NCG020883_MONITORING INFO_20200123

N vo
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/v Da o
DOC TYPE
❑ HISTORICAL FILE
❑� MONITORING REPORTS
DOC DATE
❑ �� �% a
YYYYMMDD

DOC TYPE 1 ❑ HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE 1 ❑
YYYYM M D D

Individual NPDES Permit No.
Certificate of Coverage (COC) No.
S T ORMVVATER DISCHARGE OUTFALL (SDO)
ANNUAL SUMMARY DATA MONITORING REPORT J,)MR)
Calendar Year 7 6 /q
AN
This monitoring report summary of the calendar year should be kept on file on -site with the utility SPPP. RECEIVE®
Facility Name:
County:
Phone Number:
=I i
7
Total no. of SDOs monitored
JAN 2 3 2020
CENTRAL FILES
DWR SECTIOr'
Outfall No.
Is this outfall currently in Tier 2 (monitored monthly)? Yes ❑
Was this outfall ever in Tier 2 (monitored monthly) during the past year? Yes ❑
If this outfall was in Tier 2 last year, why was monthly monitoring discontinued?
Enough consecutive samples below benchmarks to decrease frequency ❑
Received approval from DWQ to reduce monitoring frequency ❑
Other ❑
Was this SDO monitored because of vehicle maintenance activities? Yes ❑
No j
NojS
No
Parameter, (units)
Total
Rainfall,
inches
1
T
Benchmark
N/A
Date Sample
Collected,
mmiddlyy
g
/
.s
'8�,7
/'O.
C t`z
F
- SWU-264-Generic-13Dec2012

Part A: Fceilify Information
Samples Collected In Calendar Year:
Certificate Of Coverage No.
Facility Name
Facility Contact
Facility Contact Phone No.
OR51WATUR WSCHARGE MO3'OlvtTy"d' (i°)
Please Mail Original And One Copy To Mailing Address Below
GEPW AL PERMIT FI0. NC^G020000
24019 (all samples shall be reported within 30 days following monitoring period)
N'CG02_1J�3 County of Facility,
_ f}T &j //Uri Name of Laboratory
S eve h —B ICE n4v-?6 efc,ev Lab Certification 4
(,7q`U_ 3�0 6Y�7
Part B: Land Disturbance and Process Area Monitoring Requirements
Onifah -
No, -
Receiving Stream
Name
_
Date
50050
00530
60675
60545
Sample
Collected
Total::
Flow
Total
- -
Suspended
Solids,
Turbidity
Settleable
,.Solids
mo/dd/
MG ��
m 1
NT
ml/V
Part D. Storm Event Chrm-acteristics
Total Event Precipitation (inches):
Event Duration (hours):
Part E. Certification
I 1 Ecpi s o
�� BAN2ge-
Pd,10
"�AL FILE s
(fA-T A W i3_A+_-_
WA{tn CLl
# .50
'art C. Vehicle Maintenance Monitoring Requirements
.
outfall
--': No.
Recelving Streartt
Name -
Dote
50.50
00555'
00530,'
00401
,Sample
Collette
Total
-
Flow.
Oil and;
Grease
Total
Sus ended
P
Solids
Fi
0 -
moldd/ r
MG
m 1C
in If
unit
"total Event Precipitation (inches):
Event Duration (hours):
(if a separate storm event is sampled)
"I certify, under penalty of law, that this document and all attachments were prepared tinder my direction or supervision fro accordance with as
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 any knowledge and belief, true, accurate, and complete. I am aware that here are significant penalties for subenitting false information,
including the possibility of fines and imprisonment for knowing violations.'
( ign -tore of Perm ttee) (Date)
Part F. Mailing Address
Attn: Central Fides, DENR, N.C. Division of Water Quality, M17 Mail Service Center, Raleigh, NC 27699-1 Sf7