WQ0038171_Monitoring - 09-2020_20201012

Monitoring Report Submittal
...........................................................................................................................................
Permit Number #* WQ0038171
Name of Facility:* Rudy Broschinski
Month:* September
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2020
Upload Document*
Sept NDMR.pdf 1.24MB
FDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-t, NDAR-2, NDMLR, GW-59).
[e-mail]
Rudy Broschinski
Reviewer: Williams, Kendall
10/6/2020
This will be filled in automatically

Is the project number correct? * WQ0038171
Is the monitoring report r Yes r No
accepted?*
Regional Office * Winston-Salem
Accepted Date: 10/12/2020

FORM NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: WQ0038171
Facility Name: Town of Boone Jimmy Smith W\NTP
County: Wa tauga
Month: September
11
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: WQ0038171
Facility Name: Town of Boone Jimmy Smith WWTP
County: Watauga
Month: September
Year: 2020
PPI: 002
Flow Measuring Point: ❑Influent ❑' Effluent ❑No
flow generated
Parameter Monitoring Point: ❑Influent MEffluent ❑Groundwater Lowering ❑5urface water
Parameter Code —o-
WQ01
0
U ~
0
c
~
O
7
CD03
U 03
a:O
24-hr
hrs
Gallons
1
2
3
4
5
6
7
8
No Discharge this Month
9
10
f
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Average:
#DIV/O!
OAO
Daily Maximum:
0
000
Daily Minimum:
0
000
Sampling Type:
Estimate
Monthly Limit:
Daily Limit:
Sample Frequency:
I Monthly

FORM; NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name:
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, 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
Permittee Certification
ORC: Rudy Broschinski
of Boone
Certification No.: 24084
Rudy Broschinski
Grade: 4 Phone Number: 828-268-6271
LteTown
Title: ORC
Has the ORC changed since the previous NDMR? ❑Yes QNo
828-268-6271 Permit Expiration: 7/31/2021
illtL tj
-a /2
WO (p
6
Signature DateSignature
ate
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