WQ0004438_Monitoring - 10-2016_20161121

NON -DISCHARGE APPLICATION REPORT
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: WQ ©00 4#3 r3
MONTH: O CTO S ERZ.
Page 3 of 'T
YEAR: -.O
FACILITY NAME: �'� �f 9 n�TEAI (D R�,— N EFUi 0 5:RN COUNTY: CR► VS0
Formulas:
Daily Loading (Inches) _ (Volume Applied (gaws) x 0.1336 (nibic fw9gaW) x 12 pdw000t)) / [Area Sprayed (acres) X43,560 (square feel/acre)) OR
= Volume Applied (gallons) / [Area Sprayed (acres) x 27,152 (QW1ons/aae4nCh))
Monthly Hourly Loading (Inchas) = ma*mum indree applied over one hour period for that day
Monthly Loading (inches) = Sum of Dally Loadings (incim)
12 Month Floating Total (Inches) = Sum of Ws month's Monthly Loading (ruches) and previous 11 month's Monthly Loadings (inches)
7 n. ,.. _ _
Did IrriFatIon —0ccurAt This Facllltr. Did Irrigation Occur On This Field:
Yea:�: ��
Did Irrigation Occur On This Field:
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■FIELD
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NUMBE ME
AgEA SPRAYED fac:.
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PERMITTED HOURLY RATE (Inche5l:1
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maximum
Hourly
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Weather Codes: C -clear, PC -partly cloudy, -c ou y,, -ra n, n -snow, 51 -sleet
Spray Irrigation Operator in Responsible Change (ORC): C I= o'Rf'E R C hl-w59N
ORC Certification Number: I "I 1 6435$ Check Box If ORC Has Changed: �
Mail ORIGINAL and TWO COPIES to:
DENR
Division of Water Quality
ATTN: Information Processing Unit
1617 Mail Service Center
RALEIGH, NC 27699-1617
Phone:'12-2�- 221.Z
(SIGNATURE OF dPERAToR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (1112005)

NO DISCHARGE APPIJCA'nON REPORT
SPRAY umGAnom sn-E(S)
Facility Slatus
Prase indicate (by Vme�urg Y(es) or N(a) in Bre � box) whetherthe facility has been c�angi�asst
vat h the fof wing pen'ra recuan nts: (lvokr ffa nulu iemera does not apply t a ymmiamwpuf (M) in itle
compflant bmc )
-l_ Tt. apps afim rates) 4Vd riot wwaW tine Mrrit(s) spedrwd in the permit:
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4L BM WKer MMis as ® thB )lam w9m Maln� dwimg each Tion.
ra The freabowd in ItIt, tMOWMnts131Alor stmWe l G"n(s) was not ids lffian iffie Iftn s)
s»euied Intim pefMit_
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Ifiile fasay is pleMS Sq3WM in iii spa= belay the Teason(s) the faLadY was trot in COMPrwce Wah fts
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addiii inai sheets it rr-Cassm-
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accordance vfih a system designees to awM theta!! quaffied pamannet prop -fly gattzered and evaluated the iniarmation
submilled. Bassd ori my hxleft ofthe person or persons who Manage the System, orthose persons directly responsible
fpr gathering the infpnTmffon, the WorilrAon suhfntited is. to the nest of my kwhiedg and belief, true, accurate, and
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m �amr.Wa�{pe fnrsubffMng�lseinfn „includingtnegossibifcry.ocfines
and implisomnentfor knt?vring viQlsUans.°
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