WQ0034380_Monitoring - 11-2023_20231228

Monitoring Report Submittal
...................................................
Permit Number#* WQ0034380
Name of Facility:* Sanderson Farms LLC Kinston Processing Facility
Month: * November Year: * 2023
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Upload Document*
NDAR NDMLR NDMR Nov. 2023.pdf
PDF Only
1.29MB
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 Franklin
Signature:
Date of submittal: 12/28/2023
This will be filled in automatically
Initial Review
Reviewer: Wanda.Gerald

Is the project number correct?* WQ0034380
Is the monitoring report accepted?* Yes No
Regional Office* Washington
Reviewer: _anonymous
Review Date: 1/22/2024

FORM: NDAR-1 07-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _ of
Permit No.: Q10:•
Facility Name: Sanderson Farms -Kinston.
Lenoir•nth:
November1
irrigation
• occur
at this facility?
�1,
Annual Rate (iny I
....
..
p j!i
..
■ p•
..
0 ■•Field
Irrigated?■•

FORM: NDAR-1 07-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page Z of 5
Permit No.: WQ0034380 I
Facility Name: Sanderson F- • -
.unty: Lenoir
Month:• -
1
I•
�
■�
■�
• • occur

FORM: NDAR-1 07-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page _� of,
Permit No.: W1110:•
Facility Name: Sanderson Farms-Kinston.unty:
Lenoir
I November
•
irrigation
• occur
at this facility?
PlYES NO
Hourly Rate
e
... .111110-
11-101M. .,
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Monthly Loading:
WIT
12 Month Floating Total Ciny

FORM: NDAR-1 07-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page C¢ � of 5
Permit No.: WQ0034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: November
Did irrigation
Field Name:
Field Name:Field•P]YES
occur
Area (acres):1
Area (acres):
Area (acres)
at this facility?
Cover C
Cover Crop:;
Cover Crop: 1
F-INO
Hourly Rate (in):
Hourly Rate (in):
Hourly Rate (in .
Annual Rate (in):'
Annual Rate (in):'
Annual Rate (in):
Field lrrigated?f�
�E�
Field Irrigated?
111111111111110 11-111.1 W Rkrj���
Field Irrigated
MonthlyLoading
is .•
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FORM: NDAR-1 07-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page S 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?
❑✓ Compliant
❑Non -Compliant
❑✓ Compliant
❑Non -Compliant
❑� Compliant
❑Non -Compliant
Compliant
❑Non -Compliant
ECompliant
❑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: 252 902 8906
Signing Officials Title: Complex Manager
Has the ORC changed since the previous NDAR-1? ❑yes QNo
Phone Number: 252-522-9145 ext 4105 Permit Exp.: 12/31/26
L4 U� nJ 2A � 2
Signature Date
Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
I ce 'fy rider 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: NDMLR 07-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page I- of
Permit No.: WQ0034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: November
Year: 2023
Field Name:
1A
Field Name:
1B
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:
Bermuda
Cover Crop:
Bermuda
Cover Crop:
Bermuda
Cover Crop:
Bermuda
Cover Crop:
PINES
Load Type:
PAN
Load TYpe:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Field Loaded?
❑� YES ONO
Field Loaded?
RIYES ONO
Field Loaded?
DYES ONO
Field Loaded?
AYES ONO
Field Loaded?
❑✓ YES [:]NO
z
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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
lbs/ac
gal
mg/L
Ibs/ac
Ibs/ac
December 4,180,599
14.61
22.7
22.7
0
14.61
0.0
0.0
3049565
14.61
16.6
16.6
1415869
14.61
16.6
16.6
3,267,391
14.61
16.6
16.6
January 3,110,401
17.23
20.0
42.7
0
17.23
0.0
0.0
3377527
17.23
21.7
38.3
1568109
17.23
21.7
38.3 <
3,618,714
17.23
21.7
38.3
February 3,216,573
15.44
18.5
61.2
0
15.44
0.0
0.0
2569910
15.44
14.8
53.0
984585
15.44
12.2
50.4
2,753,475
15.44
14.8
53.0
March 3,985,014
14.78
21.9
1 83.1
742,492
14.78
10.4
10.4
3663593
14.78
20.2
73.2
0
14.78
0.0
"' 50.4
3,925,282
14.78
20.2
73.2
April 1,600,510
14.05
8.4
91.5
629,486
14.05
8.4
18.8
1997173
14.05
10.4
83.6
0
14.05
0.0 `
50.4
3,824,770
14.05
18.7
91.9
May 4,174,963
17.69
27.5
119.0
1,642,028
17.69
27.5
46.3
3683784
17.69
24.3
107.9
0
17.69
0.0 -
50.4
4,525,776
17.69
27.8
119.7
June 3,299,166
12.29
15.1
134.1
1,297,573
12.29
15.1
61.4
3842546
12.29
17.6
125.5
0
12.29
0.0
50.4''
4,117,013
12.29
17.6
137.3
July 3,265,267
19.84
24.1
158.2
1,284,240
19.84
24.1
85.5
3295956
19.84
24.3
149.8
737528
19.84
11.7
- 62.2
4,765,695
19.84
32.9
170.1
August 3,715,481
14.02
19.4
177.6
1,461,312
14.02
19.4
104.9
3362660
14.02
17.6
167.4
1561235
14.02
17.6"
>79.7
3,602,849
14.02
17.6
187.7
September 3,827,707
10.83
15.4
193.0
0
10.83
0.0
104.9
2588480
10.83
10.4
177.8
1201794
10.83
10.4
90.2'>
3,927,872
10.83
14.8
202.5
October 3,331,193
12.38
15.4
208.4
=' 0
12.38
0.0
104.9
3924216
12.38
18.1
195.9
1821959
12.38
18.1
108.3
4,204,518
12.38
18.1
220.5
November 3,654,260
11.13
15.1
223.5
0
11.13
0.0
104.9
3201399
11.13
13.3
209.2
1486364
11.13
13.3
121:5
3,988,612
11.13
15.4
236.0
12 Month Floating PAN Load
(Ibs/ac/yr):
223.5
104.9
209.2
121.5
236.0
Annual PAN Load Limit
(Ibs/ac/yr):
8318

FORM: NDMLR 07-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page of 1
Permit No.: WQ0034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: November
Year: 2023
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:
Bermuda
Cover Crop:
PINES
Cover Crop:
Bermuda
Cover Crop:
Bermuda
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Field Loaded?
❑� YES ❑NO
Field Loaded?
E]YES EjNO
Field Loaded?
E]YES ❑No
Field Loaded?
E]YES ONO
Field Loaded?
DYES []NO
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gal
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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
December
14.61
0.0
0.0
2,681,984
14.61
16.6
16.6
1,108,190
14.61
16.6
16.6
4,526,931
14.61
19.4
19.4
0
14.61
0.0
0.0
January
0
17.23
0.0
0.0
2,970,362
17.23
21.7
38.3
1,227,347
17.23
21.7
38.3
3,874,114
17.23
19.5
38.9
0
17.23
0.0
0.0
February
0
15.44
0.0
0.0
2,260,143
15.44
14.8
53.0
933,887
15.44
14.8
53.0
4,006,271
15.44
18.1
57.0
0
15.44
0.0
0.0
March
0
14.78
0.0
0.0
2,758,371
14.78
17.3
70.3
1,139,754
14.78
17.3
70.3
4,963,476
14.78
21.5
78.5
0
14.78
0.0
0.0
April
150,483
14.05
5.0
5.0
844,591 =
14.05
5.0
75.3
348,983
14.05
5.0
75.3
4,951,777
14.05
20.4
98.8
0
14.05
0.0
0.0
May
565,539
17.69
23.8
28.8
3,714,908
17.69
27.8
103.1
1,534,992
17.69
27.8
103.1
2,086,851
17.69
10.8
109.6
0
17.69
0.0
0.0
June
602,114
12.29
17.6
46.4
3,379,383
12.29
17.6
120.7
988,944
12.29
12.5
115.6
4,128,300
12.29
14.8
124.5
0
12.29
0.0
0.0
July
696,983
19.84
32.9
79.2
3,911,841
19.84
32.9
153.6
0
19.84
0.0
115.6
4,067,004
19.84
23.6
148.1
0
19.84
0.0
0.0
August
526,917
14.02
17.6
96.8
2,957,340
14.02
17.6
171.1
0
14.02
0.0
115.6
4,370,263
14.02
17.9
166.0
176,535
14.02
14.7
14.7
September
574,451
10.83
14.8
111.6
2,820,396
10.83
12.9
184.1
0
10.83
0.0
115.6
4,767,545
10.83
15.1
181.1
239,231
10.83
15.4
30.2
October
614,910
12.38
18.1
129.7
2,816,139
12.38
14.8
198.8
0
12.38
0.0
115.6
4,237,145
12.38
15.4
196.5
212,617
12.38
15.7
45.9
November
583,334
11.13
15.4
145.1
3,273,986
11.13
15.4
214.2
0
11.13
0.0
1 115.6
14,168,1091
11.13
1 13.6
210.0
209,153
11.13
13.9
59.7
12 Month Floating PAN Load
/r
145.1
214.2
115.6
210.0_
59.7
(Ibs/ac/yr):
Annual PAN Load Limit
(lbs/ac/yr):l
FAA
WE FA"
Vxj/
= F//////A

FORM: NDMLR 07-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page 3 of L/
Permit No.: W00034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: November
Year: 2023
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:
Bermuda
Cover Crop:
PINES
Cover Crop:
PINES
Cover Crop:
PINES
Cover Crop:
Rye
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Field Loaded?
E]YES ❑NO
Field Loaded?
AYES ONO
Field Loaded?
E]YES ❑NO
Field Loaded?
PIYES [:]NO
?
Field Loaded.
DYES ❑NO
Qw
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Month
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
lbs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
gal
mg/L
Ibs/ac
Ibs/ac
December
3991809
14.61
16.2
16.2
3,938,584
14.61
16.2
16.2
3,033,7751
14.61
16.2
16.2
244,831
14.61
16.2
16.2
3,023,468
14.61
22.7
22.7
January
3986467
17.23
19.1
35.3
3,933,316
17.23
19.1
35.3
3,029,715
17.23
19.1
35.3
244,503
17.23
19.1
35.3
2,249,486
17.23
20.0
42.7
February
4551282
15.44
19.5
54.8
4,490,598
15.44
19.5
54.8
3,458,974
15.44
19.5
54.8
279,144
15.44
19.5
54.8
2,326,223
15.44
18.5
61.2
March
3792381
14.78
15.6
70.4
3,741,813
14.78
15.6
70.4 `
2,882,209
14.78
15.6
70.4
232,599
14.78
15.6 '
70.4
2,882,019
14.78
21.9
83.1
April
4358974
14.05
17.0
87.5
5,006,474
14.05
19.8
90.2
3,856,339
14.05
19.8
90.2
311,214
14.05
19.8
90.2
2,875,227
14.05
20.8
103.9
May
3044955
17.69
15.0
102.4
5,528,899
17.69
27.6
117.8
4,258,745
17.69
27.6
117.8
343,689
17.69
27.6
117.8
2,061,868
17.69
18.8
122.7
June
4922721
12.29
16.8
119.2
4,857,084
12.29
16.8
134.6
3,741,267
12.29
16.8
134.6
301,927
12.29
16.8
134.6
2,759,961
12.29
17.5
140.2
July
3171652
19.84
17.5
136.7
4,366,518
19.84
24.4
159.0
3,363,397
19.84
24.4
159.0
271,433
19.84
24.4 `
159.0
2,361,487
19.84
24.1
164.3
August
4610155
14.02
18.0
154.7
4,824,375
14.02
19.1
178.1
3,716,074
14.02
19.1
178.1
299,894
14.02
19A
178.1
2,891,915
14.02
20.9
185.1
September
4511752
10.83
13.6
168.3
5,141,321
10.83
15.7
193.8
3,960,206
10.83
15.7
193.8
276,721
10.83
13.6 "
1913
2,735,521
10.83
15.3
200.4
October
3511145
12.38
12.1
180.4
4,130,368
12.38
14.4
208.2
3,181,501
12.38
14.4
208.2
0
12.38
0.0
191.7
2,829,292
12.38
18.0
218.4
November
4707028
11.13
14.6
194.9
4,644,269
11.13
14.6
222.7
3,082,704
11.13
12.6
220.7
0
11.13
0.0
191.7
2,756,782
11.13
15.8
234.2
12 Month Floating PAN Load
(Ibs/ac/yr):
194.9
222.7
220.7
19L7-.
234.2
Annual PAN Load Limit
(Ibs/ac/yr):

FORM: NDMLR 07-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page _�_ of�
Did 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 11 Permittee Certification
ORC: Joseph H. Franklin
Certification Number: WW1012108T/SI1012364
Grade: 3 Phone Number:
Has the ORC changed since the previous NDMLR?
Permittee:
Sanderson Farms, LLC
Signing Official:
Jared Lowe
252 902 8906 Signing Officials Title: Complex Manager
❑Yes ❑� No Phone No.: 252-522-9145 ext 4105 Permit Exp.: 12/31/26
Signature Date Signature Date
By this signature, I certify that this report is accurrate and complete to the best of my knowledge. I certi , u er pen f.flaw, that this document and all attachments were prepared under my direction or supervision in
a 'dance 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 / of
Permit No.: WQ0034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: November
Year: 2023
PPI: 001
Flow Measuring Point: ❑Influent QEffluent ❑No flow generated
Parameter Monitoring Point: ❑Influent QEffluent []Groundwater Lowering ❑Surface water
Parameter Code -►
50050
00310
00916
00940
1 31616
00927
00610
00625
00620
00600
00400
00665
WQ09C
00931
00929
70300
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Y 2
mZ
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i
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o 2
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a
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p.
a o R
)af
Q
£
Z
:.0
co
m M
'O
o y .o
~ Nrn
o
24-hr
hrs
GPD
mg/L
mg/L
mg/L
#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
774000
721000
713000
934000
905000
677000
746000
826000
752000
730000
753000
732000
674000
711000
750000
722000
754000
784000
735000
661000
766000
689000
824000
675000
741000
760000
532000
585000
463000
366000
6.96
2
07:00
10
2
14.2
134
1
7.18
1.6
3.7
7.92
11.6
6.95
1.11
9A
11.7
217 "
737
3
07:00
9
6.96
4
5
6
07:00
10
-
6.96
7 1
07:00
10
2
1
0.53
2.1
9.32
11.5
6.92
19.2
10.2
8
07:00
10
1
6.88
9
07:00
10
2
1 "
0.53
1.6
10.7
12.4
6.89
19.6
11.4' -
10
07:00
9
1
6.94
11
12
131
07:00
1 10
7.04
14
07:00
10
4
1
0.53''
4.8
12.1 ''
17
6.93
17.5
13.7
15
07:00
10
6.91
16
07:00
10
5
1
3.19
6.4
8.39 '` `
14.8
6.97
20.4
11
17
07:00
9
1
6.92
18
191
20
07:00
10
6.96
21
07:00
10
7
1
1.06
4.8
5.78 i
10.6
6.96
17.7
7.5 "-
22
07:00
10
3
1 1
0.53
3.7
12.6 ''
16.4
6.88
16.3
13.9
23
1
6.91
24
07:00
10
6.93
261
07:00
8
26
27
07:00
10
6.92
28
07:00
10
3
1
0.56
4.5
10.2's
14.7
7.02
17.4
11.7
29
07:00
10
6.98
30
07:00
J 10
3
1
1.67
4.5
9.72 +-
14.2
6.96
1 17.8
11.4
31
Average:
- 715,167
3.44
14.20 `
134.00
1.00
7.18
1.13
4.01
9.64 "'
13.69
16.33
11`13
1 11.70
217.00
737.00
Daily Maximum:
934,000
7.00
14.20
134.00
1.00 '
7.18
3.19
6.40
12.60
17.00
T04
20.40
13.90
11.70
217.00 ,`
737.00
Daily Minimum:
366,000
2.00
14.20 -
134.00
1 1.00 ''
7.18
0.53
1.60
5.78
10.60
6.88 '
1.11
7.50''
11.70
217.00 -1
737.00
Sampling Type:
Recorder
Composite
Composite
Composite
Grab
Composite
Composite
Composite
Composite
Composite
1 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
1 Monthly
Monthly
3 X Year

FORM: NDMR 07-11 NON -DISCHARGE MONITORING REPORT (NDMR) Page Z of_�_
Permit No.: WQ0034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: November
Year: 2023
PPI: 001
Flow Measuring Point: ❑Influent ❑Effluent ❑No Flow generated
Parameter Monitoring Point: ❑Influent ❑� Effluent ❑Groundwater Lowering ❑Surface Water
Parameter Code 0
00530
o
vi=
O
c
O�
v
ao
sn
24-hr
hrs
mg/L
1
07:00
10
2
07:00
10
2.5
3
07:00
9
4
5
6
07:00
10
7
07:00
10
2.5
8
07:00
10
9
07:00
10
2.5
10
07:00
9
11
12
13
07:00
10
14
07:00
10
2.5
15
07:00
10
161
07:00
10
3.2
17
07:00
9
18
19
20
07:00
10
21
07:00
10
5.1
22
07:00
10
3.3
23
24
07:00
10
25
07:00
8
26
271
07:00
10
28
07:00
10
2.5
29
07:00
10
30
07:00
10
2.5
31
Average:
3
Daily Maximum:
5
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
Permit No.: WQ0034380
Facility Name: Sanderson Farms -Kinston Facility
County: Lenoir
Month: November
Flow Measuring Point: ElInfluent ElEffluent E]No flow generated
Parameter Monitoring Point: FlInfluent [:]Effluent [:]Groundwater Lowering 121surface water
•
•
•

FORM: NDMR 07-11
NON -DISCHARGE MONITORING REPORT (NDMR)
Page of
Sampling Person(s) Certified Laboratories
Name: Joseph Franklin Name: Environmental Chemists, Inc
Name: Dontay Holmes 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: 252 902 8906 Signing Official's Title: Complex Manager
Has the ORC changed since the previous NDMR? ❑Yes ❑✓ No Phone Number: 252-522-9145 ext 4105 Permit Expiration: 12/31/2026
t
Signature
By this signature, I certify that this report is accurrate and complete to the best of my knowledge.
?3 �, V 14- /11
Date Signature ate
I certi der 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