WQ0007026_Monitoring - 09-2016_20161024 (2)

PERMIT NUMBER:
FACILITY NAME:
NON DISCHARGE WASTEWATER MONITORING REPORT Page 't of
W00007026
Sanford Health & Rehabilitation
MONTH: September YEAR:
COUNTY:
Onia
Lee
Flow Monitorin Point:
Effluent:
[21
Influent:
❑
::
Parameter Monitoring Point:
Effluent:
Influent:
❑
Isurface Water (SW): ❑
SW Code/Name:
Was There Effluent Flow For This Month Generated At This Facility:
Yes:
L/j
No:
50050
00400
50060
00310
1 00610
00530 1
31616
00625
00620 665
D
A
T
E
Operator
Arrival
Time Operator ORC
2400 Time On on
Clock Site Site?
Daily Rate
Flow into
(Flow)
Treatment
System
pH
Residual
Chlorine
BOD -5
20°C
NH3-N
TSS
Fecal
Coliform
(Geo -metric
Mean*)
TKN
Total
Total NO3 Phosph
as N orous
HRS Y/N
GALLONS
UNITS
UG/L
MG/L
MG/L
MG/L
/100ML
MG/L
MG/L MG/L
1
8511
2
8511
3
8511
a
1
8511
5
8511
6
9:15 0.58 Y
8511
675
0.34
7
10748
8
10748
9
10748
101
10748
11
10748
12
8:50 0.42 Y
10748
6.72
0.26
13
8:15 2 Y
9678
9.2
3.3
<25
290
6.1
1.1 3.2
14
9678
15
9678
161
9678
17
9678
18
9678
.�
19
9:05 0.42 Y
9678
6.76
1 0.24
0
�o
20
10352
(-
21
10352
221
10352
231
10352
24
8:30 0.42 Y
10352
6.81
0.29
251
1
10457
26
10457
27
10457
2
2s
10457
29
10457
30
10457
31
NA
Average
9926.733
0.283
9.2
3.3
290
6.1
1.1 3.2
Daily Maximum
10748
675
0.34
9.2
3.3
0
290
6.1
1.1 3.2
Daily Minimum
8511
6.72
0.24
9.2
3.3
0
290
6.1
1.1 3.2
Monthly Limit(s)
15720 gpd
NA
NA
NA
NA
NA
NA
NA
NA NA
Composite (C) / Grab (G)
IG
G
G
IG
G
G
G
G IG
Operator in Responsible Charge (ORC):
Check Box if ORC Has Changed:
C
Randall Jarrell Grade: IV/ SI Phone: [phone]
ORC Certification Number: 7937/23925
Certified Laboratories (1): Wastewater Management, L.L.C. (2):
Person(s) Collecting Samples: Randall Jarrell
Mail ORIGINAL and TWO COPIES to:
ATTN: Non -Discharge Compliance Unit
DENR
Division of Water Quality
1617 Mail Service Center
RALEIGH, NC 27699-1617
ENCO
/ L' /J- j (
(SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
BY THIS SIGNATURE, I CERTIFY THAT THIS REPORT IS ACCURATE
AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
DENR FORM NDMR-1 (5/2003)

NON DISCHARGE WASTEWATER MONITORING REPORT
Facility Status:
Please answer the following question:
1. Does all monitoring data and sampling frequencies meet permit requirements?
Page -2—
Comp�liaantt((Y,N)
L�J
If the facility is non-compliant, please explain in the space below the reason(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 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."
(Signature of Permittee)* Date
Sanford Health & Rehabilitation
(Permittee -Please print or type)
2702 Farrell Road
Sanford, N.C. 27330
(Permittee Address)
Parameter Codes:
Randall Jarrell
(Name of Signing Official -Please print or type)
ORC
(Position or Title)
919-210-2500
(Phone Number)
01002 Arsenic
31504 Coliform, Total
00600 Nitrogen, Total
00929 Sodium
01022 Boron
00094 Conductivity
00630 NO2&NO3
00931 SAR
00310 BOD5
01042 Copper
00620 NO3
00745 Sulfide
01027 Cadmium
00300 Dissolved Oxygen
00556 Oil -Grease
70295 TDS
00916 Calcium
31616 Fecal Coliform
WQ09 PAN (Plant Available)
00010 Temperature
00940 Chloride
01051 Lead
00400 pH
00625 TKN
50060 Chlorine, Total
Residual 1
00927 Magnesium
71900 Mercury
32730 Phenols
00665 Phosphorus, Total
00680 TOC
00530 TSSrrSR
01034 Chromium
00610 NH3asN
00937 Potassium
00076 Turbidity
00340 COD
01067 Nickel
00545 Settleable Matter
01092 Zinc
5/31/2015
(Permit Exp. Date)
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 designated in the reporting
facility's permit for reporting data.
* If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b)(2)(D).
DENR FORM NDMR-1 (5/2003)