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NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page 2 of 2
Sampling Person(s)
Name: Tony Baldwin L,ICompGai_✓INan-
Name: Environment 1
Name: Name:
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
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 it necessary.
I ✓lYes l INo
Flow exceeded monthly permit limit due to I and I
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Tony Baldwin Permittee: Lake Creek Corporation
Certification No.: 29101 Signing Official: Steve Jones
Grade: SI Phone Number: 252-235-4900 Signing Official's Title: President
Has the ORC changed since the previous NDMR? Phone Number. 704-576-8462 Permit Expiration: 6/30/2016
K& Ire-4-txmed pyfor +o maiii
Signature Date Signature — 1nf i Gtea-nCt Date
By this signature, I certify that this report is accurrate 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
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

NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page of
AR-1 10-13
it No.: WQ0018708
Facility Name: Lake Creek Corporation
County: Bladen
Month: April
Year: 2016
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NDAR-1 10-13 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
ridtheapplication rates exceed the limits in Attachment B of your permit?
❑Compliant ONon-Compliant
Were adequate measures taken to prevent effluent ponding in or runoff from the sites? ❑✓ Compliant ❑Non-Compllant
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? [ZCompliant ❑Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? QCompliant ❑Non -Compliant
If the facility is non-comDliant, 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. Auacn aaanionai sneers It
over but it is down from last mounth and I am working on keeping a good free board and getting thi
Operator In Responsible Charge (ORC) Certification
Permittee Certification
ORC: Tony Baldwin
Permittee: Lake Creek Corporation
Certification No.: 29101
Signing Official: Steve Jones
Grade: 29101 Phone Number. 252-235-4900
Signing Official's Title: President
Has the ORC changed since the previous NDAR-1? ❑res QNo
Phone Number: 704-576-8462 Permit Exp.: 6/30/16
1
� . 17z0
o - r Z+u-v-n e& .C)V- +ZD met) t
Signature - W f (( Q- 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 forsubmittIng false Inforrnathn, 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