WQ0015491_Monitoring - 08-2022_20221130

Monitoring Report Submittal
Permit Number #* WQ0015491
Name of Facility:* caraway Speedway
Month: * August Year: * 2022
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR augustnondischarge.pdf 3.22MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter: * Darren A Hackett
Signature:
o nlaadlrr
Date of submittal: 11/30/2022
This will be filled in automatically
Initial Review
Reviewer: Gerald, Wanda

Is the project number correct?* WQ0015491
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 12/13/2022

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

FORM: NDAR-1 08-11
III! All MK�
I-) --n
Page fIf
❑Compliant ❑ Non -Compliant
z
Ej Compliant ❑ Non -Compliant
Compliant ❑ Non -Compliant
Compliant ❑ Non -Compliant
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 Permittee Certification
Permittee: j
ORC: Jli
Operator Responsible
ORC:
No.: —T Signing Official:
C
Grade: Phone Number: Signing Official's Title:
Has the ORC changed since the previous NDARA? ❑ Yes _L4­No­ Phone Number: Permit Exp.:
77
Signature Date Signature Date
By this signature, I certify that this report is accurate 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 -
Division of Water Quality
Information Processing Unit
1617 Mail Service Center

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) raye

NON -DISCHARGE MONITORING
Pagec" d
Sampling Person(s) Certified Laboratories
IV
t
°4 Name:
Name:
Name:
Name:
ice-s all-- monitoring data and sampling frequencies meet the requirementsAttachment A of yourp
ermiV
omphant ❑ 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 Permittee Certification
A t
n
t3RC: r l
Permittee: i -,
Certification No.: �
- ere 11L
( i F c
Phone Number: 3 Signing Official's Title:
Gracie: ®-- � .- y`� �.
Has the oRC changed since the previous NDMR? ❑ Yes Q
Phone Number: ,' E Permit Expiration: 11
J.
L
l t ter r
Signature t 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.
DivisionMail Original and Two Copies to:
information Processing Unit
1617 Mail Service Center
2aleigh, North Carolina