NCG060043_MONITORING INFO_20200107

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
G 0b b tlI 3
DOC TYPE
❑JJ HISTORICAL FILE
�TMONITORING REPORTS
DOC DATE
❑ �� 0 -7
YYYYMMDD

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted /
CERTIFICATE OF COVERAGE NO. NCG060043 SAMPLE COLLECTION YEAR r201 �I
FACILITY NAME _Ingredion Incorporated FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Forsyth ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES 'dArDISCHARGING TO SALTWATERS? [:]YES ®NO
LABORATORY ,&Q A/QAri ,;j ' Lab Cert. #
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall Z SZ or ❑ No discharge this period]
OutfalLNo.
Sample Collected,
mo/dd/yr
TSS,
, mg/L
pH,-
,. Standard units
COD,
mg/L.
Oil and Grease,
mg/L
Fecal Coliform ,
Colonies per 100 ml
Enterococci , "
Colonies per 100 ml
Benchmark :
-
100or504
,Within,6.0-9.0
120
30
1000
Soo
0
' Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ® no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
OutfalLNo.
Sample Collected,
mo/dd/yr '
Oil and Grease,
mg/L,
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/rho
Benchmark
-
' 30
100 or 504,
- 6.0 - 9.0
-
(ifyes, complete Part B)
' Only applies to facilities that use/process meats.
ZThe total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249 Last Revised: March 27, 2018
Page I of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NOPR
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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 qualified personnel properly gather and evaluate 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."
U..
(Signature of Permittee)
j o-7aoa0
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-249 Last Revised: March 27, 2018
Page 2 of 2

I x i i
i 7 i li aft MAT it M.
it i
li b or I tl` n: i livc.
For: Ingredion,Inc.
4501 Overdale Road
Winston-Salem, NC 27107
Attn: Pamela Bradsher
Report of Analysis
12/31 /2019
,,�,. GagF wlv+tyl
: to NC 434
NC I67701.
Client. Sample ID: Outfall I '
Site: Ingredion, Inc
Lab Sample ID:
Collection Dater
76283-01
12117/2019 10:00
Parameter. -
Method
Result
Units
Rep Limit. Analyst Analysts Date/Time
COD
EPA 410.4
36
mg/L
5
HW 12/23/2019
Hydrocarbon 08G
EPA 1664 Revision B/Silica Gel
<5
mg/L
5
EE 12/20/2019
PH
SM 4500 H+13-2000
6.96
Std. Units
LP 12/19/2019 1644
Total Suspended Solids (TSS)
SM 2540 D-1997
10.4
mg/L
5
AW 12/20/2019
NA = not analyzed
P.O..Box 473 106 ShortSlreel Kemersville, North Carolina 27284 Tel; 336-996-2841 Fax [phone] v .v.randalabs.corn Page 1
_ d_b�eF'y Y1C

F
Ingredion_
4501 Overdale Road, Winston-Salem, NC 27107-6145
TEL [phone] FAX [phone]
CHAIN OF CUSTODY RECORD
REGULATORY CLASSIFICATION
PROJECT NO.
CLIENT NAME
PRETREATMENT ❑ NPDES © DRINKING WATER ❑ OTHER ❑
REQUESTED PARAMETERS REMARKS / PRESERVATION
fir � � CY
Ingredion Incorporated
SAMPLERS: (SIGNATURE)
(PRINT)
-
t
aW
a
ALL SAMPLES ARE TO BE CHILLED
F
w
w
WITH ICE. GRAB SAMPLE #1 8 #2 ARE
SAMPLE ID
DATE
TIME
LOCATION
g
=
wu
a
TO BE LOWERED TOApHor2.0OR
o; o
i y vw
z
m
LESS WITH SULFURIC ACID. SAMPLE
n O Z
F g g F
za.00
O
#3 IS NOT ph ADJUSTED. ALL
LL
O u n
0., u n
d
0
m
SAMPLES ARE COOLED TO<4 C.
U u_=
Uh OO
Z
0
U
u
��
��GD
OUTFALL
\'
GRAB # 1
001
G
1
X
Must be a glass container
r!
OUTFALL
GRAB #2
i
/CUU
001
1
X
9
Analysis must be conducted within 30
minutes or collection in accordance with
p
/OCR
OUTFACE
the Field Analysis guide and documented
GRAB # 3
001
1
X
X
as such.
RELI UISHED BY: SIGNA7M,
CEIVED
BY:
DATE
TIME
LAB USE ONLY
�lka_ 2 3
i 79
i•i%
Samples <4 C
Samples Preserved
Hading Time
Lab Remarks:
Omer
Checked By:
WS-ENV-F-610.001
Effective: 3/22/2019
Supersedes: 8/29/2012

STORMWATER STORM EVENT DATA RECORD
Outfall No. 001
Date tl�
Time(')
interval
(minutes)
Actual
Time
(Hr: Min.)
Sample
Designation
Sample Container
Label
Rain
Gauge
Record ,
(inch)")
Storm Begins
0
Storm(') Ended
4
Valve Opened
L t7
0-301'I
00
Grab 1
Grab No. 1
0-30"
Grab 2
Grab No. 2
0-30'I
OQ
Grab 3
Grab No. 3
No. of hours since previous measurable rain (0.1 inches) ?�z hrs.
Pond Depth Reading to nearest 0.5 feet \D ,
pH of Grab 3 sample !/ • / J
Samples collected by Aantyz,
Rain gauge reading taken by //// 14; (a • Gr��ir�l
Comments:
NOTES:
(1) Time interval after valve is opened and discharge begins.
(2) The rain gauge level and time must be recorded at the end of the storm event.
Ingredion Incorporated, Winston-Salem
WS-ENV-F-610.002 Effective: 12/17/2012

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance onfi/ling out thisforni, please visit his://deq.nc Gov/about/divisions/energy-mineral-land-
resources/enemy-m ineral-land-permits/stornnvater-permits/npdes-industrial-s++stab-4
Permit No.: N/C/0/6/0/0/0/0/0/ or Certificate of Coverage No.: N/C/G/0/6/0/0/4/3
Facility Name: Ingredion Incorporated
County: Forsyth Phone No. 336-785-0850
Inspector: "fin! h In ('J.) / r
Date of Inspection: / 7420
Time of Inspection: C% DD
"total Event Precipitation (inches):
S.z
------------------------------------------------------------------------------------------------------------------------
All permits require qualitative monitoring to be performed during a "measurable storm event."
A "measurable storm event' is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. "['he 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period, and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Des
1. Outfall Description:
Outfall No. Structure (pipe, ditch, etc.):
Receiving Stream:
South fork of Muddy Creek
Pipe
Describe the industrial activities that occur within the outfall drainage area:
Manufacturer of High Fructose Corn Syrup, Dry Starch, and animal feed Co -products
Pale I of 2
SWU-242, Last modified 03/28/2018

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: //C - ow/7(,1t
3. Odor: Describe
any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): !V O n/-r
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
lO 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where I is no solids and 5 is the surface covered with floating solids:
Q1 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stotnrwater discharge, where I is no solids and 5 is extremely muddy:
3 4 5
7. Is there anv foam in the stormwater discharge? O Yes No.
8. Is there an oil sheen in the stormwater discharge? oYes KNo.
9. Is there evidence of erosion or deposition at the outfall? O Yes K No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids, and/or the presence of foam, oil sheen, or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SwU-242. last modified 03/18/2018