HomeMy WebLinkAboutWQ0024577_Monitoring - 11-2016_20161228 (2)FORM: NDMR 07-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page --L of
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County:
Wayne
Month:a
llFlow
Measuring Point:
influent Effluent No flow generated
Parameter Monitoring Point: El Influent R] Effluent El Groundwater Lowering El Surface Water
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I-URM: NDMR 07-13
Sampling Person(s)
Name:
NON -DISCHARGE MONITORING REPORT (NDMR)
Certified Laboratories
Name: 1=r�rG "r ' ��' F� FN, f� r,'r_'
Name: 11 Name:
Page { of /
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? ❑ 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
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Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: `j ��r?!r i+ c.J' VL'%4 ' J j .7: • ,f,_ i.Ci q 4 Mp '
Permittee:
Certification
Signing Official: I (L j(N{i-CE��=P•GC'
Grade:�.'•� „} Phone Number: ' ''�% _ �':"'l�i i "" , , �'�=•r. ' �';,^' t„Ir,.f,...
Signing Official's Title: ( f_ '
Has the ORC changed since the previous NDMR? ❑ Yes EINo Phone Number: Permit Expiration:
Signature Date %./ Signature Date
By this signature, I certify that (his report is accurrale 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 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