WQ0029169_Monitoring - 11-2020_20210111

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1 of_�___
Permit No.: •11 • .• ■
Facility Name: Town of MountOlive ReclamationWayne
Month: November1
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) 11 Certified Laboratories
Name: Plant Staff Name: Town of Mount Olive Lab
Name: Name: Environmental Chemists Inc
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? OCompliant ONon•Compllant
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
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Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Glenn Holland Permittee: Town of Mount Olive
Certification No.: 27255 Signing Official: Jammie Royall
Grade: Si Phone Number: 919 658 6538 Signing Official's Title: Town Manager
Has the ORC changed since the previous NDMR? OYes 121No Phone Number: 919 658 9539 Permit Expiration: 3/31/2020
Signature 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617