WQ0021734_Monitoring - 09-2016_20161027

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page I of _9__
Permit No.: WQ0021734
Facility Name: Franklin Water Treatment Plant
Cou nty: Mecklenburg
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FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Month: September Year: 2016
❑✓ Effluent ❑ Groundwater Lowering ❑ Surface Water
Page f_� of —3

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _�_ of
Sampling Person(s) 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 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
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: �NF� C\ oU �IZ�
Permittee:
,`�orNoC5_
Certification No.: 1,000-1 Lk'5
Signing Official:
Grade: Phone Number: Id`I \�—a`'1alX
Signing Official's Title:
Has the ORC changed since the previous NDMR? ❑ yes (0No
Phone Number: Permit Expiration:
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Signature Date
Date
sign 451.
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.y,
under penalty of law, that this document and all attachments were prepared under my direction or supervision in
,d.rvrit hh 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617