HomeMy WebLinkAboutWQ0033325_Monitoring - 01-2023_20230206FONM: NDMR03-12 NON-DISCI-ARGE MONITORING REPORT (NDMR) Page-1—of12,
Sampling Person(s) Certified Laboratories
Name: /Tl�ii✓ t Name: 6A11/1;L 6?A1, i 6A 71
�j Name: ��t=�t S'i� C/L Name:
0 monitoring data and sarru>tt Hng frequencies meet the requirreo� eats in Attachment A of you • 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.
II
�I
I�
FEB 0 6 M3
4
y
n Operator in Responsible Charge (ORC) Certification Permittee Certification
n ORC: C Permittee:
u 4mj �5
Certification No.: g76Zg3 Signing Official: /41.44)
-W e
Grade: 1q-,0;YtA# h4+,oH Phone Number: 6�� Signing Official's Title: O`iMmip/%
Has the ORC changed since the previous NDIVIR? ° Yes - ' - Phone Number: 1110 -O 82- 6q46 Permit Expiration:
d
p Signature Da Signature Date
By this signature, I certify that this report is accurrale 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 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
jj 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_ z Of2',
Permit No.: 33 Facility Name:
■
Sampling Type:t
r
�f�...a-------------
1. :-r���--------------
FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page E of 2-
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?
W,�/ICompliant El Non -Compliant
S� Compliant ❑ Non -Compliant
R"CCompliant ❑ Non -Compliant
2/compliant ❑ Non -Compliant
(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 necessarv.
Operator in Responsible Charge (ORC) Certification
Perm ittee Certification
ORC: ,414"v 60G
Permittee:
Certification No.: C�`l6 t�?I
Signing Official: AJ
6 - W a.L{
Grade: 4 - d.;dZ Phone Number: f le - 00ez - l0 99.E
Signing Official's Title:
Has the ORC hanged s� previous NDAR-1? ❑ Yes No
Phone Number: p
�`O'06PermitExp.:
,41
Signature Ilia a
Signature D e
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 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: NDAR-1 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page -Z ofm.
-
Permit No.: Vj6Z 6E, 333
Facility Name:
County:
month:
Year:
Did irrigation occur
tFa
q_
Field N�01�, 1111011 -00 U,
Field Name:
7�eid Nlame:
Field Name:
-me:
at this facility?
e a
c,
Area (acres):
Area (acres):
'
R YES ❑ NO
�_""e (in):
Cover Crop:
Crop:
Cover Crop:
Hourly Rate (in):
y atc
R (in):
Hourly Rate (in):
Annual Rate
4xt
I Annual Rate (in):
Annual Rate (in):
Weather
Freeboard
Field lrrigallpd?
M'yES ❑ NO
Field I rigated?
El YES D NO
YES NO
Field Irrigated?
DYES ❑ NO
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Monthly Loading-
12 Month Floating Total (in):
MINNA, ?11,11111,11,111011,111,11A
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