WQ0034715_Monitoring - 01-2023_20230228

Monitoring Report Submittal
Permit Number#* WQ0034715
Name of Facility:* Concert 12 Oaks,LLC
Month: * January Year: * 2023
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR january complete 2023.pdf 1.85MB
PDF Only
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: * John Parrish
Signature:
Date of submittal: 2/28/2023
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* W00034715
Is the monitoring report accepted?* Yes NO
Regional Office* Raleigh
Reviewer: _anonymous
Review Date: 3/10/2023

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s)
C
Name:
Name:
Certified Laboratories
Name: 11 Name:
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❑ Non -compliant
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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.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: u �, y� FG.. t` 1^+ S �•-�
Permittee: LLC
Certification No.:
Signing Official: soft w
Grade: Phone Number: `Z 1 9 - L) Z, Z - 3 (, (0
Signing Official's Title:
Has the ORC changed since the previous NDMR? Yes [;�N°
Phone Number: ic7 - L1 Z-Z-- 9-66S Permit Expiration: " 3 (- 7-o
r
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 far submitting false information, including the possibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information P—cessing Unit
1617 Mail, Ice Center
Raleigh, North Carolina 27699-1617

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