NCS000289_MONITORING INFO_20190221

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STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
DOC TYPE
❑FINAL PERMIT
MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
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STOR."vIWATER DISCHARGE OLgTALL (SDO)
MOtiITOR.PsG REPORT
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Permit Number: tiCS a5c� A7 ' or SAMPLES COLLECTED DURING CALEti-DAR YEAR: _
Certiricate of Coverage .'`Timber: h'CG (This monitoring report shall be :-eceived by the Division no later than 30 days from
the date ttze facility receives the samplin(g� result_s from the [aborau;rti•-)
FACILITY NAME _S r+Ln�s.+ _ {/CAS ��-^ � �_ � j\/F 0UTTNTY -01 A i�.
PERSON COLLECTING SAMPLE(S � -' ' OI�1E'`O. 6 - ' . E
CF-RTIF-M'D LA-BOR-ATORY(S) �� - Lair 0 37�
Lab±' E8 � � 24ig (SIGNATURE OF _RD+LTITEE OR QESIGNEE)
:LN j Fk.ES By this signature, I cert fv that this report is accurate
SON complete to the best of my knowiedge.
Part A: Specific Mon:fnring Requirements ow SEC
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Does this fanny- Petfo:m �chacle Maintenance Activi es US;Mg 17norc that: 55 gauons of rew motor o:i Per Month? _ ves �co
(if ves; complete Part i3)
Part B: 'Vehicle Maintenance Activito Monitoring Reauirenients
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STOR'%I E'�T.N-TCE{ARACTERLSTICS:
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Date
Total Event Precipitation (inches):
Event Duration (hours): (anly:. apgGcab'.e - set! p-c'-:nit.)
(,-` r_ore ryan arc sfrl= evcct was sa.T.pled)
Date
Total Event Precipitation (inches):
Event Duffanon (hours): (only L apgiicab:c - see
Mail Original and one copy to:
Divis:cn c"-a:er Qua :-
Attn: Cc r_ ai ::ies
16:1 Vla:: Sc-v:cv Cen:er
RaicigH, No"th Ca-o!ina 27691-,-761-7
"i certify, trader penalty of law, that Lh8 document apd all artachments were prepared under my direction or scperc'~sioo in accordance acith a
system designed to assure that qualified personnel property gather and evaluate the infartna[iar submitted. �Esed 02 -may ingWry of the person
or persons who rn=ge the system, or :hose persons directly resNnsible for gathering the infern;ation, the ia.u=—a'to t submitted is, to the bes:
of my knowledge and belief, true, accurate, and complete. I am aware that ;here are significant penalties for sub:uitt r_g false infnr-n--tion.
including the possibility of fines and imprisonment far laiowing via(ations.''
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( igaature of PerMittee) Gate}

STOR' IWA TER DISCHARGE OU TALL,;SDO}
MONITORING REPORT
Permit Number- NCS �)D6 �$'? or S.A2`4PLES COLLECTED DI;RLNG CALF-\"I)AR YEAR:
Cert�cate of Coverage '\umber- NCG (This monitoring report sh-A! be -rceived by the Divisio❑ nu Eater than 30 days from
the date the facility receives the saniptiag results f: om the laboratarv-)
FACLLM' NAME S ►.Lrti } too re5 cr�r s; �.c. RECEIVED co�..�TY _ ' a;.`t� .
PERSON COLLECIL'vG SA'NIPLE( I R_ �1Ls� ._ y_ ` O,'�F No' � � f
CERTr�-�ED LABORATORY(S) 5 C_ -- Lab � FEB 21 2919
_ Lab ii (SIG'ATU E OF P _ "�tr=E OR DESIGtiEE}
C'ENI RAL' FILE- Sy this signature, I certify that this report Ls accurate
DWR ` CTION compiete to the best of my know•iedge.
Part A: Spedfic Moniforiag Requirements
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Does this fac,T tv perforil Vehicle Mair:tenarce Activ wes us-z mo;c that 55 ga€4oc.s of new motor 01 per Moat_"? _ yes 4no
(if yes; compiete- Pw- 3)
Part R: Vehicle Maintenance Activity Monitoring Reaturenients
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STO AI E«ti f CFIARACTERLS' ICS:
Date
Total Event Pr ecipitatia¢ (inches):
Event Duration (hours): (only i:`a~pi:cable - sce Ye: it.i
(If a:ore one storm eves: was samples)
Date
Tota[ Event Precipitatica (inches):
Event Du:atiou (hours): (only u' appuca4:e - see pe=d—.)
?Main O:-tinal and one cope to,
i7ivsic Water Quail
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Ra!nig'. tio:t C'-.a:ol:ria 2769,-ice
"I certify, under penalty of Law, that this document and all attachments were prepared under niv direction or supervision La accordaace -kh a
system designed to ass -are tl;at qualified personnel properly gather and evaluate the infurmatica subruit:ec'. bad or my lag s5 oC Lhe pe son
or persons who manage the system, or those persons directly respoasib[e for gathering the infor=tion, the is, to the best
of my knowledge and belief, true, accurate, and complete_ I am aware tbat there are significant penalties for submitting false information,
inciadiag the possibility of fines and impri-sonment for knowing vio[ations."
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STORMWATER DISCHARGE OLgTALL ,;SDO)
MOtiTTORPvG REPORT
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Pertnit Number: tics $ ` or SAMPLES COLLECTED DURING CALEN-DAR YEAR:
Cert fcate of Coverage Number: NCG (This monitoring report shall be :cceived by the Division ric later than 30 d2vs from
the date the facility receives the sampUng resttits from the taboraWr-v-)
i ACILI F1' !�A'�IE ca.5 J[1s ,�^e. CoUINTY 0-
PERSON COf_LECTING SA:'VIPLE(S ,'-z 01E40�3E QEDCERTIFIED LABOPATORY(S) . i
Lab tt JQN Q ZQ�Q (SiGtiATCRE OF PE E OR DE SIG'N-EE)
By ;his sigraturc, [ certify that this report Ls accurate
CENTRAL F€LES compete to the best of my �Mowledge.
Part A: Sp- t is kfotuforing Requirements
[)WR SECTION
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(if yes; complete Pact B)
Part R: Vehicle Maintenance Activity Monitoring Requirements
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STORNI EVENT CFPtRACTER.LS T ICS:
Date
Total Event Precipitarioa (inches;:
Event Duration (blurs): (cniv alp=:cable - scc
(-t ore :Lac aae scr= cvcr:t was sasplre;
Date
Total Event Precipitation (inches):
Event Duration (hours): {o; tv is a�pucabie --
Maii C)Hg:nal and one copy to -
of Water Qua i�
A=: Cec--:-ai r:ies
67 Ma—, Service Ce :tcr
LalcigL. -No Ca=ol;na 2. 5 i .�
"I eerdfv, under penalty of Law, that this document and all attachments were prepares: trader my direction or scperc-.s on in accordance wi;f. a
system desigued to assure ti:at qualified personnel pmperiy gather and evaluate the tnforrnatioe suhmittee. Based a my inquiry of Lhe person
or persons who manage the system, or those persons directly responsible for gathering the information, the i:iformation snhm tted is, tra the best
of my irmowledge and belief; true, accurate, and complete_ ; am aware that there are sig:iifi=t penalties for subautrt:ng false L--for-rnation,
including the possibility of tines and impr?sonnsent For knowing vioiatioas."
( iI/ I
gn/attire of Perru
ittee)