WQ0037835_Monitoring - 09-2016_20161031 (2)

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1 of 2
Permit No.- l►1137835
Facility Name:
Northside
• -r
Month: September
Year: 21
Flow Measuring Point:
E]Influent FlEffluent 2jNo flow generated
Parameter Monitoring Point: DInfluent PlEffluent E]Groundwater Lowering 0surface water
•
•
Sampling Type:
Monthly Avg. Limit:

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of 2
Sampling Person(s) 11 Certified Laboratories
Name: No sampling conducted, zero gallons of reclaimed water distributed. Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? MCompliant ❑Nan -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.
September 2016: Zero gallons of reclaimed water distributed.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Geoffrey D. Cermak
Permittee: Cape Fear Public Utility Authority - Northside WWTP
Certification No.: 27164
Signing Official: Kenneth L. Vogt, Jr.
Grade: WW - IV Phone Number: 910-332-6562
Signing Official's Title: Wastewater Treatment Superintendent
Has the ORC changed since the previous NDMR? ❑Yes [211\10
Phone Number: 910-332-6586 Permit Expiration: 1/31/2021
Signature Date
Signature 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