WQ0022228_Monitoring - 10-2016_20161128

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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR)
Permit No.: WQ0022228 Facility Name: town of Farmville Reclaim Water Generation & Distributio County: Pitt Month: October Year: 2016
Flow Measuring Influent Effluen Parameter MonitoringInfluen Effluent Groundwater Lowering Surface
PPI: Point: 1:1ID t ❑X No flow generated Point: 11 t � � � Water
Parameter Code 50050 00400 50060 00310 00610 00530 31616 00076 00545 1 00630 00680 70295
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IFORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of 2 .�
Sampling Person(s) Certified Laboratories
Name: James Shoulders Name: Environment One Laboratories
Name: Name:
)oes all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? I A Compliant F-1 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 sheet if necessary
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: James Shoulders
Permittee: Town Of Farmville
Certification No.: 986266
Signing Official: Gary Stainback
Grade: 4 Phone Number: 252-753-3913
Signing Official's Title Consultant
Has the ORC changed since the previous NDMR? Yes X
Phone Number: 800-72 - 69 Permit Expiration: 06/28/2013
b/44
Signature Date
Sig ture Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge,
I certify, Lind rally 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617