WQ0004438_Monitoring - 11-2016_20161219 (2)

NON DISCHARGE WASTEWATER MONITORING REPORT Page � o.
PERMIT NUMBER: C) 000 `f MONTH: OV C3 ER YEAR: '2Q I �
FACILITYNAME: S.T. W00 -1-E0 C10,RF PPA/ BERN COUNTY: C►3 1% f�
Flow Monitoring Point: Effluent
Oa influent:
❑
-
Parameter Monitoring Point:
Effluent: 2,
Influent:
❑
ISurface Water (SW); ❑
SW CodefName:
Was Then= Effluent Flow For This Month Generated At This Fasillty:
Yes:
XNo:
Q
" 50050
1
1 Operator
D Arrival Daisy Rate
A Time Opartnr ORC ' (Flow) into
T 2400 Time on on Treatment
clerk site Sita? , System
00900 1 5000000310
Residual
y Pts Chlorine
BOD -5
20'C
00610
NH3-N
00530
ISS
31010
Fecal
Gollform
(Geo -metric
P,7---)
N a3 -R
�
n
HRS YIN GALLONS
UNITS UGIL
FAGIL
'.IC -11-
N1GJL
1100tAL
NiCt L
M L
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305 1,2
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Daily Maxirnurn �
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Daily Minimum !I ®
P
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Monthly Limits) 13 D
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Composite (C)/ Grab (G)
Operator in Responsible Charge (ORC): C CORGI✓ R C>�L,1.-150 1 Grade: W L - ?- Phone:[phone]Z I a
Check Box if ORC Has Changed: ❑ URC Certification Number: 1J4 9,73 1 Z V t3 S$
If
Certified Laboratories (1): E>nV ig0 h M evil- 1, Ise, ww l.R :1 O (2)=
Person(s) Collecting Samples: G eoR G E R CA LL_) S D N
Mail ORIGINAL and TWO COPIES to:�--
DENR (SIGNATURE OF OPERATOR IN RESPONSIBLE CHARGE)
Division of Water Quality BY THIS SIGNATURE, i CERTIFY THAT THIS REPORT IS ACCURATE
ATi"N: Information Processing Unit AND COMPLETE TO THE BEST OF MY KNOWLEDGE.
1617 Mail Service Center
RALEIGH, NC 27699-1617
DEINR FORM NDMR-1 (1112005)

Page_ oi�
Facility Status:
Please answerthe following question:
compliant MNI-I
4. Does all rnoriftring data and s✓afrrpling fmquencies Mest permit: r0quirerrnernts? -
li u�te fac3iiy is r�oaa-�on��aii please explain in the beta* the reason(s) the facility was no,. in compiiance
urlh itti parmiL Provide in your explanation elle date(s) ofthe non-compliance and describe the conec&e aciion(s)
taken. Attach additional suets r necessary. 11
11 certify, under penalty of law. thstthis document and all attachments were prepared under my diaecffbn or
supeMsion in accordance w th a system designed to assure =that all qualiffed personnel properly gathered and
evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or.
those personas dimly msponsible ibr gathering the it orrnation, the information submilted is, to the best of my
itrvMedge and Wlef, tagger accurate, and complete. i art aware that there are significant penalises for submitting
false irrforaYaation, including the pdssibift of fines and imprisonment for knowing violations.
(Signature of permftw fixate (Name of Signing dEd PWIse print or )
Nn) DDI -E714 ��f��DRI TI�ri
(PerafteePlease pftt ortype)
Po. Sox, -9,f05-
(Permittee Address)
D1 V is lot i MA-7QAC r i&
{POSitiara orTAtie)
-773 1 ` 1
(Phone Number) (Permit Exp. hate)
V iW2 Aim
v
orrs -ra ar
00928 --Dan.
00680 atazaraos
tMt SPR
men so=a�4
0=0 SODS
010a COPPW
Gem RM ---
OD745 zw-da
OUM
0M TDS
aiG4Gf CO&.*=
Sdif.' M iRldW Ldeg
V-43FE .moo
OOeiS tin
3tOir i'amaCbWacm
VVM PAN(d A%M9aW.a)
Mato Temperatme
60!m ctitodda
01051 lead
00400 PHSWW
TffPt
32730 Pr mXft
Od680 TOC
TaRat
00M
79900
da665 .Raul
00530 Tssff-gR
ataa4 CW01*9
Maio W"B8SH
OW37 POS
OW76 Thy
OOM t
otOG IGCWA
l OW05 semume Mwer
ate2 MM
par meter Casae a s'tsiancearra} be distaioed by raTMg ftte lurcher i W3ffI%i -- land ApprcaWn Unit at (919) 715 -6189 -
The monthly average for Fecal Coiil'ann isto be reported as a GEOMEMIG mean- Use oniv the units designated in the reporting
ibcfflWs verinkfor revoafina.dais
if si ped by offaerthan tiva parraaW of skinatM mAbOft mu -St be on file wits the state W IGA NCAC 28 -OM (b)(2)ln).
CENR FORM NDMR 1.4 (1112005)