NCG140189_MONITORING INFO_20020630

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT N0.
/V CCU I ��
DOC TYPE
❑HISTORICAL FILE
2-MONITORING REPORTS
DOC DATE
❑aooa o& 3 l
YYYYMMDD

NCDENR
DISCHARGE OUTFALL MONITORING REPORT
GENERAL PERMIT NCG140000
(All sample data shall be reported no later than 30 days after receipt of lab results)
certifiqa , t'e, of Coverage
NCG 14
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Certified Laboratory #
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Collectors Signature
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Sarre le Information'
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Storm Event CharacteristicsJ,
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Does this facility perform Vehicle Maintenance Activities using on average more than 55 gallons of new motor
oil per month? 0 Yes 0 No If yes, complete information, below.
Stormwater Discharge Monitori Lag from Vehicle Maintenance Areas
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SWU-241-080199 Page lof 2

Part B: Process wastewater discharge monitoring data
Sample #
Effluent Sources for this sample J
Vehicle / Equipment Cleaning ❑
Raw Material Stock -pile Wetting ❑
Mixing Drum Clean -out ❑
Recycle System Overflow ❑
Parameter'''
Y•�.. R
Unit
A'Uata
Collection Date
mo/dd/yr
Total Flow
MG ,
Event Duration
hours
pH
Std. units
TSS
. mg11
Settleable Solids;
`, mUl.
Sample #
Ffflu`eitt.„ vtirct' efor!ttit �.si1; " le°
❑
C7••�•
❑-
Vehicle / E "ui ment CleaningC7
Raw Material' Stock= `ile,Wetfi.n
'°Mixin �Drutn'Cleaii-'out"•'"�:°::.:°t:�:".;�.,`�;,
Recycle System Overflow
Parameter r
{i�><fttit
• .Data, t`� '`
Collection,Daie
mo/dd/yr
Total Flow'
--MG
Event Duration
hours
pH
Std. units
TSS
mg/l
Settleable Solids
mUl
Mail original and one copy to:
Attn: Central Files
Division of Water Quality
DENR
1617 Mail Service Center
Raleigh, NC 27699-1617
Sample #
Effltient Sources for this sam le
❑
❑
❑
❑
Vehicle / Equipment Cleaning
Raw Material Stock -pile Wetting
Mixing Drum Clean -out
Recycle System Overflow
" Parairt`eter ;„
Unit
Data
Collection Date
mo/ddlyr
Total Flow,
"IMG
Event Duration'
hours'
pH
Std. units
a:
Settleable Solids
inu
t r;
ur
Sample #
ue txSoit si or:tlits"�sam ,le��'`"
.r
4❑I�w
❑.
Vehicle:''/ ui meet Cleanin ;,
aRavV--Material;Stock�ile.Wettin
Mixing,Dtuiii'Cleaii=out 'L="; ► _ x
:Rec cle System Overflow
Paarameter
Untt '
' �'DA1;R��'��
•-Colleetion.Date
tno/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units
TSS
mg/l
Settleable Solids
mill
" 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 tie 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
violation " .
AU G-�1
(Print Name of Perrnitte or Designee)
.,,A 10 31
(Sign ermittee or Designee) (Date)
t+y
SWU-241-080199 Page 2 of 2