NCS000289_MONITORING INFO_20190718

STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
fvb <� 0 a CQ "
DOC TYPE
❑,fFINAL PERMIT
LI` MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ Doj/ 6) 7 /
YYYYMMDD

Pe: -suit ti'r_ nzber: NCS rya 170.
Cercifcace of Cove: -age 'tietmber: NCG
or
vTO tit «'AIER DLSCHARGEOUTTALL;SDO)
MOtiITORLNG REPORT
FA CCLfTY NA.,MT S h t.n4s • J -
PERSON COLLECTLNiG SA.M TLE(S _ V .1n�4`^
CER-riFMD L A.BOR_ATORY(S) �- _ Lab #? '376
—Lab z
Part A: jpedfic hlomforag Requirements
S.6—N PLES COLLECTED DUKLtiG CA LE-N-DAR YEAR:
(This monitoring report shni; be received by the Divis'on nc Inter than 30 dat•s from
the d� t cilito ecet'_res the samp[ing resc:it_s from the [aboratc.cy.i
pep_ I Vt 0
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CEidT -r RE OF PElUpffrrEE OR DE-SIGNTEE}
DWR SEQTJQNs s7gz;at,.Lrc, i cert :lr that this report is accurate
complete to the best of rny knowiedge.
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Part B: VeWcie Maintenance Activity Monitorng Requirements
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STOIZtii EVENT CF .RaC: ERIS i ICS:
D ate
-fatal Event Precipitation (inches):
Event Duration (hours)_ (oafy ifarp;-cab[c - scc permic.j
(if Lore Lean- Grin sic: -tom evcct was sampicd,'
Date
Total Event Precipitatioa (incl;es):
Event Du: adon (hccr s): _- (o--;v - anrlcab:e - see pc,-�i:.?
::ail Qrtti nal and are copy to:
Divs;c; o Water QuaE:-�
AtIc: Cea::a? Fi;es
1.5: o Mai: Sc-vic Cc,- -r
RalcigL, N. CaroLina 27695-76;
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"I certify, tinder penalty of Law, that L't}s documetit and ail•at4mchments were prepared under my direcCatz ar superr'sion in accordance -iih a
Ustem dedgued W assure that qt "`ed personnel propcHy gather an evaluate ,he infor---aticc submit'.ec. BEseu on mv inquiry of t_lie Person
or persons who manage the systerm, or those persons directly responsible for gathering the information,, the informa*-�an gubmimed isz to the .'es,
of my imawiex.'ge and belief; true, accurate, sad complete. : am aware tEat :here are signibcant penalties far submirt;rg false i� Or-nador..
indading the possibLHtF of .ancs and imprsonment far 6mocv:ng violations."
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