WQ0022224_Monitoring - 11-2020_20210105 (2)

FORM NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page i of 5
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FORM: NDMR 05-16 NON -DISCHARGE MONITORING REPORT (NDMR) Page_ of
Sampling Persons) Certified Laboratories
Name: Bill Simpson, Salvador Valdiviezo, David Atkinson Name: Environment 1, Cameron Labs, Town of Clayton
Name: Chad Wallace, James Warren Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 12kompliant am -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 sheets if necessary.
Flow for October 2020
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: James Warren
Permittee: Town of Clayton
Certification No.: WW4- 7149
Signing Official: James Warren
Grade: W W-4 Phone Number: 919-553-1536
Signing Official's Title: Wastewater Operations Superintendent
Has the ORC changed since the previous NDMR? Des a.
Phone Number: 919-553-1536 Permit Expiration: Oct. 31,2026
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By this signature, I certify that this repod is accurrate and complete to the best of my knowledge
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
subm rted. Based on my inquiry of She 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
m 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