WQ0004967_Monitoring - 10-2019_20191205

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?
Were all freeboards maintained in accordance With the specified freeboard heights in your permit?
Page
Compliant ❑ Non -Compliant
21.Compliant
Po2empliant
'Compliant
Compliant
❑ Non -Compliant
❑ Non -Compliant
❑ Non -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: Danielle Hunter
Permittee:
AIIJuice Realty, LLC
Certification No.: 1007992
Signing Official: Robert Barr
Grade: Si Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since Ehe'previous.NDAR-1?
❑ Yes ElNo
Phone Number: (828)-251-1900 Permit Exp.: 3/31/22
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 property 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page
Sampling Person(s)
Certified Laboratories
Name: Richard Swilling Name: Pace Analytical
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ompliant ❑ 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 kesponsible Charge (ORC) Certification Permittee Certification
ORC: Danielle Hunter Permittee: AlUdice VWWTF
Certification No.: 1007992 Signing Official: Robert Barr
Grade: SI Phone Number: [phone] Signing Official's Title: Signatory
Has the ORC changed since the previous NDMR? ❑ Yes ❑ No Phone Number: (R9R) 9R1 _1 Qnn cpr..,t+ 9=vni�iron-
V \I— it
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617