HomeMy WebLinkAboutNCS000289_MONITORING INFO_20191120STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
DOC TYPE
❑ FINAL PERMIT
bMONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑
YYYYMMDD
STOt2L4 WA i�R DISCHARGE 0UTTALI- (SD0)
YiO'TTOR NG REPORT
a
Permit NT�mber: NCS rno or SA.MPI.ES COLLEC-FED DURING CALENDAR YEAR:
C emit:care of Coverage Na=bec: N-CG (This mar-itmin g report shall be received by the Div&oa ne Later than 30 days from
the date'the facility receives the sacnpUng results from the [aboratcr<'.)
FACILI'f' NAME ►mot- ' 47" L% C.
PERSON COLLECT2; G SA_MTLE(S
CERT=D L kRORATORY(S) `) C V Lab # a7�Cam*
Lab 4 RClFIVED
Part A: Specific Moa fEoring Requirements
NOV 2 0 2019
DWR SECTION
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COUINTY 1 O..t
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(SiGNATL:TRE OF PEXU-VME OR DESIGNEE)
By this signature, I cert {_r that .his report is accurate
coinplete to the best of me know=edge.
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Does this fact-ry perform Vehicle Mainicaance ;c ,:ties us:rg ..g than 55 gallons of ew Motor o:.k per ai h? yes Ono
(i_f yes; complete Pa,': B)
Part B: Vehicle Maintenance ActiTity Monitoring Requirements
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STORNt EV N'TCFIARACTERLSFICS:
Date
Total Event Predpicatioa (inches):
Event Duration (bct -s) _ (a; iy if ac;pL-cabIc — scz
(if more '~ one scr= CVCm waS sampicG"
Datk
Total Event Precipitation (inches;:
Event Du:atiou (hours): (oil} `app!�cabie - see Y4:
Mail Original and one copy to-
D;vis.o n of `Vater Quai:;
A=: Ce7:_:ai . iies
her,,.: r
Raicig- a u Ca:oLma 2; 59S 617
"I certify, Linde- peralt�y of Law, that this doc=eut and ail arachcaents were prepared under my directiogcr super-v-:sion in accordance with a
system designed :n assure that quaii,led personnel pmper[y gather and evaluate the in;or...ado: subtuit'.ed. $a_sec on mv ingai,-y of'-' e person
or persons who manage the sps-(em, or those persaas directly respoasih[e far gathering the infarma tiou, the i tfo tin. submitted is, LO the ` es'
of my imaw[edge and belief; true, accurate, and complete- : am aware that there are s Ku loam pemalties for submitt --g faLse v.:orraa: on,
inciading the possibiLty of Cones and imprisonment for imawttsg violations."
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