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� FORM: NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page I of �
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! FORM: NDAR-1 10-13 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 sites7
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 permit7
❑+ Compliant
❑� CAmpIaM
❑+ CAmpllaM
❑� Compliant
❑+ Comdiant
❑NorrComPliaM
❑NoirCompliaM
❑NorrCan0liaM
❑NorrCanpliant
❑Non-Complian[
If the facility is non-wmpliant, please explain in the space below the reason(s) the faciliry was not in compliance. Provide in your explanation the date(s) of the non-compliance and descnbe the corrective
action(s) taken. Attach additlonal sheets if necessarv.
Operator in Responsible Charge (ORC) Certification Permlttee Certiflcation
oRc: KARL GRIFFITHS Perminee:
CHAMPION HILLS, POA
CertiTwtion No.: 15613 Signing Otficlal: KARL GRIFFITHS
Grede: Phone Number: 828 606 1962 S�gn�ng Offic�al's 7itle: ASSISTANT SUPERINTENDANT
Has the ORC changed since the p e ious NDAR-77 ❑y� Orvo Phone Number: 828 606 1962 ` Permit Exp.: 1/31/19
�
' 12/19/16 12/19116
gnature Date Signalu Date
ey mis sigrature, i ertHy thet tMs report is aaurate antl complete to IM best o( my kroMeage. I cenlry, untler penatty o( law, that Mis docume ne an anachmerns were
prepareE un�ler my direction or supervision in accordanca
xtllh a systam tlasignetl ro assure that all qual' persomel propeAy gathered antl evelueletl tM informatbn submMtetl. BaseG on my
irquby o( ihe person or persom who manage ihe system, w tlnse persas tlkectly respwaida (a gathering the iMamation, tte
iMortnation submitted is, to Me best ot my krox7etlge antl belief, bue, accvete, antl complete. I am aware that there are significaM
perekies (ar submmirg false iMorme[ion, inclutlirg He possibYiry of finas antl imprisonmenl for kiqMng vblalb2s.
Mail Original and Two Copies to:
Divislon of Water Resources
Information Processing Unit
7677 Mail Service Center
Raleigh, North Carolina 27699-7617
- ------ �— - ------ - - --�- ---- - -... __ -- -- - - - --0� - �
FORM: NDMR 03-12
NON-DISCHARGE MON�TORING REPORT (NDMR) - � - - - - - -� - -PaSe °f -- -�
- ` ' ' Certifted Laboratories
Sampling Person(s)
Name: Danielie Hunter , � Name: James & James Env. Mgt., Inc.
,..
Name: Name Research & Anal ical
� Does alhemolnyto�rong d'a�ta p e[IS ampinng sP equ e wcnes meet the 'requirements m Attachment A of your permit? ❑ compiiant ❑ Non-Campliant
,- son(s) ihe facilily was, nol In compllance. Provida In you explanetfon the date(s) of the non•compliance and describe the corrective
� � ' actlon(s) taken. Attach addltionel sheeta if necessary.
O�erator in
�_, � �.�.
ORC: Danielle Hunter
No.: 23477
Certification
II Phone Nurribe�: � ' 82&697-0063
changed since the rp`/�(���ous NDMR? ❑ Yes C7 No
!� N I / �./
- � J��w L�y� 12/28/2016
'�'� Signature pate
the signature, I certify thaf this report is accurate' and complete to the best of my knowl�
Certiflcation
Hills POA
Official: James & James Env. Mgt., Inc.
Official's Title: Contract Operations
Number: 828-697-0063
J-t1�l1�.- �a-- ' 1
Permit Expiration: 1/31/2019
I certify; under penalty of law, that this doaiment and ail attachment were prepazed under my direction or supervision in accordance
with a system designed to assure that all qualifled personnel properly gathered and evaluated the infotmation submitted. Based on
my inquiry of the person or persons who manage ihe system, or those persons direc8y responsfble for gathering the informatlon, lhe
informaGon submitted is, to the best of my knowledga and belief, true, accurate, and complete. I am aware ihe ihere are sign{ficant
II penalBes for subminina talse informatlon, induding the possibility of fines and imprisonment for knowing violations.
Mafl Original and Two Copies to:
Division of Water Quaiity .
Information Processing Unit
7G17 Mall Servlce Center
Raleigh, North Garolina 27699•1617