WQ0000165_Monitoring - 08-2016_20161027

FORM: NDAR-2 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Page
Permit No.: X1111
•
Carteret
•2016
infiltrationDid occurSite
this facility?
Name:
Area (acres):1
1
U14ES F-1 NO
Site Infiltrated?
Site Infiltrated?
r
• •.• . -•
�jjj�j��jjj���jjjj���ijjjjj�j/��jjj/�jjj/�jj�i
j/�/j�������/
1
j�jjjjj�
�/�jjjjj��jj�j/
1
jjjjjjj/
jjjjjN

FORM: NDAR-210-13 NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Page of
Ilid the application rates exceed the limits in Attachment B of your permit?
F not a basin, were the sites kept free of -vegetation and raked?
F not a basin, were there any instances of effluent ponding in or runoff from the sites?
F basin were there any instances of breakout from the berms?
(] Compliant ❑ Non -Compliant
n., Compliant ❑ Non -Compliant
Compliant ❑ Non -Compliant
Q Compliant ❑ Non -Compliant
a ,
0 Compliant C] 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 reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe th6 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-2Z ❑ Yes (] No
Permittee Certification
Permittee:
Signing Official: C \ �\ CID C
Signing Official's Title: Gc
Phone Number: a.A--�
Permit Exp.: .A pr%� .30i' toa t
Si ature Date
Signature Date
By this signature. I certify that this report is accurrate and complete to the best of my, knowledge. FInformat
r penalty of law, that this document and all attachments were prepared under my direction or supervision in ac00rd ce
designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
e person or persons who manage the system, or those persons direcfiy responsible for gathering the Information, the
e, and complete. I am aware that
n submitted Is, to the best
alties for submitting false Information,of my knowledge
ncluding the possibility of nes and imprisonment for knows gttviolations.ere are gn��nt
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
o. i_*..h Alnrth f_arnlina 27699-1617