WQ0022224_Monitoring - 09-2022_20221128

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * September
Report Information
wg0022224
Sam's Branch WRF
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Year:* 2022
Upload Document*
September.pdf
PDF Only
2.67M B
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter: * William Simpson
Signature:
Date of submittal: 11/28/2022
This will be filled in automatically
Initial Review
Reviewer: Gerald, Wanda

Is the project number correct?* wg0022224
Is the monitoring report accepted?* Yes No
Regional Office* Raleigh
Reviewer: _anonymous
Review Date: 11/28/2022

NON-DISCHARGEs •-REPORT°
;1ermit No.: WQ0022224 Facility Name: Sam's Branch WRF County: Johnston, 11 Month: September
Flow Meas uring Point: influent 7, Effluent I — 1 No flow ciener.,
tell e.114METZ tfaa RETAIME
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page __I_Z_ of
Sampling Person(s) Certified Laboratories
Name: Cand Wallace, Salvador Valdiviezo, Mattie Frazier, Name: Environment 1 Inc., Cameron Testing Services, Meritech Labs
Name: Michael Ratley, Illona Williams, William Simpson Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? E compliant El 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 sheets if necessary.
Sam's BranchWascompliant for All Days Of Dischargeing Reclaim Water. Reclaim Discharges occurred the Following Days in September,1-2. 5-7, 12. 21-23. and 26-27. All other days were zero discharge.
I I
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: William Simpson Permittee: Town of Clayton
Certification No.: 1001099 Signing Official: William Simpson
Grade: 4 Phone Number: 919-553-1536 Signing Official's Title: Water Reclamation Superintendent
Has the ORC changed since the previous NDMR? Yes � Iva Phone Number: 919-553-1536 Permit Expiration: 10/31/2026
Z_Z
C
Signature Date Signature Date
By this signature. I certify that this report is accurrate and complete to the best of my knowledge. 1 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