WQ0000948_Monitoring - 10-2016_20161130 (2)

`FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page of
Permit No.:,WQ00009418 �
Facility Name:
TOWN OF JACKSON
county
Northampton
Month: o G� �2 R
Year: 0/ `�
•
PPI:
Flow Measuring Point:
❑ Innuent CI Effluent ❑ Plo floyr generated l
Parameter Monitoring Point:
Elinrluen_t
[(fluent ❑ Groundwater Lowerhig ❑ Surface water
Parameter Code —p
. 50060
00310
31616 ':
006.10
00625
00620
170400 ; .
50060
00630.
70300
00910
m
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t
; .
o
H
."
m
`o
E
W
r�.
o M=
r
r.,
—
t°- n CO
lo- N v
24 -hr hrs
GPt7 •' `
mg1L
'SP1 il)t] en[
mg1L
mg/L
mg1L
• su
mg1L
mq/L ':
mg1L
3
8
4
910.0Y10
�o
.o
5
��09
-
6
s. �
8
1
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1I
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:.I
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8
hin
o .off
F 3
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t
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q_
GT
14
14
15
16
•17
<<
0
•19
zo
o22
z1
777
-77777
7777
23
v1?
24
/ 35 0 ll
08
25
/(0,30 0Y
0
_
lo.
278
/T
/.3/0
29
30
0
31
.�.Da2,
Average:
'16
Daily Maximum:
, ['.
-
Daily Minimum:
o p
Sampling Type:
-Recorder
Compoe '_
sit
rab'
Composite
Composile
-Composite
Grafi f
Grab 4
Coinposile
Composite
Composite
Monthly Limit:
203,000
Daily Limit
Sample Frequencyj'ContinUOUS'l
Monthly
Monthly
Monthly
Monthly:
Monlhly
1 X 1 Disch.
1 X 1 Mich.
Monthly
3 X Year
3 X Year,

's FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page 1 of 1
Sampling Person(s) Certified Laboratories
Name: Johnny G. Young Name: ' Environment 1, Inc. Greenville, N C
Name: I Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ Compliant 1�pNon•Compllant
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.
vV✓ G ,�" /Zsc.-,0 �.2�-/il iC/12/t-CC ✓1 '� ,/�/ 'Gr 1T�•C�oc.e�.S �?(G�2r'�dl� LGLZ7`t�� �c.iYv7S 0,-)4
�G� l Tom, /.�v "zLr �vyz ,/1�G�CrJr�Ti v rverl 7=1� �` _ ��T• t �.� �2o��c ��L�?`F-� • ���s�
-� �. ass cr�S � c����'1-✓ "���J i�0�-�✓—C�,�7rs�i .-�••v� �s.SvcrS.
�6T�!`Yt �./amu �''_� G�� C�.ss� ✓� �n.4-c.� .s-,�.� �- ` c�i�i G��¢,S� X1.4 -c -� �� ��' tem-�,s2.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Johnny G. Young
Permittee: Town of Jackson
Certification No.: 23129
Signing Official: Jason S. Morris
Grade: 1 collection Phone Number: 252-534-3811
Signing Official's Title: Mayor
Has the ORC changed since the previous NDMR? ❑ Yes W No
Phone Number: 252-534-3811 Permit Expiration: 12-31-16
I/Sign'ature
Signatu Date
Date
By this signature, I certify that this report is accurrate 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 property 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. 1 ant
aware that there are significant penalties for submitting false information, Including the possibillty 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