WQ0001817_Monitoring - 06-2022_20220708

ti
DWR - NonDischarge Monitoring Report Submittal
'
•4 ..
NORTH CAROLINA
Enrlranmenlel QHaflly
Monitoring Report Submittal
..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Permit Number#* WQ0001817
Name of Facility:* Albemarle Utility Company
Month:* June Year:* 2022
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR June MRs2022.pdf 9.11MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2,NDMLR,GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter:* danny S perry
Signature:
Date of submittal: 7/8/2022
This will be filled in automatically
Initial Review
.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Reviewer: Gerald,Wanda

Is the project number correct?* WQ0001817
Is the monitoring report accepted?* Yes No
Regional Office* Washington
Reviewer: _anonymous
Review Date: 7/12/2022

ORM.NDMi-,,C3-12 NON-DISCHARGE MONITORING REPORT(NDRIR) Page._1_,
Per_mit No.: W00001817 ' Facility Name: G
County A uir ns t :
PPE r101 Flow Measuring Point: themarie Utility Company
D Inrit..elt Li Effluent Li No a:v;hienuratei _i : Perqna i monh
Parameter Monitoring Point: [1.7,Influent Li Effluent Li e
rounjcii„:37 I Yea-r: 2022
Loweting LI Surfach*dims
Pariameter Code -* 50050 1--003-1-0 00940 06' 50e60 I 31616 -010 00625 -08620 00600 I 00400- [00665 1 70300 00530
----
,
.._
I ' .
-r. m
0 ..7.
ce 0
_ vi
ci
0
03 I?:
C
.- ta..-
4a; 7i., ,1,.. 0,..s.-
p-- z ta o
0 o
PI
0
1-- - ..
z 2 0)
o e
z x _ II* 1.,___ 6 3
tO
6 07:00 :hrs OPD 019a- :911- mg6:,,,, '#1100 all- Pr,911,- 1997 rn:/1.- Mal- 1 su MO: :9: iThilte
8 56,800
8
54400
3 . 57,400
8
51,400 !
. ,.
57400
'4:100
I--
9.17........--m--,..
, ...... - -
___ ._
iiim _.
. i
:5321 0°°82 77747-::'0°°81°°°1
II
8
8 07:00 ' W4f4
8 57,000
---1
I I
9 07:00 8 59,500
le 07:00 8 56,4o0 51 3.14 1 MPN <0 02 5,9 0.16 6.2 8.6 5.77 151
.., ,
11 56,400
12 56 300
r-----
'‘ .
13 07:00 8 56,200
14 07:00 8 59,700 .
15 07:00 8 52,700
16 07:00 8 53,600
17 07:00 8 40,100 0.75 8.86
18 40,100 F-
_
19 40,200
1 .
20 07:00 8 123,900
21 07:00 8 50,700
22 07:00 8 57,100 0.83 I- 9.15 -
23 07:00 8 55,900
!-- .__
24 0700 8 55,8130 '
25 55,800 _
26 55,800 .
-----1
27 07:00 8 58,700
I-•
28 07:00 8 57,100 -4 [--
29 07:00 8 54,400
--,
30 07:00 8 56,900 0.69 9.13 E_
31
--Average: 56,807 51.00 0.56TIT-4-0 *REF! #REF! 0.16 6.20 5.77 151.00
Daily Maximum: T23,9CTi) 1111111131 0.83 0.00 *REF! #REF! 0.16 6.20 9.17 5.77 151.00
Daily Minimum:Minimum: 40,100 51.00 0.14 0.00 *REF! #REF! 0.16 6.20 8.80 5.77 151.00
.,-. -
Sampling Type: Recorder Grab Grab Srce, Grab Grab Grab Grab Grab Grab Grab Grab Grab
Monthly Avg.Limit: 102,264
1- F
i Daily Limit: L 250 rrig/L. 1_1.5 MO_ i 0 mg/L 1.5 mg/L 8 5-3 5 Sit 500 iyigli._
LSample Frequency: Continuous 1 Month 1 ly 3 X Year Week,/ i Monthly Monthiy Monthly 1 Monthly Monthly .1-7J,leekly fV:oritt;1-1-3y X venr I Monthly , -I

FORM. 2.,
<_ , 2 e ( -D1SC i MONITORING IS P R ( Dot ale '¢
Sampling F e . .t„ i Cetlified Laboratories
i
Name.: Tom Beasiev € Name: Environmental Chemists
!Name: Name:
Does- all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? .n Compliant E r-O orw—o't
if the facility is non-compliant. douse explain in the specie b,tor=,the reason(s)the 1acii ty was not in compliance. Provide in your explanation the date(s)of the non-comp=a -ce and describe the corrective
action(s)taken.Attach additional sheets it necessary.
ph high ire 4 wecbs was checked 612--P.17.6f10--6.6 E117 R 36,6122 9 15 6136 9 1. i
1
I
I
[e_e_ _ — --- — — — _ —_ ----- — e
1
0
OperatorinResponsible Charge Co —Von t Certification
CRC: Danny Shelton Perm 4ittee: Tames Sinnott
Certification No.: i6651 11 1 Stoning O`slat: Sh-ayr a Lanile 1
t aor. Si Phone Number: 1-252-.26-E u 7 Signing Official's"title: COtp. Sestetary
i
Has the ORC changed screen the previous» ? E Yes E1 No Il s Phone Number: €-252-426-1126 Permit Expiation: 5131.-20,5
t
00 ---2 i„, ,
„, , _._ ,,,_.
3
,, ,,,, /-
iSignature Date Signature Date
By this sidnatu_.I certify that this report:s agewrate aen complete to Me best o'my k.,owledge. 1„er fy-uncor penalty of!axe,that th3s document a,d ail attachments were pfepareo.:nde my¢1^ctioe or supervisor:r
accorsianco with a system designed to assr e that all Q..a s ed personnel prep:dy gathered and evaluated the ir4ormagor.
submitted Based on ivy rcuiry of the person or .suns who manage the system. those a .sons directly responsthie for
ga herrg the information,tne-triton-nation bmttec s the of my khcwledge and belief.true.acasate.and complete am
aware that th.,e are g f:ca.t penalties:o. b t a fall nfo rnat n .c:ading :e,--so -b offie and--rtiris e er
.a..�.` . K,:OW "I viOS3._ S
Mai.Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Ra;eioh,North Carolina 2769 -1 17

„NIIIIIIIIII„olv„1,I,o,ivr„,I„;'!'r.II:JI:,Ill'vllii,11,yll,hlIlluilH,„,I,,,.III„, ,, '..., i 11„, 1 e 1 „tal Ube tists 111' rt c'
voipme 11111111:„11,11111,q0,i:1,111.11),11111,1111„,11111„1111:11„:1gliii:1,1111111!:11,1,1;1111111:1,1111„:11111111:,„1,„Ilr.
, ielliyivixtviiilm,40!",111:1,H, 6602 Ohnatrad1H/Vay, MR1044442914 NR. 28492 4 9.G d 392 0222
11194,1;111117"111;11," "':,,1",11:1?,11011'111111,11,11''',1,0,1,H111111111111141hijililhIlhiliIIIIIIH1,01111,11,111:10111
"71 ,P fiowserh Rya r Road Manteca ''',1(.'27954 4 252 12
'14""16(1,1:1:,,,l',11,111',11V111,i'4,1,11,I,1,11,,,,,I14114111111,11:10:::,ifilil,A1111111' ,,
255 AVVIllmoTton Hoaftway, ,,ack4,0t94.2219, l'51( 28540 5 910 347 584 1 ab al.a,
ANALYTICAL&CONSULTING CHEMISTS mfo,a enworunenIalciwni Ist,,L om
Albemarle Utility Date of Report: Jun 22, 2022
862 Holiday Island Road Customer PO#:
Hertford NC 27944 Customer ID: 09110024
Attention: Danny S. Perry Report#: 2022-10776
Project ID: Wastewater-Monthly (WQ0001817)
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
22-26102 Site: Effluent 6/10/2022 9:02 AM Water Tom Beasley
Test Method Results Date Analyzed
Ammonia Nitrogen EPA 350.1,Rev,2.0,1993 < 0,2 mg/L 06/10/2022
Chlorine Hach 8167 0.140 mg/L 06/10/2022
Fecal Coliform Idexx Colilert-18 1 MPN/100m0 06/10/2022
Residue Suspended (TSS) SM 2540 0-2015 151 mg/L 06/13/2022
Temperature SM 2550 8-2010 27,2 C 06/10/2022
pH SM 4500 H 8-2011 8.6 units 06/10/2022
Total Phosphorus SM 4500 P(F-H)-2011 5.77 mg/L 06/20/2022
BOO SM 5210 8-2016 51 mg/L 06/11/2022
Nitrate Nitrogen (Calc)
Nitrite Nitrogen EPA 353 2,Rev 2 0,1993 0.12 mg/L 06/10/2022
Nitrate+Nitrite-Nitrogen EPA 353.2,Rev 2 0,1993 0.28 mg/L 06/15/2022
Nitrate Nitrogen Subtraction Method 0.16 mg/L 06/20/2022
Total Nitrogen (Calc)
Total Kjeldahl Nitrogen (TKN) EPA 351.2,Rev 2 0,1993 5.9 mg/L 06/17/2022
Total Nitrogen Total Nitrogen 6.2 mg/L 06/20/2022
Comment: ,,, ,,
i 4 )Win
Reviewed by: jjj,k,„}-0 tki ,, 'LI! -4)
4rn111440110/MM41.1.11114441444414/4 1,111..ry 1...41.4,444.1111M4114141081414111/rn
114..44.1 41 41411011,1 4 4111,1111

Wastewater Operation Log
Month .4,,,- " Li
Plant ,H / I e: a
--
Date INT ' Hrs ORC WC Temp Rain Effluent flow Spray flow . spray time ' PH , / 1 - . Freeboard
,
111.1 ,
. .
2
,,,,,,li3„
c,„::0,,''' ';1! 4.5"
.
( — ... •
3
. .
1 . ,
4 , .
5 ,
' . II„
, .
, .
III,
. .
81 .,
1 .
, 1 ,
. . al
. .
; .
,
, .oo,o 12 l 1 ,
. .
all'
, .
. , .
h-,----- :
. .._ ...,1
' .
f---- . ,
. . ._
, .
. .. ,
. .
IIII18
.. ;
. l '
, . .
1.9
. .
. . . i
rl000000, _2 1;
1 . ----1 ,,„.
. . ,
, , l
— ,
....._ 25 ,.:
l , ,
.1111
, ' - -------1
r 27111A ; ,
' l 1---
2 8 111 .
: .
. ,
' —
, -
l........_ . ' , 1.. , .
l , .
Hof.,,,„, !exr, ,,' ,.
,
7.._ , ........_ . __......1,
......
Am m TSS N+N Am m TSS
DOD P TN BOD P
Nitrate F e c a I 'TKN Nitrate Fecal
chlorides IDS TOC Chlorides TDS

FOR"- =vL. R-'. 05_1 t APPLICATION REPORT f`_.
Permit No.: Y 01 0 18 i 7 1 FacilityName: - Albemarle UtOt\,Company P _�_
County: Perquimans Irllor�tl�: ure Vc,,ar2
Field Name: A 3 Field g=am-.:, Field Name: C Field NBine: D
Did irrigation or cur _-�_
Area(acres): 7.34 I Area(acres):I 7.96 Area(acres): 9.78 Area(acres): 7.33
at this facility? Cover Crop: Fescue Cover Crca Fescue Cover Crop: Fescue Cover Crop: Fescue
p=_ p: p�
Hourly Rate(in): 0.15 Hourly Rate(in): 0.15 Hourly Rate(in): 0.15 Haurfy Rate(in): .�5
Annual Rate 04' 12.66 Annual Rate(in): 12.66 Annual Rate(in): 12.66 Annual Rate(in): 12-66
Weather Freeboard Field Irrigated? 0 YES NO Field Irrigated? Li YES J so Field Irrigated?, 0 YES NOField Irrigated? Y E NO
�. a 1` � �, � � E
, _ j g
I u E1 4, ›. c Le Em o , - ar ›. . c E � ea F
cl III a I 14 Q oet. PF flo r2i fi
P 6' 4 - I- z1 ©ro ra sa > Q - a -3 � _.1 ffi . > � n ms
°r in ft ft gal miry in in gal rain in inmin in in gal min irs r;
1 G 94 1 ! r —
2 G 96 ��� �
a
i_____
3 G 87 11men l VALIUEI �-
4 G 83 -----T-
1 -1_ I
5 C 84 3.24
6 G 82 i
I � -.-
7 G 86 _ _�__.
8 PC 87
10 C 82
11
11 C 85 � 65—I
f12 C 87 0.3 3.06
13 G 94 0.2
14 CL 91 �� —
15 C 85 i ---_-,I---_
16 CL 82 I 0 2
18 C 88
19 C 79 3.46 I 20 C 83 1
21 G 83 F _ ME
22 G 88 0,3 � T
23 G 81 9.1
24 G 81
25 C 86
26 C 88 I I _---
3.62
27` 89 , e _
C
28 C 86
29 C 83
30 G � 90 i � �
31 �
'.ally Loading: 0 0.00 0 0 0 0 0.00 S 0 0 00
1---- _12 Month Floating Total(in) „ IIIIIIIIII, .: _, _._ . _ Zt-AiliZt

FORM: ND AR-1 c5 NON-DISCHARGE AP U(CATI N REPORT( D n1) Page _;, _-
Permit No,: O000181 7 Facility Name: Albemarle!I y Company County: Perguimans 1 Month: JUne Year: 20'.2_1
iT � Field Name: E ? Field Name: # Field Name: G Field a e:
Did I m ion cc �(_
Area(acres): 4.11 [=....,_ Area(acres): 6.74 Area(acres): 6.06 Area(acres): ._
at t Q facility Cover Crop: Fescue Cover Crop: Fescue Cover Crop: Fescue I Cover Cro Feuv a
_ i�= �;
Hourly Rate(in): 0.15 Hourly Rate(in): 0.15 mm Hourly Rate(in): 0.15 Hourly ly Rate(in): 9.15
Annual Rate(in): 12.66 Annual Rate(in): 12136 Annual Rate(in): 12.66 Annual Rate(in): 18
W 0 1 t o Field Freeboard Field Irrigated? eld Irrigated? mt Y-' c Field Irrigated? ( YES 0Field Irrigated? a
_�. _ A
0,
a3s to a# O 0) z -. --. ,
d IL
in .2 § 'c. E `sus i�s{ E 1I t
;c .5 EIt5 zzt Ea ±a l` z . a . `� . -2 ; = 37
t
1
ir►in in n c i rtt n i[ Erb
4F in ft gal min in in L gal ;ran in in
is C ' 94 1.1 I
2 C 95 3 C 87 [
I --t- f
--
4 C 83 1 I I
Cn i 84 3 24 t
.k._ ,
isi86r E___
in 87 [ 4
Elsa
C 82 1_ , I _
C 1 85
112_ C 87 MI 3-35
14_ C1 91 4 �� — t
15_ C 85 -
El CL 82 0-2 j
- ----- - -1 >t
17 C 96
I
[18 C t 88 t__ —I— 1 I s
___1_ ]
19 C 79 - I 1 --I— 1
20= C 83 I
! i �_
al C 83 4 I
i #
m C 883 9 — I
C 81 a a �
® C 86 '
6 C 88 3.62
EB
C 86 r! -I - � --
r �� .�
Ei _Cl 83
Iiii C I 90 __e i rt
Monthly Loading: 0 0.00 = 0 0.00 3 9,0u ice`

FORM NDAR=1 35-18 NON-DiSCHARGE APPUCATION REPORT(NDAR-1) Pa,..,..---:_
Permit No,: WQ0001317 Facility Name: Albemarle Utmy Company I County: PerqUi=i Month: iiine 1 Year 2022
- — — , — —
Field Name: 7 1 Field Naine:1 8 Field Name: 9 I Field Name: 10
Did irrigation occur ,.__.
Area(acres): 3,47 Area acres):l 2 1 Area(acres): 8.12 Area(acres): 8 56
at this facility? Cover Crop: Fescue oroj Fescue Cover Crop: Fescue Cover Crop: Fescue
Hourly Rate(in): 0.15 Hourly Rate(in): 0 15 Hourly Rate(in): 0.15 Hourly Rate On): r_l 15
Annual Rate(in): 18 ' Annual Rate(in). 18 Annual Rate(in): 18 Annual Rate(in): 18
Weathe: i Freeboard Field Irrigated? 0 YES Ct NO . Field Irrigated? 0 YE s 2 NO Field Irrigated?, 0 YES El NO Field Irrigates? Eli )'ES iT, isic,
-I 1 1 ' .
I
o .2., , 1 izz- I
7, ,.; g a-F4 ocl ,b2 , ,$) § F v7, w •Fi; , F ; C - F E° 2 4, 1 ' >,v) gz vg .
a = E .r. = -.a e .. ..75. 1 5 ---a E C*;23 ':7- '5 i E '--- -13 5 lit,' E 4° vs Ali '6 n =6 E ro 7,-; ii ,E t '1Ei
cl ',i; P i •-c2. 8 iPa Za rz .-P 8 a ...fi 1 r4 -6 o.. I i:-- -;2 g 'rui 17', ,22, Za i--- 4? a 1g )41 8 :a - IL- -?_--' ca ,T,z• g -:‘- ;:',.
CD i-.- 0. ,.7.•
'-----4— ! ,
ri min in in gal_+ min 1_ in_ in gal min in in 01min 1 in in
1 C 94 l 1.1
in c II _ 95 _.1 87 I ,_ ____i____
83 1
111 I C 84 I 3 24 ----t•-• —--ti------ —--
aC 1 86 i 1 T
-A-
CL 87 all i
9 PC 92 I —I i — IIM
MIES 82
000 223 IIII
IIIEII
T1
i
,,
--1.,-
--
iw _ 4 = i ---
_ _
ED C 79 I EMI= -r.___
20C 83 ' .
im C 83 ,
C 81 0 1 III
I ------ -
C 81
E3 C 88 ENE —
L---1' i-- F ----4------ -----i_i
1 C 89 I
-(-51_ 6-1 _4_ i —1- -
mime 90 1 -r-i
FrIonthly Loading: 0 - 0 00 - :- f.), 000 -- 004 o 0.00 . :- o _ :.c4,2-1 ,
12 Month i7leating Total(in): ._.- .,..- .• ,,,,:,:_ •:- i.:-,-,_-.:011-2ifit--,7 _ Fk'ritli--.::;-.z.,--:-.-1 _ -_

FORM NDAR-' G5-16' NON-DISCHARGE APPLICATION REPORT(NDAR1) Pcge _I__
Permit Na: VVQ000181 7 Facility Name: Albemarle titli;y Company County: Perquimans Month: June Year. 2022
Field Name:M Field Na' .e i 12 Field Name: 13 [ Field Name:' 14
Did irrigation occur I'
Area(acres): 7.78 Area(acres): ?74 Area(acres): 7.56 Area(acres): 8 82
at this facility? Cover Crop: Fescue Cover Crop: Fescue Cover Crop: Fescue Lover Crop: Fescue
7 YE
Hourly Rate(in): 0.15 Hourly Rate(in): 0.15 Hourly Rate(in): 0.35 Hourly Rate(in): 0.35
Annual Rate(in): 18 Annual Rate(in).j 18 Annual Rate(in): 60 ArLima,Rate(in): 60
' --: A :7 No
Weather 1 Freeboard Field Irrigated? CI YES C:1 NO Field irrigated? 1___ YES 2 NC Field Inigated? 1-3 YES a No Field irrigatcd? L ,AA-,
,
i
o c 15 72)
p 01 E 0)
7; ,i- ; ' a i ' l's . 2. § >, r °' -8 -..., , 2 5 '''' 2 gig —,1 ›..c ,= -...,.. E ,c' ri) 2 ,--,,s-
t 0 21 I 2 2 E 8 E iii = Ce$ E N.Iri 5, t E % Ta '5 E 5 E = 7-1, E e -. o .,E 8 13 2 a .g_
17". r. 8 2 , r., :2')
f=, ,,,J -I > d t: -
— I------- ,
'F i in ft ft gal min in in gal min in in gal , min in in gal min in in
1 C1 94 1 1 L
* 233,9'60 504 CI 98 0 42
2 C --t--95 i
3 C -1- 87 I I 2i
4 C 831
7 C ,
,
5 ' C 84 3 24
6 C Es 4
86 , L ----__
i CL 87 I
PC 92 i
123,800 282 0.60 0.13
______, -----
, 4 4
10 C 82 219100 A80 I 0 L'i u I
[---- -I- -
11 C 85 -4
1 f_i
12 C i 87 0 3 3 06 i
13 C 94 0 2 i
14 CL 91 —1 222,200 456 1.08 0.14
15 C 85 214,..-TO 462 0 E;f_.3 0 d
16 CL 82
-1---
17 C 96
I —4- 1- -
11: c8 c-i 87: ---' 3 46 8 ,
__ '
''---- -T ( i--
1
— ------t-
20 C 83 r
I
21 C 83 LI I-- 94,700 210 0,46 0.13 I--
22 C 88 C 3 _T ____;__
120,600 270 0.59 0.13 92 400 204 3 39 0 11
i---- i
23 C 81 0 1 1 96,800 210 0.47 0.13
24 C 81 i
25 C 86
1-
2 62
1 —
27 C 89 I
29 f 83
30 C 90 i i
—1--- — I 1
7 -,----*----4- Monthly Loading: 0 0.00 - 0 :5"Wil- 0 00 ii-Virli- 658,100 _-- - ME= - _ -, 1"QC. -,, ,.,I;. .-,R.,:,'-',";,. ' -vitri,:tfor4v-
-
.1-- 12 Month Floating Total(in)::,,..._,..,:o1;_-_,:, _ ,_ . -i,--,.rA4c"4,1'''',';-...,",.4;---..-."*. rt:3";Xt3.-;‘1. - --", - , 45 17 :, ,"'

FOR : mi.-,AR-1 cab-le NON-D1SCHARGE APPLICATIONREPORT(NDAR-1` Page_ _
Pei t' it No.. WO0001817 Facility Name: Albemarle Ut:l:t, Company - County: Perguimans - Month: June a 2022
Field Name: 15 Field Name: Field Name: Field Name:
Did irrigation occur
Area(acres): 6,53 Area(acres): Area(acres): Area(acres):
at this facility? Cover Crop: Fescue Cover Crop: Cover Crop: Cover Crop:
,; Hourly Rate(in): 0.35 Hourly Rate(in):I Hourly Rate(in): Hourly Rate(in):
n
Annual Rate(in): 60 Annual Rate(sn}: Annual Rate(in): Annual Rate(i.i):
Weather Freeboard Field Irrigated?, )YES a DM nolo irrigated?' i; £_v E No Field Irrigated? 0 YES CI 40 Field Irrigated, Li YES a NO
_ is xs t ' CV is 0, i E >, in 4b 30 �¢s 0 g ›, CO --17; C" I�� g , p
E a. i 'gip ei Q, ct 2 l 't t ti .2 3 1 5 ' '� E C� I F 2 #t: t- `e 0 0 o ° '- cl iq x g
c 2 to a > < * -I 1 > < 6 I _, is. > a . . > < �_ r
aF , in ft ?t gal , min - in in Lgai -- in in gal min in in gal min in 1 iii
1 C 94 1,1
2 C 95 230,200
i1-1
- 64 1.30 0.14
_ ,
I #
4 . ; F 83 I
5 , C 84 . 3.2
6 = C 82
3 Ct I 87 j ' I
I
��z
9C ` 92 . s- p o� h_
-t— '
12 C 87 0.3 `. !_ I r
13 C 94 _ 0.2 183,600 456 1.04 0,14 I I
15 C 85 T -- # t 4---
3
16 Ct_ i 82 0 2 63,600 156 0.36 0.14 � I
17 C 96 i 147,600 366 0,83 0.14
18 C 88
19 C 83 3.46 i 1 I
t--I
'—1:4--
r—
21 83 —
22 C I 88 0.3 I I
f— _l__. _______1_
25 C 86 'm
26- C 88 3.2 l —I ---t 1
127
27 C 89
�_ I
28 C 86 )
o Loading:oadin 625,000 3.53 0 W, is 0O 0 0.00 0 " OF
- }.:_ 12 Mo'i'Eti Floating Total(r' - ,s '--_ J' __" "§' _.*':e_ -'-. ,_ - �.._______

FORM:N[JA _ 1 u a D1 C PPU O.s REPORT T _ R age of
Did the appiication rates exceed the limits in Attachment your permit? LI Con,.,.a,a ili NothColliplillt
Were adequate effluent measures taken toprevent� �_uent n rir in C runoff from the sites? rz, compriart rii Istrithairrioliant
Was suitable vegetative cover maintained on all sites as specified in your permit? ,,,,p :,;i Li Non-Compliant
Were ail setbacks listed in our permit ai t ned for every application to each permittedsite? .
Were all freeboards maintained in accordance with the specifiedfreeboard he tyour
in permit?
_l CQmp,3uii u .v..Corilpiian+.
If the facility is non-compliant:please explain le 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 co .eative
action(s)taken.Attach additional sheets if reecersc=ry.
gg
E
1
1
,., -- - _________ - ,,„ - - ____ A
_ _ ______ __ _ _ _ _ __. ____
Operator in Responsible Charge( C)Certification n taermitsee Certification
s7
r'' c`t'Danny t3€€ '`,Perry
,--_.� _. �� .€' 2 Pe: _ te -._ _� �... .,,� ..:�. _ ., _.
James Sinnott
II
Certification No,: 1005111 lj Signing official: Shayr12 Lamb
Grade: Si Phone Number ' 252 26-1007 Sioning Official's Title: Corp. Secretary
ORC < 'O ` D _ t 252 j 2 t 1 28 €' - 11 f2
Has thechanged e£F since€ f r Y§vet € -`€? Ye r _ Phone Number: s 3 J®i G' Permit f 5..1
ii
f
i-- _I „<„,, e_i_i_tr, 7- 3---„„) , r
Signature Date Signature Date
i3.,this signature,I certify that this report is occur;ate-arid>.e.:.,n;ete to the best of my kriciwlec ge. 1 i certify,under penalty -law,that t.pis n e n ieni and all attachments were orepaieg under gily directing or supervisioiiin accordance
with a system designed to aSaire t'7at-all qualified personnel oropeity gathered ed -id evaluated the information J Si Based my
'ir qu-r the person or persons who manage the system,orthose persons directly responsible r gathering the..or,ration,the
information submitted s-to the best of my knowledge and belief true,accurate,and complete :aio aware that there are significant
penalties for submitting false information,including the possibility of fines arid imprisonment for knowing violations
Mail Original and Two Copies t _
Division of Water Resources
lnformation ProcessingUnit
617 Mall Service Center
Raleigh, North la€=olii€x. 2 63 siS1