WQ0006863_Monitoring - 08-2016_20161007

fi FORM: NDAR-2 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Page 1 of 3—
Permit • X111.:6
Genesis
Carteret
•
1 16
• infiltration occur
this facility?
• •. 1 1Area
Area (acres):-.
N21 YES El O
Rate (GPD
Rate (GPD/ft):
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0
•Site
Infiltrated?
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FORM: NDAR-210-13 NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Page 2_ of 2
Compliant ❑Nor -Compliant
lid the application rates exceed the limits in Attachment B of your permit?
0 Compliant ❑Nor -Compliant
F not a basin, were the sites kept free of -vegetation and raked?
❑+ Compliant ❑. Non -Compliant
F not a basin, were there any instances of effluent ponding in or runoff from the sites?
Compliant E] Non -Compliant
F a basin, were there any instances of breakout from the berms?
Compliant ❑Non-compliant
Vas the onsite automatically activated standby power source tested and operational?
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 date(s) of the non-compliance and describe thfi corrective
action(s) taken. Attach additional sheets if necessary.
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 accurrete and complete to the best of my knowledge.
Permittee Certification
Permittee: Ge tA0� CJD ­" a O.ta
Signing Official:
Signing Official's Title: fADjav-r—
Phone Number: Permit Exp.: 20 i.
916'
Signature Date
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
c.,rei i, M^v4h ramlina 27699-1617