MHC000010_Annual Report_20210323

FORM HAUL-1
RECEIVEDManure Hauler Operation Annual Reporting Form
MAR 2 3 2021
Record of Manure Received
Manure Hauler Name: 2.t r7' 1. /1 /),j, d
Mailing Address: . SO 56N4 B o F L)J
e � � Cr-cA. - a'71
Company Name: NL
Phone Number: 4'/ 9- 5 2/ 92
Registration No.: al 1 c o D D 12
Amount (tons)
Location Where Manure Was Generated
Date(s) Manure Received
Farm Name
Farm Address/Location
County/State
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Submit completed form(s) for manure received during each calender year to the Total
following address by March 1 of the following year:
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NC DENR DWQ - Aquifer Protection Section
Animal Feeding Operations Unit
1636 Mail Service Center.
Raleigh, North Carolina 27699-1636
02/21/07 Version
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 qualified personnel properly gather and evaluate 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.
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Date: ` o - O D