WQ0019908_Monitoring - 02-2024_20240910

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month: * February
WQ0019908
Johnston countycountry club
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2024
Upload Document*
tiff2pdf (20).pdf 1.94MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
astephens3241 @gmail.com
andrew stephens
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Reviewer: Wanda.Gerald
9/10/2024
This will be filled in automatically

Is the project number correct?* W00019908
Is the monitoring report accepted?* Yes NO
Regional Office* Raleigh
Reviewer: _anonymous
Review Date: 10/15/2024

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FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s)
Name: NA
Name: NA
Certified Laboratories
Page i of 2
Name:
II Name:
-
i
Does all monitoring data and sampling frequencies meet the requirements In Attachment A of your permit? �Compllant ❑Non Compliant
If the facility is non -compliant, please explain in the space below the reason(s) anot h s in co opal sheets if Provide
in your
explanation the date(s) of the non-compliance and describe the corrective
action(s) ones) taken
Operator in Responsible Charge (ORC) Certification
Permittee Certification
Permittee: Holt Lake Golf & Rec. LLC Di A�Johnston Co. Country Club
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Certification No.: NA Signing Official: C �.�r, S �
Grade: NA Phone Number: 3 % Signing Official's Title: C/r�„t (✓4 ;
Phone Number: Permit Expiration:
Has the ORC changed since the previous NDMR? ❑�pjYes No �
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2 / Date Signature Date
Signature
I certify, under penalty of law, that this document and all attachments were preparod under my direction or supervision in
By this signature, I certify that this report is accurrate and complete to the best of my knowledge. 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
RalPinh. North Carolina 27699-1617