NCG140029_MONITORING INFO_20020628

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
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DOC TYPE
❑HISTORICAL FILE
I� MONITORING REPORTS
DOC DATE
❑ d�� a DlD a
YYYYMMDD

A� ,
NCDENR
DISCHARGE OUTFALL MONITORING REPORT
GENERAL PERMIT NCG140000
(All sample data shall be reported no later than 30 days after receipt of lab results)
.Ccrtifi'cate. of Coverage .
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Person -,C(!!1'e,6ting Sample(s)
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Gpllectors Signature
SamP16 Informatidn.,
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Does this facility perform Vehicle Maintenance Activities using on average more than 55 gallons of new motor
oil per month? 0 Yes 0 No If yes, complete information below.
Stormwater DischargeMonitoringfrom Vehicle Maintenance Areas
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SWU-241.090199 - Page tof 2

Part B: Process wastewater discharge monitoring data
Sample # I
Effluent Sources for this sample
Vehicle / Equipment Cleaning
❑
Raw Material Stock -pile Wetting
E
❑
Mixing Drum Clean -out
Recycle System Overflow
Parameter
Unit
Data
Collection Date
mo/dd)yr
�, o-L
Total Flow
MG
Event Duration
hours
(, , a
pH
Std. units
g, at�
TSS
mg/l . •.
; - ZIP. a`....:
Settleable Solids
.ml/I
Sample # v
Lffluoue pure .$-for;tliil;is ttt le "
❑
❑
Vehicle / ui rnent.Cleanin
Raw Material Stock -pile Wetting
'Mixing Drurti•Clban�out'
Recycle System Overflow
P�aramete f��
�S i�.p Ya 1J r#tl��
' E PDatLL uwl
Collection Date
mo/dd/yr
Total Flow
MG
�}
Event Duration
hours
(o. p
pH
Std. units
TSS
mg/l
Settleable Solids
mill
--
Mail original and one copy to:
Attn: Central Files
Division of Water Quality
DENR
1617 Mail Service Center
Raleigh, NC 27699-1617"
Sample # S
Effluent Source(s) for this sant"le 4
Vehicle / Equipment Cleaning ❑
Raw Material Stock -pile Wetting "
Mixing Drum Clean -out
Recycle System Overflow ❑
Parameter
=Unit
Data
Collection Date
mo/dd/yr
Total Flow
mo
o iv
Event Duration
hours
pH
Std. units
dl r} t
- „°: -:TSS ,-;."- -
-•::mg/l..
rzq, �
Settleable Solids
.;• • •mUl;
--
Sample #
"$ffli,ri'Sodree 1ftirtiiii"sseiti
-,Vehicle/ Efuipment'Cleanin ❑ `
Raw'MateriaL Stock -pile Wetting:
`Mixin 'FDruin Clean=out' ❑ 'x`::= ,
Recycle System Overflow ❑
Collection Date
mo/dd/yr
Total Flow
MG
Event Duration
hours
pH
Std. units
TSS
mg/1
Settleable Solids
ml/1
" 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."
(Print Name of Permittee or Designee)
(Signature of Permitte or Designee) (Date)
SWU-241-080199 Page 2 of 2