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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of _
Sampling Person(s) Certified Laboratories
Name: Charles Parker Name: Par Lab
Name: 11 Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Aompliant ❑NomComptianc
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: Lee Pennington
Permittee: Al Abedi
Certification No.: 987583, 987903
Signing Official: Al Abedi
Grade: 2 Phone Number: 704-8742754
Signing Official's Title: Vice President
Has the ORC changed since the previous NDMR? Elves EINo
Phone Number: 704865-1201 Permit Expiration: March 31,2020
ignature Date
Signature 4 *De4(0
By this signature. I certify that this report Is acGmate and complete to gra best of my knowledge.
I certify, under penalty of law, that this document and all attachments were prepared under my direction or suIm"slon In
accordance with a system designed to assure that all qualified personnel property 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
gagrertng the aHormalbn, the Information submmed is, to the best of my knowledge and befief, true, accurate, and complete. I am
aware that there are signflcant panalties for submitting false Information. Including the possibility of fines and Imprisonment for
ImaMng violations.
Mall Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mall Service Center
Raleigh, North Carolina 27699-1617