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HomeMy WebLinkAboutWQ0005790_Monitoring - 10-2022_20221129Monitoring Report Submittal Permit Number #* Name of Facility:* Month: * October Report Information WQ0005790 Fish Factory Road Type * NDMR, NDAR-1, NDAR-2, NDMLR Confirmation Email Address:* Name of Submitter: * Signature: Date of submittal: Initial Review Year:* 2022 Upload Document* NDMRS OCTOBER 2022.pdf 6.51VIB PDF Only Please upload one PDF containing all applicable monitoring reports (i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59). fishfactoryrd@oakislandnc.gov Kenny Reviewer: Gerald, Wanda 11 /29/2022 This will be filled in automatically Is the project number correct?* WQ0005790 Is the monitoring report accepted?* Yes No Regional Office* Wilmington Reviewer: _anonymous Review Date: 12/12/2022 vRM - o :v- NON -DISCHARGE CATf! N ;EEO `� AR-2 �� 3=.00 '05790 z - F ....-_.� i - _ "\ 3 _ Month: i � \ ." Li712 _e_rnric lr o � [ Site Na 0, �' ` t g a ac €I - es Mc _ t : u' a _' TTA t ' — — - Rate R Im-ebo _ are t _-.filtrated? _ a- Q 0\, \� '' C Z LA T` .f gal rn- n G,`°D— itg Fx al I E i t --. ... tlirr � <�-t gal in GDI' _- R - r C . 57 000 I I a ar zC i Ca .. = E vJ 1 a g — - n — ,>, - 39 F. , ik—PCI n i _ t u a n =�. P _ ,� t 0 l rn \ _� L b _ v r _ i 1 f C, -_- -- - 681 ;,= a ,.4 1 I _ C3 C 000 A E V 1) A— E 4 rt, r: -. v 62 r 010ji- - \ J=_ r_ \i\off �.JiJ�immmmmmmgl TfCilllttl' t — ��vv 4Dttrt�#. DIVIQ. NDP-R-2 0r -6 NON-DiSCHARGE APPUCATIONEEPO£ N. -21 Did the application rates exceed the limits in Attachment B of your permit? If not a basin, were the sites kept fir of vegetation and r k-e If not a basin, were there any instances of effluent ponding in or runoff from the sites? If a bas;n, were there and. instances breakout from the barbs? Was the o site automatically activated standby power source tested and operational? if t'I , _ S .,�,� ;;� .' 't e v exp e. s^ „e belowvaUcr s, he `3 .ty was of 3.,, , coc c__ Provide in ; �.1, empla, anon , vt,. ,. . _ , ac, on(S. aken Attach adc t onal sheets IT necessary Operate,- in Responsible Charge (ORC) Certification ;RC- Keenny Von Voigt Certificalion o.: 100636n Grade: 2 Phone Number: 91035214315 Has the O C changed slice the previous NO R-�7 t c Permittee: T Signing Official: L Signing Official's Titl Phone Number: 0 Permit Exp,: 7131/27 //z,/= r Signature Date Sla ; rE Gate i �=- r �w aro a;. n , ..�;st 011 K.o..iedee .� _ .tE , , t .,.:r r ll „ la-V 110 m.5 as aItt attachments were prepared under my d€rechon or supervision €n accordance t� K SWCM '_ 3 Arlod personnel properly gathered and evaluated The information subm ttecd Based on my C€ t., ,. _ . ,< �. E,e s{lum or those persons directly responsible for gathenng rho information, the .. , . „ €i+Y kno;vtedge and belief, true accurate, and complete. 1 am mare that There at- significanl nf9trafron, inelud art the pos mility of fines and imprisonment For Knowing vloiatinns. Mail Original and Two Copies to: Division of Water Resources information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Sarin pie Frequency: 1 , See e, ma i 3 X Yes 1 5 3 X Year I See ParMitj C©nunuOusl e_. xi= 3. le'VOCCO5790Cif I5 VICk Month: 1 Year: 2€9L R i,t w Mea5 :frog- € Prot- ? - � • _ - € � m r *; [ ,_a,x f >.<•, crirtg Point. ? ' Inf:: nt F C`=il ��, m _ tt € _. am- monsigaw", u c LL FOOM 0 w, v i s c e ttF RIM Ra SWE €� 33 114 _0 p v x 4 0 t2v _ e 233 0 s— d _i u n 28 s =fie s 0 Average 0 -- Daily Maximum-r) FORM ND _ NON -DISCHARGE MONT ORING REPORT IND a R) Name; Kienny Von €•�t aAie: Natr. Does. all monitioring data and sampling sr t $encies meet t€ e requir T ns -in Att ch ent A e i. _,. €, J -_cm . _ .plea_e exp-lain n irle SDa_e be --w , .e reasa t , -e , ==3'3. n --._-- - n._z_. a: in your expla ada t',a r ul cpt 3 necessary C - d `-t ; aFvr agu on oul amrncinia nitnagen lrnt_ .,e ,ave been Page - `• e(s) of the nor; _� anice and describe the ..endive a .[_ on for similar oueraaes in previous months. Orierato. is Responsible Charge tORC)i Ge tiricat o n Permittee Certification ORC- `eni •etn V gt Per ittee: Town of Oak Island Certi iciat n Nci, `s 9 Lisa Mites Signing Official Phone Number: 9 - 0 2 4� Signing Official's Title: Town Clerk I I Has the O C cha-nged since the previous r DMR? _ Y., N E Phone amber: (910) 20I-8C1Q4 Permit Expiration-. 7131I20f -� rt _ ] i , Signature Date I cerfihi. under penalty of lav;, drat tills document an all anachmenis were prepared under nay d ra_„on of sup ­son n a<cDoanc -kith a syslem designed to assure that all qualified personnel propeily gathered and evaluated ins a io.mation bmitteu Based on my inquiry of the. person or parson';; °rng manage the sylle n, or those Person, directly m_p«, ble for vathenng the t formalivn the ;nfurmalinn subrnidteo €t to ttie ties[ of my Knowledge and belief, True, accurate and corup1mc t am maam that there are s3,ndtcard pPnaitfus for submitting false m€onnation_ intruding the posstbtify of ryes and i pnsinl ent tar knowing violations Pail Original and Two Copies to: Division of Water Resources Information Processing Unlit 1617 Mail Service Center Raleigh, North Carolina 27699-1617 �,R-! C-5-`6 NON -DISC HARG E APM ICATION RE-POR-1 [NDAR-1) VV005-CK Fac: Narnc: 'd -ounty: Bru Month: Year: 210 2 2 Field Name: �el Na�­ Emir! LA Did i.rrigatloln. occur 22 Area 'acresl: 1 2 Area (acres): - athiMcl.,V? iI!s _ ------ Cove- cove� Croc- Cover Crop: 0A Houfl Rate fhn: 11 Houri, R,,tz fin). A 04 !i Hourly Rate (in): Annuad Rate U nrr,a� Rate R,111 Annual Rate (in); 5 5 2 _f Weather 5rei��d i 1,01 h 'NO va Y. Y -i o Field Irrigated? YES NO S E _U a) 75 r '3E z -o E fG if tj 'R 0 M 'o CL E M I- M 0 0 M C C_ 0 0 0 > < M mirl In in gal min In in ft a ft gal min in in gal 1 3 9 1 0 0 0 00 0�00 3T845 �28 070 033 0 0 000 0.00 C 56 0 i 0 0 0 C, 0, 0 0,00 0,00 0 01 0,00 0,00 0 6 000 0.00 55 3 9 1 0 C) U�Uu a- or-) j 0,00 0.00 0 0 0-00 0�00 0 0 000 0013 4 1 C 57 0 0 0 00 0 180 0.53 0.18 25 06 0 86 0A6 0.32 0 I 0 000 000 C 0 -3 9 4 0 0 1 O.57 0,19 6_0 944 210 1 12 032 0 0 0 Oc 0.0c o, 3 9 _J C) 0 mw C3 c, 34 120 180 0.56 019 11 11.166 210 1.13 032 a 0 000 croo C - 0 0 OC 0' 0 0 - 32-351 181 0-57 a 19- 6a.883 210 11.12 0-32 0 0 000 000 8 C 3 Si 1 4 0 0, 32 124 180 056 G 19, 60�574 �209 1 1 1 12 032 0 0 o 00 u 00 60 1 0 90 0 CO 1 0 0 1 180 0-56 0 61,010 210 112 0,32 0 0 000 000 -10 C L -8 0f _0 0 4n, _32,090. 32,412 180 0,57 v< 60,953 210 1 12 0,32 0 0 0 0o 0,00 44,956 154 0-83 03, 0 0 07TC) .0,0o 4 0 0 0 �00 12242 180 C 19 8,833 30 0,16 0,16 C. 0 0.00 C, 00 LL,2 PC 7 0 3,c 0 1 rj C, 00 2:098 180 S' 5 6 1 0,19 39 4 1? I n C, U G I OAjo 32.120 180 9 5 �60 1 �9 8;646 30 016 0,16 0 0 Q.aO 0.00 19 4 0 C o 0 3 1 C co 311811 0 -6 0,19 8,611 30 0.16 0,16 06 0 c o C,00 8.733 30 0.16 1 0,16 0 1 C) 0,00 000 r D C� �_ 0�00 32- 2_51 ib_ i 0,19 81894 30 1 0,16 0-16 0 0 o.co 000 r, i 000 1 18 0557 019 0 t--O _-,2,229 8,716 30 O� 16 016 0 0 coo 0 C, 0.19 0 0 Ci OC, 0 0 0 j Q D C GO 056 0.19 8,733 30 0.16 016 0 0 0,00 c., 0 37 C F3, 8 i 4 f n 0 Go C 0 C, 1 BID 0,56 7— 30 0,16 016 0 0 000 o ofj 1 8,733 30 016 016 0 0 0.00 001) c0 0 C., N O 160 0,57 0.19 8785 30 aiii 015 0 0 000 0.0.0 t, 4az 4 G 0 C, 0 180 0,56 0-19 1 0 3 180 O�57 0A9 8M3 30 016 016 0 0 000 0 DO 2-2 C, 4;� 4 0 a00 C 6 2 0 38 0 no cz 18o 057 019 &820 30 0,16 0.16 0 0 0.00 0,00 n rj 0 Dn' 0,57 019 8,772 30 0,16 OA6 0 0 0.00 000 8,716 30 0.16 0.16 0 0 0,00 000 n C, 00 -_-5 32,050 �J, 8 �00 5 6 0,19 0� 0 DO 31968 180 1 0,56 019 8,711 30 016 016 0 0 om 0-00 8, 772 30 1 0.16 0,16 0 0 000 0Y00 - 7j 0 00 1 38057, 019 7 0 1 000 226 180 4 0 000 32;404 180 — 0,57 019 8,938 30 1 O� 16 0.16 0 0 000 C). 00 P_ 0 3 2.526 180 0,57 0.19 8.676 30 0,16 0 0 0.00 0.00 8,759 30 016 0.16 0 0 000 0.00 ------ ------- C 1 C 9 n C 000 32,116 180 0-56 C 19 0 JJ 000 32,491 1 180 0,57 019 8.646 30 0.16 c i6 0 0 000 000 0.00 oading J F z 000 899,938 1 EIN 15J8 Room 648,489 11 �94 E ­z Rva_flnP -m MEMNON I-iM�N— 56.22 llwiz 6:19-91-11 , 7T64 0,00 NON -DISCHARGE . LIC AMN REPORT , . gym• Area� n� 1. Cove- GTOD" Cove, L 3 Cover Crop . � 4ourt Rate: in = . n, want= .re ,t Pale Month: October 2022 r (in) 02 Rate (in)1 127 r=c Id lrrigated7i VA y � f >_ � L 3 _ � X HS \ ��� in =5 ft gal Min f in 3n gal -r,i jn to � 4� ": �`�if6�n rr3 ! to gal rn in in in a v' G y.16 = ? '-5 p,1 p 18 48 r,88' , ' 0 1 I C1.17 �,51 t 31 0.1 - I 0 13 y 3,9 4 G E G 0 "G "?'a i€ 0 0 0,00 p 00 p' 0 no GG 000 G C p.Gu 0,00, 0,00 1 0 i 0 0-00 000 00 0,00 0 0 0 JC I 0 C-110 C Y.C' i C.' a G O.pO 0.00 0 O.00, 0, DO 0 --_. 0 0.00 O.rC t C i 47r _ C C oo 0, `` F 45 0.19 019 7E966 C.1 i 0 17 . ,?4 0.13 0 1= 61 ['5, n 9 4 i 0 0 GO f.00 j y y 47 0.19 019 7 B^8 46 0.17 0.17 5.403 3': On r,=� eFK-7 Au y Co 2� ( 47 p 18 0 18 1c 46 017 0 17 5498 31 ti 1 u 3 al R `, C 4G no -V 0,00 6.2714 47 018 fl 18 7 SID4 466 0.1 r 0,17 5 4-34 31 0 13 C 13 z i G _2vy 7 C 36 17 C i ?C ?i G 18 C 1U4 G 8 39 j l-9,0C-0 = 240 0 C' i� 6.Cf78 ; 47 0-18 C 8J 46 017 017 5,263 31 0,13 0-13 PC x< - 48 0 240 C 0 18 1?_ 4 94 p 36C 2 3 9,758 58 t721 - 0,21 ! 5.1�J � 31_ 0.12 0 12 0.17 p 17` :R C9 85 p.33 � PC a tr 2 8 = c d'r 0 'r 722 j 46 t u € rV v , u r ; �6.vC ? 7,830 gg 45 E p.17 ( 017 5.24b 31 0-12 0 12 41 - f 72 t i I 0--Do i 5 : 8 j 47 C ' 8 --C 7,464 46 _ G. 6 ( 16 5,21.4 31 C.13 0 13 .e.. C 52 a - € .� 4 i ;0 '0 v. •=' C�.O _=1 t . .x: s x 18 7.813 fib p 16 �._ G i6 5,20;i at 0.13 [ C.13 _� � 0-C; v - 6�r �� i �_ - C 19 7,661 46 0.17 ) 17 -.424 31 C= 13 0.13 7.713 46 0.17 0-17 511 31 Q.13 0,13 a ,: u u 4 # <00 24u 0 - 19 0 19 _u A C E2 0 1 ; 9 4 f 45,6b0 2AC 0 71 [ 018 3 -, j 19 019 7.778 45 1 0 17 C.9 r'' ij 5.590 31 013 0 i 3 _u 7 1 t 4S :C: 24C : t 1 0 19 0,19 7 879 46 017 0-17 6 5 5C7 31 013 C 13 7,852 45 OA 7 017 _ 5 953 31 G.13 013 20 ,y u 3 0 [ _ . J= 0.19 0,19 2 € "' € 4 ri 0 0 r f ; _ G.39 i7 1 ° 7, v48 46 0.17 0.17 5Cr2 31 0 13 G i i 7,852 45 017 OA7 5,563 31 0.13 0.13 0 1.0G 0,00 47 0 19 G 19 7 $d4 46 p 17 4.17 5 da9 ( 3 0.13 0.13 C, r =i. v 0,19 C 19 t 1 C 6 r x 4 � --- -ry '' 3 - ---_ 4 -__ u r „ - ! 0_ ;rt G' a '4 _ 47 0.19 0 19 7,883 46 0.17 0-1' I 5.572 31 p.t3 p.13 p 1 7 0A i 5,-59 31 � 013 0.13 vu v 0 0 '0 ] r.4a4 _ 47 p.19 p.19 a7,826 46 0.17 p.17 5,511 30 013 0,13 0: r F-0 G Ge I 6,392 47 019 C 19 7,813 46 27 ,.3 v t t x u •0 € 6,d79 47 0 19 p.19 7,$96 46 p.17 0 17 5.585 31 1.13 p.13 p.17 0.17 5, 7 b4 31 p.14 L. 14 = O CO 5,505 47 0.19 0 19 7,926 46 58 - b ss t_ v v P vz u C GOG 5,5ai _ 4 G-1J 019 7,8n1 46 0,17 p_17 5,642 31 0-13 013 1 1 1 _ c, 0 0 E 0.00 6,544 48 0.19 0 19 8,G75 46 0.1i 017 5,598 31 0.13 0.13 C _- 1 _ v-Ou p.pp 6,405 47 0.19 019 8.014 46 0,17 p,17 5,502 31 0.13 0.13 1-,1. u_ n , y , u 183 9Cip _ ' 5,42 av- 220,529 4 78 162,218 _ 3.85 41 52 23.75 ,..-- 7 ;t � L� \.. a1 ti 48.09 _ 43 91 �. �c - iR A <y Page yr ...c No.; 00005 90 Fac; t 'a€=,v. r P-- wOctober s > 122 ° t Field Field Naar r-�t Did Eroccur <�r� Area , 2 4' , Area ,acres): t2 ,his l y �tCover.- � Cover Crop: G�V r cc:� cr P l ._. _r,t .e i�sj --._. .? i..,, ?'� P,F t t t _.._ Ho-u Ep Raf .€E,F; = 0 (in)x. { Ui GJ i J sae« E mtn aE e . ,�3 12 Annual Rate (tr} _ Wet c a F3 � r _ _ �€ d �_=i at d e gated?I i Es E, rdo Fred Irrigated? FNO v e 337 �r 3 1-\p\ \ a a RE � i q g � i j .c � gal _ r�€ER €n j 4n � gal � €� p I31 x(� �y p� €� 9�\��� �`�\.�.\�[� �' - €E3 E {r� �r� ';64 C,24[. rv0"00 00 00 0 OM Gv0 r a ✓ 'v 0 00 0 00 t 0.00 0ro _ z t r t 00 0.00 \ \\ 0 0 00 ! 0 0.00 O-00 - 8,078 0 0 11 0 0 000 OM 0 0,00 0.00 E 20 € 0 t S O, { i G 0i coo 0=00 0 £)0 0.00 0 O j 0' O,DO 043 30 0 1 011 l 0 0,00 00 \ \ \\ O 00 0.00 4726 25 O. i 0,1 E a, 4x �_`=i i U `'- i 1 0.11 t.' 0_00 4e.0�\\\� .� ..'�3 ['J E 0.00u 0.._0 oo 0.00 g � £ I=1 a t ., _ a _ ._ § -; xh 0. j . `�^-�s' �;y r --v 0. , 9 -. .'i d: �1 0 O n1t0i O.V4t Ot i3,tL} V. V \ � \ �. \\� � 01 0 i!it :f;,=�1 V-Vo OO.t€1i -.. OM 0 k J.iUtO� _ €i_ --- 00 fq� S� V Ev 13U 000 9 i= r 0' 0 a p {.'o 0, t G. u - 0 0.00 0 00 .. 0 0 0.00 0.00 0 0 0.00 0.00 r 4 { b 3 - s0 +-,'; , ` i 0 0 0,00 0.00 4:893 26 0,0€ 0.07 0 0 [ 0.00 0.00 e ` , _ - -� 4 1 6,020 -0 1 3- a r.0 1- t 011 LV 1 ;=. 0 0.' _ ! ;i. 3 - } C° 0 0 0 00 0.00 i}.CiO 000 0.00 O flO 0 0 { © 0 0 0,00 0,00 0,00 0.00 0 0 i 0 0 0.00 0.00 _0.00 4.00 0-00 0 0 00 0.i 0 6 0___ � 0.00 .. 9 4 ( 0,03>4 �50 O, x I 0_ 1' 0a0 0.00 0 00 V 0 0 0,00 000 0 0 000 0.00.E r E `=-2O i v0 I Y=.1 _' 0.00 -O 0� F 0 0 0,00 fl 00 0 t 0.00 0,00 ? € 70 30 0.' O_ E u 00 0 ,r : 0 0 0,00 0-00 0 0 0.00 0.00 (0€ G 8; t w0 1 F>�> C.' 0..3 3 0 0 0 9°.� 0 0 0 0 00 a00 O 0 0,00 0 00 122 r _ a _ 4 t 30 P '3 , 3 0`: 0 ;,; 0 9 i 0, E 0 ;' 0 z 0o v L C u 00 000 0 0 0 0 0-00 - 0.00 1 0 0 0.00 { O,OG 6 0.00 OM 0 0 0 co 0.00 0 0.00 0,00 0 0 On 0-00 € > U CL U 55 � _ v' _.0 c ;; C: ,78 1 3C I0 t E_, 0 w .. 000 0 O 0 00 0,00 0 0 0 000 0.00 0 O 0.00 MO 0 0.00 0.00 0 0 o_OO Ow a-€ r; , -R { nn Ewe 1 0 fi r y F 9 PC __' a u 4+ U 04 0r, _= 3:0 r-. v 32 M 0< " . 0 ( r. 0"{ �- . 0 0 0 e 0-00 000 0.00 0.00 0.00 0,00 000 0 00 0 00 0 0 0 0 0 0.00 0.00 0 0 O.oO 0.1,0 0 0.00 0,00 0 0 0.00 0 00 0 0.00 0=00 0 0 0.00 000 0 0 00 0.00 0 0 0.00 0.00 0 0.00 0,00 0 O 0 00 0.00 _ -=v a 4 E 0. 0 0 3: G, E _ UO 0.00 0 0 0 00 0,00 0 0 0.00 0.00 -._.. C t ,i t>i v t O,£2 0 r 4 0 ��� t. F Total y.wagog \\ 0- _j 0 0 `� ? 1 0 0 000 0124 ply 2 0.00 0 4_810 0 0.00 0.00 0 0- 0.00 0.00 0,07 3 4,72; _ 2 y€ Wit, ..._ , _ c ., , _ -.Year: 2022 irrigati occur Feld m ;eld - -idd at=s€_'cam --c ' Ama -- _ f'Ver r �o re' uu Cover Cr .3\ i Cm!er Crop: 1 , - >rf ate? : a It s 'P ', z c Rate !I P ours Rate (cr)- nu `I R ,7 Annual Rate A.. uA R: n € � Annual Rate fin): 1I Field Irrigated?l .E, s ezthei F eboa-, Field ir<.ga__ec , I ,'iTs Field . r3 t_ i :v brig d z r T i a < R � f 3 a[ � a I it f in � f+ f'� � _al Min � ,€< ..,= It• ;j gal j f`�' "t r .el ii ?i3Pr2 � :�\�I �� �\fF1\\. �� =_`97 i1i - j IF L v_ n z a 02 �\\:�\\. t4 W. £€ ..c b .. aJ _ .,.\�\\\\� \\ \_ a i' �. v 4 .0`- 45 i 1 2 j 01 JJs C'. -2 I ' :L \\\\ \\\\ \ ��� �� -. f a „` 902 15 024 i1.°a =. hires `' --.' S.2 �€,72\ \ • \\�\\ \\\\\\\ , y u< z i i 131 ( y0 : u7 24 L� e n uv ! 0 2 0 32 \ i n PC v >?pii j 45 '.L_ 07i '�� c.31.# f 3 0.24 . 0-24 €I 3393 0.32 U2 ;� 7�' 31 J £� 7,717 � 45 C,c-e i V.L4 - t'i P3 V n >31 tS 1 V.� E 3 j € i € T a2 2 9 4 1 7E00 1 45 i 2' v 3 4 3i 1 E x = K u-u V 4 8,040 5 1 D 25 j 0.22 45 032 0,32 I 0,25 -. 32 45 0.32 OM -_ _ « �. a I 45 €.32 P 32- R n C [ T931 45 e u 25 1 0,25 ,6 55 54 45 0.32 I 032 r r - ., _, 4- H L ::. -., 4 - 32 CL [45 i -_ -t t� r=_ 10 4 t 7, ! c v 24 2 `. �z E f_I 32 2 w:- � u v _- - _ -4 :5 I- _0'A ',' -.. a 3 ti 32 u +3 f1 ryF 7 4 8, r -r 45 r 25 1 025 - 32 ,32 ?ice 40 f z-- I 0 2-5 _ 45 0 32 �.32 NOWDISCHARGE APPLICATION REPORT , Did -he i.�t .ate it I Attachment i perm Were adequate '€€acs s r $. taken to Drevent effluent ponding in or €`unc.ff from the sties" Was a suftabie vegetative Were A-H setbacks i€med in yourpermit, rn=a?n?iCefor every application to eachpermitted s,; .1=e all freeboards €€oa€tIed in accordancew[h it pec[th£ freeboard heights in your et? zn­­­7-v'aqt oesle e--p m ti . s v_ 'velow .e ,aa=- s,1 _le fa as v=t in €,o- ance. jide in F at_ a , e?sl of operator in Eesportstble Charge !ORC) Certification j Permittee Certification C)RC: Kenneth th on ,g; "Perrmittee: [ own of teak Island 'erhff etion No,: 1008360 �; .signing official: Lisa Stites Grade. 2 Phone Number: 9103521435 Signing Official's Title: Town Cler;x Has the o C --hartged si nee the pr ie s �,DA -1? 1.3 o Phone Number: t9 0) 20+-800-4 Permit Ex /31127 . 5 the '<b�__, , t If i.=it1 r Date , .:r"" _ �;>•_. r, �: €ent 9nd all aritachmenis were prepare,; under my erred€an ut supGrNlsjod in ===ur,;a ce v€ al t as pereonne. properly gabl_red and evacuated the information subm°ttea. Based en my Ofa,r,) manage ,ne syst rn or those persons direct1v responsible for gathering [he infn minion. the besl of my Kn_vAudge and belief true a,-Urate, W1 COMplet,.. f am aware that (here are ugn f,-ant .._ . ,. , ta�,e in cr na€i`rn, rti ffiu, p9ssibil,ty of fines and impinsonmenl fo, k€,ot n; woutens, Mail Original an Two Copies to: Diai ion of Water esources Information Processing unit 1617 fail Service Gunter sleigh North Carolina 27699-1617