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STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
DOC TYPE
❑FINAL PERMIT
3,MONITORIN6 REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ (a u I ll
YYYYMMDD
STaRti'IW'ATER DISCFLARGE OL-ITALL ;SDO)
MOtiITOR.i.'r'G REPORT
0
Permit Number: tiCS or SA-NfPLES COLLECTED DUI --LNG CALF\-DAR YEAR: _
Cent fcate of Coverage Number- :�r'CG (This monitoring report sh.111 be-ccrived 5g the Division nc later than 30 love from
the date the faclit7 receives the sampling resLJis f: em the laboratcr}'-J
1 � ; r
� c t
FACILTi�Y tiAME S t+Lna+• W J 1'"� ��1��� COC TY i ck.is L
PERSOti COI LECCL'�G SA'KPI,E(S -� .tom=ems 1 itiE ti0
CERYU71ED LABOR-ATORY(S) � Lab #-a -IUG 1 S 2019
Lab u SIG,tiATL-gtE OF PER_ E OR DESIGti`EE)
;LAC Bc thissigrat=e, I cert fv that `t is report is accurate
GEN i riAL
compto Lie best aF ��' �cnowle ge. DWR SECDOAJ
Part A: Sperm is Mon-fforing Regiittrements
i
Does t;,is €ac!= ti' pcfc= Veaic':e ?v'a r enzcce Ac v yes tis -g o . 55 gallons 0i new matar 02 re: �,cct^? _ yes 4-'a
(Lf ves; complete Pw. B)
Part B: VehLide Maintenance Activity Monitor�.ne Rmuirenients
HRN
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STORN2 E' EN7 CHARACTERISTICS:
D ate
Total Event Precipitat1on (inches):
Event Duration (boors): (only if arpL'cab?e
(Lf Marc ',:. . one stem evccl was sa.mpicd)
Date
Total Event P. ecipitatioa (iacbesj:
Event Dti:atiou fhcu: s)_ (o.^ v : appHcabie — see ec:r=i:.)
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?':ail 0 y : of and one Cop to:
;vs:c:. of %Vacer Quaii:;
Ann: Cca- ai �7L'.cs
6 i i Ma:: Scrvi..,. Ccr,,cr
Ralcig tioti� Carolina 2%6SS-i6
"I certify, trader peaaIty of Law, that this doc=eat a_nd ail attnch=eats were prepared under my direct:Qtz ar superrsian Ln accordaoae with a
system designed to accnre that gaaiied personnel properfy gages and evaluate Lhe information subulitted. �a_sed on my inquiry of the person
or persons who ntaa.age the system, or those persons directly respoasible for gathering the information, the i:2fornradGn submitted iS. to the best
of my 1CIIl]W(edge and belief, true, accurate, and complete : ant aware that :here are sig i kcant penalties for submitting faLse =iafn A^ _on,
including the passibiLtY of fLues and imprisonment for knowing viaiatio.s."
( iguattrre of Pe xni teej teat