WQ0002052_Monitoring - 11-2016_20161219 (2)

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page L... of.-
County:
Rutherford -FM
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Month:
November
Year: 2016
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FORM: NDMR 03-12
1
NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) 11 Certified Laboratories
Name: Barbara J. Warlick Name: Water Tech Labs #50
Name: Name: Research & Analytical Laboratories, Inc #34
Page -P of a
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? OCompliant ❑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
taKen. Httacn aaanional sneets It necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael D. Fortenberry
Permittee: Milliken and Company -Golden Valley Plant
Certification No.: 27004
Signing Official: Mike Tutterow
Grade: SI Phone Number:,,. 828-247-4300
Signing Officials Title: Plant Leader
Has the ORC changed since the previous NDMR? ❑Yes RIM
Phone Number: 828-247-4305 Permit Expiration: 3/31/2017
Signatur Date
Signature Date
By this signature, I certify the is 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617