NC0081825_Lab Data_20111122

EFFLUENT~
NPDES PERMIT NO. NC0081825 DISCHARGE NO 001 MONTH October EAR 2011
FACILITY NAME TOWN OF ANSONVILLE VVVVTP CLASS II COUNTY ANSON
OPERATOR IN RESPONSIBLE CHARGE (ORC) WILLIAM WADDELL III GRAD! II
CERTIFIED LABORATORIES (1) PACE ANALYTICAL SERVICES -2
CHECK BOX IF ORC HAS CHANGED
Mail ORIGINAL and ONE COI4Y t' : `v
ATTN: CENTRAL FILES
r i/ I �. ANT
V. OF ENVIRONM 4�fAt MaA
DEHNR
1617 Mail Service.Center
RALEIGH, NC 27699-1617
PERSONS COLLECTING SAMPLES DIANNA MCLAUGHLIN
x
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE) DATE
BY THIS SIGNITURE, I CERTIFY THAT THE REPORT IS
ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE
1\1OV 1 g 2011
,t 2011
= Operator Arrival
cn Time: 2400 Clock
Operator Time On
cn
z Z ORC On Site?*
50050
00010
00400
I 50060
00310
00530
101032
31616
1097
00300
00340
00056 100655 100600
FLOW
TEMPERATURE
CELSUS
a
CHLORINE RESIDUAL
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TOTAL SUSPENDED
RESIDUE
c
N
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(GEOMETRIC MEAN)
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DEM Form MR -I (12/93)

Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
All monitoring data and sampling frequencies do NOT meet permit requirements
xx
Compliant
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation,
maintenance, etc., and a time table for improvements to be made.
"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 qualified personnel properly gather and evaluate
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 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 violatons."
PO Box 437 Ansonville NC 28007
Walter Edwards, "ayor
Date
704-826-8404
Permittee Address
Phone Number
Permit Exp. Date
PARAMETER CODES
Page 1