HomeMy WebLinkAboutNCS000334_MONITORING INFO_20190701STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
v
DOC TYPE
❑FINAL PERMIT
MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ Quill 0-� 0
YYYYMMDD
STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCSOoo 3,3q
FACILITY NAMEJCsJOPWSCAeomc Ty -
PERSON COLLECTING SAMPLE(S) CL3cL-& IM GLe-0_,F ,L
CERTIFIED LABORATORY(S) CAP—iS11-c LaL5{_-r�C.Lab #
t*..2Lab #
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR:10 I
his,monitorin report shall be received by the Division no later than 30 days from
p� Y
thetdate.theffac Lity receives the sampling results from the laboratory.)
JUL 1 2019 COUNTY V_Q4 I *0Q',L
CENTRAL FIL S PHONE NO. (20Lj) — R
0110? SECT, ,,
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall
No.
Date
Sample
Collected' : "
50050
Total
.Flow if app.),
kainfall
sus�en
-`SS
2es' 1kkaP�.os�tvoru_c
Total
'
3,
moldd/ r s
MG
inches `
ir`n" ." "G
`
Yh
S, U •
aol
6 I
O.
3
<o.o
�•ot
6- - E30
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ()yes Ono
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Monitoring Reauirements
Outfall'. -
No.
Date
Sample :
, ' `
00SSG,.`;.3. •... _.;
00530'00400:
Total Flow
Total.
OBI & Grease
Non polar
Total,---
'pH
=New Motor.
Collected
(if applicable)
Rainfall "
(if apply
O&G/TPH
Suspended
Ozl Usage
�.
(Method4' 664
Solids
..
SGT HEM); if
�
mo/dd/yr
MG:_
inches
mg/l
m/i
unit
't;al/mb` .
Form SWU-247, Iasi revised 611212015
Page I of 2
STORM EVENT CHARACTERISTICS:
Date 0 (o IL 19 - Z�
Total Event Precipitation (inches): a
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Energy Mineral and Land Resources
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penaltyof law, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person
or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the
best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisonment for knowing violations."
4-;zv moo,
(Date)
Form SWU-247, last revised 611212015
Page 2 of 2