WQ0017824_Monitoring - 09-2016_20161028 (2)

FORM: NDMR08-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page _1_of_5_
_ToiMiddle
Flow Measuring Point: n influent ■ Effluent ■,
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Daily Minimum:
Type:Daily
Sampling
Monthly
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FORM: NDMR 08-11 NON -DISCHARGE MONITORING REPORT (NDMR) '
Sampling Person(s) 11 Certified Laboratories
Fred R. Thomen JIName: Cameron Testing Services
Allen Kerns JIName:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
ECompliant ❑ Non -Complaint
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: Fred Thomen
Permittee: Randolph County Board of Education
Certification No.: 986613
Signing Official: Larry T. Chilton
Grade: Spray Irrigation Phone Number: 3366-215-8494
Signing Official's Title: Director of Facilities and Maintenance
Has the ORC changed since the previous NDMR? El Yes o/
Phone Number: 336-215-3835 Permit Expiration: 3/1/2020
Signature Date
Signature Date
By this signature, I certify that this report Is accurrate and complete to the best of my knowledge.
I ceAlly, 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 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