WQ0031030_Monitoring - 10-2016_20161121

FORM: NDAR-2 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page l of
Permit No.: •00North
SchoolOctober.
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FORM: NDAR-2 10-13 NON -DISCHARGE' APPLICATION. REPORT (NDAR-2)
Page of
Did the applicationrates exceed the limits- In: Attachment B of your permit?
❑� Compliant
❑Non -Compliant
If not a basin, were the sites kept free of vegetation and raked?
pCompliant
[]Non-compliant
If not a basin, were thereany instances of effluent ponding in or runoff from the .sites?
RICompliant
❑Non -Compliant
If a basin, were there any instances of breakout from the berms?
❑p compliant
[]Non-compliant
Was the onsite automatically activated standby power source tested and operational)
ECompliant
❑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
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Signature Date
Signature Date
IMMA
Operator in. Responsible Charge (ORC) Certification
Permittee Certification
ORC: Randall Marrs
Permittee:
Michael Warren
Certification No.: 993714
Signing Official: William G. Freed
Grade: WW2 Phone Number: 252-340-4586
Signing Official's Title: President; Envirotech
Has the OR a ed since the previous NDAR-2? ❑Yes ❑✓ No
Phone Number: 252-207-5853 Permit Exp.: 12/1/15
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I 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 forgathering 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
Informatlon Processing Unit.
1617 Mail Service Center
Raleigh, North Carolina 27699-1617