WQ0005233_Monitoring - 09-2016_20161122

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1 of 2
Permit No.: 0111
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:ORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR)
Sampling Person(s) Certified Laboratories
Name: J. Clayton Name: MCAS Cherry Point, NC 28533
Name: Name:
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Page 2 of 2
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Q. Compliant ❑ Non-Compli
If the facility is rion-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 corre
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Jeffrey Clayton
Permittee: U.S. Marine Corps Air Station, Cherry Point
Certification No.: 998515
Signing Official: George W. Radford
Grade: SI Phone Number: 252-466-5874
Signing Official's Title: By direction of the Commanding Officer
Has the ORC changed since the previous NDMR? ❑ Yes 0 No
Phone Number: 252-466-4599 Permit Expiration: 7/31/2019
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Signature Date
Sign lure 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, t is 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
1617 Mail Service Center
Raleigh, North Carolina 27699-1617