MHC000095_Application_20210511

State of North Carolina
Department of Environment and Natural Resources
Division of Water Quality
Registration Form for Manure Hauler Operations
The Division of Water Quality (Division) amended its rules for "Waste Not Discharged to Surface Waters" on
September 1, 2006. Among the changes was the addition of registration and reporting requirements for manure
hauler operations. A manure hauler is defined as any person who accepts or purchases animal waste and land
applies the animal waste on land not covered by the generator's permit. In accordance with 15A NCAC 02T
.1403(a)(2), any manure hauler that land -applies a total of more than one hundred (100) tons of animal waste
per calendar year must register with the Division by September 1, 2007. Any new manure hauler operation that
will exceed the 100-ton threshold must register with the Division prior to accepting or purchasing manure..
Please provide all of the following information in clear print:
1. Name of manure hauler:
Z f iW "5 (kAidiL st-i4L-t—)
2. Manure hauler company/organization (if applicable): 2.I- I dklZ VS
3. Mailing Address: P, L• Go J 1
City, State: SA L Ii jj t�
Zip: i L
Telephone: (70L3 ) Z5't 1Z03 E-Mail: :k vt \ St•1cL) ( % ne±
4. Amount of animal waste land -applied: X100 — 750 tons/year ❑ > 750 tons/year
5. Counties/States from which manure is received: ) OOI -E 1 "‘..etc/A
6. Counties/States where manure is land -applied: 1?-0(A)6'/), * v a )) RA'J wail)
ii 14% W(r� / dg LiAvviefO , N0016-Ovi. 24
I hereby certify that the above information is correct and that I have read and understand the requirements for
manure haulers contained in NCAC 02T .1400. I understand that there are significant penalties for submitting
false information, including the possibility ofj -uy s.
Signature:
Date:
L/ /-2.51-2,/
Please send this completed form to the following address:
North Carolina Division of Water Quality
Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
FORM: REG-MHO 12/06
MAY 04 2021
NC DEQ/DWR
Central Office