WQ0018992_Monitoring - 10-2016_20161202

FORM: NDAR-2 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-2) Page of
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FORM: NDAR-210-13
NON -DISCHARGE APPLICATION REPORT (NDAR-2)
Did the application rates exceed the limits in Attachment B of your permit?
If not a basin, were the sites kept free of vegetation and raked?
If not a basin, were there any instances of effluent ponding in or rundff from the sites?
Page of
0 Compliant ❑ Non -Compliant
Compliant ❑ Non -Compliant
0 Compliant ❑ Non -Compliant
2] Compliant ❑ Non -Compliant
If a basin, were there any instances of breakout from the berms?
Compliant E] Non -Compliant
Was the onsite automatically activated standby power source tested and operational? a
If the facility is non-compliant, please explain in the space below the reason(s) the
s) taken Attach in compliance.
sheets if nide in ecessa your explanation the date(s) of the non-compliance and describe the corrective
a
Operator in Responsible Charge (ORC) Certification
ORC: Donaid.Omara
Certification No.: 22801
Grade: SI Phone Number: [phone]
Has the ORC changed since the previous NDAR-2? ❑
Yes [D No
Signature
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
Permittee Certification
Permittee•A PL -AGE 4 -,j -r0 -f_
Signing Official: -IL-
Signing
I -
Signing Official's Title: ri4aJ�l, 6t—
Phone Number:z3 t� 1 Permit Exp.: q Jab /20
ZSz-2�cn—
h/14/1—
Date
Date Signature
ance
I certify, under penalty of law, that this document and all attachments-weregathered and evaluated the information submitted. Based on y
with a system designed to assure that all qualified personnel properly g
inquiry of the person or persons who manage tha system, or those persons directly responsible for gathering the information, the
information submitted oris, 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
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617