WQ0008489_Monitoring - 09-2016_20161028 (2)

FORM: NDMR 03-12
Sampling Person(s)
Name: TOM &CASLE Y 806BY FOX
Name: 'TOSEPH P. SADLER
NON -DISCHARGE MONITORING REPORT (NDMR)
Certified Laboratories
Name:
Name: FNp)CON mENT = INC
Page_I of I -
Does all monitoring data and sampling frequencies meet the requirements In Attachment A of your permit? Ocompsmt ijodrFcompla rc
If the facility is non-compliant, please explain In the space below the reason(s) the facility was not in compliance. Provide In your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets If necessary.
T{4IS
FA�ILti�
wRs NoN-ComPUPIJT 13KAuilW .
-ROPKAL STGiP% 41FR►AtN11:7 fsoaaccjo 20.1 1
Raw FOR
mogTt+ of SEPTEMBER 2016
operator In Responsible Charge (ORC) Certification Permittee Certification
oltc: 'Ta6EPN F, SADLt?R
Permittee: COUNTY OF .IfVDE PINEY WOODS WW TP
Certification No.: W W I S S 1q Signing Official: JOSEPIi F• SADLER
SC IS1650
Grade: 01 Phone Number. G„$�) q2(a- 222 U Signingoeicial'snde: /IANA&ER. -- ORO-
-34'A'j. &�L_ 1
-
Signature
By nes stgnMae, I may ant tis nprt N eaarale and complete to the best of my Wro A dga.
4 Penult Expiration: 07 131 1 A017
Date U Signature Date
I miry under penany of law, Cast tis doaanent and al antimere, were pWared urdr my dredbn or a mvisim In
acrrdwm with a SWW deigned to sawn that as gwffdd Pannone! properly 980mvd and evetoalad the Itrormaeon
submitted. Bned m my rgdry of the person or persona who mmege the System. r ghee Praaw *'* naprur is rr
genering the Inforowilon, the kdormagon suberaled Is. to the beg of knowledge and beser,
and
swan that then stprJlkam Wattle, for &&m "false rdrmad n• kAxNng the Possibility y of N 10 knpdsonm
"A for
hm+hV violations.
Mall Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center