NCS000084_COMPLETE FILE - HISTORICAL_20190730

STORMWATER DIVISION CODING -SHEET-
RESCISSIONS -
PERMIT NO.
n/Ls (�D(7 o� /
I�
DOC TYPE
I� COMPLETE FILE =HISTORICAL
DATE OF
RESCISSION
❑ I
YYYYMMDD

STORMWATER D_'_CHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS (no Oog't
FACILITY NAME S Q JA_ _b4_l n zr rGceS tea,
PERSON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S)
Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: tC,
(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.)
COUNTY i�e�:.� �' ra �✓
REPHONE �` ` PHEI)ONE N `�� —16 -3L`Vb
1� l� V (SIGNATURE OF PER MITTE ESIGNEE)
JUL 3 0 2Q19By this signature, I certify that this report is accurate
CENTcomplete to the best of my knowledge.
DWR S CTION
Outfall
No.
Date
Sample
Collected
50050
Total
Flow (if app.)
Total
Rainfall
C-0 T
mo/dd/ r
MG
inches.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ryes
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-HEPA), if
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/vr
MG'
inches
m
m
unit
al/mo
Form SWU-247-062 3 10
D_ 1 _r I

STORM EVENT CHARACTERISTICS:
Date
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, thaU 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
oUrny knowledge and -belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of tines and imprisonment for knowing violations."
(Signature of Permittee)
"7
(Date)
Form SWU-247-062310
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