WQ0006317_Monitoring - 12-2016_20170201

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page of Oz
Permit No.: w111.317
Facility Name:
Colonial Pipeline• •.
• •
December
1
Point:Parameter Monitoring
Parameter Code I.
•
n
1. 1 ©�---------------
1 . 1 ©�---------------
®
1 . 1 ©�--------------
ME
1 11------��------

FORM: NDMR 10-13 w
NOW DISCHARGE MONITORING REPORT (NDMR) Page �Z of '` � I
Sampling Person(s) Certified Laboratories
Name: Faron D. Leigh Name: Analytical Environmental Services
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? QCornmant 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 necessarv.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Faron D. Leigh
Permittee: Colonial Pipeline Company
Certification No.: 14891
Signing Official: Darren J. Pruitt
Grade: Phone Number: 336-669-7903
Signing Official's Title: Operations Manager
Has the ORC changed since the previous NDMR? E] Yes FY] No
Phone Number: 336-339-1280 Permit Expiration: 9/30/2019,�,
-
3( j/7
Signatu re 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 dlrection 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

r FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page -,I—/ of
Permit No.: !11116317
FacilityName:
Colonial Pipeline• •.
• •
December1
•
• irrigation occur
at this facility?
Field Name:
r-grgm
Area (acres):
Cover Crop:
Cover Crop:
■ NO
Hourly '.
1
1
Annual Rate (in):
Annual Rate (in):;
Annual Rate (in):
••. .
•
0 •
Field Irrigated?Q
•
•
•
Monthly ... .=1111��INN/,
111
VNI /.
11111111
�������1
111111111

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page OZ of I
Did the application rates exceed the limits in Attachment B of your permit?
QCompllant DNon-compiiant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? pCompilant F1 Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified, in your permit? []compliant ❑Nun -compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?pcompllant ❑Non-compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? pCompliant - ❑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
actirinfsl takpn Attarh nrlrlitinnfli nhcetif
-__- - _.._......_._..-............. - uoa,y.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
611C: Faron D. Leigh
Permittee:
Colonial Pipeline Company
Certification No.: 14891
Signing Official: Darren J. Pruitt
Grade: Phone Number: 336-669-7903
Signing Official's Title: Operationsw Manager
Has the ORC changed since the previous NDAR-1? 17 Yes [2]No
Phone Number: 336-339-1280 Permit Exp.: 9/30/19
P
a
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 Informatlon 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
penaltles 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