WQ0012696_Monitoring - 09-2016_20161013 (2)

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Certified Laboratories
rage — VI
Barrie: frequencies meet the, requirements in Attachment A of.your Permit? Pe-�pliant [I Non -Compliant . '
Does all monitoring data and sampling r explanation the date(s) of the non-compiiance and describe the corrective
non-compliant, please explain in the space below the reason($) tile facility was not in compliance. Provide in you
if the facility is action(s) taken. nota sheets if necessary.
Operator in Responsible Charge (ORO) Certification
ORC,
Certification No.:
Grade: 1 Phone Number,
Has the ORC changed since the previous ND R? El YC5 -
Permittee Certification
lico -Y
Parmitteo: Al PA -Yin k"ver r—er'
Signing Official: h. erg I)OIloviel)
signing Official'sTitle, 1�0"VAI-er
Phone Number: 2 g2_ qh4 PerniltExpiratiOn:
&- o -/I
Date
Signature
signature
Date
or w r
ce der -a
I carlify, under penalty Of law, that this document and al attachments were prepayed under my direction $up lziO in
assure that all qualified Personnel properly q8thara-I and evatoated 410 InfOrmatiOn
By this signature, I cartily that this report is accurrate and complete to the best of nmTj iedge,
accordance with a system designed to ass
"c's 44'
submitted. Based 100 MY inquiry of person or person9whO manage the system, or those persons d1rectiYMPOnSible for
e end ca
rra
gathering M
the Information, the Information submitted is, to file best of my knowledge and bellef, true, accurst mPlete' 1 a
that , Inciusfing the possibility of fines and iinialsOoment for
awarere � the a. ng false information
aware thst there are significant penalties for submitti knowing violations.
mail Original and Two C013103 to*
DIVIsion of Water Resources
information processing Unit
1617 Mail Service Center