WQ0038171_Monitoring - 03-2020_20200331

FORM: !NDMR 05-16
NON -DISCHARGE MONITORING REPORT (NDMR)
Page � of 3
Permit No.: W00038171 Facility Name: Town of Boone Jimmy Smith WWTP County: Watauga Month: March Year: 2020
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page Z of S
Permit No.: WQ0038171 Facility Name: Town of Boone Jimmy Smith WWTP County: Watauga Month: March
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s)
Name:
Name
Name:
Name:
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
❑Compliant ❑Non -Compliant
If the facility is non -compliant, ptease explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s.)_of the nm-complian4"and describe the corrective
artinnrsl taken Attach additional sheets if necessarv,
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Rudy Broschinski Permittee: Town of Boone
Certification No.: 24084 Signing Official: Rudy Broschinski
Grade: 4 Phone Number: 828-268-6271 Signing Official's Title: ORC
Has the ORC changed since the previous NDMR? ❑Yes EINo Phone Number: 828-268-6271 Permit Expiration: 7/31 /2021
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Signature Date J Signature ate
By this signature, 4 certify [hat this report is accurrate and complete to the best of my knowledge I certify, under penatty 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 responsUe Tor
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 vtolattorts.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617