HomeMy WebLinkAboutNCS000037_MONITORING INFO_20190701STORMWATER DIVISION CODING SHEET
NCS PERMITS
N �S O� O v `�
PERMIT NO.
DOC TYPE
[I FINAL PERMIT
MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
-)Uj�
DOC DATE
❑
YYYYMMDD
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS bon 3 SAMPLES COLLECTED DURING CALENDAR YEAR: a O (-I
(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. a r m 0Gs fi I' ICt 11COUNTY e c, k l e..
PERSON COLLECTING SAMPLE S) CTIONE NO. 70
CERTIFIED LABORATORY(S) JJA CLr' ^_Lab # t-10 tl.
C 4 a ri ft , Lab # 560 (SIGNATURE OF PERMITTEE OR DESIGNEE)
Part A: Specific Monitoring Requirements
By this signature, I certify that this report is accurate
complete to the best of my knowledge.
:Outfall
Date
150050'-
'
`Y�Q` Q,
v0•
:� O
No:
Sample ::
" Total
Total
-�
:Collected...
Flow.(if
a }:`
,Rainfall
�`
=tnoldd/''r
3MG.
inc€ies
M
�.-.{�
per.
t7r— A,
f,, -n- 1
i. J.4
'15i
14
.�
LF
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per mbnth? _ yes _no
(if yes, complete Part B)
Part R- VohirTn Mnintonnnro Activity Mnnitnrina RPniiiVampntc
Outfall
Date0050;
Sample-.
;Collected
f j
` ,x
:00556
00530
0040Q,.,,
:Total'F7ow
(if applicable}„
TotaG
Ra�nill.
Oil& -Grease
[ifappl.) '
Non polar
:O&G/TPH� ' =
(IVlethod1664"
SGT IEM)s:if
ap6l.
Total:
5uspextded
S6lids_rx
pH°
New-1Vlotor
O►1 Usage
mo/dd/ _r";
MG'
'inches::.
m
-
unit .
^ aUmo
Form S W U-247-062310
Page 1 of 2
STORM EVENT CHARACTERISTICS:
Date 1'1?-11
Total Event Precipitation (inches):
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.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 person$ who manage the system, or those persons directly responsible for gathering the informatiop,' the information submitted is, to the best
of my knowledge and belief, true, accurate, and complete. I am aware that them are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
(Signature of ermittee) (Date)
Form S W U-247-062310
Page 2 of 2