NCS000302_COMPLETE FILE - HISTORICAL_20190228

STORMWATER DIVISION CODING SHEET
RESCISSIONS. ^.
PERMIT NO..
n/ G � O C� Li 30�
v
DOC TYPE
5 COMPLETE FILE'HISTORICAL
DATE OF
RESCISSION
p A 0I 1 0�c) O
YYYYMMDD

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCGNE
DOC TYPE
❑ HISTORICAL FILE
DOC DATE
❑
YYYYM M D D

STORMWATER DISC LARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number: NC �r� U cr- .3 y 2— or SAMPLES COLLECTED DURING CALENDAR YEAR:
Certificate of Coverage Number: NCG ('Phis monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the samp mg results from the laboratory.)
FACILITY NAME c�Gr'� I�i 1 j�� �v COUNTY
PERSON COLLECTING SAMPLE(S) NICZT'1�1 i3& PHO NO {, 5A)
CERTIFIED LABORATORY(S)'n u I ✓o c Jt, le Lab #pw-r--� E { V ED —
_ Lab # (SIGNATURE OF PERMITTEE OR DESIGNEE)
FEB 28 2019 By this signature, I certify that this report is accurate
complete -to the best of my knowledge.
Part A: Specific Monitoring Requirements CENTRAL FILES
nWR SECTION
Outfall
No.
Date
Sample
Collected
50050
Total
Flow
G o d
{ s S
moffl! r
MG
�-
:A
nleo
Sal
ri
1�1_
5L9
13
6 U
04 5�3
"3 _5
%, �
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? zyes _no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
No.
Date
Sample
Collected
50050 '
00556
00530
00400
Total Flow
Oil and
Grease
Total
Suspended
Solids
pH
New Motor
Oil Usage
mo/ddlyr
MG
m
m
unit
gallmo
Form SWU-246-051100
Page I of 2

STORM,EVENT CHARACTERISTICS:
Date
Total Event Precipitation (inches): K 5
Event Duration (hours):
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours):
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty of law, that this document and all ailachments 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."
�2-2�
(Signature of Permittee) (Date)
Form SWU-246-051100
Page 2 of 2