WQ0029653_Monitoring - 08-2016_20161004 (2)

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: •00 •.
•August
1 11 SIR
Flow Measuring Point: El Influent [] Effluent No flow generated
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s) Certified Laboratories
Name: Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑Compliant ❑ 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: RICK HARRELL
Permittee: SOTCH HALL PRESERVE WWTP
Certification No.: S1986118
signing Official: MARK DONACHIE
Grade: Phone Number: 252-724-1663
;Signin icial's Tit GENERAL MANAGER
Has the ORC changed since the previous NDMR? E]Yes E]No
hone Number: 252- - Permit Expiration: 2/26/2020
- – — / 9/22/2016
9/22/2016
Signature Date
Signature Date
By this signature I certify that this rep/s accurrate and complete to the best of my knowledge.
By this signature/ertify that this
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