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Home My WebLink AboutWQ0019095_Monitoring - 12-2016_20170203FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of Permit No.: Q11 •1•ColfaxGuilford December1 . 11Flow Measuring •. v ■ ■ . flow generated . . . -. ■ .v ■ . . . . �. M..Err, ®F1 �___�--_�_®_-_-_ pro Me, I 111 111 ---- 1 , ® 11 1 • 1 11 ��.' / 1 1 �® 1 1 1 1 1 1 1 ---- FORM: NDMR 03-12 MON-DISCHARGE MONITORING REPORT (NDMR) Page z of --7-- Sampling Sampling Person(s) Certified Laboratories Name: Fred Thomen Name. R and A Laboratories Name: Name: Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? (DCompliant ONon-Compliant If the facility is non-compliant, please a>plain in the space below the reason(s)the facility was not in compliance. Provide in your explanation the date(s)ofthe non-compliance and describe the corrective action(s)taken. Attach additional sheets if necessary. Operator in Responsible Charge (ORC) Certificati on Permittee Ce rtification ORC: Fred Thomen Permittee: Jackie Landreth Certification No.: W.W. 26007 S.I. 986613 Signing Official: Mandy Minion Grade: 2 Phone Number: 336-267-4846 Signing Official's Title: Corporate Secretary Has the ORC changed sincethe previous NDMR? ❑Yes I0No Phone Number. 336-855-0498 Permit Expiration: 4/30/2020 /� d,11Q - _: � 2 1-2flil 7 L�� I a 41 /4 - Signature Date Signature Date By this signature, I ce rgfy tha t thi s re po rt is a ccurrate and complete to the best of my knowledge. I certify, under penalty of law, that this document and al I attachments we re prepared under my direction 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 forgathering the info rmatio n, the information submitted is, lo the best of my knowledge and beg ef, true, accurate, and complete.I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonmentfor knowing violations. Mail Origin al and Two Co pies to: Division of Water Resources Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page —L–of Z Permit • (111 •1• • revs . I December r 1 / irrigation EIYFS EINO• •. 1 • �. 1 • •. 1 . �. •r' , ..rMINI MINI MINI MINI M M a3 1/ 1 1 1 1 11 1 1 1 1 11 ZME1/ 0�� ... iiiiimiiiiiiiVzz FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page — of Z— Did the application rates exceed the limits in Attachment B of your permit? gCompliant ONon-Compliant Were adequate measures taken to prevent effluent ponding In or runoff from the sites? SComplianl rINon-Compliant Was a suitable vegetative cover maintained on all ekes as specified In your permit? RICompliant ONon-Compliant Were all setbacks listed In your permit maintained for every application to each permitted site? 59Compliant ONon-Compliant Were all freeboards maintained In accordance with the specified freeboard heights in your permit? Scomplianl ONon-Compliant If the facility Is nonconnpianI, please explain In the apace below the reason(s)the facility was not In campience. Provide In your explanation the date(s) of the noncompilance and descdbe the corrective aotion(s) taken, Attach additional shestelf necessary. Operator In Responsible Charge (ORC) Certification Permittee Certification ORO Fred Thomen Permittee: Jackie Landreth Certification No,: WWII 26007 31986613 Signing Official: Mandy Minion Grade: Phone Number: 336.287-6248 Signing Official's Title: Corporate 9eretary • CIYes 11J'Nc Has the ORO changed sirwetheprevious NDAR-17 Phone Number 336-866-0498 Permit Exp: 4130/26 Signature Date Signature Date By his aignature, I cenly fiat hb report b am nate and complete to the best of my knoMedge. I eorty, under perat rAv, t this doeumant and au a"mentt wera prepared under my d1raedon orsupeftlar h accadarcowdhasotom nedoessuraMetal qudYbdporeonnelproperly gathered and waluatedthe lnbrmelon at bm0.ted Booed on my hquhy dfho pereen a pemona who manage the syebm, orthoee persata throaty responalbb br gathering ho hbrmrtbn lino hfortnathn twbm 0.bd b, to the beet of my lamledge and beld,true,accureb, and campole,l am aware thatthera aro efdngtoanl penaltba br arbmlttng robe Information, InducI g the poael6Bkyoff nas and Imprimmen for knowing violations, Mall Original and Two Copies to: Division of Water Resources Information Processing Unit 1817 Mall Service Center Raleigh, North Carolina 27889.1817