WQ0003090_Monitoring - 08-2016_20160908 (2)

FORM: NDMR 07-13 (NON -DISCHARGE. MONITORINGREPORT (NDMR) ' .Page 1_bV-1_
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Flow Measuring Point:
Onfluent Duflue4 ONo flow generated
Parameter Monitoring Point: Dnfiuent
afnuent EIGroundwaber Lowering D3urface water
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FORM: NDMR 07-13
:NON -DISCHARGE' MONITORING -REPORT (NDMR)
i 'Operator in Responsible Charge (ORC) Certification
Permittee Certification -
ORC: ; -Eliz Tremaine Fike -
P®rmittee Roy 'Lynch
Certification No.: 989290 -
Signing Official: -
Grade:, SI Phone Number 336-622-2990
Signing Officlafs Title: Town Manger',
Has the ORC changed since the previous NDMR7 ' Elyes Deo
Phone Number. 336-622-4276. Permit Expiration: 4/30/2019 i
,
,.. Signature Date t
_. 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 rrmy Inquiry of fhe person or persona who manage the system, or those persons directly "responsible for
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gathering the Information, the Infomtatlon submitted Is, to the best of my knowledge and belief; true, accurate; end complete. I em
.....,_ . _-._ .. _
aware that there are significant penalties for subrhittlnQ (alae infonnetion, Including the possibility of fines and Imprisonment for
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knowing violations.
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Mail Original and Two Copies to:._:.._
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Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617