WQ0033325_Monitoring - 10-2022_20221030

FORM: NDMR 03-12 NON-USCHARGE MONITORING REPORT (NDMR) Pa e
1 f1 g -�z of�
Permit Mo.: ) ;

i FORM: NDMR 03-12
NON-DISCWaiRGE MONITORING REPORT (NDMR)
Page —IL of 1-71
Sampling Person(s)
Name:�,�
Certified Laboratories
Name:
'Name:
CQ �� ffo�4�nQ'eOffUfl�C� l'ec� ands6iUir11pV�0�g fU��d9�IC➢��0� Oo➢C�r Gale requirements Ol l Attachment®f your �mefPlfNit?
ompllzm ❑ 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
ORC: A14--1 Cd5 e
Certification No,:
Graeae:e5tAo 6wrQOr4 PhoneNumber: _
&RDSs C42A-naC-K,0AJ
Has"the-ORC-changed"since•the-previous=NDMR? ° Yes "'""-_
Permittee Certification
Permiicee: PW _ IddA Co. Wet+e -
Signing Official: MAU 6e G�
Signing Official's Title: &A-00-ciA
Phone Number: ®d�0'�����"���� - "-Permit Expiration:
_ _ - --`�—. -- - - --- - — ___..�--�—_—_- _ _ __ -
Signature Date Signature
- -T-4�—
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
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: NIDARA 10-13 NON -DISCHARGE APPUCATiOM REPORT (MDAR-1) Page A of
PermitNo.:VJ6Z
Facility Name: ✓
County: Month:
Year:
Did irrigation occur
Field Name:
ild N' Field Name:
this facflfty?
Area (acres):
�qrts y Area (acres):
at
i-M-0
Cover Crop:
Cover Crop:
YES El NO
Hourly Rate (in):
6�y
Hourly Rate (in):
Annual Rate (in):
Annual Rate (in):
Weather
]rFreeboard
��Ld fl7r.L.
+ AYES, I
Field Irrigated?
YES NO
F'��,IXU ff[At,(6
�.,Elky, 0,,9Q J'
g?
Field Irrigated?
❑ YES EJ NO
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Ells FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page I of �
id the application rates exceed the limits in Attachment B of your permit?
►ere adequate measures taken to prevent effluent ponding in or runoff from the Sides?
oas a suitable vegetative cover maintained on all sites as specified in your permit?
,�_, ,�Compliant El Nan -Compliant
[R/Compliant ❑ Non -Compliant
E Compliant ❑ Non -Compliant
Pere all setbacks 91sted in Your permit maintained for every application to each permitted site' LY1 Compliant Non -Compliant
/ere all freeboards maintained in accordance with the specified freeboard heights in your permit? E(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 necessary.
Operator in Responsible Charge (ORC) Certification
RC:.41-1A0 lL�
ertification No.: 1L 764,?,?
rade: pp m Phone Number: f ejO - pa
--- �ttiB.U.•--�8rdsr.�. , ---
as the ORC changed since the previous NDAR-1? ❑ ye No
Signature
By this signature, 1 certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Perrnittee:''�?a
Signing Official: -
Signing Official's Title:
Phone Number: &71,V 46 z 69V,6a Permit Exp.:
Date Signature Date
1 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 Imowledge 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.
Iv 0 Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617