WQ0000165_Monitoring - 10-2016_20161129

-FORM: NDAR-2 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page of
•1111 .
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Carteret
October Year:
2016
• infiltration occur
this facility?°
° :
_
YES NO
iiir
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• Page of
NON -DISCHARGE APPLICATION REPORT (NDAR-2)
FORM: NDAR-210-13 Q Compliant C] Non -Compliant
a ^ rates exceed the limits in Attachment B of your permit?
Did the application []r Compliant ❑Non -Compliant
If not a basin, were the sites kept free of vegetation and raked? Q ,pliant ❑ Non -Compliant
If not a basin, were there any instances of effluent ponding in or runoff from the sites? ❑ Compliant ❑ Non-compliant
If a basin, were there any instances of breaKoui rrvrtit U11W w`.••• Rl Compliant ❑ Non -Compliant
Was the onsite automatically activated standby power source tested and operational? d
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
if the facility is non-compliant, please explain in the spa actions) taken. Attach additional sheets if necessary.
Permittee Certification
Operator in Responsible Charge (ORC) Certification
Permittee:
ORC: Donald Omara
Signing Official:
Certification No.: 22801
Signing Official's Title:
Grade: SI Phone Number: [phone] permit Exp•:
�j yes [] No Phone Number:
Has the ORC changed since the previous NDAR-2?
/-1.A ,. \ \ �1 L`\Cf Date
Date orad under my direction or supervision in accordance
Signature ents•were prep
1 certify, under penalty of law, that this -document and all attacgathered and evaluated the infornationsubmitted. Based n my
that Uric report is axurate and complete to the best of my knowledge• with a system designed to assure that all qualified personnel property �� perms directly responsible for gathering the information, the
By this signature. I certify inquiry of the person or person who manage the system.and complete- I am
or em are significant
Information submitted Is, to the best of my knowledge and belief. ��scan-ate. nes and Imprisonment four I nowingthat hviolatins.
penalties for submitting false information, Including P�
Mail Original and Two Copies to:
Division of Water Resources
Information Processing rces
1617 Mail Service Center
Raleigh, North Carolina 27699-1617