WQ0009098_Monitoring - 01-2021_20210304

FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page A_ of
Permit No.
Facility Name:
9ILL
1 ,
County:
Month:
PPI:
Flow Measurina Point: n Influent
n Effluent No flow generated
Parameter Monitoring Point:
❑ Influent [—] Effluent ❑ Ground r Lowering F.]Surf
Parameter Code 0
50050
N
E
U F
0
O
c
O
Y
U
O
C
24-hr
hrs
GPD
1
2
3
4
5
Eo:
6
.
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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
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? VCompliant ❑ 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 coi
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
`a
Certification No.: %03
Grade: S Phone Number: IR-(,,.*—a
Has the ORC changed since the previous NDMR? ❑ Yes No
r Signature
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Sc,�l-em
Permittee Certification
Permittee: :::5a"Y_S Ta� t [,- - j/Y�j-�'Q
Signing Official: �
Signing Official's Title: ukaftl(Ini s(Aor
Phone Number:��_�Qaa-acl(Per it Ex iration:I_ N1,3 l 0,
Signature
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
rammi
County:
• irrigation occur
at this facility?
■ YES i
Name:Field
I
Area (acres):
Area (acres):
Cover .•
,
•.
.•
I
'Hourly
-.
-.
AnnualRate(iny
Annual Rate (in):
Annual Rate (in) -
Field Irrigated?
Monthly Loadirir.�
Floating12 Month ..
FielckName:
Area (acres):
Cover Crop:
Hourly Rate (in):
Annual Rate (in):
Field Irrigated? n YES
E N N 2,
m - v
o a P o 0
>a
min I in

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?
Page
of ,
�-mpliant
❑ Non-Compli
[[Compliant
❑ Non-Compli
[/Compliant
❑ Non-Compli
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? �ompliant ❑ 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 No.: y q
Grade: ) Phone Number: c{ _7N.
Has the ORC changed since the previous NDAR-1? \ ❑ Yes
Signature '
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee:
Signing Official: FA(1)eJcameS-
Signing Official's Title: (��(1
Phone Number: 3 Per it Exp,:
Signature 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