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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Sampling Person(s)
Certified Laboratories
Name: Plant Personnel Name: Smithfield Farmland Corporation Tar Heel Division
Name: Name: Environmental Chemists, Inc.
.4 rim" Ah+� �mA c,mmnlinn frnniiinnrina mno+ Oho rornniromonfc in A#arhmonf A of vnnr narmif? 14.13liant F-1 Non-ComDliant
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
iaKen. Auacn aaamonal sneeis IT necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Timothy L. Weaver
Permittee: Smithfield Farmland Corporation - Tar Heel Division
Certification No.: 21875
Signing Official: Kyle Narron
Grade: NC WW Grade 4 Phone Number: 910-862-5248
Signing Officials Title: General Manager
Has the ORC cha ed since the previous NDMR? ❑ Yes No
Phone Number: 910-862-5261 Permit Expiration: 10/31/2018
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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
Raleigh, North Carolina 27699-1617