WQ0033325_Monitoring - 02-2023_20230605

Monitoring Report Submittal
Permit Number#* WQ0033325
Name of Facility:* Bladen County Water District - Tobermory Road
Month: * February Year: * 2023
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR DMR TOB FEB 2023-corrected.pdf 698.2KB
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: * Alan Edge
Signature:
0/�
Date of submittal: 6/5/2023
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* WQ0033325
Is the monitoring report accepted?* Yes No
Regional Office* Fayetteville
Reviewer: _anonymous
Review Date: 6/6/2023

FORM: NDPXR 03-12'
Name:
Sampling Person(s)
Name: /f5w'vV If eS'f'erle—
NON-MSCHARGE G1fdONIT®RNG REPORT (MMIR)
Certified Laboratories
Page --I— of 121
Name: A� �OA 1,V eA-
Name:
Does Q u7D©mototrong data and CaDY4pQarlllg l lGq¢IeQVCpsS V1fD89u the>raCJMOUePirlel�fts on Attache>ra�� ®vio' ��eUnuot? inpllant ❑ 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
actien(s) taken. Attach additionai sheets if necessarv.
Operator in Responsible Charge (ORC) Certification
ORC: A1P� 6r4 '
certification No.: T74 �� g
Grade: �`�s3��� ��-j-ioaa Phone Number: $IV
G�tass- �Anec�-:p�j
Has the ORC changed since the previous NDMR? ° Yes °' 0
Signature
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certitiiffyication 1
Signing Official:
Signing Official's Title:
Phone Number: o�P®`���.` �$Pp Permit Expiration:
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
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
penaities 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 Mai; Service Center
Raleigh, North Carolina 27699-1617

ORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page e of .�
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?
ReCompliant ❑ Non -Compliant
2/Compliant ❑ Non -Compliant
LI Compliant ❑ Non -Compliant
Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
Compliant El 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
actions) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: �'41'444J cd5Ir e +
Permittee: 41�
Certification No.: g7621_91 Signing Official:
Grade: - Phone Number: g{® - Signing Official's Title: Ajla '""'
Has the OORRCCcchanged since the previous NDAR-1? L�!E, _ Phone Number: ev'9 -16Z- 61% Permit Ex
❑ Yes °'N. p,;
Al�
10,
Signature Date Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge. [ 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

FORM: IVDAR-1 10-13 MON-DISCHARGE-9."RGEAPP�LICAT Cif REPORT (h191�A}a'-G) Page � o �
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