WQ0019095_Monitoring - 02-2021_20210331

F NRM. NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _—of
WQ0019095
Facility Name: Colfax Furniture
County: Guilford
Mo nth: February
MeasuringPeraitNo.:
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S-2RM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of 7.—
Samplhg Person(s) 11 Certified Laboratories
Name Fred Thomen 11 Name: Pace Analytical laboratory
Name: 11 Name: Cameron Testing Services
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? RlCompliant ❑Non -Compliant
If the facility is non -compliant, please explen in the space below the reason(s)the faciity was not in compliance. Pro\Ade in your explanation the date(s)ofthe non-compliance and describe the
corrective actlon(s)taken. Attach additional sheets if necessary.
Operatorin Responsible Charge (ORC) Certification
Permittee Certification
ORO Fred Thomen
Permittee: Jackie Landreth
Certlflcatlon No.: W.W. 26007 S.I. 986613
Signing Offidal: Fred Thom an
Grade: 2 Phone Number. 336-267-4846
Signing Official'sTitie: ORC
Has the CRC changed since the previous NDMR? 0-Yes ENo
Phone Number. 336-855-0498 Permit Expiration: 9/30/2027
Signature Date
Signature Date
By this signature, I cerIfy the tthl a repo rt Is accurrels and comp ate to fla best or my knowledge.
I certify, under penalty of law, fiat this document and all attachments were prepared under my direction or supervision In
accordance with a system do signed to assure the talI quaBiad personnel properly gathered and evaluated the information
submitted. Based on my Inquiry of he person or persons who menage tha system, or floss persons directly responside
forgathering the information, the Information submits is, to the best of myknow ledge and bar of, true, accurate, and
compie Is. I am aware that there are slgnIflcant penaties for submitting false information, IncludIng the possibility of fines
and imprisonmenlfor knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FQR M: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ of
Perrr�t No.: WQ0019095
Facil ity Na me: Colfax Furniture
County: Guilford
W nth: February
Did irrigation occur R)
this facility?
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FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page Z of -Z
Did the application rates exceed the limits in Attachment B of your permit? Compliant LINon-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? ECompliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? (]Compliant ❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? (]Compliant ❑Non -Compliant
If the facility is noncompliant, please explain in the space be low the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the noncompliance and describe the
corrective action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Fred Thomen
Perrrittee:
Jackie Landreth
Certfication No.: 26007
Signing Official: Fred Thom en
Grade: 2 Phone Number.
Signing Of cial'sTitle: ORC
Yes ° No
Has the CRC changed since the previous NDAR 1?
Phone Number. Permit Exp.: 4/22/20
2-1
Signature Date
Signature Date
By his signature, I certify hat his report is accurrate and complete to the best of my knowledge.
I verify, under penaKy of law, that this document and a atachmen iswere prepared under my direct on or s upervisi on in
accordance with a system designed lo assure Ihatall qualified personnel properly gat) ere d 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 he information, the information siAxnitted is, to the best of my knowledge and belief, true, accurate, and complete. I
am aware fiat there are significant pen allies for submitfng false information, including the possibilityof fines and imprison men
for kno wi ng vi ola t ons .
Mai Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617