WQ0034380_Monitoring - 12-2022_20230127

Monitoring Report Submittal
Permit Number#* WQ0034380
Name of Facility:* Sanderson Farms Kinston Processing Facility
Month: * December Year: * 2022
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR NDAR, NDMLR, NDMR Dec. 2022.pdf 1.2MB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address: * [e-mail]
Name of Submitter: * Joseph H. Franklin
Signature:
, C4lF� �iY. 1j�ta rA1iwr
Date of submittal: 1/27/2023
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* W00034380
Is the monitoring report accepted?* Yes NO
Regional Office* Washington
Reviewer: _anonymous
Review Date: 3/15/2023

FORM: NDAR-1 07-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
PermitNo.: WQ0034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: December
• irrigation
Field Name:
Field Name:
Field Name:
occur
Area (acres):
Area (acres):
Area (acres):
at this facility'?
Cover Crop:
Cover Crop:
Cover Crop:
PIYES EINO
Hourly Rate (iny�
Hourly Rate (in):
Hourly Rate
®
���

FORM: NDAR-1 07-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 2- of 6
No.: WQ0034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: December
Did irrigation occur
FieldPermit
-
Area (acres):
[ZYES
Hourly Rate (in):
Hourly Rate (in):
�.
Annual -
..
Monthly Loading:
W-T-TV M.
12 Month Floating Total (in):
RIM_

FORM: NDAR-1 07-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page ,i of
Permit No.: Q10:1
Facility Name: Sanderson Farms-Kinston.unty:
Lenoir
Month:DecemberArea
Did irrigation
Field Namie�j
occur
(acres):
Area (acres):
/
Cover Crop:
Hourly Rate (in)::
Hourly Rate (in)_:_,�
Annual Rate (in):
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FORM: NDAR-1 07-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page G/ of_
Permit No.: WQ0034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: December
Did irrigation
occur
at this facility'?
•1
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111

FORM: NDAR-1 07-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page 5 of 5
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
R]Compliant ❑Non -Compliant
OCompliant ❑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: Joseph H. Franklin
Permittee:
Sanderson Farms, Inc
Certification No.: WW1012108T/Sll012364
Signing Official: Jared Lowe
Grade: 3 Phone Number: 252 939 6433
Signing Official's Title: Divison Manager
Has the ORC changed since the previous NDAR-1? []Yes ❑✓ No
Phone Number: 252-522-9145 ext 4105 Permit Exp.: 12/31/26
i
Z,
IZ-77
Signature Date
; Signature Date
B this signature, I certify that this report is accurrate and complete to the best of m knowledge.
Y 9 fY P P Y 9
I certify, under penalty of law, that this document and all attachments were prepared under m direction or supervision in accordance
dY P Y P P Y P
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: NDMLR 07-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page i of 4
Permit No.: W00034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: December
Year: 2022
Field Name:
1A
Field Name:
113
Field Name:
2A
Field Name:
2B
Field Name:
3A
Area (acres):
22.4
Area (acres):
8.81
Area (acres):
22.4
Area (acres):
10.4
Area (acres):
24
Cover Crop:
Rye Grass
Cover Crop:
Rye Grass
Cover Crop:
Rye Grass
Cover Crop:
Rye Grass
Cover Crop:
PINES
Load Type:
PAN
Load Type:
PAN '
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Field Loaded?
❑� YES ❑NO
Field Loaded?
AYES []NO
Field Loaded?
❑� YES ❑NO
Field Loaded?
OYES [-]NO
Field Loaded?
EYES ❑NO
d
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Month
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
January 3,376,494
15.26
19.2
19.2
0
15.26
0.0"
0.0
2761293
15.26
15.7
15.7
1282030
15.26
15.7
15.7
2,958,531
15.26
15.7
15.7
February 3,027,795
27.5
31.0
50.2
0
27.5
0.0
0.0
2852284
27.5
29.2
44.9
1324274
27.5
29.2
44.9
3,056,020
27.5
29.2
44.9
March 3,427,340
20.53
26.2
76.4
427,412
20.53
8.3
8.3
3326334
20.53
25.4
70.3
1544369
20.53
25.4
70.3
3,563,927
20.53
25.4
70.3
April 3,267,603
17.4
21.2
97.6
1,285,158
17.4
21.2
29.5-
3051059
17.4
19.8
90.1
1416563
17.4
19.8
90.1
3,854,122
17.4
23.3
93.6
May 1,161,060
13.78
6.0
103.5
456,649 `
13.78
6.0
35A
984478
13.78
5.1
95.1
457079
13.78
5.1
95.1
4,014,227
13.78
19.2
112.8
June 963,299
11.6
4.2
107.7
0 `<
11.6
0.0
35.4
3786527
11.6
16.4
111.5
1758031
11.6
16.4
111.5
4,056,993
11.6
16.4
129.2
July 3,880,430
6.26
9.0
116.7
0 `
6.26
0.0
35.4 '
2479229
6.26
5.8
117.3
1151071
6.26
5.8 "
117.3
3,907,353
6.26
8.5
137.7
August 2,791,022
9.92
10.3
127.0
0
9.92
0.0
35A
3296113
9.92
12.2
129.4
1530337
9.92
12.2
129.4
4,025,857
9.92
13.9
151.6
September 3,047,946
8.26
9.4
136.4
498,910
8.26
3.9
39.3 -
3592580
8.26
11.0
140.5
1667984
8.26
11.0
140.5
3,832,851
8.26
11.0
162.6
October 4,052,881
11.81
17.8
154.2
1,594,012
11.81
17.8
57:2 `
1312401
11.81
5.8
146.3
609330
11.81
5.8
146.3
4,156,199
11.81
17.1
179.6
November 3,523,0951
21.4
28.1
182.3
602,814
21.4
12.2
69.4''
2404349
21.4
19.2
165.4
1116304
21.4
19.2
165.4
3,625,160
21.4
27.0
206.6
December 4,180,5991
14.61
22.7
205.0
0
14.61
0.0
69.4
3049565
14.61
16.6
182.0
1415869
14.61
1 16.6
182.0
3,267,391
14.61
16.6
223.2
12 Month Floating PAN Load
205.0
69.4
182.0
182A
223.2
(Ibs/ac/yr):
Annual PAN Load Limit
8318
(Ibs/ac/yr):

FORM: NDMLR 07-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page - of t
Permit No.: W00034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: December
Year: 2022
Field Name:
3B
Field Name:
4A
Field Name:
4B
Field Name:
5A
Field Name:
5B
Area (acres):
3.51
Area (acres):
19.7
Area (acres):
8.14
Area (acres):
28.5
Area (acres):
1.4
Cover Crop:
PINES
Cover Crop:
Rye Grass
Cover Crop:
PINES
Cover Crop:
Rye Grass
Cover Crop:
Rye Grass
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Field Loaded?
DYES [-]NO
Field Loaded?
EYES [:]NO
Field Loaded?
YES ❑No
Field Loaded?
EYES ❑No
Field Loaded?
EYES [-]NO
CD
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Month
gal
432,684
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
lbs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
lbs/ac
gal
mg/L
Ibs/ac
Ibs/ac
January
15.26
1 15.7
15.7
2,428,461
15.26
15.7
15.7 '
0
15.26
0.0
0.0
4,205,545
15.26
18.8
18.8
211,032
15.26
19.2
19.2
February
446,943
27.5
29.2
44.9
2,508,482
27.5
29.2
44.9
0
27.5
0.0
0.0
3,771,225
27.5
30.3
49.1
189,238
27.5
31.0
50.2
March
521,584
20.53
25.4
70.3
1,602,148
20.53
13.9
58.8
0
20.53
0.0
0.0
3,545,629
20.53
21.3
70.4
177,917
20.53
21.8
71.9
April
563,666
17.4
23.3
93.6
3,163,591
17.4
23.3
82.1
0
17.4
0.0
0.0
3,410,493
17.4
17.4
87:8
171,136
17.4
17.7
89.7
May
587,081
13.78
19.2
112.9
2,295,016
13.78
13.4
95.5
733,116
13.78
10.4
10.4
4,609,5061
13.78
18.6
106.4
231,302
13.78
19.0
108.7
June
593,336
11.6
16.4
129.2
3,330,115
11.6
16A
111.9
1,375,997
11.6
16.4
26.7
3,732,8741
11.6
12.7
119A
187,313
11.6
12.9
121.6
July
571,451
6.26
8.5
137.7
1,656,453
6.26
4.4
116.3
684,443
6.26
4.4
31.1
4,038,8591
6.26
7.4
126.5
202,666
6.26
7.6
129.2
August
448,697
9.92
10.6
148.3
3,304,558
9.92
13.9
130.1
1,365,437
9.92
13.9
45.0
5,085,291
9.92
14.8'
'141.2>
255,176
9.92
15.1
144.3
September
0
826
0.0
148.3
2,604,478
8.26
9.1
139.2
1,076,165
8.26
9.1
54.1
3,693,466
8.26
8.9
150.1'
111,215
8.26
5.5
149.7
October
0
11.81
0.0
148.3
2,913,301
11.81
14.6
153.8'
1,203,770
11.81
14.6
68.6
5,048,006
11.81
17.4
167.E
0
11.81
0.0
149.7
November
0
21.4
0.0
148.3
12,975,654
1 21.4
27.0
180.8'
1,229,534
21.4
27.0
95.6
4,388,139
21.4
27.5
195.1 '
0
21.4
0.0
149.7
December
0
14.61
0.0
148.3
1 2,681,984
14.61
16.6
197.4
1,108,190
14,61
16.6
112.2
4,526,931
14.61
19.4
=214.4'
0
14.61
0.0
149.7
12 Month Floating PAN Load
148.3
197.4
112.2
214.4`
149.7
(Ibs/ac/yr):
Annual PAN Load Limit
(Ibs/ac/yr):

FORM: NDMLR 07-11
NON -DISCHARGE MASS LOADING REPORT (NDMLR)
Page 3 of
Permit No.: WQ0034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: December
Year: 2022
Field Name:
6
Field Name:
7
Field Name:
8A
Field Name:
8B
Field Name:
9
Area (acres):
30
Area (acres):
29.6
Area (acres):
22.8
Area (acres):
' 1.84
Area (acres):
16.2
Cover Crop:
Rye Grass
Cover Crop:
PINES
Cover Crop:
PINES
Cover Crop:
PINES
Cover Crop:
Rye Grass
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Field Loaded?
E]YES ❑No
Field Loaded?
EYES ❑NO
Field Loaded?
❑e YES ❑NO
Field Loaded?
OYES ❑NO
Field Loaded?
YES ❑NO
Q
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Month
gal
mg/L
Ibs/ac
lbs/ac
gal
mg/L
lbs/ac
lbs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
1bs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
January
3722578
15.26
15.8
15.8
3,672,943
15.26
15.8
15.8
2,829,160
15.26
15.8
15.8
228,318
15.26
15.8
15.8
2,441,929
15.26
19.2
19.2
February
4372506
27.5
33.4
49.2
4,314,207
27.5
33.4
49.2
3,323,106
27.5
33.4
49.2
268,181 '
27.5
33.4
49.2
2,189,743
27.5
31.0
50.2
March
4750356
20.53
27.1
76.3
4,687,019
20.53
27.1
76.3
3,610,270
20.53
27.1
76.3
291,356
20.53
27.1 '
76.3
2,478,702
20.53
26.2
76.4
April
1391381
17.4
6.7
83.1
4,761,841
17.4
23.3
99.7
3,667,904
17.4
23.3
99.7
296,007
17.4
23.3
99.7
1,656,477
17.4
14.8
91.2
May
5736466
13.78
22.0
105.0
5,659,981
13.78
22.0
1211
4,359,715
13.78
22.0
121.7
351,837
13.78
22.0
1211-
2,676,487
13.78
19.0
110.2
June
1938969
11.6
6.3
111.3
4,840,917
11.6
15.8
137.5
3,876,233
11.6
16.4
138.1
312,819
11.6
16.4
138.1
2,957,578
11.6
17.7
127.9
July
3434820
6.26
6.0
117.3
4,835,733
6.26
8.5
146.0
3,724,821
6.26
8.5
146.6
218,625
6.26
6.2
144.3
2,033,044
6.26
6.6
134.4
August
2402913
9.92
6.6
123.9
4,371134
9.92
12.2
158.2-
3,366,954
9.92
12.2
158.8
0
9.92
-0.0
144.3
3,382,512
9.92
17.3
151.7
September
2598058
8.26
6.0
129.9
5,565,219
8.26
13.0
171.2
4,286,723
8.26
13.0
171.8
0
8.26
0.0
144.3'
1,293,405
8.26
5.5
157.2
October
2465897
11.81
8.1
138.0
5,335,4021
11.81
17.8'
188.9
4,109,700
11.81
17.8
189.6
0
11.81
0.0
144.3
2,931,102
11.81
17.8
175.0
November
3409616
21.4
20.3
158.2
4,708,5811
21.4
28.4 '
217.3
3,626,881
21.4
28.4
217.9
70,922
21.4
1 6.9
1 151.2 JF2,547,952
21.4
28.1
203.1
December
3991809
14.61
16.2
174.5
3,938,5841
14.61
16.2
233.5-
3,033,775
14.61
16.2
'ME=
234.2
F244,831 '
14.61
1 16.2
1 167.4 113,023,468
14.61
22.7
225.8
12 Month Floating PAN Load
174.5
233.5
234.2
167.4
225.8
(lbs/ac/yr):
-
-------- - -
Annual PAN Load Limit
(Ibs/ac/yr):

FORM: NDMLR 07-11
NON -DISCHARGE MASS LOADING REPORT (NDMLR)
Page q of
Did the mass loading rates exceed the limits in Attachment B of your permit? OCompliant ❑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: Joseph H. Franklin
Certification Number: WW1012108T/S11012364
Grade: 3 Phone Number: 252-939-6433
Has the ORC changed since the previous NDMLR? ❑Yes ❑✓ No
YZ 1L 23
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee:
Sanderson Farms, Inc
Signing Official:
Jared Lowe
Signing Officials Title: Division Manager
Phone No.: 252-522-9145 Permit Exp.: 12/31 /26
r
Signature Date
I certify, under 1penalty 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 07-11
NON -DISCHARGE MONITORING REPORT (NDMR)
Page -L of ..-5
Permit No.: W00034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: December
Year: 2022
PPI: 001
Flow Measuring Point: ❑Influent ❑✓ Effluent ❑No Flow generated
Parameter Monitoring Point: ❑Influent ❑✓ Effluent ❑Groundwater Lowering ❑Surface water
Parameter Code -0
50060
00310
00916
00940
31616
00927
00610
00625
00620
00600
00400
00665
WQ09C
00931
00929
70300
o
m
¢ E
O�
O
c
O
i- y
O
O
o
a
O
m
2
�a
U
o
t
U
m w°
U. cm
U
E
c
a�
�a
E
E
¢
�_
1 2
�._
H Z
z
_
o 2
-�
Z
a
o y
►- G
IL
me
m o
o >_
¢ Z
o
a o m
N��
¢
a
N
c
o v°r o
Hm
p
24-hr
hrs
GPD
mg/L 1
mg/L
mg/L 1
#1100 mL
mg/L
mg/L
mg/L
mg/L
mg/L
su
mg/L
mg/L <
Ratio
mg/L
mg/L
1
07:00
10
597,000
2
13.6
1
7.62
0.53
4.3
18.5
22.8
6.82
36.6
19.9 `''
10.1
188
2
07:00
10
697,000
6.80
3
835,000
4
65,000
5
07:00
10
1,068,000
6.81
6
07:00
10
1,024,000
3
1
5.32
9
5.91
14.9
6.98
24.1
9.7:''`
7
07:00
10
1,026,000
6.76
8
07:00
10
1,029,000
5
1
9.58
15.4
8.09
23.5
6.81
20.1
14.7
9
07:00
10
769,000
7.40
10
924,000
11
768,000
121
07:00
10
684,000
6.89
13
07:00
10
658,000
3
1
2.66
8.5
10.3
18.9
6.84
18.8
1 13.5
14
07:00
10
679,000
6.81
15
07:00
10
750,000
4
1
5.32
20
6.65
26.7
6.89
18.2
13.8
16
07:00
10
667,000
6.92
17
750,000
181
715,000
19
07:00
10
590,000
6.77
20
07:00
10
554,000
3
1
3.78
7
11.1
18.2
6.78
17.3
14.1
21
07:00
10
`' 679,000
6.70
22
07:00
10
646,000
4
1
6,47
10.8
6.41
17.3
6.91
19.1
11
23
07:00
10
1 532,000
1 6.68
241
512,000
25
" 463,000
26
484,000
27
07:00
10
570,000
9
1
17.8
23.2
4.03
27.3
6.83
19.2
14.6
28
07:00
10
578,000
6.85
29
07:00
10
629,000
6
1
18.3
22.6
9.67
32.3
6.78
19.1
20.2'
301
07:00
1 10
649,000
1
6.76
311
07:00
1 4
872,000
Average:
692,355
4.33
13.60
1.00
7.62
7.75
13.42
8.96
22.43
21.39
14.61
10.10
188.00I
Daily Maximum:
1,068,000
9.00
13.60
1.00
7.62
18.30
23.20
18.50
32.30
7.40 '
36.60
20.20
10.10
188.00 F
Daily Minimum:
65,000
2.00
13.60
1.00
7.62
0.53
1.4.30
4.03
14.90
6.68
17.30
9.70(
10.10
188.00
Sampling Type:
Recorder
Composite
Composite
Composite
Grab
Composite
Composite
I Composite
Composite
Composite
Grab
Composite
Calculated
Calculated
Composite
Composite
Monthly Limit:
1,400,000
Daily Limit:
Sample Frequency:
Continuous
2 X Week
Monthly
3 X Year
2 X Week
Monthly
2 X Week
2 X Week
2 X Week
2 X Week
5 X Week
2 X Week
2 X Week
Monthly
Monthly
3 X Year

FORM: NDMR 07-11
NON -DISCHARGE MONITORING REPORT (NDMR)
Page 2 of 3
Permit No.: WQ0034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: December
Year: 2022
PPI: 001
Flow Measuring Point' _]Influent ❑Effluent ❑No flow generated
Parameter Monitoring Point: ❑Influent Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code —s
00530
-
>
O
_
U
m
tp
24-hr 1
hrs
mg/L
1
07:00
10
3.3
2
07:00
10
3
4
5
07:00
10
6
07:00
10
2.5
7
07:00
10
8
07:00
10
2.5
9
07:00
10
10
11
12
07:00
10
13
07:00
10
2.5
14
07:00
10
15
07:00
10
3.6
16
07:00
10
17
18
19
07:00
10
20
07:00
10
2.9
21
07:00
10
22
07:00
10
3.4
23
07:00
10
24
25
26
27
07:00
10
5.6
28
07:00
10
29
07:00
10
5.9
30
07:00
10
31
07:00
4
Average:
4
Daily Maximum:
6
Daily Minimum:
3
Sampling Type:
Composite
Monthly Limit:
Daily Limit:
Sample Frequency:
2 X Week

FORM: NDMR 07-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page 3 of
Sampling Person(s) Certified Laboratories
Name: Joseph Franklin Name: Environmental Chemists, Inc
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A 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 Permittee Certification
ORC: Joseph H. Franklin Permittee: Sanderson Farms, Inc
Certification No.: WW1012108T/S11012364 Signing Official: Jared Lowe
Grade: 3 Phone Number: 252 939 6433
Has the ORC changed since the previous NDMR? ❑Yes ❑✓ No
i
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
Signing Official's Title: Divison Manager
Phone Number: 252-522-9145 ext 4105 Permit Expiration: 12/31/2026
t -7/ �.
, I! LA i
j Signature Date
/ Icertify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in
accordance with system designed to assure that all qualified personnel properly gathered and evaluated the information
submitted. Bas d 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