WQ0022523_Monitoring - 10-2016_20161207 (2)

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page
Permit No.: WQ0022523
Facility Name: H&T Truck wash facility
County: Greene
Month: October
Flow Measuring Point: © Influent ■ Effluent ■
■ Influent
■ Effluent■Groundwater Lowering ■ Surface Water
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Olson•

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of,_,_
Sampling Person(s) Certified Laboratories
Name: NA Name: NA
Name: NA Name: NA
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑x Compliant ❑ 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
taxen. Attach acottlonai sheets It necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Timothy A.Sugg
Permittee: Jeff Turnage
Certification No.: SI -24668 WW1 -24001
Signing Official: Jeff Turnage
Grade: 1 Phone Number: 252-714-2398
Signing Official's Title: Owner
Has the ORC changed since the previous NDMR? ❑ Yes Nx No
Phone Number: 252-717=0370 Permit Expiration: 3/30/2017
i
Si nat re Date
Signature Date
By this signature, I certify that this report is aocurrate 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 knovvIedge 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 kno ving violations.
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617