WQ0004270_Monitoring - 11-2016_20161213 (2)

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FORM: NDMR 03-12
Sampling Person(s)
NON -DISCHARGE MONITORING REPORT (NDMR)
Certified Laboratories
Page of
Name: Charles Parker Name: Par Lab
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? *mpliant ❑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
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Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Lee Pennington
Permittee: Al Abedi
Certification No.: 987583, 987903
Signing Official: Al Abedi
Grade: 2 Phone Number: 704-874-2754
Signing Official's Title: Vice President
Has the ORC changed since the previous NDMR? Dyes EINo
Phone Number: 704-865-1201 Permit Expiration: March 31,2020
2 f t/
nature 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617