WQ0004910_Monitoring - 08-2016_20160906 (2)

FORM: NDMR03-12 NON -DISCHARGE MONITORING REPORT (NDMR) "ge_j 01 �.
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Permit No.: W Q OC)oq i) 1C)
Facility Name: •� wn �� 1
County: 1U�rA Cun
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Month:
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Year:
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PPI:
Flow Measuring Point: ❑ Influent J2rEfflUent ❑ No flow generated
Parameter Monitoring Point:/�
❑ influent
'Effluent
El Groundwater Lowering
El Surface Water C*
Parameter Code — P
50050
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703,00
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Average:
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7, (m 2—
Daily Maximum:
/ e oo
0.6(0
, 73
Daily Minimum: 5 0 e u
Sampling Type: t?,CiO: c�Gf
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Monthly Avg. Limit: ,{fit
Daily Limit:
Sample Frequency: ;�,.�
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FORM: NDMR 03-12
Sampling Person(s)
Name:%b % -&
Name:9_4 L-WTOYI
NON -DISCHARGE MONITORING REPORT (NDMR)
Certified Laboratories
Name: P/1uS+'_n INT,
Name:
r
Page r! of 2•
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ompliant ❑ Non-Cornpllam
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
Certification
ORC:1A.J6er�J_' C.... �L� �
\Permittee
Permittee; bi,"
Certification No.: 9Q&V)sy95%)59s7
Signing Official:
-2— 587 --7,,, )
Grade: Phone Number: 2_5
Signing Official's Title:
Has the ORC changed since the previous NDMR? ❑ Yes o—
Phone Number: J ! Permit Expiration:
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 Resources
Information Processing Unit
1617 Mail Service Center
0