WQ0009098_Monitoring - 08-2016_20161004 (2)

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NON DISCHARGE WASTEWATER MONITORING REPORT
Facility Status:
Please answer the following question:
Compliant (Y,N)
1. Does all monitoring data and sampling frequencies meet permit requirements?
o f e�w
If the facility is non-compliant, please explain in the space below the re on(s) the facility was not in compliance
with its permit. Provide in your explanation the date(s) of the non-compliance and describe the corrective action(s)
taken. Attach additional sheets if necessary.
"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 property 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
fal�nformation, including the possibility of fines and imprisonmenuor knowing violations."
(Sigr(4ture of
(PerrTee-Pl #se print or type) -
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1-C4 a
(Permittee Addres .)
Parameter Codes:
of Signing
I n
(Positlon or Title)
r
one N tuber)
01002 Amork
31604-ColfforrN Total
00800 N , Total
00929 Sodkim
01022 Boron
OOOW conxtuclift
00630 N028NO3
00931 SAR
003106005
01042 Copim
00620 NO3
00745 Sulam
01027 CadrNum
00300 Dissolved oxygen
00669 09 -Grum
70296 TD9
00916 Calcium
31616 Foal CoOtarm
WQ09 PAN Plant Avallabla
00010 T
00940 Chlodda
01061 Land
.00400 pH
00625 TKN
500M Chlorine, Total
Residual
00927 Wwaslum
71,900 marmy
32730 Phwx*
00666 , Tow
00680 TOC
00630 TSS(TSR
01034 Chromium
00610 MUM
00937 Potassium
'00076 TurbkWy
00340 COO
01067 Nkkal
00840 Settleable ARafW
01092 Zinc
or type)
l /,z I I (S '
irqSit Exp. ate)
Parameter Code assistance may be obtained by calling the Water Quality Compliance/Enforcement Unit at [phone] ext. 529.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only the units desianated in the the units in the re��na
facility's permit for reoortina da.
If signed by other than the permittee, delegation of signatory authority must be on file with the state per 13A NCAC 28.0306 (b)(2)(0).
DENR FORM NDMR-1 (512003)