WQ0000948_Monitoring - 08-2016_20161004 (2)

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page / of
Permit No.c WQ000094$ p Facility Name: TOWN OF JACKSON _ _ County: Nordlamptoll Nlonth_� Year:
PPL' Flow Measuring Point: ❑ innuent 61 Efnuent ❑ w flow generated Parameter Monitoring Point: ❑ Influent ❑Q Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code —!>
. 50050
00310
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Daily Maximum:
Daily Minimum:
,Recorders
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Sampling Type:
Monthly Limit:
, 203,000
Daily Limit
Sample Frequency:
Contirnious
Monthly
Munthly
Monthly
Monthly:
Monthly
17X 1 Disclt.
1�DlzchMonthly
3 >( Year
3 X Year.

-jFORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1 of 1
t Sampling Person(s) Certified Laboratories
Name:Johnny G. Young Name: 'Environment 1, Inc. Greenville, N C
Name: Name:
r% w.. ..11 A-4— -"A frnnnnne+ine mnn4 Oho roetidrmmaknfe in Af nit-hmanf ® of vnur nprmi+? 4911colDliant ❑ Non-compliant
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: Johnny G. Young
Permittee: Town of Jackson
Certification No.: 23129
Signing Official: Jason S. Morris
Grade: 1 Collection Phone Number: 252-534-3811
Signing Official's Title: Mayor
Has the ORC changed since the previous NDMR? ❑Yes No
Phone Number: 252-534-3811 Permit Expiration: 12-31-16
nature Date
Signature Date
By s signature, I certify hal this repo urrate and complete to the best of my knowledge.
I 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 quaGged 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 27699-1617