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Home My WebLink AboutWQ0022224_Monitoring - 12-2021_20220331Monitoring Report Submittal ........ ......... ......... ......... ......... Permit Number #* WQ0022224 Name of Facility:* Sam's Branch WRF Month: * December Year: * 2021 Report Information Type* Upload Document* Revised - NDMR, NDAR-1, NDAR-2, December 2021.pdf 204.57KB NDMLR PDF Only Please upload one PDF containing all applicable monitoring reports (i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59). Confirmation Email Address:* wsimpson@townofclaytonnc.org Name of Submitter: * William R Simpson Signature: Date of submittal: 3/31/2022 This will be filled in automatically Initial Review Reviewer: Gerald, Wanda Is the project number correct?* WQ0022224 Is the monitoring report accepted?* Yes No Regional Office* Raleigh Accepted Date: 4/18/2022 FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1 of 3 Permit No.: loll •unty: Johnston Month:December1 11Flow Measuring•. ■ Influent e Effluent e No flow generated Parameter Monitoring•. DInfluent EjEffluent ■ Groundwater Lowering ■ Surface Water FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of 3 Permit No.: loll •unty: Johnston Month:December1 11Flow Measuring•. ■ Influent e Effluent e No flow generated Parameter Monitoring•. DInfluent EjEffluent ■ Groundwater Lowering ■ Surface Water • m�� m�� FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 3 of 3 Sampling Person(s) Certified Laboratories Name: David Atkinson,Salvador Valdiviezo,Chad Wallace, 11 Name: Environment 1 Inc., Town of Clayton, Cameron Labs Name: Mattie Frazier, Stefania Maroquin Name: Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? El Compliant El 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: William R Simpson Permittee: Town of Clayton Certification No.: 1001099 Signing Official: William R Simpson Grade: WW4 Phone Number: 919-553-1536 Signing Official's Title: Water Reclamation Superintendent Has the ORC changed since the previous NDMR? El Yes ❑� No Phone Number: 919-553-1536 Permit Expiration: Oct. 31, 2026 � Digitally signed by William Simpson William Simpson DN: cn-William Simpson, o-Town of Clayton, ou-Water Resources, email-wsimpson@townofclaytonnc.org, c-US . . � Digitally signed by William Simpson DN: cn-William Simpson, o=Town of Clayton, ou=Water Resources, W I i a m S i m p s on email wsim3 c—US Date: 2022.03.31 17:16:56-04'00' Date:31n@tow 22f 040onnc.org, Signature Date Signature Date 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