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Home My WebLink AboutWQ0030245_Monitoring 2019-11_20191230r iMi � i- r +• -.—,�'. ._ '" ... - ° �J •t-_ is ° '�:•:1�• .-_ -. iiiil• -EM tP�C�.'.'0�' _ .�Ix-Y•"' r ., • El LI �C= -_I _I t _- � "HIV_-- � �- -�� __.�._ -- `_�C:. _�1- _ -�C_= . . ��. •:�C- - - � I IL 'FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of Sampling Person(s) Certified Laboratories Name: Name: Pace Analytical Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 21compliant ❑Non -Compliant 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 corrective action(s) taken. Attach additional sheets if necessary. Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: Dale Wike Permittee: Town of Rosman Certification No.: 1000267 Signing official: Brian E. Shelton Grade: SI Phone Number: 828-586-5588 Signing Official's Title: Mayor HaZtheC d since the 5�previous DMR? ❑Yes RjNo Phone Number: 828-884-6859 Permit Expiration: 3 s - 12 3d Signature Date Signature Date By this signature, I certify that this report is accurrate and complete to the best of my knowledge. I certify, under penally of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. Mail Original and Two Copies to: Division of Water Quality Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 L—r ' t�lw'.b :J IF :'I also __-- • r yyIj I 1 11 PPPPFPORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Did the application rates exceed the limits in Attachment B of your permit? Page of (]Compliant ❑Non -Compliant Vftre adequate measures taken to pievent effluent punding in or runuff froln the Sites? ✓ Compliant Non-Compiiant Was a suitable vegetative cover maintained on all sites as specified in your permit? OCompliant ❑Non -Compliant Were all setbacks listed in your permit maintained for every application to each permitted site? OCompliant ❑Non -Compliant Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ❑✓ Compliant ❑Non -Compliant 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 corrective action(s) taken. Attach additional sheets if necessary. Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: Dale Wike Permittee: Town of Rosman Certification No.: 1000267 Signing Official: Brian E. Shelton Grade: SI Phone Number: 828-586-5588 Signing Official's Title: Mayor Has the O changed since the previous NDA -1? ❑yes ❑✓ No Phone Number: 828-884-6859 Permit Exp.: Signature Date Signature Date By this signature, I certify that this report is accurrate 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 in accordance with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations. Mail Original and Two Copies to: Division of Water Quality Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617