WQ0019095_Monitoring - 11-2016_20161222

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page I of z
Permit No.: WQ0019095
FacilityName:
Colfax Furniture
County: Guilford
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FORM: NDAR-1 10-13.
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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 spedfied freeboard heights In your permit?
Page 'Z . of Z-
gCompiiant ONort-Complient
BCompliant ❑Non -Compliant
@Compliant ❑Non -Compliant
Mcompilant ONon-Compliant
C)Compliant ONon-Compliant
If the facility Is nonoompient, please explain In the space below the resson(s)thefacliKy was riot In compliance. Provide In your explanation the date(s) of the noncompliance and describe the
corrective action(s) taken. Attach additional sheets if necessary.
operator In Responsible C herge (ORC) Certificad on
Permittee Certification
ORC: Fred Therrien
Permittee: Jackie Landreth
Certification No., WWII 26007 S1986613
Signing Official: Mandy Minion
Grade: PhoneNumber: 336.267.5248
Signing offlolel'sTitle: Corporate Serehary
Has the ORO changed since the previousNDAR-1? 10Yes (-,,,No
PhoneNumben 336-655.0498 Permit Exp,: 4/30/7Z)
Signature Date
Ignature Date
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Mall Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail service Center
Raleigh, North Carolina 27689.1617