WQ0034201_Monitoring - 08-2016_20161004 (2)

FORM; NDMR 03-12

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDIVIR)
Sampling Person(s) II Certified Laboratories
Name: Lynn Aldridge Name: Statesville Analytical Cert ## 440
Name: 11
fdaine: Rowan Wastewater Management Cert. # 5621
Page Z of Z
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? C1 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
I. action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
ORC: Lynn Aldridge
CertificationVo.: SI 993778 WW 993294
Grade: 2
Phone Number:
Has the ORC changed since the previous NDMR?
Permittee Certification
Permittee: Cruse Meat Processing
Signing official: Lynn Aldridge
704-431-5266 Signing Official's Title: Owner, Rowan Wastewater Management
❑ Yes E) No
--- Signature Date
By this signature, 1 certify that this report Is accurrate and complete to the best of _my knowledge.
Phone Number: 704-431-5266 Permit Expiration: 12/31/2016
/ Signature Date
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 property gathered and evaluated the information
submitted. Based on my ingWry of the parson 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617