WQ0029653_Monitoring - 10-2016_20161202 (2)

rORM; NDMR 03-12
NON-DISCHARGR=MONITORING REPOIRT (NDMR)
§arnpling Person(s) Cwtified Laboratories
Name: Name:
Name: Name:
Page of
Does all monitoring data and, sampling freque 4dies meet the requirements in Atta0ment 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. Provrde in your explanation the dates) of the non-compliande and describe the corrective
action(s) taken. Agacn aoaltional sneets Ir necessary.
s
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: RICK HARRELL
Permittee: SCOTCH HALL PRESERVE WWTP
Certification No.i S1986118
Signing Official: DANIEL SUMEREL
Grade: Pho€ta dumber: 252-72.4-1663
Signing Official's Title: GENERAL MANAGER
Has the ORC dhaiiiged since the previus NDMR? ❑ Yes ❑ No
Phone Number 919-300-9316 Permit Expiration:
he
20
Signature Date
Signature Date
by this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, undef Penally of law, that this document qnd all attachments were preparEld under my direction or supervision.in
accordance with a system designed to assure th9t all qualified personnel properly gathered and evaluated the information
submitted. Based on my inquiry of the person or persgns who manage the system, or those persons directly responsible for
gathering the inforfttion, the information submitted is, to the best of my knowledge and belief, true, accurate, and complE.' .l am
aware that there efe significant penalties for submitprig false information, including the--posslbility of fines and imprisonrrlept for
knowing violations.
Mail Original and Two Copies tib:
Division of Water Resources
Information Processing Unit
1617'Mail Service Center
Raleigh, North Carolina 27699-1611