WQ0033325_Monitoring - 11-2023_20231204

Monitoring Report Submittal
.....................................................
Permit Number#* WQ0033325
Name of Facility:* Bladen County Water District - Tobermory
Month: * November Year: * 2023
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address: *
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Upload Document*
ndmrtob1123.pdf 1.73MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Alan Edge
�lar 6 S�' *
Reviewer: Wanda.Gerald
12/4/2023
This will be filled in automatically

Is the project number correct?* W00033325
Is the monitoring report accepted?* Yes NO
Regional Office* Fayetteville
Reviewer: _anonymous
Review Date: 12/6/2023

FORM NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page Of_-.,7
Did the application rates exceed the limits in Attachment B of your permit? ,,__,,//KCompliant ElNon-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? L mpliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? Mr .Mphant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? M/.rnpliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? L Compliant ❑ Non-Complant
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
artinn/cl takpn Aftnrh additional sheets if necessary.
/Operator in Responsible Charge (ORC) Certification /J /a� ♦ '-,!P-ermiittteee.Certification
ORC: 4I4N GI GatPermittee: �, 1,�(M 04./tc�tJ/-¢�1�,//Q.wua
Certification No.: R761ZW Signing Official: Qo,- -
-taajl - oo A.1i 1
Grade: 4 _ ,d���� Phone Number: glf0 - �6Z. 6916 Signing Official's Title:
Has the ORC changed since the previous NDAR-1? Cj yes No Phone Number: g(O - 06 2- 64Q,6 Permit Exp.:
Signature Date
By thrs signature, I certify that this report is accurrate and complete to the best of my knowledge.
Signature Date
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision m accordance
with a system designed to assure that all qualified personnel property 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 th—forniabon the
Information submitted is. to the best of my knowledge and belief, true, accurate, and complete. I am aware that mere are sign,fK .-.t
penalties for submitting false information, including the possibility of fines and imprisonment for knowing rrolauons
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
o..r..o ­. n...,. r.... Henn 11241r

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page __I__ of
// / Sampling Person(s) /' / CertifiedLaboratories
1
1 Name: /Tlfii✓ �� C Name: 6N V 1D 6'A1, i t`N /F/C at_7�0C O'RP O
Name: V �CS7<C/e_ Name:
[L i
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your {permit? v<iompltant ❑ Non-Comphant
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.
9
P
Operator in Responsible Charge (ORC) Certification
Certification No.: Q76J] 473
9-we//,
Grade: /{-Q�S*R.%S'7rroa Phone Number
CYless ffr.
Has the ORC changed since the previous NDMR?
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: /.31qde_., (74,, u)q+edr *q, ej
1
Signing Official: AI,4.) tole !�6/.
Signing Official's Title: 0j�et_10/4
Phone Number: q10-86Z-6446 Permit Expiration:
-.4-?3
Signature Date
certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision In accomam
with a system designed to assure that all qualified personnel properly gathered and evaluated the Indonnation submitted. Based on
ny inquiry of the person or persons who manage the system, or those persona directly responalble for gathering he informehM 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 violatoM
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page_ A of .2
Permit No.: W ,•
Facility Name:
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at
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•Crop.Cover
Crop:
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Hourly
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FORM. NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of 3
Permit No.: D •
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