WQ0000488_Monitoring - 11-2016_20161207 (2)

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page l of
Perflift No.: WQ0000488
Fad ifily Name:
Jordan Lake SRA - Vista Point
County:
Chatham
Month: November
Flow Measuring Point:
Influent Effluent No flow generated
Parameter Monitoring Point:
Ej Influent
[2] Effluent E] Groundwater Lowering El Surface water

FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) Certified Laboratories
Name: Craig Autry Jr Name: RNA Labs
Name: William Baker Name:
Page
Z of z
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
OULIU1 IkZ) LOA011. l LLL J1 PUUMU1101 01 1061) 11
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Craig Autry Jr
Permittee: Jordan Lake SRA
Certification No.: 991564
Signing Official: Shederick Mole
Grade: SI Phone Number: 919-218-6410
Signing Officials Title: Park Superintendent IV
Has the ORC changed since the previous NDMR? ❑ Yes Q No
Pho a Num er: 919-362-0586 Permit Expiration: 10/31/2020
1 Z
S' nature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
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 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617