WQ0033325_Monitoring -12-2022_20221230

��: `i' ` • FORM: NDMR 03-12 r
MONOSCo-ARGE MONITORING REPORT (NDMR)Page__�_of7
Sampling Person(s)
Certified Laboratories
Name: A1= sty P
Name: 11X elL9
Name: l✓� �� � � ��
Name:
Do,,:.s a f(pVL`au1l�LOG'06�c�7J d,7eeY ahol.saf(➢ pfing fre4ue"ncies; ffi eeL 1rhe frequire0'ifteffts if�i "fiCiC91Cr(11mefi�'"it A of your per'�iT➢K 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 dates) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
JA N '-2023
JAN ,2 5 2�23 Ini,nmai-gin Pro, :- i
nit
= DEQ-FAYETTEVILLE REGIONAL OFFICE
i •
!� Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Permiftee:
ji Certification No.:
Signing Official: r-
m t)
�i
-
Grade: �-,�®Si�eeo �ei3'�a®vt Phone Number: �QQi - t��•p ��
5i nin Official's Title:
9 9
gg'� . ff
----,O-Yes=_---L�fNo---
---
---_ = -i l-lasth6 ORC changed since the Previous NDMR? - " - -- -
Phone Number: 4f4�,- Permit Expiration:
!;
Signature Date
Signature Date
II
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:
®ivision 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.2,
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.� ,FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page ofI'll
®id the application rates exdeed the limits in Attachment B of Your permit? J compliant ❑Non -compliant
Were .adequate measure . stakein to prevent effluent pond!ng `in or runoff from th6 sines? ER Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as, spedffied in your permit?
IJ Comprant Non -compliant
Were all setbacks listed in yyou perMit maintained for every., application to each -permitted site? C compliant • ❑ Non -Compliant
Were all freeboards maintained. in,acoordancce with the speeiffied.ffreeboard•ffueights in your permit? LYCompllant [I 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 euplanation 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
Perm ittee Certification
ORC: A
Permittee:
Certification No.:
Signing Official:
Grade: 94- Phone Number: ��[d ��� o ���
Signing Official's Title:
Has the ORC changed since the previous NDAR-1? ❑,Yes 5�
Phone Number: g1dq46 z_— 49V,6 Permit Exp.:
Signature Date
Signature, Date
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 property gathered and evaluated the information submitted:' Based on my
IforI
inquiry of the person or persons,who manage the system, or those persons directly responsible gathering , the 'information, the
information submitted is, to the best of my,knowledge and belief, true, accurate, and completetam aware that there,are significant
penalties for submitting false information, including the possibilityof fines and imprisonment for knowing violations.
Mail Original and Two Cooles to:
Division of QVVater.Quality
Information Processing ,Unit
1617 Mail Service Center
Raleigh, North Carolina "27699-1617i

FORM: NDAR-1 10-13 MON-DISCHARGE APPLICAMN REPORT (HOAR-1) Page of .2—'
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