WQ0002857_Monitoring - 09-2016_20161101 (2)

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NON -DISCHARGE WASTE WATER MONITORING REPORT
PERMIT NUMBER: W00002857 MONTH: September YEAR: 2016
FACILITY NAME: Piedmont Custom Meats WWTF 4 COUNTY: Caswell
* Sample analyzed out of hold time due to laboratory error
Operator in Responsible Charge (ORC): Steven Yarbrough Grade: SI Phone: [phone]
Check Box if ORC Has Changed: F] ORC Certification Number: 986612
Certified Laboratories (1): R & A Laboratories, Inc. (2):
Person(s) Collecting Samples: Steven Yarbrough
Mail ORIGINAL and Two COPIES to:11
ATTN: Non -Discharge Compliance Unit X
DENR (SIGNATURE OF O BATOR IN RESPONSIBLE CHARGE)
Division of Water Quality By this signature, I certify that this report is accurate and
1617 Mail Service Center
RALEIGH, NC 27699-1617
complete to the best of my knowledge.
DENR Form NDAR-1 (5/2003)

NON DISCHARGE WASTEWATER MONITORING REPORT
FACILITY STATUS:
Please answer the following question: Compliant (Y,N)
1. Does all monitoring data and sampling frequencies meet permit requirements?
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 a qualified personnel properly gather and evaluate 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
informs submitted is, to the best of my knowledge and belief true, accurate, and complete. I am aware that there are significant
pena ies for bmitting fals ation, including the possibility of fines and imprisonment for knowing violations."
James M. Cheshire
(Si natu of Permite Dat (Name of Signing Official -Please print or type)
(Permittee -Please print or type)
9683 Kerr's Chapel Road
Gibsonville. NC
(Permittee Address)
01002 Arsenic
01022 Boron
00310 BOD5
01027 Cadmium
00916 Calcium
00940 Chloride
50060 Chlorine, Total
Residual
01034 Chromium
00340 COD
PARAMETER CODES
31504
Coliform, Total
00094
Conductivity
01042
Copper
00300
Dissolved Oxygen
31616
Fecal Coliform
01051
Lead
00927
Magnesium
71900
Mercury
00610
NH3 as N
01067
Nickel
President R & A Laboratories
(Position or Title)
336-582-8247 .
(Phone Number)
00600 Nitrogen, Total
00630 NO2 & NO3
00620 NO3
00556 Oil & Grease
WQ09 PAN Plant Available
00400 pH
32730 Phenols
00665 Phosphorus, Total
00937 Potassium
00545 Settleable Matter
03/31/21
(Permit Exp. Date)
00929
Sodium
00931
SAR
00745
Sulfide
00515
TDS
00010
Temperature
00625
TKN
00680
TOC
00530
TSS/TSR
00076
Turbidity
01092
Zinc
Parameter Code assistance may be obtained by calling the Water Quality Compliance/Enforcement Unit at [phone], extension 529.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only 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 213.0506 (b) (2) (D).