NCG130022_MONITORING INFO_19961108

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
IVC& I3OD�'�
DOC TYPE
❑HISTORICAL FILE
f�MONITORING REPORTS
DOC DATE
❑ I 9 5� I I o
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
7A SAMPLES COLLECTED DURING CALENDAR YEAR:
CERTIFICATE OF COVERAGE NO. NCG 1 -1OU 0 ^_ (all samples collected during a calendar year, shall be reported no later than January 31 of the
following year)
FACILITY NAME 'S0;, - Klee" CZ COUNTY Ro tc5
PERSON COLLECTING SAMPLE(S) RHONEN . 5 O $1i
CERTIFIED LABORATORY(S) Lab # T
Lab # (SIGNATURE OF PERMITTEE R DESIGNEE)
By this signature, I certify that this report is accurate and complete
to the best of my knowledge
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? — yes Xno
(If answer is Yes, complete report below)
Vehicle Maintenance Activity Monit ring Requirements
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STORM EVENT CHARACTERISTICS:
Total Event Precipitation (inches):
Event Duration (hours):
(if more than one storm event was sampled)
Total Event Precipitation (inches):
Event Duration (hours):
1 Applies only for facilities at which fueling occurs.
2 Detergent monitoring is required only at facilities which conduct vehicle cleaning operations.
Mail Original and one copy to:
Attn: Central Files
Division of Environmental Mgt.
DEHNR
P.O. Box 29535
Raleigh, NC 27626-0535
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 violations."
(Signature of Permittee) (Date) Form MRVM

6
'NOV 8 1996
ENV. MANAGEMENT
PAYETTEVILLE REG. OFFICE