WQ0004967_Monitoring - 10-2016_20161130 (2)

FnRM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR Page 1 of A
Flow -measuring Point:
El
Influent El
Effluent
0 No flow generated
Parameter Monitoring Point:
0 Influent El Effluent 0 Groundwater Lowering [3 Surface
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR Page_.2_oa
Sampling Person(s)
Certified Laboratories
Name: Juanita James
Name: James & James Env. Mgt., Inc.
Name:
Name: Research & Analytical
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ Compliant ❑ Non -Compliant
If the facility is non-compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in you explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Juanita James
Permittee: Alljuice Food & Beverage
Certification No.: 25034
Signing Official: James & James Env. Mgt., Inc.
Grade Phone Number: 828-697-0063
Signing Official's Title: Contract Operations
Has the ORC changed since the previous NDMR? Yes No
Phone Number: 828-697-0063 Permit Expiration: 4-30-17
lf'Atxlig 11/28/2016
Lit& 11/28/2016
Signatur Date
Signature Date
By the signature, I certify that this report is accurate and complete to the best of my knowledge.
certify, under penalty of law, that this document and all attachment were prepared under my direction or supervision in accordanc
ith a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Based o
y inquiry of the person or persons who manage the system, or those persons directly responsible for gathedng the information, t
formation submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware the there are significa
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