WQ0006941_Monitoring - 11-2022_20221229

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * November
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_November.pdf 509.66KB
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
12/29/2022
This will be filled in automatically

Is the project number correct?* WQ0006941
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 1/19/2023

FORM: NDMR, 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page _1_ of —2—
Permit No.:
0111.941 Facility Name: Stoney CreekElementary ••l County: Caswell ,Month: November
liFlow Measuring Point:
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s)
Certified Laboratories
Name: Glenn Price Name: Pace Analytical Services
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ar6mpliant ❑ Non-comprent
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: 336-996-2841 Signing Official's Title: Field Services Director ( Pace Analytical }
Has the ORC changed since the previous NOMR? ❑ Yes p No Phone Number: 336-996-2841 Permit Expiration: 8/31/2021
F�
Signature
By this signature, I certify that this report is acwnate and complete to the best of my krwv edge.
Date Signatuov Date
I certify, under penally of taw, that this document and al attachments were prepared under my direction or supervision to
accordance with a system designed to assure that all qualified 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 responsiMe for
gathering the Information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware than there are significant penalties for submitting false information. Including the posshTdy 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 .Caroll6a 27699-1617

Month: November IYear: 2022
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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?
00( mpliant
❑ NonCompliant
i��`i&mpliarrt
❑ Non-Compllant
LNCompliant
❑ Non -Compliant
LKCompliant
❑ Non -Compliant
Lt3'Compliant
❑ NonCompliant
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: 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? ❑ Yes O No
Phone Number. 336-996-2841 Permit Exp.: 8/31/21
y
Signature Date
Si re Date
By tNs 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 aorordance
with a system designed to assure that all qualified 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 belief, true, accurate, and complete. I am aware that there are significant
penalties for submitting false Wormeron, 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