HomeMy WebLinkAboutWQ0029169_Monitoring - 01-2023_20230306FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
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Sampling Person(s) II Certified Laboratories
Nance: Plant Staff II Ncino: Town of Mount Olive Lab
Name: II Name: Environmental Chemists Inc
P(-Tao r1l r7i(,n tPr€r r (ant rt R meet the in Attachment A Cm$ your PerMit? ❑Compliant ❑Non -Compliant
If the facility is non -compliant, please eyplain in the space below the reasons) the facility was not in compliance. Provide in your explanation the datc(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? DYes Elm
Phone Number: 919 658 9539 Permit Expiration: 3/31/2020
ignature ate
Signature _ Date
By this signature, I certify that this report is accurrale and complete to the best of my knowledge,
1 certify, under penally 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 27699-1817