WQ0009098_Monitoring - 02-2021_20210406

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR)
Permit No.: Facility Name:LOLO
ktim-r" County:
PPI: X I Flow Measuring Point: n Influent ❑ Effluent No flow generated I Parameter Monitoring Point:
Page --A— of --Z,
I Month: FPh�L1CiY"ln �'7��
Influent [—] Effluent n Groundwater Lowering ❑ Surf
Parameter Code —►
50050
M
Q
O
c
O
:L
O
C
24-hr
hrs
GPD
1
2
3
4
5
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: 11 Name:
Name: II Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? L4 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.
�0 r
As c6,ared Tr.►+o
Ut3 0-f IF S��m
Operator in Responsible Charge (ORC) Certification
Certification No.:
Grade: S Phone Number: t' l—��
Has the ORC changed since the previous NDMR? ` ❑ Yes No
00
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: TSVYN _. , l (� Li vY1 l"��1 �a n �1,
V�
`f f
Signing Official: (�}e j . MC� 1 L'L'(�
Signing Official's Title:
0 VV\(V\ 1 S 1 v(� fG
Q(
Phone Number: Permit Expiration:
5(-,;i i .-a,
�z 17.
Signature P4 Da
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 submilG
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
Did irrigation occur
Area (acres):
Area (acres):
Area (acres):
at this facility?
..
..
Cover C..
F] YES VNO
Hourly Rate (in):
i Hourly Rate (in):
I Hourly Rate (i
I -
Hourly Rate (in):
-
__ ___ __
Annual Rate (in
-
Annual Rate (in):
I Annual Rate (in): I
Annual Rate (in):
Ism- w MR R.
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?
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?
[Compliant ❑ Non-Compli
[[Compliant ❑ Non-Compli
Compliant ❑ Non-Compli
Q/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:-PavoAf k MC btit t �to,V,
Certification No.: 1 � aO?
Grade: S T Phone Number: (J JR •404to —at--A q
Has the ORC changed since the previous NDAR-1? ❑ Yes [VIN.
Signature r
By this signature, I certify that this report is accurrate and complete to the best of my knowledge
Permittee Certification
Permittee: _50IMe.S RtLIM
Signing Official:�v�neS
Signing Official's Title: �� ; rcU o r
Phone Number: -11%� —3n �� �
Permit Ex .:
1
r t
Signature pa
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