WQ0012696_Monitoring - 10-2016_20161109

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FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLIr ATION REPORT (NDAR-1) Page _of_
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Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
[r}Carollax ❑ NarconoYent
I.nmpllant ❑ No Comolent
2canwont ❑ NmcoeoNent
LKcandlent ❑ nurcarotant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? Pt6�01ant ❑ Ncn-coeollart
If the facility Is noncompliant, please explain In the space below the reaaon(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 necessary.
Operator in Responsible Charge (ORC) Carfificatlon
ORC: Go?_Y M A- PAI
Certification No.:
Grade: I Phone Number: -25-z— 9bµ— 4-57/
Has the ORC changed since the previous NDAR-1? ❑ Y. M-<
V Signature Date
By We epnaure, I ced1y met We report u acclimate and conpMe to the beet of my knowledge.
Permittee Certification
Permifbe: N4-UD7 )0/L4.m1,eo R,-ver�errl
Signing Official: 5/f err y /ND/jlo til e/l
Signing Official's Title: M4Njll e r -
Phone Number. 25'Z- 9bY- 415`2/
Signature
Permit Exp.: I - 3D-20 Zb
Date
I certry, under pauM of low. Mut Nb aooamen and ail aftld t were Prepared under my tlkedan w =.n=
Wlh a geWn deaprud to nev re OW ail queabd perwrvul properly gatlered end evehoted tlo Mommb y
epWry d the person a persons who= the system. a ease pawns directly resmabe for geheft to Inrarmaton, tree
Ydoerotlon suembed Is, to the ben or my knowledge end teen. We, ncavele, and complete. I am aware Mut Men are clgnacan
peruMes to suWrM%fabs bdannellon. Indudkp to Poesbay Of see end Wripleoranerd fa knuwirp ylnetans.
Mall Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mall Service Center
Raleigh, North Carolina 27699.1617