WQ0011655_Monitoring - 09-2016_20161027 (2)

FORM: NDMR 10-13
NON -DISCHARGE MONITORING- REPORT (NDIVIR) C) 21 G I A )— Page __L of
Permit No.: WQ001 1655.
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FORM: NDMR 10-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page : of
Sampling Person(s) Certified Laboratories
Name: Nelson Medford - Name: Environment 1, -Incorporated
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Compliant ❑Non Compliant
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.
All reports are months late. Trying to get things up to date per permit requirements.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:- Nelson Medford
Permittee: East Carolina Council, BSA
Certification No.: 995478
Signing Official: Doug Brown
Grade: SI Phone Number: 252/947/0008
Signing Official's Title: Scout Executive
Has the ORC changed since the previous NDMR? ❑yes ❑✓ No
Phone Number: 252/522/1521 Permit Expiration: 28 -FEB. -2019 .
Signature ate
Signatu 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
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.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617