WQ0000948_Monitoring - 09-2016_20161101 (2)

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page / of
,Mermit No.: WQ0000948 I Facility Name: TOWN OF JACKSON county: Northcmpton Month: SE- tE1n bt-Pz Year: Q/(p
PPI: Flow Measuring Point: ❑ innuent CI Erfluent ❑ do flow generated Parameter Monitoring Point: ❑ Influent Q Effluent ❑ Groundwater Lowering ❑ Surface Water
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Daily Minimum:
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Grab
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Sampling Type:
Monthly Limit:L.9nflnUOUS
03,000
daily Limit:Safnple
Frequency:
Monthly
Monthly
Monthly
Monthly:
Monthly
1 X 1 Disch.
1 X / Di 11.
.Monthly
3 X Year
3 X Year.

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page / of
Sampling Person(s)
Name: Johnny G. Young
Name:
Certified Laboratories
Name: 'Environment 1 , Inc. Greenville, N C
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ Compliant 91 Mon -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.
4/G— y—p �,we c�fc`� a�� i�8 cnJ .�. v/i�'t y�2 �t c9 �J &4 g — ?li5 HCl c' ^ z 2 T/�C'l muJ,.J c'K�°�
i�Lc' �� tr' � res y �/1s tz�✓ /S �.�Gtp eCF%— ,r6 ,� z /St+v �s u1«
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�l/2�ulT d�= �-!L�/% %EY.G�t/Gf� ��i���2 G�i9ST1����c"J f�6.SlS? �J-✓L�'- e4-P/'� -�-c �' _
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Johnny G. Young
Permittee: Town of Jackson
Certification No.: 2 312 9
Signing Official: Jason S. Morris
Grade: 1 c o l l e c t i o n phone Number: 252-534-3811
Signing Official's Title. Mayor
Has the ORC changed since the previous NDMR? ElYes iXl No
Phone Number: 252-534-3811 Permit Expiration:12 - 31- 6
z IR
Sign Date
Signature Date
By this signature, I certify that this report Is accurrale and complete to the best of my knowledge.
I certify, under penally 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 Quality
Information Processing Unit
1697 Mail Service Center
Raleigh, North Carolina 27699-1617