HomeMy WebLinkAboutNCS000289_MONITORING INFO_20190218STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
I
DOC TYPE
❑FINAL PERMIT
MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ � U � rI U
YYYYMMDD
4 TOR,%1 WVITR DISCRARGE OLTI`FALL (SDO)
MONITORPIK; REPORT
Permait Number: GCS Mb $ ' or
Certificate of Coverage Numb er::s,'CG
r A C u.r-r-Y NAME S h t L�111 tloJ c
PERSON COLLECTDtiG SAMYLE(S -e s�—MLj,cy��g
CFWrI TED LABORATORY(S) 5C Lab # 7�
Lab z
Par, A: Spe�Ic MaUi`.or- z ReCiLdrements
SA.�LES COLLECTED DURLNG CALEN-D. -R YEAR: _
(This monitnrirg report shall be mceived by the Division no Eater t.4ao 30 days from
the date the facility receives :he sa npHag results from the [aboratc.-?.)
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C0i�tiTY Ck-.t i
FEB (SIGtiATliRE OF P �LIi'r'EE OR DESIGN E)
2OiB- this signature, I certify that tl:ic report is accurate
cam ,fete to tue hest of =y �owledge.
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"I oertifp, trader pezaity of iaw, that tl is document and A arachBents were prepared Lmder my d&ec6an cr sspervsicn in accordance with a
system designed to a-wure that gtaIified persaQnei grape � gather and evaluate the in.�or rat7va sahautted. Eased oc y inga ry cf ate pe soc
or persons who manage the system, or those persons directly respaasible for gathering the infermation, tFe iafor=don suhm�ttec_ is, to !fie hest
of my imawfedge and belief; tie, accurate, and complete_ ? am aware that there are significant penalties for submitts� false a`orna�o
including the possibLlity of flues and imprisonment for knowing violations."
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