NCS000289_MONITORING INFO_20191016

1z0
STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
�I C � V v U
I
DOC TYPE
0 FINAL PERMIT
MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑
YYYYMMDD

RECE/ vE
STORMwATER DISCHkRGE OUITAr L ;ADO; UL I B ZQJ�
W1ONrroRL'vG REPORT CpAf
Permit 'vttmber_ '!CS co(�, A $Q ' or
CertScate of Coverage Number: -NCG
FACU.= NAN E S J t-
PERSON COLL,ECTLtiG SA_MLPLE(S)Res_
CF-RTU71EDLA-BORATORY(S) SC L.ab#a7S_
Part A: SPecTic N, 10aiEer•ng Requirements
p�n� T�L P1LE:
SAMPLES COLLECTED DLR NG CALEti"DAR A :S CTIlm—
(This rncaitaring report sh.iU be received by the Divis:oa nc Fifer t.`iaa ?4 dsys from
the date the facUity receives the sarnpUng res[_fts f:-cm the taboratc.r. )
f {�
LAs
COLtiTY C
P" NE NO. f
(SIGtiA-ruRE OF PE E OR DESIGNN—r E)
H, this sigrat-,:re, C certify that tLis report is accurate
"mp[ete to Lhe best of my knowledge.
yG
� - li'�1;.�t•'��'�`'a�•_.'T. �� s��f': .-.ti��_'������.���
�
.° �,- �ata0a'
i .L
��
I-.
p�7�,.ay',.YtZ3�+n�1��w��K����
`!if eK: `gyp (L:a $, f' r .l FZ �t7ct��+-- ► fat [-_� McmOWN
_wn
-
a..i,` 4 �VJ'�. '=.�a i�Fy • O'7}sy
f
?'i...i i''T'
- xi -.
��kF
•.•;�1,;,.�
�G_c'LM'-:�rt�^•�-R=e_.�L•�. a. i�:.��. ..r+ - � 'S� R-.�,..,:_��:.''^.�L�I'c�'
•' a+L3rs��...,
�� �a .: r �i� .• ,�.
..
p,�� ��.�[V �,���:
n e e f �5�y���'. �'� � "_„ t!] �re•L`,:w:r�...s1_�...: �iY3��..:.
= feltirl�*ri�k' �!
�?a'�"• ,�• sit.�'.�_' T .a• -
�. �� � s'
Does Ids fac,? t,y perform Vehicle Maineczance .ice they us rig that. 55 xaUo7-s of ❑ew motor 0.1 PC- mcntb? yes kco
(i-f' VI--S; co-anpletc Part B)
Part B: Vehide Maintenance Activity Monitoring Requirements
NEW
„
tf�"`; �'` '
,s'•�'`r�4�` • a .�7.'C�i�r� �.,
�
r a9�i� •i%i�i��'"'�3 `. ss�i ; �=''+'�
�'
. i sii"�'azr-•7 �;�
- �.�Y' ������ 7' �,14e S �
a
� s ���,t' e t''��i�� �e��f i
� t
s�.� �,�.- �.r.���.Sr`.:
�.ij,��-.�'i"?s�"•�'?• :�er • -
b � o ` 'e��e ��r
•�`t,°,ti.�+�*��''.
„ ,� tat . - • f' i
�
�
_ .`�i:;,.��_r�lr�'r,'�
-
� e a � �
� rq
a -I-
_
.e o 'e�ef� ��������5�
��S�s`����i'�ELl3j�
���-u�.�`tS'E.
•�.. ',Y a e _

STORM E�"E -T CFI.=�-ftACTEFZ€Si ICS:
Date
Total Event Precipitation (inches):
Event Duraaou (homes): (cniv i-'a-,;pL-cab c — scc �c^ait.)
WIr ore tl roe scr= ever'[ was sa=.r ica)
Date
Total Event Precipitation (itzches):
Event Duration (hcn: s): (o v appLcablf - see
Mai[ Original and one copy to:
D;v;S'o : of w`a-el_ Q-
Arc: Ccc' ai :;cs
I I a� SC mice Cer.�r
R_3_1_ciwLL. CaioLna 2 695
"I certify, trader peaalts of Law, that this docttment and ail artachment_s were prepared =der my directiogar super—Osion in accordaece vgith
system designed W assure tha: quali-ed pemmnel properfy gather and evaitmte the information submitted. Based on tnc iagriry of tl1e person
or persons wbo manage the system, or those persons directly responsible for gathering the ioformatioa, the iafor=t=on suhu;ltted is, to the hest
of my kn6wfea?ge and belief; true, accurate, and complete_ I am aware that ;here are si,gni Ec.ant penalties fo: submittrg false :a`or .2"or_:
incinding the possib iity of fines and imprisonment for knowing viaiatious."
(..igrature of Permittee) a 1

STORMWATER D[SCgARGE OUITALL (SDO)
MOtiTMRPtiG REPORT
Permit Number, '!CS CC�6 ` 70, or
Cert~Cicace of Coverage Number: ;N'CG
FA CIL= NAME S t► fX►4�• � L!u� c
PERSON COLLECTD G SA.MpLE(S en.,.t
CERTIFIED LABORATORY-1 S C Lab
Lab #
Part A. Specific Moafter*:ng Requirements
I
R C FIVE®
Sip 18 Z019
SANTLES COLLECTED Df."RZ�G CALE'. -D..-R YEAR: _
(T'his rnoaitnrieg report sh.-LLi tie received by the Divisioa no Iatcr ttssu 30 days from
the date the facility receives the samptitxg restdts from the (aboratc.,-%)
C0UNTY f aE L
"E'tiO.r b- f
iGNATCiRE- OF PE LITI'EE OR DESIGNTEE)
By thissignature, [ cert;..fy that this r epar t rs accu: a:e
cotrplete to the best of my imow;edge.
Does :his faces: perform Vehicle Mairtenance Acdv ties its = r :o e tha^. 55 gauons of rew motor oL, per mo d^.? yes Ono
tLf V^.s: complete; Part B)
Part B: Vehicle Maintenance Activity Monitomw Recui-renients
��at�fi��`I'7:i�:tti9s.tx?h".
�'P•'-r. —n"'. _ 4'
•'.'r,^.a.na
'��v,Y,.`..r-�
�'+0��
f 4' �:i�`
1'/v.- Y
oa ',,_
iti 1 y�
J~r� �, �
_
.}J ••�`C'�,_}�rF.
R',
�• a .,
v a 'i�''`• k '"g�"��
1 .��y (+�'�J J]j �'"'�v.:tY[
l�r_�+
o ���: �{«c'... t ��c {
s �i4r �����7• r3+`Sl '�r'f t .� .�:._ +tr �e
t .irti79(yi�•+�i�••( ry d~.' '� � .�� h� y
ir"y�•�t�f"ey�,iY b r�. a 'E^�'vlx*�'1
iTllyvry
� [•�• �M •1i.
tiC )a
M1' .x
}ri7-'yl'
�I :�a'�E+�•-'#
1�`7 tj�r,i' ♦. }�*•
}v�4 'YS
.
w•
�..��'^d��k�_��_
�kkk=!��lG:�l:..�e .J
�+'=�;i/^S _rf�r y,��� �
ru..,4+F,.E'C Ly! � oSr''�^�_
�-
_
.R a ,e °,Pa
•i�n�.+.
6R �5'7'?�r"_}_wf�—.°Y. J32Y�T• �. �:y1Y�j=4�
�•
_
'1 a a _
:
Fa: - w 5 .2F.;^g

STORM EVENT CHARACTERfSTICS: Mail Original aed one copy to:
C:Vs:Q'I C. Wate: QUAL"
Date Alta: Cca:rai:€cs
Total Eveat Precipitation (inchesj: ' 61, ; MaL Sc,vice Cenci:
Event Duration (hours): _ (only if arpLcabic -- scc pc, ui[.} Ralcigh, ^+onin. CaroLina 27fi9S :E1
(Lf MOrC '.ia:, CMC S[G'= CVCLt was SaMPICQ;
Date
Total Event Precipt2don (iuches):
Event Duration (hcctrs): (ocly .` appHcabje - see permj?.)
�s
"I certrfy, under penAts of Law, that this docament and ad att2chtaeats were prepared cinder my direction or supervlsioa La accordance with a
system designed to assure that qua[ified personnel prope iy gather j tad evaluate the info razatioa subaziged-- H ased oa my ingci.-y of the persan
or persons who manage the system, or those persons directly respoasib[efor gathering the iaformatica, the iaforFr_antica submitted is: to the besc
of my icaoi wiedge and belief, true, accurate, and compiete_ l nm aware drat there aresigu Est peaaldes for sabmitt�ngg Fatse Lafor;aaCon.
inciud ng the possibiUty a{ `cues an ' prisoaincut for knowing vio[ations."
( zEguatu�re of "Perrz�Licree'