WQ0015491_Monitoring - 10-2016_20161228 (3)

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page oft
10.
e0015491
Facility Name:
Caraway Speedwayat
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■YES'
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FORM: NDAR-1 08-11
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 specified freeboard heights in your permit?
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�m ❑ Nmrnmdiant
cant ❑ NaKmgliant
a�mlpllerlt ❑ Non{aoplWnt
mpliant ❑ Nm{ompliant
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: Darren A. Hackett
Permittee:
Russell H. Hackett
Certification No.: 25029
Signing Official:
Grade: SI Phone Number: (336) 629 - 5803
Signing Official's Title:
Has. the ORC changed since the p ' us NDAR-1? ❑ yes ❑.rte
Phone Number: [phone] Permit Exp.: 4/30/17
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Signature Date
Signature ate
By MIs signature, I certify Mal Ws report is accumate and complete to the best of my knuMedge.
I certify. under penalty of law, that this document and al attachments wars prepared under my dbacllm of supervision in accordance
with a system designed to assure that al qualified personnel propedy gartered and evaluated! the information subnytlatl. Based on my
Inquiry of the perm or persona who menage the system, w those persons directly responsible for gathering the information, the
Information submitted Is. to the best of my Imovdedge and beget. sue. acctmle. and ranplete. I am aware that there are signaram
penalties for submitting false Information, inducting the possibility of fines and Impdso mmt for knowing violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mall Service Center
Raleigh, North Carolina 27699-1617