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Home My WebLink AboutWQ0012696_Monitoring - 12-2016_20170111mnm-nlQrLJ°M,�.~~' ~.---_-- FORM: NDIVIR 03-12 sampling Personis) Certified Laboratories t'age V1 - Name: Name: Name. Nanie- frequencies meet the requirements in Attachment A of your permit? U� <Cniplitint ❑Non -Compliant Does all monitoring data and sampling planation the date(s) of the non-compliance and describe the corrective if the facility is non-compliant, please explain In the space below the reasonaction(s) then) taken . Afacility was not addit ch in complince. Provide in your ex ---- (ttaionaal sheets if neves sary. operator in Responsible Charge (ORC) Certification ORCGly �oN - Certification No.; Grade: Phone Number: Has the ORC changed since the previous NDMR? ❑ Yes /-1-1-7 Date Signature By this signature, I certify that this report is accurrate and complete to the bast Of My knowledge• . Permittee Certification Permittee: AJ600-T PAM I"cO R,'v,,r Feo-y Signing Official: 5116'r-ry 4011"Well PITT Signing official's Title: m"IeK Permit Expiration,* -3v-;20Z0 Phone Number, 25- - %Lt -y5-7-1 Date Signature I cerfity, under penalty of law, that this document and all attachments were prepared under my direction or In accordance with a system designed to assure [hat ell qualified personnel property gathered arid evaluated thspin formation submitted. Based on my inquiry of the person or persons who manage thesysitem, or those persons dkeotly responsible for gathering the information. the information submitted is, 19 the best Of MY knowledge and belief, true, accLuele, and complete. I am aware that there are significant penalties for sub . mitling false Information, Including the possibility of tines and imprisonment for knowing violations. gait original and Two Copies to: Division of Water Resources Information processing Unit 11617 Mail Service Center Raleigh, North Carolina 27699-1617 FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of Qi0 River Did irrigation occur ■ YES ONO NOUN i EMMMMMMMMasp®� ®®�■® V1 M. /REM FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 'O Did the Apication rates exceed the limits in Attachment B of your. permit?. ( mpllant ❑ Non -Compliant Were adequate measures taken to prevent effluent ponding in or runoff from the sites?ompliant .[],Non-compliant .. , Was a suitable vegetative cover maintained on -all sites as specified in your permit? p,p,lanc ❑ifon-Comp„anc Were all setbacks listed, in your permit maintained for every application to each permitted site? p�mpliant ❑Non Compliant Were all freeboards' maintained in accordance with the specified freeboard heights. in your permit? II;J�fompliant ❑ 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: V /7?�1 , SQ/li Permittee: AM1207 pi9�("liCo R, ue Certification No.: Signing Official: ✓ ei Grade: ( Phone Number: 25-2 — 46 Li q5-2) Signing Official's Title: HKkl Q/$� Has the ORC changed since the previous NDAR-11? y . - Phone Number: - Permit'Exp.: �— 30 17 Signature Date Signature Date By this signature,.l certify that this report is accurrate and complete to the best of.my knowledge. I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision In accordance with'a system designed to assure that all qualified personnel property gathered and evaluated the Information submitted. Based on my Inquiry of the person or persons who menage 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, end complete. I am aware that there are significant penalties for submitting false Information, Including the possibility of fines and imprisonment for knowing violations. Mall Original and Two Copies to: Divi'sion of Water Quality Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617