WQ0004910_Monitoring - 10-2016_20161212 (2)

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Permit No.: W ��Dii �� tQ
Facility Name: w� L� VV ? �l i`
County: AjOrAr,,,
Month:liJ C . b
Year:
PPI: W\y� •
Flow Measuring Point: ❑ influent f c�"Effluent L7 No flow generated
Parameter Monitoring Point-
❑ influent
S Effluent
[a Groundwater Lowering
Surface water
ti
Parameter Code —0
50050
C)03 -No Nc bO
34ltitb
00�,10 D, 2-a
00 ZQ
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fXVQ0100U,50.30
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001
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is
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24 -hr Ctrs
GPD
L
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ere %�
rn
54
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10-73(2 ,$
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76
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5 9 0 00
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$
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9
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17 , j
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19 Q
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20
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21
1 6
22
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24
25
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31 sJ 5i3 C� t G+
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Daily Maximum: �;d.r�oco
5
Daily Minimum: `ji dc)cy
to9-
Sampling Type: SamplingTyf?e: F�EtUtit
-
w v n egg �w,f `�-•
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csr;� fir? %,Y ,fie
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Monthly Avg. Limit:
Daily Limit:
Sample Frectueney: ,.c, ,i, ck.l�
-

PageFOf?kl: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR)
�
y�Sampling Person(s)
Marne: U ► `, ��! x d ftsj a'+�
Name: WLiijol-�
Certified Laboratories
Name: Z�70rwq—,9.t`T►" /( )�/'�`,
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? eg compliant ❑ Noli­':cmp0iin.
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 descrik e the torr -acture a.:ii,n,(s) raker,.
Attach additional sheets if necessary.
Operator in Responsible Charge (ORO) Certification
Permittee Certification
ORC:� �,y1, �)?�
y
Permittee: AP
Certification No.: �� �) �j4�1�<v
Signing Official:
Grade: Phone Number: — V7 -7l 6
Signing Official's Title:
r 4_52
//�®
Has the ORC changed since the previous NDMR? [IYes KYNo
Phone Number:,? -/J&, f Permit Expiration:
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 ui s1.ipervrz3ion 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 fed. ponsible for
gathering the information, the information submitted is, to the best of my knon')ledge and belief, true, accuraba, 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 Resources
Information Processing Unit
1617 Mail Service Center