WQ0033325_Monitoring - 10-2022_20221130

"t'POR1UI: NDMR 03-12
MON-MCHARGE MONITORBNG REPORT (.MDMR) Page of
1.�
Sampling Person(s)
Name:
Certified Laboratories
Name:
Name: ,
Does afl� rrv©>I-uu`�©rru�u � 'u ��v1� ��i��Vu�u� urr�m)al���u�� wue?�°u t�Gu� rr�o)u�urr�ov��ou>t� urra � �t�G�u�t2u�� Q ®u'' ®Mli° ®�fP�V➢OL�' ompliant ❑ Mon -Compliant
If the facility is non -compliant, please explain in the space below the reasons) the facility was not in compliance. Provide in your explanation the dates) of the non-compliance and describe the corrective
actions) taken. Attach additional sheets ifnecessary.
�C o m 2022
Operator in Responsible age (ft Certification
ORC:
Certification No.:
�IGrade: �Q-�oSb�IQo 69��"o®na Phone Number:
.. CAOSS- &7AI6SG-�epdyJ - b�
Permit'cee Certification
Permiicee: ���� �. �e+LDer GU /�iaee Q•�
Signing Official: AIAV ems,, d, —
Signing Official's Title: &4emiDA
Phone Number: Permit Expiration:
Date- Signature - - --- - ' Date
ji By this signature, I certify that this report Is accumate 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 accordant
if
jl with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. •Based on
N 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, . .II
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 MONITORMNG REPORT (NDMR) Page_ Z Of —,I.
11 Permit No.: p " 33.�a Facility Name: ,$
County:
99
Month:
Year:
PPI: ��
FIOVV Measuring Point: O Influent DEffluent ❑ No generated
Parameter Monitoring Point: nFluent 6IzTfuent O Groundwater Lowering ❑ Surface.Water
Parameter
1
Code
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00
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hrs
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Average:
Daily Maxi
Daily Minimum:
Sampling Type:
Monthly Avg. Limit:
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Daily Limit:
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Sample Frequency:
-
- -
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.r FORDA: NDAR-1 08-11 NOVA -DISCHARGE APPLICATION REPORT (NDAR-1) Page of Z.
Dill the application rates exceed the limits in Attachment B of your permit?
(Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding In or runoff from the sates? 9/compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? VCompriant ❑ Non -Compliant
Were all setbacks listed In your permit maintained for every application to each permitted site? L'/Compliant • El Non -Compliant
Were all freeboards maintained In accordance with the specified freeboard heights in your permit? LI 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.
0
Operator in Responsible Charge (ORC) Certification
Perrnittee Certification
ORC: Al*v C-a� ,6-
Perrn ittee: a
Certification No.:
Signirog Official:
�®
Grade: Phone Number: wo — �� — � �
Signing Official's Title:
--L,,�
Has the ORC changed since the previous NDARA? El Yes No
--
PhoneNumber: Al'V �6 z— 69V1' Permit'6xp.:
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. I am.aware that there are significant
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
It aH Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

MON-DISCHARGE APPLICATION REPORT QNDAR-1) Page -7% of
Permit No.: Facility Name:
County: Month:
_2
Zip
Field Name:
Did irrigaVon occurr Field bmame:
"A
Area (acres):
at this facHity? Area (acre-,.
Cover Crop: Cover Crop:
IT
F61YES ❑ NO Hourly Rate (in):
Hourly Rate on
u. &
Annual Rate (in):
0-
_­�4 Annual Rate in:
Weather Free oard
Year
:
-2
Field Irrigated? yEs El NO I .Field Irrigated?, i� YES E❑
YES
Njpr. • Field Irrigated? El IYES
!L L F
El NO
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