WQ0007217_Monitoring - 09-2016_20161021

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of 2
Permit No.: QO 00
.
Flow Measuring Point:
21, influent E] Effluent
No Flow Generated
Parameter Monitoring Point:
na Influent Ej Effluent Groundwater Lowering E] No Flow Generated
Sampling
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR)Page 2 of 2
Sampling Person(s) Certified Laboratories
Name: J. Clayton Name: MCAS, Cherry Point, NC 28533
Name:
Name:
.all monitoring data and sampling frequencies ,meet the requirements in Attachment A of your permit? ' [2]Compliant Ej Non -Compliant
t
ie facility is non-compliant; please explain in the space below the reason(s) the facility was not in compliance- Provide in your explanation the dates) of the non-compliance and describe the corrective
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Jeffrey Clayton
Permittee: U.S. Marine Corps 'Air Station -Cherry Point.
Certification No.::. 998515
Signing Official: George W. Radford
Grade: SI Phone Number: 252-466-5874 :.
Signing Official's Title: By. direction of. the Commanding Officer
Has the ORC changed since the previous NDMR?' [] yes F±] No
Phone Number: 252-466-4599 Permit Expiration: 4/30/2016
10/14/2016
Signature Date
Signat a 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, at this dumen and all attachments were prepared under my direction or supervision in
accordance with a system designed to ass at 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 Quality
Information Processing Unit:
1617 Mail Service Center
Raleigh,.North Carolina 27699-1.6:17