WQ0012796_Monitoring - 02-2022_20220321

. FORM: NDMR 07-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page —,Y - of —ty -
'ermit No.: WQ0012796 ,-
•• •.Greene
i I
11Flow
Measuring '•genera
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-.[D Effluent El Groundwater Lowering 0 Surface Water
int: Influent
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CORM: NDMR 07-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page 3 of
Permit No.: WQ001 2796
Facility ame: Lakeview Packing Company
County: Greene
Month:
11Flow
Measuring •.
'• 0Effluent El Groundwater Lowering El Surface Water
•
•

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 9 of _ _1_
Sampling Person(s)
Certified Laboratories
Name: //
rJ
Name:
AA
Name:
Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? r"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.
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Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: �/� Zc1 � i ,r:-'- r A.� C
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Permittee: � /�-� W - �41
Certification No.: ct
Signing Official: ,�r�C it tj
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Grade: 14-." L4.J.. Phone Number: �,� S 5 �% " E� (YQ 0
Signing Official's Title: �)
Has the ORC changed since the previous NDMR? O yes wf
Phone Number.,,2.,5�2 `� 5^ �: ' C�( �t Permit Expiration:loll
Signature Date
Signature Date
By this signature, I certify that this report is aceurrate and complete to the best of my knowledge.
1 certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordan
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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page & of-3—
P WQ0012796
Lakeview Packing Company
t Greene- _:.
at this facility?
Did irrigation occur YES 53"NO
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page_V of-'Y,
Permit No.: WQ0012796
Facility Name: Lakeview Packing Company
County: Greene
Did irrigation occur
at this facility?
ElYES i�i •
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page A of 8
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?
El Compliant ❑ Non -Compliant
�mpliant ❑ Non -Compliant
t`_'J Compliant ❑ Non -Compliant
Compliant ❑ Non -Compliant
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: �G J�j 1-N
Permittee: L /9K� U. ew ��Z_ . A-�_ A%&'
Certification No.: / 9 �(,�
Signing Official 73'�_G A.r-_
Grade:wu)j- Phone Number: ao,<-1515 9 — 7 84V
Signing Official's Title: ? cs d"�
Has the ORC changed since the previous NDAR-1? El Yes 9,9o'
Phone Number��_1!5'15-9 - 5,Lf6s Permit Exp.: 30 `,,Z OA
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 or 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: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page '�71 of 3
'Permit No.: WQ0012796
Facility Name: Lakeview Packing Company
County: Greene
Month: �� w� N
Year:
Field Name:
1
Field Name:
2
Field Name:
3
Field Name:
4
Field Name:
5
Area (acres):
1.26
Area (acres):
1.26
Area (acres):
1.21
Area (acres):
0.81
Area (acres):
).11
Cover Crop:
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CoverCrop:
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Cover Crop:
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Cover Crop:
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Cover Crop:
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Load Type:
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Load Type:
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Load Type:
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Load Type:
PAN
Load Type:
PAN
Field Loaded?
❑ YES 9NO
Field Loaded?
❑ YES 03 No
Field Loaded?
❑ YES Q No
Field loaded?
❑ YES Ro
Field Loaded?
❑ YES [.. <b
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• FORM: NDMLR08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page _'5� of
Permit No.: WQ0012796
Facility Name: Lakeview Packing Company
County: Greene
Month: ��
Year:
Field Name:
6
Field Name:
7
Field Name:
8
Field Name:
Field ame:
Area (acres):
1.11
Area (acres):
1.11
Area (acres):
1.47
Area (acres):
Area (acres):
Cover Crop:
r (
Cover Crop:
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Cover Crop:
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Cover Crop:
Cover Crop:
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
Load Type:
Field Loaded?
❑ Yeso
Field Loaded?
❑ YES (f0 i
Field Loaded?
❑ Yes ®iro
Field Loaded?
❑ YES ❑ No
Field Loaded?
❑ YES ❑ No
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FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page _/ of c3
ISid the mass loading rates exceed the limits in Attachment B of your permit? 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: -i—ctC C) v
Certification Number: 9 5 1 7 0 5
Grade: (i(J�,�,i I Phone Number:a5.2-5-3 9 - y80.9
Has the ORC changed since the previous NDMLR? ❑ Yes I+ to
r
v
fV
Permittee Certification
Permittee: bq/<Q U+ e L--� PC( C-A i N� 4 G I
Signing Official: J Cx 6 06 1-14 IV If / C"
Signing Official's Title: / Ye-S id t`,ut/
Phone No.:,Jl� -S� 9.. ✓ S3 Permit Exp.:
Signalture 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 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