WQ0034102_Monitoring - 10-2016_20161202 (2)

FORM: NDMR 07-1 3 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of
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FORM: NDMR 07-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page _ of
Sampling Person(s) 11 Certified Laboratories
Name: Ray Bostic Name: Microbac, Fayetteville Divison. Cert#11
Name: Kenneth Stanley Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? l]Complianf ❑Noncompliant
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
ueeu. rrudcn duuaronai sneers IT necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Ray Bostic
Permittee: Town of Fremont
Certification No.: 1000088
Signing Official: Barbara Aycock
Grade: SI Phone Number: 252-560-2816
Signing Official's Title: Town Administrator
Has the ORC changed since the previous NDMR? ❑res ❑O No
Phone Number: 919-242-5151 Permit Expiration: 11/30/2014
Signature Date
Sign re Date
By this signature, I certify that tlxs report is acarate and complete to the best at my knowledge.
I cerlfpe
y, ui.w nally of isw, that this docurnem pr
and all attachments were epared under my Direction or supervision in
accordance wIM a system designed to assure that all qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry or the person or persons who manage the system, or apse persons directly responsible for
garnering fine information. fine information submitted is, to the best of my knovAedge and better, true, accurate, and complete. I am
aware that them are significant penalties for submitting false Information, Including the possibility of fines and imprisonment for
knowing viblabons.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617