WQ0028666_Monitoring - 12-2022_20230131

Monitoring Report Submittal
...................................................
Permit Number#* WQ0028666
Name of Facility:* Cannonsgte @ Bogue Sound
Month: * December Year: * 2022
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR 2022 12 Cannonsgate DMR.pdf 2.18MB
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: * Erikah Martin
Signature:
cgimz# r�<Lt&*
Date of submittal: 1/31/2023
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* W00028666
Is the monitoring report accepted?* Yes NO
Regional Office* Wilmington
Reviewer: _anonymous
Review Date: 3/21/2023

FORM. Ni3AR-2 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page { 0f 2
Permit No.: WQ0028666 Facility name: Ca"ncn5 *. 5C`i:_x-v-,6 County: Carteret Month: December Year: 2022
Did infiltration occur at , site Name: z
{.,k x ��.
this
Site Name: 4
h&is lacili 7 y { a >�a€ f�
• �} - ¢y}
Area 8Cr@S Q.67 1.rtu zt
�• �..�`si ��i'tfrk'd"§ � � t z{ Area (acres): 0.36
YES []NO 'f i4 €Tg tiz4"{�rfS€k4 4cx{tar,3{w,
a
Bale (GPDIft', �i� Rate (CPDIftx}• 1.145
Weather Freeboard ,, x F � `a� ` Site Infiltrated? (�rES ❑ry0 ;, u i � � '� ��qq�3 ;€ Site Infiltrated? []res ❑NO
l}%.
sxs 2, f tYY s r {t
p T '3 �r4
r €5 x y t t y f ?z+
'� �T ' {zxk� z r'ta �s € 3t2 IN!,}3i' €€ { } �.
14 L�3. f�0 z' i xz� : n si1.' r ' Qt 'LI GJ '� Cis ,S t J s _ ' { ,
{ 3� [3 M q �3 S xk �r ci zs c
fp l6 s €ri:� O Q
O1-6 x l9 G
zEE�a x.i?t �tE 2 to W ❑ 9 'pTO!Q o 7 m fCfl
OF in ft ft
<
gal min GPDIit? ft a (fir.' Gj�i.itrL i"
gal min GPDIfta ft
1 55 3.8 ? y " rya ��€ii $ q �� #4€ {� . � 2 750
r 0,44 � 3r 12,750 0.81 111XIiii 41. -
2 61 3.$ 'iKgkrt �J t,�ir �%�: 9,250 0.32a;: �r5s.'.'.... `�i: 9250 x.
3 68 3.8 '"x'8 "y ` < 4 s z 4 2 ,j : 9,250 0,32 zA
119 25d '' €, k' €' 4 ..; #. i z.,; . ,'.. , Qr:-`: 9,250 0.59 ; r.
a 61 3.8iaz { Er pY3 fig13 r x€0" 9,250 0.32 ;;r�a�it €t{n 3e �iEaa90" 9,25q
5 61 003 3.8 iFQ ?�zr�1 s (1'1 xs€t i 2tB€ 11,000 0.38 11,000 0.110,%its
6 69 3.8 get � {sx`€ E i { 2iJ 9,750
0.33 x i�FS �x' f y4� T 3 7it 9,75Q 0,62 #3`i
7 73 3.8 1 z ,3 "i3$) 9,500 4.33 9,500 0.61 7f
8 66 3.8 �x`� p €�{t�l Qg'sas(3 10,250 0.35,Rc�a ��`t� i0.250 0.$5I'�
r { € d 8,0.2$39 56 0_09 8,583 0.55 3C� 3
10 5$ 3,8 6 s's rCk,1 ti i20 8,583 0.29 ��}Ziir s �583 ss t <f € 3z t 8.5$3 0,55 RSa39 qv
11 58 3.6 8,583 0.29 �*it FNd
.,�€'; i"3a { x"16:�iQ't' $,583 0.55
12 54 3.$�s stzrf1 8,750 0.30 ,"3a `�k` �r`u �s€' f Qa55` t 9� 8€750 0.56
13 52 3.8 "9ii {r}€i�z tCl �tt yt 9,004 Q.31�� }€Q ga, t,� {�{;
i4 52 3.8 , fi `z 3f { a11 z �6 3, f 9,000 0.�7 v
a € Y
�€ a}2v 9,750 q.33 i`{ r7�r �� 3 3 3E: 9.750 O.E2 f74s
15 6$ 0.93 3.8 „5C1 ' € s'°s ✓a3 a 4i1 9,750 0.33 9,754 0.E2
16 56 3.6 tzi' {fjP sl, Lts1 A441 10,083 0.35 P �t��
=�l�a 10,083 0.64
17 55 3.6 y0:� zc#is oaf ._,€€' st1 :: 10,083 0.35 10,083 q.64
18 53 3.8 �'{4�€�g�9s��n���A2v'`� 10,083 0.35z4 �(,��' 11r,�{`s�{lr 14,483 0.64,, f
19 47 3.6 {`ti R c 7{ '""_ €tf 'S;6J 3 tt ' a 9,50Q 0.33 e a' rt s?` �� s i ; ,,°'? _#: ,"" 3..8t3„ 9,504 0.61 °n s4.
iQ�2 F E €
20 47 3.6 "' : �� `t� `r; $1fi13a'' �� ' 0s 9,500 0.33
a. Y s'_ i {4i'€{ ;r� 9,500 0.61
21 F 52 0.02 3.6 �€t�: 't`dfs �1��€` 11,250 0.39t, 11,250 0.72:�h
22 F 65 1.92 3.6 S � E � f i €vx,$RO {z 9,250 0,32 si' a ¢ 3 F .,.° , Q..,. 9,260 0.58
23 60 0.02 3.6 Yivi ors i i er$ raft's 4?�f .: 9,687 0.33's`15 d
24 30 3.6 i axi 9.687 0.3$ss 9,687 0.62
25 41 3.6 Yr ➢ t ii n � + i},` 9,687 0,33
9,687 0.62�;
26 44 3.6 � I,'t �� € u Y = : `' IQ 9,687 0.33 i E. ��"fi t'i RMI,"Y' 9,687 Q.62
27 49 3.3 5.750 0.20OUR, k 9 Y¢ 3 zs ,tt3 '' F54 5.750 4.37 s
28 55 3.3 0�1001 _� , � � 0 �, � g 5,750 0.20 2E� k €
�.>�%$frtgr ��uft t'g'3 5,750 0.37�`Y
29 C 62 1 1 3.3aa n? %z r?iZ< z9` Q 1,500 0.05 t a, .:zi ',,$ 1,500 0.10
E
3ti C 70 3.3 f 'x % r ' ft t fi: 9,750 0.33 : i ' ° i 2 fl i r 7 ,` Fn Ii z 9,750 Q.62 h
31 68 10,221 3.3 .. r>Yt � � 3t ; is s...?t , 9,750 0,33 <R, < , , :s 0 i :.F s,.:3 9,780 0.6277
Monthly Loading (GPDf ): 0.32 59
Yoat to Date Loading GPDffir 3.86 1`', 7.14

FORM NCAR-210-13 NON -DISCHARGE APPLICATION REPORT INDAR-2) Page Z cf Z-
Did the application rates exceed the limits in Attachment 13 of your permit? econipi t [INoh-Cmipmrx
If n t a basin, were the sites kept free of vegetation and raked? [�ICornpli M DNon-C€mpltant
If n t a basin, were there any instances of effluent ponding in or runoff from the sites? t;,js.orrq*ant ❑Non -cam» piont
If a basin, were there any instances of breakout from the berms? ecomprant ONon-cdmpliam
Wa� the onsite automatically activated standby power source tested and operational? 0corr"tint ❑Ikon -compliant
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) ofthe non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (oRC) Certification
Perrnittes Certification
ORC.
Raymo-id Lacy Braxton
Permittee:
Aqua. North Carolina INC
Certl
;cation No.: 999895
Signing official: Christopher A. Collins
Grade;
IV Phone Dumber: 910 431-9248
Signing official's Title: Coastal Regional Supervisor
Has the
QRC changed since the previous NDAR-2? []Yes QNo
Phone Number: 910 779-0794 Permit Exp.: 8131/24
Jr -
Signature Date
Signature Date
By this signatute, I cert4 thar this WOtt Y8 a0wrratg arid COrhptete to the best of my knowledge.
P CertOy, urtdar of law, that this d=ment and RA a1180hment$ were ed under Idwactlon or supervision Pe� prepay o1j1 p8(YSsi4e3 in atcexdarice
With a system designed to assure that all qualified persdnn0l prWetty gathered and evaluated the ihfonnatk)n submitted Bared on
my inqulr3 of $te person or persons who manage ttre system, or tlt SO persau dlrecity respansFNe for gaft4hing'the information, the
i
information submitted is, to the best Of my knowledge and belief, true, arcurats, and complete- I am aware tttai there are sigrdflcant
penalties for stdtmiitog false infiormawn,Ong fhb possibility Of rtrtes and irnp}aq€tmarri for kttawing wioiations.
Flail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1817 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT �NDMR)
Permit No,: WQ002 666
Facility Name: Cannonsgate at Bogue Sound
County: Carteret Month; December
Ppl. 001 Flow Measuring Pl—nfirt Lfiaflaw 9erwal—j
Pa rarrie' 'W&Anwnugtrp
Founa"ter
Parameter Code
0
00310
':
31616
00625
00600
""ApW
00G65
00530
E
IV,
p
E
.9
a
"`vt
":X
, "
g
0 0
MI
N"A
M
'2
'k
0 CL
F_
0 2L
Nf
-9 z
0
24-hr
hrS iiij
mg]L
#/100 mL
3
mg/L
mqJL
MgfL
mg/L
7 07:00
p
2
2 07;00
ip
1117-
NA,
RR,
3
3
QW4
4
]L7
V low R
5
07:00
3
r a-0,
6
07:00
1
42pia
. . . . . . . . . . .
_
12;00
1
9
14-00
1
5K
10
121
OT00
2 4W
13
07700
2
14
0700
2
<2
50.9
72
<2
15
D7:00
2
16
06;30
3
17
d
19
OT30
A
4 1'
20
07:30
3
I M
",1 2-
P11% 400
21
07:30
4
22
OT30
5
23
07,00
2
24
L5
0
26
H
27
07:00
2 q
0
SVI'Ii'Vil
28
07T0
2
"1
U
'N"',
29
07:00
2
30
07�00
M"RV'12
2LE
�2_
7--
—
31
4"g
Average:
0,00
1,00
0. 00
48.35
000
0A
Daily Maximum: A"N"'.W %'o
2.0o
V
U0
0
'WNR
50.90
7.23
Daily Minimum:
Z00
1.00
o.so 1-"N
45.80
7
663
250 '%
Sampling Type. '�;R# Wdft,
f'r
Composite "Corm""
Grab
composite
Composite
Composite
composite
,'
Monthly Avg. Limit.
14
5
Daily Limit:
is
25
moon
Sample Frequency: _2
x Month
2 x M*nth
1
2x Month
2 x Month
2 x Month
Page I— of /10
Year. 2022

FORM: NOMR 1€I-13 NON -DISCHARGE MONITORING REPORT (N63MR) Page of W
Sampling Person(s) 11 Certified Laboratories
Raymond Lacy Braxton II Name: Environmental Chemists, INC
Name:
Does, all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
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 fife corrective action(s)
taken Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Perrnittee Certification
ORC:
Raymond Lacy Braxton Dyes 0No
Permittee: Aqua, NC. INC
Certification
No.: 999895
I Signing Official; Christopher A, Collins
Grade:
IV Phone Number, 910-431-9248
Signing official's Title: Coastal Regional Supervisor
Has tat-
ORC changed since the previous NDMlR?
Phone Number: 910 779-0794 Permit Expiration: 8/311202 4
Signature Date
Signature gate
By 1W signatime, I cerlily that Sims repot is accurrate and compete to the best of my kncwiedge.
I rarrtfty, under penalty of law, that this documertr and 911. a3lachments yens prepared under my direction or supiuvislon in
=w4ame with a system designed 10 assure drat ail qualr5ed personruei properry gathered and evaluated Vie earmllan
submitted. Based on my inquiry of the person or persixns who manage the "eM, or those persons direu;y misponsible for
gathering the information, the Yffmmahon submitted is, to the best of my kno ffge and belief, irve, accurate, wd complele. I am
aware that there are sigMACaru penalties for suIDIMMing raise information, indc t N the possibility of fuses and mprisorimm for
knoo6og 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 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 3 of 16
Permit No.: WQ0028666 Facility Name: Cannonsgate at Bogue Sound county: Carteret Month: December Year: 2022
mm
__

FORM: NDMR 10.13 NON -DISCHARGE MONITORING REPORT (NDMR) Page A' of
Sampling Person(s) 11 Certified Laboratories
e: Raymond Lacy Braxton 11 Name: Environmental Chemists, INC
Mir Jew Name:
p1complunt ❑NW -Compliant
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
If the fe cility 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:
Raymond Lacy Braxton ❑yes QNo
Permittee: Aqua, NC. INC
Certific
ation No.: 999895
signing official: Christopher A. Collins
Grade:
IV Phone Number: 910�-431-9248
Signing Official's Title: Coastal Reginal Supervisor
Has th
ORC changed since the previous NDMR?
Phone Number: 910 779-0794 Permit Expiration: 8/31/2024
Signature Date
Signature Date
By this sxnoture, I ce" that this report is accurrate and complolo to the hest of my knowledge:.
I certify, under penalty of law, that this document and all attachments were prepared under my dTectim or supervis¢on in
accordance with a system designed to assure that all qualdted personnel properly galhered and evaluated the €nformation
submitted. Based on my ingtgry of the person or persons vino manage the system, or those persons directly respomiVe for
gathering the information, tfw inrormaitat submitted Is, to the Crest of my knowledge and belief, true, accurate, axf compkrte, l am
aware that there Oro significant penaitiss for submitting false information, krWng IN possib Ay of tines and I.npmonment for
kwwoig Hofations,
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORK NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR)
Permit
No.: WQ0028666 Facility Name: Cannonsgate at Bogue Sound County: Carteret
p
P
,
1: 003
Wn -C*t U, Muent ETN—olra �gervM5
Flow Measuring 0 r
ParamaLm
Para
mi
ter Code
31616
00400
N',
49 0
TZ
1sS
'E
>
w
I , -,
E
W"I"N",�'R111",� 0
0
14,
CL
8" 0
11'4 ,"
1
a
Oil
0
2
-hr
hrs
su
I
0
:00
21 0
'00
1
"J'
5
0Y:00
1 3
6
0'':00
1
7
U:00
8
1
.Go
_h0
9
1,:00
1
'of
11
12
2
IN
13
2
14
OtW
2
T95
Is
0
:00
2
H
30
77
mom
_1S
R,:30
3
0
0
30
3
21
07:30
4
22
07:30
5
&
23
0-):00
2
24
25
26
H
27
O
:00
2
0
,00
2
7,-
29
01:00
j
2
3128
0
0400
1
1
Page 5- Of Id
Month: December I Year: 2022
Average-
7,WAP'si, 1.00 pq,,ggwi
. . . . . . . . . .
D�lly Maximum 1.00 .
Fti7.95
N,
I 'a4 minimum: 1,00
IN R' E!
Grab Grab
ampling Type.
Mon hly Avg. Limft.,
Daily Limit:

FORUM: NDMR 1(I-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page C of /a
Sampling Person(s)
Raymond lacy Braxton
Certified laboratories
Name: Environmental Chemists, INC
oar ra, 11 Name:
puriS Non -Compliant
Does all monitoring data and sampling frequencies meet the requirements in Attachment of your permit?
It the f i ility 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 it necessary.
Operator in Responsible Charge (ORC) Certification
Permlttee Certification
ORC:
Raymond Lacy Braxton CJYes Et4a
Permittee: Aqua, NC. INC
Certification
No,: 999895
Signing Official: Chrisopher A. Collins
Grade:
IV Phone Number: 910-431-9248
signing Official's Title: Coastal Regional Supervisor
Has thi
ORC changed since the previous NDMR?
phone Number. 910 779-0794 Permit Expiration: 8-81-24
�� / �
� � --- t' 1Q 3
Signature Date
Signature Date
By this signature, l corttfy that Stus report is accurrate ano complete to the tiest or my krxwdedge.
t matry, udder penalty of taw, that Ns 0owmem sort ail agachments were prepared ur€dw my lost wn or supervision in
aowrdwca with a system designed t® assrue that a✓f qualified persmr4q property gathered am evmkiated the information
submitted. Based on mY iaQx;ry of the person or persons who manage the system, or those persons directly responsitw for
gatheY#!tg the into mahon, the intormabon submitted is, to the best for my krsowiedge and belief, true, accurate, and complete. d am
aware that therare si e gnlr'Gant penalties for submiltmi; false information. inctud6V the possibility of rates and imprisonment for
knawirV vtotatoins.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, Borth Carolina 27699-1617

FORM: NCMR 10-13 NON -DISCHARGE MONITORING REPORT (NOMR)
Perrr it No.: W00028666 Facility Name: Cannonsgate at Bogue Sound County: Carteret
I n - eferatea —_
P Pll: 004 Flow Measuring WinVen' U""ue" Ljplo W4 9
Param,'eter C de b 00600 00480
0
`N
E
F-
0 2 B'R�
RS�
V
R
a wpn
V
W
p4?
0
�4-hr hrs. 411 mg/L
E-1
'0
#20�00
5
017,00
3
6
_._01,.7:G0
1
7
1
:00
1
8
0:0o
1
9
10
11
12
O
:00
2
13 —
O
:00
2
14
0
:00
2
15
O�:00
2
76
OT-30
3
117
!is
19
0-1:30
3
20
07:30
3
21
01:30
--0730—
4
22
5
23
2
24
26
26
H
27
01-00
2
28
01:00
2
29
04ZO
2
30
07:00
1
31
Average:
—baily
Maximum:
Paily
Minimum:
7
Page of 1)0
Month: December I Year: 2022
amplinq Type:[,) I Grab I Grab I klllell"� 1 17777-7 1
Mon hly Avg. Limit:
N, N,
Daily Limit:
Annual :Annual `7W7.,

FORA; NDMR 10-13 NON -DISCHARGE MONITORING REPORT" (NDMR) rage 9 cf to
Sampling Person(s)
Name: Raymond Lacy Braxton
Name:
Certified Laboratories
Name; (Environmental Chemists, INC
Name:
t✓uuts tots rnonixoring aaia ana sampling rrequencies meet the requirements in Attachment A of your permit? Erompiiaot i_lrsW-C mpiiant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compl€ante. Provide in your expranation the date(s) of the non-compliance and describe the corrective actions)
taken Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Perrnittee Certification
ORC:
Raymond Lacy Braxton
Permittee: Aqua, NC. INC
Certiff€
atiun No.: 999895
Signing Official: Christopher A. Collins
Grads:,
IV Phone Number: 910-431-9248
Signing Official's Witte: Coastal Reginal Supervisor
Has th
ORC changed since the previous NDMR? Clye�s CNo
Phone Number: 910 779-0794 Permit Expiration: 8/31/2024
123
Signature Date
Signature Date
Bythis scgrww*. I ce" that Ws report is amulmls and Complete to the Hest of my kw%,Aed9e.
1 CWOY, under PwmltY of law, that Nils document and all attachments were prepared under my drrecim or wpervlsm in
acaomvsir x with a system designed to assure that ON syuWod personnel property gathered and evaluated olormatlon
submdted. eased 00 my irryuiry of the parson or persons Yrtt{I manage the system: br those persons directly re le for
gathering the information, the informallon submitted is, to the best of my kr*wiedge and beret, rare, accurate, 3,4 complete. i am
a*we that there are $ignrCicant penalties for submitting false it fomaatan, including the poss+hifity of tines and rmprisonment f*r
kn Mng violations
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORK NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 9 ai /0
Pe '"ift
P
No.. W00028666 Facility Name. Cannonsgate
l. 005 Flow Measuring �Jartlnjrent
at BOgue Sound
ganeraw
County:
P a r a m e"r" 'o"
Carteret
Month: December
1-:J560ce -Water
Year:
2022
ParaM
�4-hr
1 07-,00
T
3
4
6
ter Code
F-0 65 q i
1
C�
0 �10
hrs
1
�0 1
�0 R
3
00600
z
mcj/L
CE
gii
" a
,,
R�
0
00480
Z
n
mg/L
u q
W
1,M
f.
V
d
01,
A
. . . . . . . . . . . I
R
7, 7,
5
t
,
2."MN
p
�N R
. . . . . . . . . . . .
, nw
N."'g
Pa
E
R0
116
wo
Y
A A
YES
qp
:
7 1p:00
8 11:00
9 14:00
10
121 0�f':00
13 OT:00
I 0t00
16 0100
170
19 0,J%30
20 07:30
21 07-30
22
23
4 25
26
2
27
28 OATO
29 0 1:00
To 07:00
31
DAy
C
�ampling
M�Onjhly
Samole
4�
I R
155
1 It R
qg�
501%
2 a ly C'r
2
:2
2
3
3
3
4
2
Hyp
2
2
2 5 92,
'S
Averagv,
maximum:
a 11 Y M i n I m u m:
Type- Grab Grab
Avg. Urrift: M
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FORK NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1 C# trf 1
Sampling Person(s)
Raymond Lacy Braxton
Carted Laboratories
Name: Environmental Chemists, INC
Name:
all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
If the f cility 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)
takers, Attach additional sheets if necessary
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Raymond Lacy Braxton Dyes 2NO
Permittee: Aqua, NC, INC
Certifi
tion No.: 999895
Signing official: Christopher A. Collins
Grade:
IV Phone Number: 910431.9248
Signing Official's Title: Coastal Regina€ Supervisor
Has thi
o ORC changed since the previous NDMR?
Phone Number: 910 779-0794 Permit Expiration: 8/31/2024
Signature Date
Signature Late
By this signature, I c eflify that this report is accurrets and complete to tt* best of my knowledge.
i ceft under pw" of law, that this document and as attarimtents wexe prepared under my direction or tupeNsm in
soomdame with a system designed to assure that all quaMW personnel PrOty gathered a1d evaluated the irformattion
submitted, based on my irquiry Of the or persona who manage the system. or arose persons directly responsible for
gathering the information, the information submitted is, to the best of my kmwdedge and belief, true, atcuam, aid complete. t am
aware tract "*re are signirirmt penalties for submitting false inf xrMation. kx*AUV the possibility o trnrs and wqxisonment for
krlr>Niing VkNaftt)rF5
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617