NCG120066_MONITORING INFO_20190211

WS�/b
STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V CCU I� ��
DOC TYPE
❑HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

Permit Number: Kcs—LLL2 0 �O
CntM=te of Coverage Nwnber. NCG—Lc�mu .70
FACILM NAME
PERSON COLLECTING SAMPLE(S)
CHRTHMW LABORATORY(S)
Lab 0—
Part A: Specific Monitoring Requirements
STORMWATER L WE OUTFALL (SDO)
MONITORING REPORT
SAMPIM COLLECTED DURING CALENDAR YEAR: Lz2a Z) ;;� an
('i'bb'moultortag report shallbe received by the Division not%ter tham 30 days from
the date the fktcMty receives the suWang results from the laboratory.)
COUNTY
mNE o.
2 L--
(SIGNATURE OF PERbUTTEK OR DESIGNEE)'
By this signature, I certify that this report Is accurate
complete to the best of uW knowledge.
AL,
..... . . . . .
22
Does this facility palbrm Vehicle Maintenance Activities using more dum 55 gallons of new motor oil per month? _ yes --W
(if yt& complete Part B)
RECEIVED
FEB 11 2019
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C IvIaM enanCe
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41
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\L FILES
ECTION
Form SWU-246-0623 10
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STORM EVENT CHARACTERISTICS:
Dab i v
Total Predoltatlon (incJies):
Event Damdon (hours): (only if applicable — sea permit.)
(if more than one storm event was sampled)
Date
Total Evart Predpitation (hushes):
Event Duration (hours): (only if applicable =see permit.)
Ma8 Original and one copy to;
Division of water Quality
Attu: Central Piles
1617 Mail Suvice Ceater
Raleigh. North Carolina 27699-1617
"I mrft, and penalty of law, that this aoc umat and all attainments were ptepred under my direction or mqmThdon In accordance with a
sly deed to aware that qualified personnel property gather and eevalttste the hft=don =but&& Based on may fnqufry of the person
or persons who umnap the systeukk or those I c non directly raspondbte for dw'kdbrmatlm the information sobmltted la, to the best
of may knowledge and bekfef, true, accanbe, and coamplete. I an aware that there are pummes for sung else information,
hx1ading the pos011ity of Mrs and ieuprisoament for knowing violations."
(Sigaatmv of Ptrmla m) (Date)
Porto SVM-246-062310
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