WQ0038171_Monitoring - 02-2021_20210305

Monitoring Report Submittal
...........................................................................................................................................
Permit Number #* WQ0038171
Name of Facility:*
Month:* February
Report Information
Town of Boone WWTP
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter:*
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
februaryndmr2021.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
3/5/2021
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: 3/5/2021

FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: W Q0038171
Facility Name: Town of Boone Jimmy Smith WWTP
County: Watauga
Month: February
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FORM' NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: Qil38171 Facility Name: Town of Boone Jimmy Smith WWTP
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FORM, NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Persons) 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 betow the reason(s) the facility was not in compliance Provide In your explanation the dates) of [he non-compliance and describe the corrective
actlonls} taken Attarh arfrh innal choat� if naraccnn,
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 UNo Phone Number:. 828-268-6271 Permit Expiration: 7/31/2021
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Signature ate Signature Date
By this signature. I cerlify that [his report Is accurrate and complete to the hesl 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 voiahons
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617