HomeMy WebLinkAboutNCG120066_MONITORING INFO_20200113STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
G
DOC TYPE
0 HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑ C)
YYYYMMDD
STORMWATER I . IGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS 12D000 , or
Certificate of Coverage Number: NC
FACILITY NAME W; Ik e-s CouvLi� L9jld�.11
PERSON COLLECTING SAMPLE )
CERTIFINDLABORATO] e e a eb
----JAb #—
Part A- Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR* -2=—Zc?c?
(This monitoring report dmn be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY
PHONE 0 V A, 17
(SIGNATURE OF PERMWrEE OR DESIGNEE)
By this signature, I certify that this report Is accurate
complete to the bed of my knowledge.
0,
No.
'
Date
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CBe -
-7 —77-17`7-7-
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CAN
JAN I
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Does this facility pedom Vehicle Maintenance Activities using more than 55 gallons of now motor oil per month? — Yes --00
(if yes, complete Part B)
Part B: Vehicle
Maintenance
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Form SWU-246-062310
Page I of 2
STORM EVENT CHARACTERISTICS:
Date
Total Event Prtdpltadon (inches): IVO t" 1
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (Inches):
Event Duration (hours): (only if applicable —see permit.)
ma Oeigltral and one copy to:
Division of Water Quality
Attu: Central piles
1617 Mail Service Center
Raleigh. North Carolina 276"-1617
"I certify, under penalty of law, that this docomant and an attachments were prepared and my direction or sapervldon in aaordnnca with a
Bynum designed to assure that qualified persound propEriy gather and evaluate the information submitted. Based on my lagairy of the person
of persons who mange the system, or those pcMae directly responsible for gethalog the Information, the information submitted Is, to the best
of my knowledge and beget, tree, accurate, and complete. I am aware that there are dpifl=M penalties for snbmitthhg false laformadon,
Including the possibility of [twee and imprisonment for Imowing vlobdom
d69I r�-
(Signstom of Permittee)
f U
/-6-7,O
(Hate)
Form SWU-246-062910
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