NCS000452_MONITORING INFO_20191118

F-STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
� L � V � � LI J
DOC TYPE
❑FINAL PERMIT
[� MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
� U I � I
DOC DATE
❑
YYYYMMDD

STORM WATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS: NCS000452
FACILITY NAME: Culpeper of Ramseur, LLC
PERSON COLLECTING SAjMPLE(S): Timmy Pugh
CERTIFIED LABORATORY(S): Shealev Environmental Lab #: 329
SAMPLES COLLECTED DURING CALENDAR YEAR: 2019
REC rm storing report shall be received by the Division no later than 30 days from the
C CC erfacility receives the sampling results from the laboratory.)
NOV 18 2019 COUNTY: Randolph
CENTRAL FILES PHONE NO. [phone]
DIVR SECTION
Part A: Specific Monitoring Requirements
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Outfall__
No..
_
---Date :_
'.Sample '.
Collected`
50050 _
`Total_ .-
Flow _
(if app.):
Total
Rainfall
pH '=
r
-TSS
Total--
Copper
BOD5
COD
�mofddl r �.
y
MG _
inches
Units - .
MGIG�
MG/ -
?VIGILr `'
MGIL"
001
10/31/19
0.02
0.05
5.6
BDL
BDL
BDL
BDL
Does this
facility perform Vehicle Maintenance Activities usina more than 55 eallons of new motor oil ner month? NO
(if yes, complete Part B)
tart B: vehicle Maintenance Activity Monitoring Requirements
.Outfall
No
Date =
Sample
:50050,. , -. '
-
; I=_
00556 :
. `-
00530 ` - �
00400�- -
_
.Total:Flow °-
-
Total
:Oil:& Grease '
.Non- 'olar
P
-
Total
"pH
'Newe'Vlotoi
-, .
-_
-
Collected _
(if applicable) .,Rainfall
(iTappl.)
O&cG/TPH
Suspended
'Oil, Usage"
m
_
- -
-
(Method 1663
-
-Solids
_=
µ
-
appl
v
>m6/dd/yr_
iV1G
inches;
unit
gal/n�o
Form SWU-247, last revised 611212015
Page 1 of 2

STORM EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches):
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 penalty of 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."
Q:�4 4aw� 11 /1 4/2019
(Signature of mittee) (Date)
Form SWU-247, last revised 611212015
Page 2 of 2