WQ0006941_Monitoring - 10-2021_20211130

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * October
Report Information
WQ0006941
Stoney Creek Elementary
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
Stoney Creek_Oct.pdf 1.08MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Jessica Mize
jwd rA lip
Reviewer: Zhong, Vivien
11 /30/2021
This will be filled in automatically

Is the project number correct?* WQ0006941
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Accepted Date:
12/8/2021

FORM: NDMR 06-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page _1_of_2_
•1116941
Facility Name: Stoney Creek Elementaryr•
.
. October
IN=
F11 w Measuring Point:
Parameter Monitoring Point:
•
•
Daily Maximum:,
Sampling Type:,
zRadzi

FORM: NDMR 05-16
NON -DISCHARGE MONITORING REPORT (NDMR)
Page
Of
Sampling Person(s)
Name: Glenn Price
Name:
Certified Laboratories
Name: Pace Analytical Services
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
❑ 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
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Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Glenn Price
Permittee: Baron Neal McDuffie ( Authorized Agent)
Certification No.: 987931/20771
Signing Official: Baron Neal McDuffhe
Grade: 11 Phone Number: 336-996-2841
Signing Official's Title: Field Services Director ( Pace Analytical }
Has the ORC changed since the previous NDMR? ❑ Yes [21 No
Phone Number. 336-996-2841 Permit Expiration: 8/31/2021
Signature Date
ature Date
By this signature, 1 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, We, accurate, and complete. 1 am
aware that there are sigru scant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 05-16
NON -DISCHARGE APPLICATION REPORT (NDAR-4 ) Page _2_ —2—
Permit No.:
•111.941 I Facility Name: Stoney Creek Elementaryr• - October
at this facility?
• •. •..
■ YES !➢ NO Hourly
Annual Rate (inY Annual Rate (in).� Annual Rate (in):.
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FORM: NDAR-1 05-16 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
LKCompPrant ❑ Non-Compriant
GK°ompliant
❑ Non -Compliant
Ci&mpliant
❑ Non -Compliant
C&—&mpriant
❑ Nan -Compliant
Gp( Ompliant
O 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
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Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Glenn Price
Permittee:
Baron Neal McDuffie (Authorized Agent)
Certification No.: 987931/20771
signing Official: Baron Neal McDuffie
Grade: II Phone Number: 336-996-2741
Signing Official's Title: Field Services Director (Pace Analytical Services)
Has the ORC changed since the previous NDAR-1? ❑ Yes 21 No
Phone Number: 336-996-2841 Permit Exp.: 8131/21
�l �2 r
//-3�-�- t
Signat 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 ell 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. 1 am aware that tare 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617