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Home My WebLink AboutWQ0000224_Monitoring - 09-2016_20161031FORM: NDAR-210-13 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Pageof �_7Mrslffi Did this facility?®�- •:- i.- L1 YES M -NO Site Infiltrated? Sam= Site In iltrated? 110mmmmmm'. m mm mm � WPM KIM mmm m m � m_____I'i��'___ _� MMMM RVA=�F.��rj��rVVM��s�� m=Mmm=wm� ///////�///////.rL'i�d►�%//////! /��M///O/////IQr .H%/////// /////////.%moi, ////////'////////%//////��%/////% • 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? 11 If a basin, were there any instances of breakout from the berms? Was the onsite automatically activated standby power source tested and operational? Page _of_ ZI&-pliant ❑ Non -Compliant [ECympliant r ❑ Non -Compliant t/&�oCom [Ipliant Non Compliant Er&mpliant ❑ Non -Compliant Phone Number: 2S 2,- 35- if -633,S Permit Exp.: PJ 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 than. none, auunrvua, �„�o.� „ Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: S.�.�.� �..,,,.j - Permitte_r � es , h+- ewr..All U Certification No.: Signing Official: _Sr f I' Grade: Phone Number:ay l -$tits Signing Official's Title: PqssOr- Has the ORC changed since the previous NDAR-2? O yes ❑ No Phone Number: 2S 2,- 35- if -633,S Permit Exp.: o-7_7-16 Signature Date Sig tura Date By this signature, I certify that this report is accurrate and complete 16.the best of my knowledge. I certify, under penalty of law, that this tlocument an 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 knuwiedge 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