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Home My WebLink AboutWQ0015491_Monitoring - 09-2016_20170103�. , ., . � . .- •.- . - �� --. _ . ... _..e , . .. • �� . :0 ■ ■ . . ._-. •. . - .• . . •. ■ 0 ■ .�. .- . _ . ■ .� � '�� i�.�� i�.� �� ii. � �i i . . ��. i �i. -�-�_ � . • • : �m�� ' i i ��-�-�-�- 0--�-----------�-�- �--�--------__----- �--�---�-------�-_- 0--�-----�-_---�--- 0-_�-�-�-�-�---�-�- 0--�-�---�-�---�-�_ 0--�-_---------�-�- 0_---------------_- � ��' �-------------_- m' r�n��[�.�7��ti�� m/11MI11��.��-��I��_�_!!T.T�mi�il� m �i� ��-��_�:Sii�l�il�l� m �� i��RJ�i�� m��i��r��R';7� m �� i��s��"�` .�:'y�.�'NI�� m��-�0�� :.l�_!!it!5"v�►1111r�� m/!�l�1l��i��i�� m��-�-�_��-� m /11�!'L�I� i��l�O_� m��_� m �� [Al��G-��-�� m��-��l�� mFl��_��i�� m �1�!'i.�Q'� �t�'9��-�i�-�-��-� m�r-�� m��-� m��_��i��_� m I��f� ��-�-�i�_0�� m��-�� m ��-��-�_��1�� m��_�_� � .. , ��_��-�� ' u ��_� ��-� �� -� � -• � =� �� • e aaaa�-�-�� eaaaa�� —, �::,-i �.s;. FORM: NDMR 03-12 ftlON-DISCH,4RGE MOi�ITORINIG REPORT (i�DMR) Page4� ot� Sampling Person(s) Name: �� /�J '� 4-� (—� Name: Certified Laboratories /� '%f ` �% �/ /. Name: rl e,��C✓ [�'� V / fi/1 G/� �C� I �—c �./ �G i' Ge�c., � iVame: Does all enonitoring c�ata and sampfing fires�a�eu�caes �raee� $he s�eq�i�-emea��s on Attach�en$,�, of �o�a� g�e�m�t? Oc�ma��a�t ❑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 a�tinnrcl takPn_ Attach additional sheets if necessarv. 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 e previous NDMR? ❑ ves ❑ No Phone Plumber: (336) 629 - 5803 Permit Expiration: 4/30/2017 ' � /J � `� f � � � Signature Dat . Signature Date By this signature, I certiTy that this report is accurtate and complete to the best of my knowledge. I certify, under penalty of law, that this document and ali 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 infortnation submitted. Based on my inquiry of the person or persons who manage the system, or ihose persons directly responsible for gathering the information, the information submitted is, to ttie best of my knowledge and belief, We, accurate, and complete. I am aware that there are significant penalties for submitting false infarmation, including the possibility of fines and imprisonment for . knowing violations: flflail Original and Tvvo Copies to: Division oflfUafier Qualify Information Processing Unit 1617 Mail Service Center Raleigh, Morth Carolina 27699-1617 ,., FORM: ND,4R-1 08-91 . �lOi1�-DISCHi4iZGE APPLICA710N REPORT (NDAR-1) __ Page � ot� _ _ .�, . . , ,. FORM: NDAR-1 08-11 iVOf�-DISCHe4RGE APPLICATION EtEPORT (NDAR-1) • rage� or y Did the application a�ates excee�C $he 9emi$s Bn A$tachr�ae�t ��f �oe.ar �e�mu�? comp��a�t ❑ Non-Compliant !�leu�e.adequa�e �vaeasu�es �aker� $o prevea�t e�fluen$ @�o¢�cEin� o�o �u� �ua�of� �u�o�aa ��ae sites? Compliant ❑ Non-Compliant :1�l�S � Sl.al$219�1� �/�ge$�fi!/� COV�1' �'41ai�1f�[B��d Oi12111 �9$eS �S Sp�CI$s��ll A� y��Y' p�C'V'9'10$? comp�iant ❑ NomCompliant l�lere ail setbacks listed on your pe�mi� ¢r�aqn$a¢�e� fo� eveoy applic�too� $� eac9� �e�mi�$ed se��? ,L�I Compl' nt ❑ Non-Compliant � ir� accord�nce wo$f� fhe s ecifiec@ freeboar� 9�eegff��s an you� pea�rr�0t? Compliant ' ❑ Non-Compliant !�lea�e all freeboards maintaaned p 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: Darren A. Hackett Permittee: Russell H. Hackett Certification Mo.: 25029 Signing Official: � Grade: SI ' Phone Number: (336) 629 - 5803 Signing Official's Title: Has.the ORC changed since t r, ious NDAR-1? ❑ ves No Phone i�umber: (336) 629-5803 Permit Exp.: 4/30/17 c� � % Signature ate Signature � Dat By this signature, I certify that this repoR is accurrate and complete to ttie best of my knowledge. I cerlify, 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 aIl qualified personnel properly gathered and evaluated the infortnation submitted. Based on my inqui 'ry of the person or persons who manage the system, or those persons direclly responsible for gathering the informaBon, the • infortnation submitted is, to the best of my knowledge and belief, tnie, accurate, and complete. I am aware that there are significant penalfies for submitting false information, including the possihility of flnes and imprisonment for knowing violations. • IViail Original and Tw►o Copies to: Division of VNater Quality Information Processing Unit 1617 Niail Service Center Raleigh, iVorth Carolina 27699-1617