WQ0012696_Monitoring - 08-2016_20160913 (2)

FURM:, 9R 03-12 NON -DISCHARGE MO. 3RING REPORT (NDMR) Page _ ,of
Permit No.: WQ0012696
Facility Name:
Pamlico River Ferry Terminal
county:
Beaufort
Month:
Year: D/
PPI: 001 Flow Measuring Point: ❑ Influent E Effluent ❑ No flow generated
Parameter Monitoring Point:
i] Influent
i] Effluent ❑ Gro ndwater Lowering
❑ Surface Water
Parameter Code --► = 50051) -
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Sample Frequency:j,,L'j_ I y,7
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FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
rage of
;_... - Sampling Person(s) -. ..;.. .._......Certified Laboratories
Name: Name:.
Name: Name: .
r,h-- wll m^n6 fhn'rnnuirnrr%nn4c_in Affnr-hmonf A of wnrrr n#%rft iii?- z Conibllant• - ❑ Non-compliant' '
:he 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_desa_ribe the corrective
actinn(Q1 taken. Attach additional sheets if necessary.
Operator in -Responsible Charge (ORC) Certification
Permittee Certification
ORC: l� f�Y ymt r✓
Permittee: A/CPO 1PO4 f� CO ell A ray ..
Certification No.:
Signing Official: _ 4rl y #0110W eft _.
Grade: Phone Number: ZS2 9 bIf-� 49�z (
Signing Official's Tltle:
Has the ORC changed since the previous NDMR? ❑ Yes M48
Phone Number: a�2. 9bL��J�$�z l 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 Inquiryof 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 tin -it.,
1617 Mail Service Center
Raleigh, North Carolina 27699-1617