WQ0012796_Monitoring - 12-2016_20170106

.&ORM: NDMR 07-13 NON -DISCHARGE MONITORING REPORT (NDMR) Pageof_�
Permit No.: WQ001 2796
Facility Name:
Lakeview Packing Company
county:
Greene
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1)
Page __& of
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D • irrigation occur
at this facility?
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FORM: ND ARA 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of
'Permit No.: Q00Company
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RM; NDAR-1 08-11
NON -DISCHARGE APPLICATION REPORT (NDAR-1)
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, c_
L -,I Compllant ❑ Non -Compliant
2,6ompilant ❑ Non-Compllant
Was a suitable vegetative cover maintained on all sites as specified in your permit? I_7Compliant ❑Non -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted,site? LKCompilant ❑Non-Compiiant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? G,cmpitant ❑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
taKen. muacn aounional sneem IT
Operator in Responsible Charge (ORC) Certification .
Permittee Certification
ORC:..� t� Gam® A. -A.,4 q
Permittee:
Certification No.: 9 v�
Signing Official: ��+-GA'7 G tr tii2
Grade:wcol" Phone Number: 017 - C���
Signing Official's Title: e�5 G�t�rf7 C
Has the ORC changed since the previous NDAR-1? Y, i_KIto
Phone Number w-'5�S-%- 9lrd s Permit Exp.: S'31 p2.U1,7
Signature Date
01*1 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 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

IFORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDMLR) Page -!Y- Of
Permit No.: WQ0012796 Facility Name: Lakeview Packing Company County: Greene Month: Year:,2 C))
Field Name: 1
Field NIS e
Field Name: 3
000 "t
Field Name. 5
F
Area (acres): 1.26
(acres)'Area
Area (acres): 1.21
( acres):
Cover Crop:
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Crop:
Cover Crop:
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Load Type: PAN
Load Type: OAN
Load Type: AN
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Field Loaded? [I yEs L4 No
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"FORM: NDMLR 08-11 NON -DISCHARGE MASS LOADING REPORT (NDIVILR) Page of
Permit No.: WQ0012796
Faclilty.Name: Lakeview Packing Company
County: Greene
Year,
Field Name:
6
Field Name:
8
Feld Name
A Field Name:
Area (acres):
1.11
Area (acres):
1.47
Area acres :
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Cover Crop:
cover Cro P
Cover
Load Type:
PAN
Lo
Load Type:
ANS
Load Type:
Field Loaded?
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Field Loaded?
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11 FORM: NDMLR 08-11
NON -DISCHARGE MASS LOADING REPORT (NDMLR)
Did the mass loading rates exceed the limits in Attachment B of your permit?
Page / of A—
L►QCompliant ❑ 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
actlanfsl taken. Attach additional sheets if necessary.
Operator In Responsible Charge (ORC) Certification
Permittee Certification
ORC: J Gt"G O v t,—
Permittee: `qA2 Uo a tv is r—Ai euq C.. joa jtpG '
/u r/VCL
Certification Number: 979 D _5
Signing Official: � e. oto j_ 1V'* ��
! 1
Grade: (�Li.� 1 Phone Number:a9'a
Signing Official's Title: �,S d @MGI
Has the ORC changed since the previous NDMLR? ❑ Yes 2'�o
Phone No.:,2Jl / ' Cls 0,9 Permit Exp.: 3 -•3 1 a a CV/
Sign ture Date
Signature Date
By this signature, I certify that this report Is accurrale and complete to the best of my knowledge.
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 aware that there are significant penalties for submitting false information, Including the
possibility of tines 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