HomeMy WebLinkAboutNCS000037_MONITORING INFO_20191209STORMWATER DIVI510N CODING SHEET
NCS PERMITS
PERMIT NO.
v
DOC TYPE
❑FINAL PERMIT
Y MONITORING REPORTS
❑ APPLICATION
0 COMPLIANCE
❑ OTHER
DOC DATE
❑ �� J � 1 a v C�
YYYYMMDD
STORMWATER DISCHARGE OUTFALL (SDO)
MONITOWNG REPORT
Permit Number NCS� o 00 n 3 SAMPLES COLLECTED DURING CALENDAR YEAR: . 0 � 9
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
FACILITY NAME C t' `� -t- � O �1 C a n COUNTY ex. k e-rn j8 Lk
PERSON COLLECTING SAMPLE(S) BONE NO.
CERTIFLP LABORATORY(S) = Lab # O
C i a r ic, fa;t,,�__ Lab #� i403 (SIGNATURE OF PERMTTTEE OR DESIGNEE)
By this signature, I certify that this report is accurate
complete to the best of ray knowledge.
Part A: Specific Monitoring Requirements
`Outfall -_
No.
Date "::_�0050:-
Sample',
Collected
. '
�
0
Total
- F'low(if a
Total
Ravi all
'
C O� r
MiWd& r
;MG..
Inc
r)C— a
tt_tn_ t
_ S2
z �7
ti\. Q
r..+ S2
Does this facility perform Vehicle I'daiintenance Activities using more than 55 gallons of new motor oil per month? _ yes ✓no
(if yes, complete Part B)
Fart tf: Vehicle Maintenance Activity Nlomtortng Requirements
Outfall ~ `< "': "
'No.
Date
Sample::
S0050 "
,
:00556"
y
Total Flow =
rTotal
Oil'& Grease
Nan polar
Total .
pH ' {
New Motor
Collected
if applicable)
Rauol'all.
(if appL) "
0&G/TPH
Suspended
F_y
Otl Usage
.
(Method 1664.
Solids
-,...
SGT HEM},af
ap 1,
mo/dd/vr
MG::
iriclses'::
.. . .
t7afJl ._
"unit „ -. '.'
a:I mo _
Form SWU-247-062310
Page t of 2
Storm Event Characteristics: Mail original and one copy to:
Division of Water Quality
Date: l - 1 a - 1 Attn: Central Files
1617 Mail Service Center
Total Event Precipitation (Inches): Raliegh, N.C. 27699-1617
Event Duration (hours) :
(if more than one storm event sampled)
Date:
Total Event Precipitation (Inches):
Event Duration (hours) :
(only if applicable - see permit)
" 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 imprisionment for knowing
violations."
(Singnature 4 Permittee)
(Date)
Form SWU-247-062310
Page 2 of 2