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HomeMy WebLinkAboutWQ0022384_Monitoring - 11-2016_20170111FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page I of 3 •County: Permit • at MITI M., I Field - • irrigation • at this facility F? .... FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of ®iia 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? Compliant ❑ Non -Compliant Were all setbacks listed in your permit iviaintained for every application to each permitted sate? [Y. Compliant ❑ Non -Compliant Were all freeboards ivlaintained in accordance With the specified freeboard heights in your permit? t4Compliant 11 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. information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant Operator in Responsible Charge (ORC) Certification Permittee Certification ORC: Permittee: onfen�1f`, Certification No.: �'�612 rPI I� l Signing Official• C,moi(('E� I � f:t�,1�t''f�`F-+ �(jIdjT(- Grade: Phone Number: 2�Z 5Zl i�5�`i Signing Official's Title: D54i , ' �agef Has the ORC changed since the previous NDAR-1? ❑ Yes L�No /dI Phone Number: Z5Z- 5 zu-`j%/ Permit Exp.: I w Signature Date Signat a Date By this signature, I 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 properly gathered and evaluated the information 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 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 Quality Information Processing Unit 1617 Mail Service Center Raleigh, North Carolina 27699-1617