WQ0021289_Monitoring - 10-2016_20161130 (2)

_.FORM: NDMR 08-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page I of S
Permit No.: WQ0021289
I vallyl I I
County:
Perquimans
Month:
October
■ .
�---------------
Daily
Daily

FORM: NDMR 08.11 NON -DISCHARGE MONITORING REPORT (NDMR) Page Z of_0-
Sampling Person(s)
Name: Operators
Name
Certified Laboratories
Name: Environment 1, Inc.
Name: Town of Hertford WWTP Laboratory
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? QCompliant Don -Compliant
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)
WACn. rUudai dUUILIVIIdI JIICCW 11
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Charles A. Jones, Jr.
Permittee: Town of Hertford
Certification No.: 985305 / 993143
Signing Official: Brandon Shoaf
Grade: IV / SI Phone Number: 252.333.6948
Signing Official's Title: . Town Manager
Has the ORC changed since the previous NDMR? Des ZNo
Phone Number: 252.426.1969 Permit Expiration: 12/19/2014
dzV,4A rt 4t
�l6
t5-(�
�r-�s�
Signature Date
Signature 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, 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. 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