WQ0007103_Monitoring - 08-2016_20161004

FORM: NDAR-2 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Page
•-
l�111 1
• •� -Sea--
•
2016
DYES
■ •-.(GPD/ft):-
Site Na
te am
e .•
(ac
Area (acres):
Area (acres):,Area
e .•
.•
..
D
■ •
-. .•
-. -•
■ ■ •Site
Infiltrated?Site
■ •
ESMME■
...D
Infiltrated?
■ •
MIMI
0 0__
ME
NE
MIN
am
MMENME
U
�_-
__
-_--
amEN
M0
.:
.
MIN
�M
_ __
.: e e ��-
MEN
m�____
.eee
e e
.eee
e e
--■iel
V'HOW
EM
ME
®0_MEMIN
___
ee ®®
ee _IWE
ME
m
0__
__
•eee ®
e e
'eee
-
-_ME-
.eee -®--_
e e
----
®0____
.eee ® e e
m�____[am
--��-
NE NE
-
Mm
e e _®-
-_�-
-_-ME
M
NO
ME
EN-
ME
®m__
__
:eee _�-
:eee -®ED
-_ME
----
ee M0
-_ME
-_--
®m____
ee _��
. e e -®-
-_ME
-_--
®0__
__
. e e -�-
e e -®--_ME
----
__
e e _�-
X11
®
e e
®-
®���
--_�--_--
ME
ME
-_
ME
----
ME
m
In
m
MM
0__
__
__
M
MEN
•ee
��EM
e e
EM
M
�
�

l .
t .t
r ^FORM: NDAR-2 10-13
NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Did the application rates exceed the limits in Attachment B of your permit?
If not a basin, were the sites kept free of vegetation and raked?
If not a basin, were there any instances of effluent ponding in or runoff from the sites?
If a basin, were there any instances of breakout from the berms?
d t db ower source tested and operational?
Page of
❑✓ Compliant ❑ Non -Compliant
n Compliant ❑ Non -Compliant
❑✓ Compliant ❑ Non -Compliant
Compliant ❑ Non -Compliant
2] Compliant ❑ Non -Compliant
Was the onsite automatically activate s an Y p
If the facility is non-compliant, please explain in the space below the reason(s)
th(s) taken Attach addnal opal sheets if idem your explanation the date(s) of the non-compliance and describe thf§ corrective
Operator in Responsible Charge (ORC) Certification
ORC: Donald Omara
Certification No.: 22801
Grade: SI Phone Number: [phone]
Has the ORC changed since the previous NDAR-2? ❑ Yes 0 No
Signature
Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: so Uri �1' / '��/ ��•�
Signing Official: {' /a V .5 p9 -z-
Ass0 �l ��h %'0na-`)1'
Signing Official's Title: Phone Number: o�_V• 3 _-3 5 5' Permit Exp.:
Signature
TI -Q I/l
Date
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
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 know ng violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617