WQ0015491_Monitoring - 01-2020_20200511

FJRM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ I of

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of 2:
Did the application rates exceed the limits in Attachment B of your permit? compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? Vsmpliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? �ompuant ❑Non -compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? , compliant ❑ Non -compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permitltee Certification
ORC: I 1 %� H e`_1, -r-(
i� I
Permittee: ? 11� !' I C' e.j', 'il /1—P�� Y
Signing Official: Ie 1 c C � c �1
Certification No.: L%• 1
( (�-� ,/
Grade: � l Phone Number: 3 `�(, — 5� �!
Signing Official's Title:
9 9
Has the ORC changed since the vious NDAR-1? ❑Yes ❑rltf
Phone Number: 3 , (; 3>� � `�Y Permit Exp.: �(� 3.� �2 2-
1 V G
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
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 all qualified personnel properly gathered and evaluated 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.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _L_ of
Permit No.: WQ0015491 Facility Name: Caraway Speedway County: Randolph Month: �� Yes J? j
PPI: 001 Flow Measuring Point: D influent ❑ Effluent ❑ No flow generated Parameter Monitoring Point: ❑ Influent ❑✓ Effluent ❑ Groundwateriowering ❑ Surface Water
Parameter Code --1,- 50050 00400 50060 00310 00610'''1 00530 g311616 ., 00620 00625
m O — j
O F U U m N Z_
o
O O _
24-hr hrs GPD 1 Su mglL mg/L mg/LI mg/L mg/L mg/L
�,-
2 -- -- - —� _ ----j --
3 --; - —
5 _ -.�_ -4
6 - ---- -r
-- - i
7.�
9 � _
10 - - - —
12
13 - --i
14 --- -- --- — -
15
16
17
18 - - ---- - ( -
19
20 �— �- --- --
21 —i-- - —
22 1 _
23 I i— - —
24 ----
' 3
25
i
26 - —
27
_ I '
28
29 I —
30
31
Average: #DIV/0!
Daily Maximum: 0
i
Daily Minimum: -
Sampling Type: Csrmate Grab Grab Grab Grab - Grab Grzo j Grab Grab —
Monthly Avg. Limit _ --- --" {
Daily Limit 9,99a gpr - - --- -- --- --- ---
3 X yr 'rvr 3 X yr 3,X yr 3 X yr

FORM: NDMR 03-12 NON -DISCHARGE, MONITORING REPORT (NDMR) Pagew� of__
Sampling Person(s)
Name
Name
Name:
Name:
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessarv.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC':'�
Permi4fiee: �"1(,l.Ja'� �i � �• l ,
Certification No.:�
Signing Official:
g g
Phone Num4�b
Grade: - ' ' �3 G)
Signing Official's Title:
Has the ORC changed since the P re�rious NDMR? El Yes Igor '
Phone Number: 1 `%y Permit Expiration:
i ..
c//3
jq7
70,
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
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 all qualified personnel properly gathered and evaluated 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 imprisonmentfor
knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617