HomeMy WebLinkAboutWQ0038171_Monitoring - 05-2020_20200604FORM: NDMR 05-15 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: WQ0038171 Facility Name: Town of Boone Jimmy Smith WWTP County: Watauga Month: May Year: 2020
PPI: 001 Flow Measuring Point: ❑Influent ❑FffEuent ❑No Flow generated Parameter Monitoring Point: ❑Influent QEffluent ❑Groundwater Lowering ❑Surface Water
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Sampling Type;
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page
01138171 Facility Name: Town of :.• ..
INN.
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) 11 Certified Laboratories
Name: 11 Name:
Name:
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑compliant ❑neon-Cornphant
If the facility is non-compfiant, 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
Perm ittee 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 Qlvu
Phone Number: 828-268-6271 Permit Expiration: 7/31/2021
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Signature V Date
Signature Date
By this sgnature, I certify that this renori 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 (hat 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 A 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 tmprisonmenl 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