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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s)
Name: Charles Parker
Name: Par Lab
Certified Laboratories
Name: 11 Name:
Does e8l monitoring data and same ing frequencies meet the requirements in Attachment A of your permit? Compliant ❑Nan -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
ORC: Lee Pennington
Certification No.: 987583, 987903
Grade: 2
Phone Number:
Has the ORC changed since the previous NDMR?
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704-874-2754
[]Yes E]No
%
ignature Date
By this signature, I certify that this report Is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee: Al Abedi
Signing Official: Al Abedi
Signing Official's Title: Vice President
Phone Number: 704-865-1201 Permit Expiration: March 31,2020
/ Signature Date
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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, north Carolina 27699-1617
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Field Name:
County: Gaston Month;
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Annual Rate (in):
Field Irr*gated??l
1011
Hourly
Annual Rate (i 1
Field Irrigated?' N
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FORM: NDAR-310-13 MON-DISCHARGE APPLICATION REPORT (NDAR-3) Page of
®id the application rates exceed the Hints in Attachment B of your permit? Compliant ❑Non -Compliant
l tyre adequate measures taken to prevent effluent ponding in or runoff from the sites? ACompriant ❑Non -Compliant
VVas a suitable vegetative cover maintained on all sites as specified in your permit? TTT*Compliant ❑Non-compliant
Were aill setbacks lusted in your permit maintained for every appllCation to each permitted site? ompfiant ❑Non -Compliant
Werealll freeboards maintained in accordance with the specified ffraeboard heights in your permits I/dlt.ompliant ❑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-co/mpliance and describe the corrective
Operator in Responsible Charge (ORC) Certification
ORC: Lee Pennington
Certification No.: 987583, 987903
I Grade: 2 Phone Number: 704-874-2754
Has the ORC changed since the previous NDAR-3? ❑Yes 2No
taicen. Auacn aaaltional sheets if necessary.
Permittee Certification
Permittee:
Al Abedi
Signing Official: Al Abedi
Signing Official's Title: Vice President
Phone Number: 704-865-1201 Permit Exp.: 3/31/20
b(}'gnature Date `– I Signature -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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617