WQ0019908_Monitoring - 05-2024_20240613

Monitoring Report Submittal
Permit Number#* wg0019908
Name of Facility:* Johnston county country club
Month: * May Year: * 2024
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR may ndmr 2024 2 001.pdf 1.54MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address: * randallaustinv1 @gmail.com
Name of Submitter: * Austin Randall
Signature:
Date of submittal: 6/13/2024
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* wg0019908
Is the monitoring report accepted?* Yes NO
Regional Office* Raleigh
Reviewer: _anonymous
Review Date: 6/18/2024

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s)
Name: NA
Name:
Name: NA
Name:
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Aompliant ❑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
' C(
ORC: /4US+i
Permittee: Holt Lake Golf & Rec. LLC DBA Johnston Co. Country Club
n
Certification No.: NA
Signing Official: u r is MLrnC 1
^'
Grade: NA Phone Number: i�S( �(� ��!
Signing Official's Title:
/
Has th ORC changed since the previous NDMR? Dyes Eu
Phone Number: Gi �3 .� I / f Permit Expiration:
Signature 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.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617