WQ0002052_Monitoring - 10-2016_20161122 (2)

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page i of
Permit No.: w101
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Area (acres):
Area (acres):
Cover Crop:
Cover Cro, p-:
Cover Crop:
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FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Did the application rates exceed the limits in Attachment B of your permit?
Page IL of a
17Compliant ❑Non -Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
OCompliant
❑Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?
gCompliant
❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site?
OCompliant
❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
gCompliant
❑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
taKen. Attach aooitlonal sheets it
Operator In Responsible Charge (ORC) Certification
Permittee Certification
ORC: Michael D. Fortenberry
Permittee: Milliken & Co. Golden Valley Plant
Certification No.: 27004
Signing Official: Mike Tutterow
Grade: S. I. Phone Number: 828-247-4300
Signing Official's Title: Plant Leader
Has:the ORC changed since t e previou NDAR-1? Elves ONo
Phone Number: 828-247-4305 Permit Exp.: 3/31/17
Signature Date
gnature Date
By this signatur , I certify that this report is accurrate ando plate 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 sign'rficant
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