WQ0005681_Monitoring - 11-2020_20210108

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• •- Corporation - Staley
County: Randolph•
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Sampling Type:

FORM: NDMR 08-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page 114 of I
Sampling Person(s) Certified Laboratories
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Name: Name: S (�0.G1L LG bdra-bi; c5
Name: Glenn Price Name:
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
action(s) taken. Attach additional sheets if necessary.
(Melissa is out on medical leave
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Melissa Harshman
Permittee: Pilgrim's Corporation
Certification No.: 1001745/1002531
Signing Official: Mohammed Jamal
Grade: SI/WWII Phone Number: 919-599-1295
Signing Official's Title: Sanford Complex Manager
Has the ORC changed since the previous NDMR? ❑ Yes E] No
Phone Number: 9197747333 Permit Expiration: 1 1/30/2026
a - a - 267_0
Signature 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 Quality
Information Processing Unit
1617 Mail Service Center

FC7RM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page I of
Permit No.: 11111 •:
•rim's Corporation - Staley
County: Ran•• •h
Month: November1
1
Did irrigation occur
facility?
Area (acres):
at this
YES LV] NO
Hourly Rate (in):
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Hourly Rate (in):'
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Annual Rate (in):
Field Irrigated?
Field Irrigated?
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Monthly Loading:

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page a of
Did the application rates exceed the limits in Attachment B of your permit?
❑✓ Compliant ❑ Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑✓ Compliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit? ❑✓ Compliant ❑ Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? ❑✓ Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? Q 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
action(s) taken. Attach additional sheets if necessary.
Melissa is out on medical leave
Operator in Responsible Charge (ORC) Certification
I ORC: Melissa Harshman
Certification No.: 1001745/1991779
Grade: SI/WW2 Phone Number: 919-599-1295
Has the ORC changed since the previous NDAR-1? ❑ Yes 0 No
26 2A
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee:
Pilgrim's Corporation
Signing Official: Mohammed Jamal
Signing Officials Title: Sanford Complex Manager
Phone Number: 9197747333 Permit Exp.: 11/30/26
Signature Date
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 Quality
Information Processing Unit
1617 Mail Service Center