WQ0019908_Monitoring - 10-2022_20231212

Monitoring Report Submittal
Permit Number#* WQ0019908
Name of Facility:* COUNTRY CLUB OF JOHNSTON COUNTY
Month: * October Year: * 2022
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR OCT2022NDMR.pdf 282.45KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address: * astephens3241 @gmail.com
Name of Submitter: * andrew stephens
Signature:
044&W,�k rd
Date of submittal: 12/12/2023
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* W00019908
Is the monitoring report accepted?* Yes NO
Regional Office* Raleigh
Reviewer: _anonymous
Review Date: 12/13/2023

Sampling Person(s) ' Certified Laboratories
Name: NA Name: NA
i`
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? l'Compliant HNon-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
ORC:,, c�✓�
Permittee: Holt Lake Golf & Rec. LLC DBA Johnston Co. Country Club
Signing Official:
Certification No.: NA
Grade: NA Phone Number: `®
Signing Official's Title: t% d
/ f 310 ! ` Permit Expiration:
Has the ORC changed since the revious NDMR? ❑Yes [:]No
Phone Number:
Signature Date
Sign a 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 pefson 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.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

County: Johnston
Ave ge:
Daily Maximum:
Daily Minimum:
i