WQ0014306_Monitoring - 10-2016_20161121 (2)

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _Loft
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ of
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?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
Ocomplant ❑Na CompsmR
2compliam ❑Non-Compkelt
0cmixiant ❑NanCanplx t
Bcompliant ❑Non-Canpart
Ecompliard ❑No-CompAad
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
®Ren. AMM moixtonai sneets
Operator In Responsible Charge (ORC) Certification
Permittee Certification
ORC: Randall Marrs
Parmittee: Sandler Utilities
Certification No.: 993714
Signing Official: William G. Freed
Grade: WW2 Phone Number: 252-3404586
Signing Official's TRIe: President, Envirotech
Heaths anged since the previous NDAR-1? ❑ya ❑yO
Phone Number: 252-207-5853 Permit Exp.: 9/30/20
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Signature Date
Signature Date
9y 0es sVrWLwe. I cartKy tlw itis ropnl is awtrrate sM complete to the ben o1 my krxowhfts.
I certey, wKiss ponsty of law.OW tma cimmat anti Y amadmMb ware Papered Lwow my dhecft a suprvWw in aWedrCp
men a system designed to assure OW ar queabd ppeorrW propo y geawed and ""lusted the Wormatlon submaed. aced w my
kxp*y of de person r panore wtp mange the system. m fess pensee essay maprede w gadmIng the afamdim the
edorrnalbn abrnated is. W the bat of my krededpa rig bead. Me. ecmaals, aM ornplre. 1 nm awre mr Owe an, sgrikora
pmW w submkft fate e/ormeUw s;kxtlkp the possEey d exa and enplisor mat for kroweV vHalbns.
Mall Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617