HomeMy WebLinkAboutNCS000591_Monitoring (Report)_20190204STORMWATWISCHARGE OUTFALL (SDO)
MORING REPORT
Permit Number NCS% () q os f��21'a r SAMPLES COLLECTED DURING CALENDAR YEAR:/9 1Yio/IiS
�y (This monitoring report shall be received by the Division no later than 30 days fro
j r Qo the date the facility receives the sampling results from the laboratory.)
FACII ITY NAME E �'t a e- W 4+Z:'-C � f lel+f dq , iJ - 'L
PERS ON COLLECTING SAMPLE(S)
CERTIFIED LABORATORY(S) Qy,f4i bGr"7e4-�ficplq(e5Lab # ,26)Q
Lab #
F F R 04 2019
Part A: Specific Monitoring Requirements r'fiCJ-ti V Q- ,"
COUNTY it) lrl
PHONE NO. (-33 6) 9 0 j -1-1 t 'l
41 SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 2.
Out all
No.
Date
Sample
Collected
50050
Total
Flow if app.)
Total
Rainfall
mo/dd/ r
MG
inches
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? Oyes no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activitv Manitarina RamrirvmPntc
Outfall
No.
Date
Sample
Collected -
50050
00556
00530
00400
Total Flow
(if applicable)
Total
Rainfall
Oil & Grease
(if appl.)
Non -polar
O&G/TPH
(Method 1664
SGT-HEM), if
appl.
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/dd/ r
MG
inches
m /1
Mg/1
unit
gallmo
Form SWU-247, last revised 611212015
Page 1 of 2
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Date
Division of Energy Mineral and Land Resources
Atha: Central Files
Total Event Precipitation (inches): 1617 Mail Service Center
Event Duration (hours): (only if applicable — see permit.) Raleigh, North Carolina 27699-1617
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
"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 flues and imprisonment for knowing violations."
(Signature of Permittee)
(Date)
Form SWU-247, last revised 611212015
Page 2 of 2
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