WQ0012696_Monitoring - 10-2016_20161109 (4)

FOO BAR 0312
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NOMR)
Cerdmad Laboratories
sampling Person(s)
Nanw:
Name:
Name:
Name:
Does all monitoring data and sampling Requencles meet the requirements in Attachment A of your permit? ce an t
❑ Nan•Comdlam
If the facility Is noncamPlem, please explain In the space below the reasons) the facility's not In compliance. Provide in your explanation the dete(a) d the non-comPllanm and 410801116 the correctva
8ftan(8) ry
taken. Attach additional sheets if lmcesu.
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Operator MP,,) Responsible Charge (ORC) Certification
C
ORC: ,Q yr r,)
CgMcatlon No.:
Orada: l Phone Number. 25-2-7k4-45-2)
SZ964-45-2)
Has it, oftc changed acnes the Previous NDMR7 ❑ yes afg,
- Signature Date
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Permittee CenMicatim
PermNtea: NC17Dr Pymlico 814(/ ' Ferry
signing ONlo1N: 34eer-Y 19ollowell
signing oftlors Tale: / `m).ger f
Phone Number: 2sz-96�i- yrzi Permit Expiration: �%—l%O—ic02(7
Date
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Mail Original and TWO COPim to:
Division of Water Resourt"
Information Processing Unit
1617 Mail Servke CenW
Raleigh, North Carolina 27689-1817