WQ0012796_Monitoring - 11-2022_20221205

FORM: NDMR 07-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page E of
Permit No.: QOO 12796 ,
. Company
County: GreeneI
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It
Flow Measuring •• ■ [DEffluent ■ No flow generated
I Parameter Monitoring -. ■influent Effluent■Groundwater LoweringSurface Water
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FORM: NDMR 07-13 NON -DISCHARGE MONITORING REPORT (NDMR) Page of _i6_11
Permit No.: W0001 2796
Facility Name: Lakeview Packing Company
County: Greene
I I
Flow Measuring '•
Point: surface Water
Parameter Code
•
•
Sample Frequency:

' . FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page CI of 9
Sampling Person(s) Certified Laboratories
Name: I Name:
Name: Name:
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? 0 Compliant o 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.
NO
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Operator in Responsible Charge (ORC) Certification
Permitteje' Certification
ORC: eo" 4.4-
Permittee: V ��4J ��� e k t!�� • .VG .
Certification No.: L / / `7
Signing Official: ` r , ,L,/f y
Grade: % 1,_; y Phone Number:
2 5„ - 5 3 % Z FV
Signing Official's Title: �y
Has the ORC changed since the previous NDMR?
yes
Phone Number:2 5 2 - S Y'i - 7ec Permit Expiration:100,
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 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 �
WQ0012796
. Company
County: GreeneDid
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irrigation occur
at this facility?
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Field Name.
Field Name:
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FORM: NDAR-1 08.11 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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CORM: NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
i
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?
Page %A__ of
LF7, Compliant ❑ Non -Compliant
[R<rnpliant ❑ Non -Compliant
Was a suitable vegetative cover maintained on all sites as specified in your permit?lJCompliant ❑Non-Compiiant
Were all setbacks listed in your permit maintained for every application to each permitted site? 21Compliant ❑ Non-Compiiant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? ompliant ❑ 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 dates) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
ORC:
Certification No.:
Grade:WWj_ Phone Number: ao,<,5�5 9 —98C6
Has the ORC changed since the previous NDAR-1? ❑ Yes g'I oo
_ ;7 - - !,W=L2129
Signature Date
By this signature, I certify that this report is accurrale and complete to the best of my knowledge.
Permittee Certification
Permittee:
Signing Official: �G-Gd� 6 tr tiL'
Signing Official's Title:
Phone Number��_� 9' / 0IPA
V& Permit Exp.: Cp - J 0 2 0✓`
l 1� _L
Signature
Date
I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision In accordce
with a system designed to assure that all qualified personnel properly gathered and evaluated the information submitted. Basedan
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 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page _�j of
`Permit No.: WQ0012796
Facility Name: Lakeview Packing Company
County: Greene
Month: /�UeX ,, ,
r
Year.,2oo
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):
i.11
Cover Crop:
f
Cover Crop:
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Cover Crop:
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Cover Crop:
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Cover Crop:
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Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Field Loaded?
❑ YES (ENO
Field Loaded?
❑ YES NO
Field Loaded?
❑ YES 21No
Field Loaded?
❑ YES ER No
Field Loaded?
❑ YES Wo
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FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page S of A"
Permit No.: W00012796
Facility Name: Lakeview Packing Company
County: Greene
Month: G L P
Year:
Field Name:
6
Field Name:
7
Field Name:
8
Field Name:
Field Name:
Area (acres):
1.11
Area (acres):
1.11
Area (acres):
1.47
Area (acres):
Area (acres):
Cover Crop:
' C NLt
Cover Crop:
00
Cover Crop:
`^,+ac. a
Cover Crop:
Cover Crop:
Load Type:
PAN
Load Type:
PAN
Load Type:
PAN
Load Type:
Load Type:
Field Loaded?
❑ YES [RNo
Field Loaded?
❑ YES I NO
Field Loaded?
❑ YES Eg<b
Field Loaded?
❑ YES ❑ No
Field Loaded?
❑ YES ❑ No
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12 Month Floating PAN Load
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Annual PAN Load Limit
(lbslac/yr):
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FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page J 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
ORC: J ct.G o v /�-�`' �'
ul'/UCt?
Certification Number: I / ! 1 D S
Grade: WW I Phone Number:,_�51Z-5-5—? - FL(,JSO
Has the ORC changed since the previous NDMLR? ❑ Yes 19<6
i 1 c 92
Signature Date
By this signature, I certify that this report Is accurrate and complete to the best of my knowledge.
Permittee Certification
Permittee:14K2L"6eL.) y"CtCArNj �G .,�n;G r
Signing Official: j a. L ob 4,-A, /V f /
Signing Official's Title: i d e v
Phone No.:,2s'.2 C)q Permit Exp.: _ -3 .. 02
Signature Date
I certify, under penally 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 awarethal 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