WQ0033325_Monitoring - 07-2022_20220805

FORM: NDMR 03-12 HON-DISCHARGE MONITORING REPORT (NDjVIR) Page of
SAL i Sampling Person(s) Certified Laboratories
i /,
Name:�Q ?. �� Name:
�I Name: ��- ✓, _ �(�"����=d � �-�`
�a '410 JV �: $3� G Name:
Does, `c'? J rrb9il11' mt'Ong chits and9 sa01 pHng frequencies rr�leet the requirements in Attachment A 02 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
ORC: U k j e
Certification No.: T6170 zell
Grade: -roSu �o �t �a ova PhoneNumber: �.
Has the ORC changed since the previous NDMR? Yes rn�co
Signature I V Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
RCCE V E D
PermitWA6C*VWa_*iP?:k ; ,
- - 3 Unk
Permittee: �� ��✓� a '17e,&r AN
n
Signing Official:�/��
Signing Official's Title: Vhlo6c( 04
Phone Number: Permit Expiration:
"Date
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
ny 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 offines 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 of
R
• ?WE
FWA
FWA

FORM: NDAR-1 08-11 OM-DiSCHARGE APPUCAlei N REPORT (NDAR-`) Page of
Did the application rates e,,Kceed the Hmits In Attachment B of your permit?
ere, nneasures taken to prevent affluent pond`ong on or runoff from the sites?
Was a suitable vegetaUve cover maintained an all sites as specified In your permit?
Were all setb2chs listed In your permit maintained for every application to each permitted site?
,,�//Compliant ❑ Non -Compliant
,L��7JCompliant El Non -Compliant
LI Compliant ❑ Non -Compliant
Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 5?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
Certification No C' „ '- P
Grade j i� .. Phone Number: Z —
Has the ORC changed since the previous NDARA? ❑ Yes No
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permee CerHffication
Perrnittee: d J16k, _11 cb
Signing Official: U4 � - ' '
Signing Official's Title: /4���
Phone Number: em246z—b1?11 PermitExp.:
re
Date
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.
MaH Original and Two Collies to:
Division.of Water Quality
informrnatlon Processing Unit
1617 Vail Service Center
Raleigh, North Carolina 27699-16117

FORM: NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-i ) Page I*-.. of I ]k
_Facility
iCounty:
-FieldName:
irrigation occur
at this facility?
&KYES ■ NO
Annual Rate (in)j
Hourly Rate (in):
ILIm
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