:.v know•ikedge.
Does .his facti perfe m esicle Mair ✓az ce .",c a res us �g r'.o •u:a 55 g�4a s a:` r,ew motor oil per mozUn % _ yes ' no
(i-f yes: complete Part B)
Par`, B: Vehicle Maiatesnnce Activity Mouitoriue Reaui.renients
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STORM E-VENT Cfi.kR_AC_VERiSTICS:
Date
Total Event Precipitation (inches):
Event Dciration (hears)- (nr� v if appLcabx - sce
(Lf More th -.. one s,G= ever:[ was sa—mPied)
Date
Total Event Precipitation (inches",:
Erect Dra:atiou (hca s): (Ociy iff apr€icab'e - see
Mail Original and one copy ta:
Divsia n c. Wait,- QuAl:
Attn: CeE:,:ai F,,ies
16.7 Mai: Service Cer;.cr
R.aicig:.. Nor, C m ina 2759S ;. ; -
"i aerti€v, Lander penalty of Law, that this document and ail attachments were prepared tmder my direction or super-v;sion in accordance with a
system designed to assuz-e that quail&ed personnel prope-Ey gather and evaitaate the iaro=. tica submitted'. EES&_4 as my inq^ai.-y of rbe pe sor.
or persons who marm a the sgstem, or those persons directly resNasible for gat: eriag the inf'Cr-'natioa, the iaformation submitted is, to the best
of my knowledge and belief; true, accurate, and complete_ ? am aware that ;here are sign, ,cast permities for subrnitt�r_g false ia`or:nat�o^.
inclad?ag the possibiLty of fines and imprrseament for knowing violations."
ignature of Per-raitte , (Ta )