WQ0006058_Monitoring - 10-2016_20161202

FORM: NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page of

FORM: NDMLR 10-13 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page of . ,
Did the mass loading rates exceed the limits in Attachment B of your permit?
0 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: Joey Baggett
Permittee: Wayne Black
Certification Number: 997056
Signing Official:
Wayne Black
Grade: SI Phone Number: 252-287-5196
Signing Officials Title: Director Perdue AgriBusiness Environmental
Has the ORC changed since the previous NDMLR? ❑ Yes ❑., No
Phone No.: 252-348-4326 Permit Exp.: 5/31/20
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Signature Date
S ig nalu 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