NCS000202_COMPLETE FILE - HISTORICAL_20190405

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STORMWATER DIVISION CODING -SHEET..,..
RESCISSIONS.
PERMIT NO.
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f'� COMPLETE FILE' HISTORICAL
DATE OF
RESCISSION
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STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS 000202 or SAMPLES COLLECTED DURING CALENDAR YEAR: 2-O kcA M AZC. ii
Certificate of Coverage Number: NCG (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.)
FACILITYNAME United States Gypsum Co. RECEIVED
PERSON COLLECTING SAMPLE(S) PR �Q��
CERTIFIED LABORATORY(S) Lab #
Lab #VENTRAL FILES
0111lR SECTION
Part A: Specific Monitoring Requirements O l__O
OU�NTY , M�chell
(PINK 4. V d28 1 765 - 9481
(SIGNAT Jt OF PERMITTEE OR DESIGNEE)
By this sig ture, I certify that this report is accurate
complete to the best of my knowledge.
Outfall
No.
Date
Sample
Collected
50050
Total
Flow (if app.)
Total
Rainfall
Oil & Grease
Total
Suspended
Solids (TSS)
Total Lead
pH
mo/dd/ r
MG
inches
m
mgtl
MO
Units
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes Vo
(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
Total
Suspended
Solids
pH
New Motor Oil
Usage
mo/dd/ r
1MG
inches
m
MRA
Units
gallmo
Form SWU-246-112608
Pace 1 of 2

STORM EVENT CHARACTERISTICS:
Date MAC-14 Z06
Total Event Precipitation (inches): 1A
Event Duration (hours): N/ A (only if applicable — see permit.)
(if nx)re than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
." Alo F-L-o w J/
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 persons who manage the Otem, or those persons directly responsible for gathering the information, the information submitted is, to the best
any loge and belie e, accurate, and complete. I am aware that there are significant penalties for submitting false information,
c din the ossi tty o r es and imprisonment for knowing violations."
of
3
(dale)
Form SWU-246-112608
Page 2 of 2