NCS000202_COMPLETE FILE - HISTORICAL_20190516

•" - ' -- STORMWATER 01VISION CODING SHEET-
RESGSSIONS .
PERMIT NO..
DOC'fYPE
�3, COMPLETE FILE =HISTORICAL
DATE OF
.RESCISSION
❑ o((7I� Q J
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NCS 0DO2O'Z or RECENSAMPLES COLLECTED DURING CALENDAR YEAR: 20 "q AP�1
Certificate of Coverage Number: NCG MAY 16 monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the piing results from the laboratory.)
CEENTRAL FILES RrEt-1�
FACILITY NAME QT j iel) SIUMS (�,f PSJn Cc r^ fAN y QVVR SECTiQ`,) O Y 'rG
PERSON COLLECTING SAMPLE(S) O ) -7
CERTIFIED LABORATORY(S) Lab #
Lab # ( A MITTEE OR DESIGNEE)
By this sig ure, I certify that this report is accurate
FLow
j � complete to he best of my knowledge.
Part A: Specific Monitoring Requirements jl \`ll
Outfall
No.
Date
Sample
Collected
50050
Total
Flow (if app.)
Total
Rainfall
Oil & Grease
Total
Suspended
Solids (TSS)
Total Lead
pH
mo/dd/yr
MG
inches
mgtI
m
mg/l
Units
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes v_no
(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
MG
linches
m
mvA
I Units
I gal/mo
Form SWLJ-246-112608
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date AeP,1L- 2- 01 c�
Total Event Precipitation (inches): z J A
Event Duration (hours):P1_ZA._._ (only if applicable - sec permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable - see permit.)
"I certify, under penalty of law, that
system deli ned to assure that qual'
or perawle%d
wage t system c
of my belie true, ciincludhe ' i of es a d
(Signature
t-i'Q0
Lo L. J !i
Mail Original and one copy to:
Division of Water Quality
Attn: Central files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
us document and all attachments were prepared under my direction or supervision in accordance with a
d personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
those persons directly responsible for gathering the information, the information submitted is, to the best
rate, and complete. I am aware that there are significant penalties for submitting false information,
iprisonment for knowing violations."
(Date
Form SWU-246-112608
Page 2 of 2

Permit Number: NCS 000202
Certificate of Coverage Number: NCG
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
SAMPLES COLLECTED DURING CALENDAR YEAR: Z O 1q Ma►rG%,%
(This monitoring report shall be received by the Division no later than 30 days from
�Vie`1 1 tI>�[acility received the sampling results from the laboratory.)
E
FACILITY NAME United States Gypsum Co.
PERSON COLLECTING SAMPLE(S) --MAY 2��9
CERTIFIED LABORATORY(S) Lab # "'LN, T RAL FILES
Lab # MR SECTION
or
F If
Part A: Specific Monitoring Requirements O Lpvj
Itc II
H. ( 8 765 - 9481
I-- EE OR DESIGNEE)
By thire, I certify that this report is accurate
complebest of my knowledge.
Out€all
Date
50050
No.
Sample
Collected
Total
Flow (if app.)
Total
Rainfall
Oil & Grease
Total
Suspended
Solids (TSS)
Total Lead
pH
mo/ddl r
MG
inches
m
-mg1l
m
Units
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes v no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv 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
molddl r
MG
inches
m
m
Units
al/mo
4.
Form S W U-246-112609
Page i of 2

STORM EVENT CHARACTERISTICS:
Date t4O"rc,�% 20ka
Total Event Precipitation (inches): N iA
Event Duration (hours): W 1A (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.)
N () rLoW "
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 system, or
Alose persons directly responsible for gathering the information, the information submitted is, to the best
of my know rid belief, true, ac te, and complete. I am aware that there are significant penalties for submitting false information,
including toe posse 'li" fine andfitqprisonment for knowing violations."
(Signature of
s-// y
(Dat
Form S W U-246-1 12608
Page 2 of 2