WQ0003090_Monitoring - 09-2016_20161012 (3)

FORM: NDMR 07-13- - - . .. ._ .._ •„ :' ,, : -' Pe
NON=DISCHARGE MONITORING -REPORT (NDMR) ge 1_of_1_
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Flow Measuring Point: Rknfluent [Iffluent Elm flow generated
-;,"rameter Monitoring Point: Drifluent Dffluent EIGroundwater LowerIng Elsurface water
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FORM: NDMR-07-13
NON -DISCHARGE MONITORING REPORT.(NPMR)
Sampling Pars n(s) .,.,:Certlfled.Laboratories,
Niame, Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Aftachm6ht A of Vdur permit! Mompliant aon-CDmPI lant 1
If thp facility is non-compliant, please eXplain In the space below the reason(g) the facility was not In complianbe. 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: Efix Tremaine'Fike -
Permittee: -Roy Lynch
Cortiflebtion No.: 989290
Signing Official"
Grade:' ---SI Phone Number:' 336z622-2990
-Signing Officla0s Title:- - Town Manger' -
Has the', ORC changed since the previous NDMR? Elyes Die-
Phone Number: ----336-622-4276'- Permit Expiration: - 4/30/2019 -
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
acdordanre With a system designed to assure that -all qualified personnel propfly gathered and evaluated the Information ,
submitted. Based an 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, — and complete. I am
.Imprisonment
aware that there are allgrillicaiit-pinaltes for submitting false Including the possibilitytrue,
fines Impfisonme'ri-t-f-or
-knowing violations.
T
Mail Original and Two -Copies to:
Division of Water'Re"urces
Information -Processing Unit
J.
1617 Mail Service -Center
Raleigh, NorthCarolina27699-1617