WQ0009098_Monitoring - 09-2016_20161101 (2)

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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-comoilant, 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 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 'nformation, includ'ngidje possibility of fines and imprisonmr knoowiinngviolat�kn."
.cIA 1,100,4_A(%
(Sign urre,A rmitteep Date (Nam of Signing Official -Please print or type)
fftn4lPllease print or type) ion or Title)
Ohdihl
kf ck 1'aMUCii 7MIA" 12 147t -%[,I 'Lzi�- J L
e Number) (Pe it Exp Date)
I
(P rmittes Addres )
Parameter Codas!
01002 Araanle
31504 Coiftrm, Total
00600 Nltrogiirv, Tobi
00029 Sodium
01022 Boron
00094
00530 N028NO3
00031 SAR
00310 8006
01042'Copper
00620 NO3
00745 SuMda
01027 Cadmium
00300 DWWIV@d 0AY9ffl
06 -GMM
70295 MS
00916 Caldum
31616 Fecal CoUlbrm
W000 PAN Pwd Available
00010 T
00940 Chbrldr!
01051 land
00400
00626 TlOV
50060 ChWrkM Tot
Reddual
00927 plum
71900 MwCury
32730 PMnob
00666 ,Tot
00660 TOC
00630 TSS/TSR
01034 Chromium
00610 NHUM
00937 PobadumLj-
00076 T
00340 C00
01067 Nidal
00646 Setopbh AA SW
01092 Zlma
Parameter Code assistance may be Obtained by calling the Water Quality Compliance/Enforcement Unit at [phone] ext. 529.
The monthly average for Fecal Coliform is to be reported as a GEOMETRIC mean. Use only the units- Use only the units designated the re�rtinathe re�rtina
facili�'soermitfor reporrtinda.
' If signed by other than the permittee, delegation of signatory authority must be on file with the state per 18A NCAC 2iB.0300 (b)(2)(D).
DENR FORM NDMR-1 (5/2003)