WQ0009098_Monitoring - 12-2020_20210129

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _L of
Permit No.:"Flo,
,00 Facility Name: ` LA County: Month:
PPI: uring Point: ❑ Influent ❑ Effluent No flow generated Parameter Monitoring Point: ❑ Influent [-] Effluent ❑ Groundwater Lowering n Surf
Parameter Code
50050
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) 11 Certified Laboratories
Name: 11 Name:
Name: 11 Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? §T Compliant E] 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.
alp �a�te�a#er
1�i�c�trC SN4o
SJes7{e In
Operator in Responsible Charge (ORC) Certification
ORC�j�
Certification No.:
Grade: Phone Number.otlQ _oq� —a
Has the ORC changed since the previous NDMR? ` t ] Yes fVNo
I Signature I` Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: 1Clrti1 >S FVLr/i 61 E.-lvtn I+M—kr+Ae''i ( n
Signing Official: Ta M es - MC
Signing Official's Title: r^ r
Phone Number: tq Permit Ex iration:
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i
Signature Da
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 Of
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Field Name:
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•irrigationoccur
Area (acres�
Area (acres):
Area (acres
at this facility?
Cover Crop:
Cover Crop:
so
YES fti •
Hourly R
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in):'
Annual Rate (in):
W-MiTiTrITINIfUlCrOB
Field Irrigated?
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Monthly LoadinIll
12 Month Floating Total (irl

FORM: NDAR-1 10-13
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?
Page
of '
V/C'ompliant
❑ Non-Compli
M/compliant
❑ Non-Compli
[Compliant
❑ Non-Compli
Compliant [] Non-Compli
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? [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
ORC:
Tr"Ip�) f \. \CtNj'1 4'
Certification No.: I Lt RO3
Grade: Phone Number: -1 k- t4-(0c1
Has the ORC changed since the previous NDAR-1? ❑ 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: ,���e5 R-L�/1l�lij �IrnC4��i�lr"ti\�rk1
Signing Official:
Signing Official's Title:6& A,\ `il\`„
Phone Number: (]'nj
Signature
Permit Exp.:
Da
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