NCG120066 - Wilkes Co

STORMWATER DISCHARGE OUTFALL(500)
• MONITORING REPORT
Permit Number:NCS jJ( ssj n or SAMPLES COLLECTED DURIlyG CALENDAR YEAR: r than 30 days from ~.
Certificate of Coverage Number: NCG .O ! (This monitoring report shall be received by the Division no late Y
• the date the facility receives the sampling reeults from the laboratory.) 1
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FACILITY NAME �.;I K es (nu n eSO l ick Vjosie, . COUNTY 11 1 e,5 •
PERSON COLLECTING SAIVIPL + 5) . • is :.t. AAA . PED ;;M + )`10.
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CERTIFIED LABORATORY(S) �., - A VI-. I`� 'Lab# 'rrj .E I °+r1e .1,j l iQ^.1._)
Lab# (SIGN• TURE OF PERMITTEE OR DESIGNEE)
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SEP 0 6 2016 By this signature,I certify that this report is accurate
complete to the' est of my knowledge. •
Part A: Specific Monitoring Requirements ' CENTRAL FILES '
DWR SECTION ' „ , , ,
Outfall ' Dote' .. •r 50050: ;.;;:..,.L,,-.1.-z.,,.,: ,. ..`'"' . -. 4.1- ar.:.lF?:1.±1•��,',;•' , , ;., .,,', _' • . ,,,,_: . . �_,...-.,"�- ^
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5nmple' TQtai;: .,•;f,';I•%;� •;'1'Otal� .:;�y";c.a., _;�;a•,,'''!,rv•C,,•r,,;.r��: :,a,>•a 1-•,�;. �5 '•� iv.. -,+;t,::,a •'?;+� .rP, .w, �,, _ _ ,�;r
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• Collected •�: ,;' '.”, "`:` •',131•0;%.•:,,I." -
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Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?_yes o 1 z
(if yes,complete Part B)
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Part B:
Vehicle Maintenance Activity Moiiltoriupt:•Rr elsguirermo'euJ,.ts -., ��„,•, ;% r}, 4+ '�• ,
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Outfall Dptn• ',:,?' , . 50050' . , j,54 7-° x.,15••di;;;~:l`it,p,";i ",.^:'�OOS56' 7„ �'i•''�:1.d1;..:.;�:nt'., i'ii;,.+r1•.: •00530 X•14,,,i•.'',]�iy•
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Form SWU-246-062310
Page 1 of 2

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Mailriglnal and one copy to:
STORM EVENT CHARACTERISTICS: Divisi•a of Water Quality
i Attu: central Files
1 , a0 Ito• Date � � 1617 ail Service Center �°
Total Event Precipitation(taches): a. t1 4 1nil Ser Carolina ,,, 1617
µ Event Duration(hours): (only if applicable—see permit.)
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(if more than one storm event was sampled)
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Date 1
Total Event Precipitation(inches):
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i - Event Duration(hours): • (only if applicable—see permit.)
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directlan r.supervision in accordance with a
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4 "I certify,under penalty of law,that this document and all attachments were prepared under mY on my ti of with
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''�{ system designed to assure that qualified personnel properly gather and evaluate the information•subndtted. Based donsubmitted nis,ftheo the best
or persons who manage the system,or those persons directly responsible for gathering the information,
of my knowledge and beUef,true,accurate,and complete. I am aware
that
there are significant penalties fir sgbmitting false information,
including i.• ossibilit, of fines an imprisonment for knowing
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a (Sig attire of Permittee)
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I Form SWU-246"062310
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