HomeMy WebLinkAboutWQ0029601_Monitoring - 11-2016_20170103r .� FORM: NDMR 03-12 NON-DISCHARGE MONITORING REPORT (NDMR) Page � ot �S
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FORM: NDMR 03-12
Name:
Name:
Sampling Pereon(s)
Charles J. Scozzari, Jr.
Maxwell Carroll, Alberta Y. Okamoto
NON-DISCHARGE MONITORING REPORT (NDMR)
Certified Laboratories
Name: Environmental Chemists, Inc.
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
Page a o, � .
Q✓ Canpliant ❑ Non-Complunt
If the faciliry is noncompliant, please explain in the space below the reason(s) the facility was not in complianca. Piovide in your explanation the date(s) of the non-compliance and describe the corrective
_ . . _ . . _ . . .... . . . ..
e�.� �������o��.�,w���o�������o����oo.�..
Operator in Responsible Cha�ge (ORC) Certification Permittee CertifieaHon
oAC: Charles J. Scouari, Jr. Perminee: Caroiina Investments Inc.
Certification No.: 11190 Signing OHicial: SCOtt H. BrOWn
Grade: III ne Number: 910-545-1499 Slgning OHicial's Title: SeCfBtdry
Has the ORC ehanged sine prevfous NDMR? ❑ �es ❑� No Phone Number: 46-8160 Permit ExpiroHon: 7/31/2013
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12/9/2016 � �i
igna ure Date re Date
By tlus ' reWre, I cerliy ihat iMs report is accurta�e aM compele ta Ihe Eas� a my krwvAeOge. I cenM� periany ol law, �hat iNs documenl entl all anecnmerits wara preperetl u�ker my directlon w supervision in eccortlence
with a eystem tleaigned to esaure tlie� all 9�� PaB�� P���Y 9atheretl eM eveluated tl�e ktlorme�pn aubmMed. Beaed on
my upury of Me person or perems wfio menege iha systam, a Vase parsaa 6recYly respmsihle fa gelhenrg tl�e IMormatim, ihe
iNorme�bn suDmittetl Is, to �he beat d my kno�Netlge eM ENbf, true, ecwrate, entl canpete. 1 am ewere tl�e� ihere ere sigNficeM
periatliea br subnming felse kitorme�ion. induOing Ihe possidliry of finea eM NnpnsmmeM iw kmv.ing videtims.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Centar
Raleigh, North Carolina 27699-1617
J
, FORM: NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT (fVDAR-1) Page � of �
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FORM: NDAR-1 10-13
NON-DISCHARGE APPLICATION REPORT (NDAR-1)
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 sites?
Page � of � F
� Compliant ❑ Non-Compliant
❑� Compliant ❑ Non-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? Q Compliant ❑ Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? � � Compliant ❑ Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 0 Compliant ❑ Non-Compliant
If the facility is'non-compliant, please explain in the space below the reasbn(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach acJditional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Regina Myers � Permittee:
Carolina Investments Inc.
Certification No.: 1001732 Signing Official: Scott H. Brown
Grade: SI Phone Number: 910-340-1390 Signing Official's Title: Secretary
Has the ORC changed since the previous NDAR-1? � Yes � No , Phone Number: 910- 160 Permit Exp.: 1/31/11
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Si ure bate e Date
By this signature, I ceRify that this report is accurrate and complete to the best of my knowledge. I certify, un r enalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a syst esigned to assure that all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry he person or persons who manage the system, or those persons directly responsible for gathering 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
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
�
� FORM: NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page � 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? ❑� Compliant ❑ Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? � Compliant ❑ Non-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? Q✓ Compliant ❑ Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? Q Compliant 0 Non-Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? 0 Compliant ❑ 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
action(s) taken. Attach additional sheets if necessary.
n
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Regina Myel's Permittee:
Carolina Investments Inc.
Certification No.: 1001732 , Signing Official: Scott H. Brown
Grade: SI Phone Number: 910-340-1390 Signing Official's Title: Secretary
Has the ORC changed since the previous NDAR-1? � Yes � No Phone Number: - 46-8160 Rermit Exp:: 1/31/11
�
� _ _� C� 2 2�
Sign t re Date Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge. I ceA' , under penalty of law, that this document and all attachments were prepared under my direction or supervislon in accordance
with a system designed to assure that all qualitied personnel properly gathered and evaluated the (nformation submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the
information submitted is, to the best oi 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
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FORM: NDAR-1 10-13 NON-DISCHARGE APPLICATION REPORT (NDAR-1) Page�of� ,, r� y
Did the application rates exceed the limits in Attachment B of your permit?
0 Compliant ❑ Non-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? Q Compliant ❑ Non-Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? 0 Compliant ❑ Non-Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? Q Compliant ❑ Non-Compliant
1Nere all freeboards maintained in accordance with the specified freeboard heights in your permit? 0 Compliant ❑ 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
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Reglna Myel's Permittee:
Carolina Investments Inc. �
Certification No.: 1001732 Signing Official: SCott H. Brown
Grade: SI Phone Number: 910-340-1390 Signing Official's Title: Secretal'y
Has the ORC changed since the previous NDAR-1? � Yes �❑ rvo Phone Number: 910- 6-8 0 Permit Exp.: 1/31/11
. �
� ' � °� L L[� is
Signature Date Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge. I certify, der penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance
with a sy tem 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 responsibte for gathering 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
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617