WQ0009098_Monitoring - 08-2020_20201006

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page __L_ of
Pt
Permit No. Facility Name: County: Month:
oM. Cl--, Point- n TnFlnent n Fffluent F-11rld flow oenerated Parameter Monitoring Point: ❑ influent [-] Effluent n Groundwater Lowering Surf
Parameter Code —11
50050
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11
12
13
14
15
16
17
18
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19
20
21
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23
24
25
26
27
28
29
30
31
,average:
Daily Maximum:
Daily Minimum:
Sampling Type:
Monthly Avg. Limit:
Daily Limit:
Sample Frequency:

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of_ ` v
Sampling Person(s) 11 Certified Laboratories
Name: II Name:
Name: II Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ compliant ❑ Non -cc
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 col
action(s) taken. Attach additional sheets if necessary.
Oc Wa64eu)Aec
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Operator in Responsible Charge (ORC) Certification Permittee Certification
WA,
It I (� Permittee: � �' `fal)i di LjmAM Tar-hnemk'Le
Certification No.: Signing Official: ' . { 10
Grade: G'—I— Phone Number:11 ( qq Signing Official's Title �t�t rsYr1.�
Has the ORC changed since the previous NDMR? ❑ Yes No 1 Phone Number: q �(�� Permit fEx ;ration:
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Signature ate Signature Da
By this signature, I certify that this report is accurrale 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
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitt-
my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the in
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there +
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violat
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page c4, Of�
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jField Name:,
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Area (acres):
Area �■-Area
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at this facility?
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Hourly Rate (i
=Hourly Rate (in
Annual Rate (in
Annual Rate (in):
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Field Irrigated?
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FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
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?
/Compliant ❑ Non-Compli
V/C.mpliant ❑ Non-Compli
Was a suitable vegetative cover maintained on all sites as specified in your permit? Compliant ❑ Non -Comps
Were all setbacks listed in your permit maintained for every application to each permitted site? Compliant ❑ Non-Compli
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? V/Compliant ❑ Non-Compli
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 cor
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
`
Certification Noo.:�l`��'
Grade: ST Phone Number: a1A
Has the ORC cchhanged since the previous NDAR_-1? F❑' Yes -U/No`
Signature
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: Q1,y\e_s f 11v1 t [
Signing Official: V Tame-5 —McI"1l Ito,,,
t�1
1+1
Signing Official's Title:Dhir\A-�r, •
Phone Number (ail _'33a.9940�
Signature
Permit Exp.:
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1311
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I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. E
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the inform
information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violation
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617