WQ0000948_Monitoring - 11-2016_20161222 (2)

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•'CORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page / of
Permit No.: W00000948 _p
Facility Name:
TOWN OF JACKSON
County•
North@mpton
Month• Year
PPL'
Flow Measuring Point: ❑ influent 0 Effluent ❑ No flow generated
Parameter
Monitoring Point:
❑ Influent
0 Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code —p
50050
00310
31616
006'10
00625
00620
00400.
50060
00530.:
70300
00940
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24 -hr
hrs
GPb
mg/L
''J1hi004mL'
mg/L
mglL
mg/L
su
mg/L
mglL ".'
mglL
m; a L: "=:
1461
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Average:
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---
Daily Maximum:
Daily Minimum:
_ b
"
Sampling Type:
.Recorder
Composite
Fel
Composite
Composite
Graber
Grab
Composile
Composite
Camp'oslte
Monthly Limit:.203,000
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Daily Limit:a
;
Sample FreqLjency:jj.Col1tinu6u6'l
Monthly
Monthly
Monthly
Monlhly:
Monlhly
1 X I Disch.
1 A/ Disoh.
Monthly
_TX Year
3 X Year

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1 of _I
Sampling Person(s) Certified Laboratories
Name: Name:
Johnny G. Young Environment 1, Inc. Greenville, N C
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ompliant ❑ 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-copliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Johnny G. Young
Permittee: Town of Jackson
Certification No.: 23129
Signing Official: Jason S. Morris
Grade: 1 collection Phone Number: 252-534-3811
Signing Official's Title: Mayor
Has the ORC changed since the previous NDMR? El Yes LlNo
Phone Number: 252-534-3811 Permit Expiration: 12-31-16
12
Sign re Date
Oys
Signature Date
signature, I certify that this report is accurrate and complete to the best of my knowledge.
I certify, under penally 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 property 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617