WQ0004438_Monitoring - 12-2016_20170124

NON DISCHARGE WASTEWATER MONITORING REPORT Page —L—'of
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PERW NUMBER: VJ Q 000'd-4 3 moNTH: D*Ci57M.O�2 YEAR: &
- FACiI_ITY NAME• S 1, W 00'1-Q4 C -D PVP -- LA GV B t~ Rld COUNTY: 91A
Operator in Responsible Charge (ORC): G C -O R G E (Z cj1n w so t L Grade: 'l ilk W --. Phone:[phone]
Check Box if URC Has Changed: ❑ ORC Certification Number: 14531 /14-458
Certified Laboratories (1): N/} (2)=
Persons) Collecting Samples: G,EOR(:15� R Cit LLI S�t�
Mail ORIGINAL and TWO COPIES to:�=-�� '
DENR (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
Division of Water Quality BY THIS SIGNATURE, i CERTIFY THAT THIS REPORT IS ACCURATE
ATTN: Information Processing Unit AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
1617 Mail Service Center
RALEIGH, NC 27699-1617
_ DENR FORM NQMR-1 (11/2005)
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Operator in Responsible Charge (ORC): G C -O R G E (Z cj1n w so t L Grade: 'l ilk W --. Phone:[phone]
Check Box if URC Has Changed: ❑ ORC Certification Number: 14531 /14-458
Certified Laboratories (1): N/} (2)=
Persons) Collecting Samples: G,EOR(:15� R Cit LLI S�t�
Mail ORIGINAL and TWO COPIES to:�=-�� '
DENR (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
Division of Water Quality BY THIS SIGNATURE, i CERTIFY THAT THIS REPORT IS ACCURATE
ATTN: Information Processing Unit AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
1617 Mail Service Center
RALEIGH, NC 27699-1617
_ DENR FORM NQMR-1 (11/2005)

NON DISCHARGE WASTEWATER iM oNIT4DRING REPORT
Facirdv Status:
Please answerthe following questiaur.
1. Does all monitoring data and sampling fmquenctos meet pernrt mWirmnents? -
Page . of—UL
if the faeft is noa-comniianfi. #tease explain in the space below the rag,---on(s) the ilaz y was not in CM13pliance
w -h iia penT& Prouide in your explanation the date(s) of the non-compfiratce and describe the cones& aciion(s)
taken. Attach addi'honal sheets if necessmy.
" l carry, under penalty of law. th9fhis document and all aftachments were prepared under my di eefion or
supervision in accordance vAh a system designed to assure that all qualified personnel properly gathered and
evaluated the information submMed. eased an my i xp*y of the person or persons who manage the system, on:
e pemns directly responsible for gaffvanng ft information, the irr%rtnabon submMed is, to the best of my
knowWW and berief, true, accta�abe, and compteis. I am aware tW there are significant pensibes for subunttbng
babe iru6aimati indudtng the possity aifines and imprisonmet tfor knomdng violations R
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(Sign of Date (Name Of Signing Ofticda�Pl�e print or type}
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Parameter Cod®assistance shay be by OaWg tie Water QMW L -ad Wmason U1* at (919) 775 -6189 -
The unonthly aver4e for Fecal Cori o m is apa
to be ttted as a GEOMETRIC mean. Use oniv file units desianafed in 1he reraorsna
�iaC�si.V'S riesmitfor ret7orii;tc3�lata
if signed by n4iterttzan no penn=ee, delegation of 5%MOUxys must be on So vft fbe slate per't6A NCAC 25.6M (b)(2)(D -
DENR FORM NDMR 1.1(11=5)

NON -DISCHARGE APPLICATION REPORT Page 3 of
SPRAY IRRIGATION SITE(S)
THERE ARE TWO APPLICATION FIELDS PER PAGE. USE ADDITIONAL PAGES AS NEEDED.
PERMIT NUMBER: W Q Q D O Af 1f _ MONTH: EC R YEAR: —
FACILITY NAME: S T W O'bl-l✓ N co R� — Ij e W 13 C-R N COUNTY: C -RAV r✓ hl
Formulas:
Daily Loading (inches) = [VokM Applied (gal =) x M1336 (orbic feaUgaann) x 12 @mhe&Noot)] / [Area SPrayed (saes) x 43.560 (square feet/acre)) OR
=Volume Applied (gallons) /(Area Sprayed (eaes) x 27,152 (galloWaae=nch))
Mori ft Hourly Loading {metes) = rnwon m ux*u applied overa am hm pewd formai day
Monthly Loading (inches) =Sum of Daily Loadings (iches)
12 Month Roafino Total (inches) = Sum of this momh's Monft Loading (mclws) and Previous 11 momh's Monthly Loadings (orches)
Averaee Week1V Loadino finehesl = lMor&& Loadine (inrheahnomh) / Nnanhe of days in the month fdaysimemnn x 1403 vsiweea,
Did Irrigation Occur AtThis' Facility Did Irrigation Occur On This Field: Did irrigation Occur On This Field:
-- til .r•.. n V. . M No: ❑ Yes: ❑ No:
12 Month Ffoatin9 Total (Inches)
Average Weekly Loading (inches) r b Q
weather Codes: C -clear. PC -partly cloudy, Cl -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): G%*0R F R C L-L-%SCSK Phone. ?52-'a29-"fV2.
ORC Certification Number:' I IfS3 I A{*3 5S Check Box if ORC Has Changed: ❑
Mail ORIGINAL and TWO COPIES to:
DENR,/
Division of Water Quality 1C
ATTN: information Processing Unit (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail SerYice Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
RALEIGH, NC 27699.1617 COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (I 1/2G05)
PERMITTED HOURLY RATE (inches):
.
PERMITTED HOURLY RATE finches):
CONDITIONS
PERMITTED YEARLY RATE hes :
PERMITTED YEARLY RATE inches),
D
Ma)dmum
Maximum
ATemper�w
rWEATHER
Storage
Volume Time Daily
Hourly
Volume Time Daily
Hourly
T
atpradpitaLagooneppgcaeon
A -Irri-.....- Loading
Load[
A lied Irri aced Loading
Loading
eon Free -boa
^lied
:
Fnchns
nations. minutes inches
inches
12 Month Ffoatin9 Total (Inches)
Average Weekly Loading (inches) r b Q
weather Codes: C -clear. PC -partly cloudy, Cl -cloudy, R -rain, Sn-snow, SI -sleet
Spray Irrigation Operator in Responsible Charge (ORC): G%*0R F R C L-L-%SCSK Phone. ?52-'a29-"fV2.
ORC Certification Number:' I IfS3 I A{*3 5S Check Box if ORC Has Changed: ❑
Mail ORIGINAL and TWO COPIES to:
DENR,/
Division of Water Quality 1C
ATTN: information Processing Unit (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
1617 Mail SerYice Center BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE AND
RALEIGH, NC 27699.1617 COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDAR-1 (I 1/2G05)

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