NCS000233_COMPLETE FILE - HISTORICAL_20190225

•°--°- STORMWATER DIVISION CODING SHEET
RESCISSIONS .
PERMIT NO.
I'
DOC TYPE
lid COMPLETE FILE- HISTORICAL
DATE OF
RESCISSION
p jo
WYYMMDD

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
❑HISTORICAL FILE
DOC DATE
❑
YYYYMMDD

STORMWATER DISCHARGE OUTFALL (SDO)
MO�N� T O�G REPORT
Permit Number NCS 000233 V SAMPLES COLLECTED DURING CALENDAR YEAR: 2019
FEB 2 6 2019 (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.)
=iz 3 RAL FILE -
CA 4- NAME facturin In ,1'�!R SECTION COUNTY h d
PERSON COLLECTING SAMPLE(S) , _ _ Andy Borgstrom
CERTIFIED LABORATORY(S) Tes merica L r sNashville.N La _9M
RECEIVED
Part A: Specific Monitoring Requirements
FEB 2 6 2019
CFNTpAJ Cli
is mon
PHONE NO. [phone]
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall
No.
Date
Sample
Collected
50050
SM 5D"R
410.4
SW-846 9020B
EPA 300.0
SW846 9040C
Total
Flow (if app.)
Total
Rainfall
BOD
benchmark
COD benchmark
Chloropicrin
(TOH)
Chloride
benchmark
pH
benchmark
Testing Lab
moldd/yr
MG
inches
30 mg/L
120 mg/L
dig/L
860 mg/L
6-9
OF-1
01/24/19
0.57
2.81
32.1
65.3
6.7
Test America
01/24/19
0.5
1
i
1 25.8
1
Test America
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _ yes
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
_2L no
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-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m I
m /l
unit
al/mo
Form SWU-247, last revised 611212015
Page I of 2

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 Energy Mineral and Land Resources
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"1 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 those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
(Signature of Permittee)
02-21-19
(Date)
Form SWU-247, last revised 611212015
Page 2 of 2