WQ0012948_Monitoring - 10-2016_20161202

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Paget of -2i
Permit • • 1 •�:Pisgah--••-EducationOctober
1 .
11Flow
Measuring '•
■ [2]Effluent EjNo flow generated
Parameter Monitoring •. ■ []Groundwater Lowering Elsurface water
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Sampling Type:
Monthly Limit:
11
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Daily Limit:
Sample -Frequency:

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page Z of Z
Sampling Person(s) 11 Certified Laboratories -
Name: Robert Barr Name: Pace Analytical
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? Srompliant []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 your 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: Richard Swilling
Permittee: Pisgah Center for Wildlife Education
Certification No.: S1993157
Signing Official: Robert Barr
Grade: SI Phone Number: [phone]
Signing Official's Title: Signatory
Has the ORC changed since the previous NDMR? ❑Yes FZ]No
Phone Number: [phone] Permit Expiration: 3/31/2020
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 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