WQ0000957_Monitoring - 12-2020_20210122

V=r
January 7, 2021
VALLEY PROTEINS, INC.
Division of Water Resources
DENR
ATTN: Non -Discharge Compliance Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Re: Valley Proteins, Inc. — Wadesboro Division
Enclosed please find the Non -Discharge Wastewater Monitoring Report and the Non -
Discharge Application Report for the month of December, for our Wadesboro, North
Carolina Division. These two reports are submitted together.
If you require any additional information or wish to discuss this matter, please feel free to
call me at [phone].
Sincerely,
Gaz Thomas
General Manager
Wadesboro Division
Makin; a Sustainable Difference.
656 Little DUncan Road
Wadesboro, %. C 28170
O 540.8'Z2590
p i0�.69�.6145
valley p rote ins.con i

14
FORM: NDMR 08-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page _L of
Permit No.: WQ0000957
Facility Name: Valley Proteins, Inc.
County: Anson
Month: December
Year: 2020
PPI: 001
Flow Measuring Point: Influent ❑Effluent ( No Flow generated
Parameter Monitoring Point: ❑ Influent ❑ Effluent I 1 Groundwater Lowering i I Surface water
Parameter Code -►
50050
00400
00310
00610
00530
00620
00625
00929
00916
00665
00927 '
31616
00931
01027
01042
01051
_
<6
Q E
U F-
O
c
O
E e3
F
O
3
°
LL
a
p`
O
iD
m
o
E
E
a
m
M c a
o Q o
�• N (!J
rn
=
Z
`0 c
m_ a>
Y 2
Ems- Z
°
`-'
E
L
o EL
~ Q
a
E
U)
c
m o
m=
6L U
o
2
a `p a
N Q
Q
E
E
N
Q-
U
J
24-hr
hrs
GPD
su
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
mg/L
#/100 mL
Ratio
mg/L
mg/L
mg/L
1
7:00
10
177,866
2
7:00
10
169,066
3
7:00
10
191,946
8.03
16.8
15
12.5
194
42.6
135
12.2
0.46
0.016
2600
1.67
0.008
0.017
0.016
4
7:00
10
178,826
8.01
5
7:00
8
189,706
8
6
0:00
0
0
7
7:00
10
236,426
7.89
8
7:00
10
168,666
9
7:00
10
188,586
7 98
10
7:00
10
187,466
11
7:00
10
165,466
12
7:00
8
199,786
7.91
13
0:00
0
0
14
7:00
10
181.706
7 92
15
7:00
10
146,506
16
7:00
10
176,906
17
7:00
10
238,666
18
7:00
10
231,066
19
7:00
8
238,666
20
0:00
0
0
21
7:00
10
210,186
22
7:00
10
131,306
23
7:00
10
189,706
24
7:00
10
165,866
25
7:00
10
210,900
26
7:00
8
207,626
27
0:00
0
0
28
7:00
10
148,426
29
7:00
10
151,466
30
7:00
10
182,186
31
7:00
10
158,306
Average:
162,042
16.80
15.00
12.50
1.94
42.60
135.00
12.20
0.46
0.02
2,600.00
1.67
0.01
0.02
0.02
Daily Maximum:
238,666
8.03
16.80
15.00
12.50
1.94
42.60
135.00
12.20
0.46
0.02
2,600.00
1.67
0.01
0.02
0.02
Daily Minimum:
0
7.89
16.80
15.00
12.50
1.94
42.60
135.00
12.20
0.46
0.02
2,600.00
1.67
0.01
0.02
0.02
Sampling Type:
Grab
Composite
Composite
Grab
Composite
Composite
Grab
Grab
Grab
Grab
Grab
Calculated
Grab
Grab
Grab
Monthly Limit:
Daily Limit:
Sample Frequency:1
Weekly
Monthly
Monthly
Monthly
Monthly
Monthly
3 x year
3 x year
3 x year
3 x year
_ ^y
3 x year
Annually
Annually i
A^^,ialy

FORM: NDMR 08-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page -�_ of J4
Sampling Person(s) Certified Laboratories
Name: James Hodges Name: PRISM Laboratories
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 0 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.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: James Hodges
Permittee: Valley Proteins, Inc.
Certification No.: 991972
Signing Official: Gaz Thomas
Grade: 2 Phone Number: 704-694-3701
Signing Officials Title: General Manager
Has the ORC changed since the previous NDMR? ❑ yes No
Phone Number: 704-694-3701 Permit Expiration: 6/30/2023
1127 21
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

FORM: NDMR 08-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page y3 of
Permit No.: W00000957
Facility Name: Valley Proteins, Inc.
County: Anson
Month: December
Year: 2020
PPI: 001
Flow Measuring Point: L Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point: E. Influent Effluent ❑ Groundwater Lowering ❑ Surface Water
Parameter Code 0
50050
01092
00340
00600
m
>
'. a)
Q E
Of
O
c
0
E '
U
O
O
c
N
O
c
f6 LA
o 2
Z
a�:
24-hr
hrs
GPD
mg/L
mg(L `
mg/L
1
7:00
10
177,866
2
7:00
10
169,066
3
7:00
10
191,946
0.004
35
48.1
4
7:00
10
178,826
5
7:00
8
189,706
s
6
000
0
0
7
700
10
236,426
8
7:00
10
168,666
9
700
10
188,586
10
7:00
10
187,466
11
7:00
10
165,466
12
700
8
199,786
13
0:00
0
0
14
7:00
10
181,706
15
7:00
10
146,506
16
700
10
1 176,906
17
7:00
10
238,666
•';
18
7:00
10
231,066
19
700
8
238,666
20
000
0
0
21
700
10
210,186
22
7:00
10
131,306
23
7:00
10
189,706
24
7:00
10
165,866
25
700
10
210,900
26
7:00
8
207,626
27
0:00
0
0
28
7:00
10
148,426
29
700
10
151,466
30
700
10
182,186
31
700
10
158,306
Average:
162,042
0.00
35.00
48.10
Daily Maximum:
238,666
0.00
35.00
48.10
Daily Minimum:
0
0.00
35.00
48.10
Sampling Type:
Grab
Grab
Monthly Limit:
Daily Limit:
Sample Frequency:
Annually
Annually

FORM: NDMR 08-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page 1-1 of L-/
Sampling Person(s) Certified Laboratories
Name: James Hodges Name: PRISM Laboratories
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? I] 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.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: James Hodges
Permittee: Valley Proteins, Inc.
Certification No.: 991972
Signing Official: Gaz Thomas
Grade: 2 Phone Number: 704-694-3701
Signing Official's Title: General Manager
Has the ORC changed since the previous NDMR? ❑ yes [A No
Phone Number: 704-694-3701 Permit Expiration: 6/30/2023
�J, . 2 2-7 ) .2 1
-7
,
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

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 1 0f_jQ
Permit No.: Q11119Proteins,•
Anson
Month: December
irrigation
Field Narne:
• occurArea
(acres)
Area (acre
at this facility?
Cover Crop:
Fescue/Rye
Fescue/Rye
Fj� YES ■ •
�
i
.
®
Annual Rate � (in).,!
�
....111111111111120.
1 R7 ..:
■ ■ •
..
o ■Field
o ■
..
oYES .

FORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page __,?_ of 1 r->
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
Q Compliant ❑ Non -Compliant
E Compliant ❑ Non -Compliant
Q Compliant ❑ Non -Compliant
Ej Compliant ❑ Non -Compliant
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.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: James Hodges
Permittee:
Valley Proteins, Inc.
Certification No.: 18564
Signing Official: Gaz Thomas
Grade: 2 Phone Number: 704-695-3701
Signing Officials Title: General Manager
Has the ORC changed since the previous NDAR-1? ❑ Yes Q No
Phone Number: 704-694-3701 Permit Exp.: 6/30/23
QrH-.►+
Signature D to
Signature Date
By this signature, I certify that this report is accurra a 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

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page .3 of I
Permit No.: w1111957
Facility Name: Valley Proteins,•unty:
Anson
Month:DecemberDid
1 1
irrigation
occur
Area (acres�:
Area (acres):
at this facility?
••
I •ye
Fescue
• - ••
Fescue/Rye••
®
• ••
Fescue/Rye-
YES NO
Hourly
Annual Rate (in):
1 Annual Rate (in):
Annual Rate (in):
Field Irrigated?
•
Q Q•Field
Irrigate-0Q
Q•
Monthly Loading.
12 Month•

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page Al of ! D
Did the application rates exceed the limits in Attachment B of your permit?
Q 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? Q Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? EZ 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.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: James Hodges
Permittee:
Valley Proteins, Inc.
Certification No.: 18564
Signing Official: Gaz Thomas
Grade: 2 Phone Number: 704-695-3701
Signing Official's Title: General Manager
Has the ORC changed since the previous NDAR-1? ❑ Yes Q No
Phone Number: 704-694-3701 Permit Exp.: 6/30/23
1 2
0;�� /
Signature t C/ate
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

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page S_ of
Permit No.: Q1111957
Facility Name: Valley Proteins, Inc.
County:Anson
Month:DecemberDid
1
•
-•
t
irrigation occur1
Area (acres):
Area (acres):
at this facility?
jjjjW6tqu-v0w'gr#a*vm
Fescue/Rye
Cover Crop:
Fescue/Rye
Cover Crop:
Fescue/Rye
YES NO
Hourly lRate (in):
IIIIIIIIII.-IMPURF11111
W_ffilrm- I'Mm
54
Annual Rate (in):
Annual Rate (in):
YES NO
Field Irrigated?
®®®®®®®®®®®®
Monthly Loading.
12 Month Floating Total (in):

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _&— of
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
121 Compliant ❑ Non -Compliant
El Compliant ❑ Non -Compliant
Q Compliant ❑ Non -Compliant
Q Compliant ❑ Non -Compliant
2 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.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: James Hodges
Permittee:
Valley Proteins, Inc.
Certification No.: 18564
Signing Official: Gaz Thomas
Grade: 2 Phone Number: 704-695-3701
Signing Official's Title: General Manager
Has the ORC changed since the previous NDAR-1? ❑ Yes Fal No
Phone Number: 704-694-3701 Permit Exp.: 6/30/23
Signature Die
Signature ate
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

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page 11 of ! 1�
Permit No.: W00000957
Facility Name: Valley Proteins, Inc.
County: Anson
Month: December
Year: 2020
Field Name:
13
Field Name:
14
Field Name:
15
Field Name:
16
Did irrigation occur
Area (acres):
4.79
Area (acres):
19.53
Area (acres):
2.44
Area (acres):
4.03
at this facility?
Cover Crop:
p�
Fescue/Rye e
y
Cover p�
Fescue/Rye e
Y
Cover P�
Fescue/R e
Y
Cover P�
e
Fescue/Rye
Y
G YES ❑ No
Hourly Rate (in):
1
Hourly Rate (in):
1
Hourly Rate (in):
, 1
Hourly Rate (in):
1
Annual Rate (in):
54
Annual Rate (in):
54
Annual Rate (in):
54
Annual Rate (in):
54
Weather
Freeboard
Field Irrigated?
❑ YES ❑ NO .
Field Irrigated?
❑� YES ❑ NO
Field Irrigated?
❑ YES ' �❑ NO
Field Irrigated?
❑ YES C No
a
O
°
E
D
g
a
U)
�, m
-0
7.
>, Qo
o
Ln
a
a
>
-
o o
E ar
> ' _
E
°
o
J
m
E T
i
-o
v>
po
E m
E =
o
E.T
= aE
o
>
o
2E' .
o
E T
o
aa
i
_M�w
a,E._
.
o�+ CCD
oo-
E3 cm
E o
o
J
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
-
27
28
29
30
31
Monthly Loading:
0
0 00
0
0.00
0 -
0.00
0
0.00
12 Month Floating Total (in):
10.35
8.23
/
0.00
0.00

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page Hof / o
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
❑'
Compliant
❑ Non -Compliant
Compliant
❑ Non -Compliant
❑✓
Compliant
❑ Non -Compliant
❑Q
Compliant
❑ Non -Compliant
Z
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.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: James Hodges
Permittee:
Valley Proteins, Inc.
Certification No.: 18564
Signing Official: Gaz Thomas
Grade: 2 Phone Number: 704-695-3701
Signing Official's Title: General Manager
Has the ORC changed since the previous NDAR-1? ❑ Yes Q No
Phone Number: 704-694-3701 Permit Exp.: 6/30/23
l
Signature to
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

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 1_ of / D
Permit No.: W00000957
Facility Name: Valley Proteins, Inc.
County: Anson
Month: December
Year: 2020
Field Name:
17
Field Name:
18
Field Name:
19
Field Name:
20
Did irrigation occur
---
Area (acres):
1.73
Area (acres):
1.3
Area (acres):
7.89
Area (acres):
22.42
at this facility?
Cover Crop:
Fescue/Rye
Cover Crop:
Fescue/Rye
Cover Crop:
Fescue/Rye
Cover Crop:
Fescue/Rye
YES NO
C ❑
Hourly Rate (in):
1
Hourly Rate (in):
1
Hourly Rate (in):
1
Hourly Rate (in):
1
Annual Rate (in):
54
Annual Rate (in):
54
Annual Rate (in):
54
Annual Rate (in):
54
Weather
Freeboard
Field Irrigated?
?_I YES ( NO
Field Irrigated?
❑ YES NO
Field Irrigated?
1 YES [ NO
Field Irrigated?
[ YES ❑ NO
T
0
`m
:E
N
y
o
N
10
G
m
m
o
Cn
w
N
U
a
0 R
E d
3 a
oa
Q
N .d,
E_•L
_
C
'tp R
o0
J:.::
C
7
=0
J
E�
7 a
o0.
% Q
N 01
E
F=•`
_
T C
00
J
�rn
7_ C
£ 7
=o
J
£ d
Q
o°
Q
'U
Q7
1=•C
_
>.
f0
00
J
f5
=0
J.
£ N
Q
00.
i Q
d .d,
£
_
T C
fC
oo
J
7 C
£ 7 19
mio
J
°F
in
ft
ft
gal
min
in
in
gal
min
in
in
gal
min
in
in
gal
min
in
in
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Monthly Loading:
F-0
0 00
0
J :.;
0.00
0
Month Floating Total (in)
0.00
0 00
8.0612
6 C'

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page I2 of /r,>
Did the application rates exceed the limits in Attachment B of your permit?
Q 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? Ej 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.
Operator in Responsible Charge (ORC) Certification
ORC: James Hodges
Certification No.: 18564
Grade: 2 Phone Number: 704-695-3701
Has the ORC changed since the previous NDAR-1? ❑ Yes Q No
Permittee Certification
Permittee:
Valley Proteins, Inc.
Signing Official: Gaz Thomas
Signing Official's Title: General Manager
Phone Number: 704-694-3701 Permit Exp.: 6/30/23
Signature D Date mature 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 property 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