WQ0022711_Monitoring - 12-2016_20170111

FORM', NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _L_of�
Sampling Person(s) Certified Laboratories
Name: N/A Name: N/A
Name: Name: ❑' Compliant ❑ Non -Compliant
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
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 action(s)
taken. Attach additional sheets if necessary.
not utilized during this
Operator in Responsible Charge (ORC) Certification
ORC:
Certification No.:
Grade: Phone Number:
Has the ORC changed since the previous NDMR?
JAN I 1 2017
Permittee Certification
Permittee: Macon County
Signing Official: Jaimie Picou
Signing Official's Title: Solid Waste Field Environmental Specialist
Phone Number: [phone] Permit Expiration: 9/30/2020
Signature DateV.ertily,
Y Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge: 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

Form- NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Paget ofi-
Permit No.:Q..
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page v of'+'
Sampling Person(s) Certified Laboratories
Name: N/A Name: N/A
Name: Name: ❑' Compliant ❑ Non -Compliant
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
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 action(s)
taken. Attach additional sheets if necessary.
System not utilized during this reporting period.
✓ Ye No
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC:
Permittee: Macon County
Certification No.:
Signing Official: Jaimie Plcou
Grade: Phone Number:
Signing Official's Title: Solid Waste Field Environmental Specialist
Has the ORC changed since the previous NDMR?
Phone Number: [phone] Permit Expiration: 9/30/2020
Iti 30
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
t , 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 Quality
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

Form: NDr%AR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR)
Page4oft
Permit No.: Q00
- . .• .