WQ0006941_Monitoring - 02-2022_20220331

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * February
Report Information
WQ0006941
Stoney Creek Elementary School
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2022
Upload Document*
Stoney Creek_February.pdf 518.96KB
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: Gerald, Wanda
3/31 /2022
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:
4/11 /2022

FORM: NDMR05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page _1_of_2_
Permit No.: WQ0006941 I
Facill Name:
Stoney Creek Elementary School
County:
Caswell
Month: February
MEET
M-TIT11T I'm
as
�
:.

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
taken. attach aounionai streets it
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Glenn Price
Permittee: Baron Neal MCDuffie ( Authorized Agent)
Certification No.: 987931120771
Signing Official: Baron Neal McDuffie
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 O No
Phone Number: 336-996-2841 Permit Expiration: 8/31/2021
jr-
Signature Date
nature 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 krKrMedge and belief, tore, accurate, and complete, I am
aware that there are significant penalties for submitting false inforration, Including the possbility 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

2
3 PC 56 0 2.4
4
5
6
7
2.5
25
26
27
2s
29
30
31

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?
I,�C.anpliant O Non-Compfiant
(114Mpliant ❑ Non -Compliant
[&el5mpliant
0 Non -Compliant
lj;, mpllant
❑ Non -Compliant
C�npliant
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
raKen. Aaacn aaciuonat sneers it
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: 11 Phone Number: 336-996-2741
Signing Official's Title: Field Services Director (Pace Analytical Services)
Has the ORC changed since the previous NDAR-1? p yes [21 No
Phone Number. 336-996-2841 Permit Exp.: 8/31/21
Signature Date
ignature 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 end all attachments were prepared under my direction or supervision In accordance
with a system designed to assure that all qua@rted personnel property 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 befief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false iMomration, Including the passibility of thins and imprisonment for knowning violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 276994617