WQ0033325_Monitoring 09-2022_20220930

FORM: NDMR 03-12 NON -DISCHARGE MONIT ORING REPORT (NDMR) r Page Of _,2
Permit No.: WO,6033 39 Name: . 1i
I County: [Month: Year:
Ppl:
4)0 E3 Akari4ki- � "z4--
Flow Measuring Point: Influent GOEffluent 0 NUflow generatedparameter Monitoring Point: nfluent G t,."rfuent 13 Groundwater Lowering E3 Surface Water
arameter Code
b
2
4
7
lo
12
13
14
G
.17,
18
20
21
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0
0
24-hr
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ro
hrs
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26
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Average:
Daily M a3cimum:
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Daily Minimum:
Sampling Type:
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Monthly Avg. Limit:
Daily Limit:
Sample Frequency:11'
Pr

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FORM: NDMR 03-12
od0119-DISCI,ARGE MONI I ORING REPORT (NDMR)
Page of 2
1 Sampling Person(s), Certified Laboratories
;Name: 4�4A0 4_� NamJ
r G✓
1 Name: Ai(ew !y �6-sre;e_ Name:
'Does a00 rnonk©rifi o de-ALra and sanip fing 'urequanciuGs Maea rha reOaWrairne' nis inr , f iiPr°Pmrrrin,ralrn•Ir n Rnii' %#e%nnv rrnmrPnw6.".."d ompliant O Non-Comnliant
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
a
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
0RC: , 4 14,j 6� (c �
Certification No.: 176 2-IF3
Grade:-4;351-Ao 6� &aYaooa Phone Number: 4?1
Permittee Certification
PermiYcee: Cw. e,+ear ,6
Signing Official:
6-- -
Signing Official's Title:
Phone Number: Permit Expiration:
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 properly gathered and'evaluated the information submitted. Based an
My inquiry of the person or persons who manageithe system, or those persons directly responsible forgathering 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
penettles for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and i wo Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 10-13 MOM -DISCHARGE APPUCATM REPORT (MDAR-1) Page A of .7—
Permit No.:
Facility Name:
County:
Month:
Year:
Did OfPIr9C��FieldrName �9®n
n occur
Field Name:
Field Name:
at this facHity?
Area (acres):
Area (acres):
Ad
EJ ik
Cover Crop:
Cover Crop:
R'YES ❑ NO
Hourly Rate (in):
ly II(
Hourly Rate
Annual Rate (in):
LA
(in):
Annual Rate (in):
UVeather Freeboard
Field irrigated?
E] YES El NO
51 _9,290MA
F4L[j,,',y7
Field irrigated?
0 YES El NO
0
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ft
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17
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19
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20
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23
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24
7
125
o
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27
28
29
30
31
Monthly Loading:
=00
77771
12 Month Floating Total (in):

FORM: NDAR-1 08-11 MON-DISCHARGE APPLICATION REPORT (NDAR-1) Page of_s2
Did the app96cation rates exceed the H mtits in Attachment B of your permit?
Mere adequate measures taken to prevent effluent ponding in or runoff from the sites?
Mas a suitable vegetative cover maintained on a9i sites as specified in your permit?
Pere a99 setbacks HSted in your permit maintained for every ap®p9ication to each permitted site?
M eCompliant ❑ Non -Compliant
�L17(compliant ❑ Non -Compliant
IJ Compliant ❑ Non -Compliant
B/c.mpliant '❑ Non -Compliant
Nere all freeboards maintained in accordance with the specified freeboard heights in your permit? dCompfiant ❑ 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.
Operator in Responsible Charge (ORC) Certification II Permittee Certification
DRC: A1.1"v
-ertification No.:
d5''Wej_�
3rade: S4 m `Phone Number: fee e
ias the ORC changed since the previous NDAR-1?
❑ Yes 5 No
Permittee:
Signing Official:
Signing Official's Title: A.eA�&
Phone Number: q(® o?6z— 69% PermitSxp.:
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 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
informatioh submitted is, to the best of my knowledge and belief, true, accurate, and complete. l am aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonmentfor knowing violations.
Mail Original and Two Copies to:
Division off Water Quality
lnforrhation Processing. Unit
IM7 Mail Service Center
[Raleigh, North Carolina 27699-1617