NCG060043_DMR_20200429

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Qyp ity General Permit No. NCG060000
Date submitted
CERTIFICATE OF COVERAGE NO. NCG060043
SAMPLE COLLECTION YEAR
FACILITY NAME _Ingredion Incorporated EDaaCil_i aFACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Forsyth _ ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES A�AY� t 1 2020 DISCHARGING TO SALTWATERS? ❑YES ENO
LABORATORY Lab Cert. #
C� '� ` i<J" LE`" PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DWR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
Total event rainfall z or ❑ No discharge this period'
Outfall No.
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
Enterococcil,
Colonies per 100 ml
_
Benchmark
-
_
100 or 504
Within 6.0 — 9.0
120
30
1000
500
1 Only applies to facilities that use/process meats.
2The 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
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.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo_
Benchmark
-
30 u
100 or 504
6.0 — 9.0
(if yes, complete Part B)
Only applies to facilities that use/process meats.
The 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
Pale 1 of 2

i
I
*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 SECT�B.
❑ • TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FO THE SAME PARAMETER AT ANY ONE OUTFALL? YES NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NOX
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
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."
(Signature of Permittee)
41 C;z
(Date)
Additional copies of this form may be downloaded at: http_[/portal.ncdenr.orweb�gLws/su/npdessw#tab-4
i
W U-249
Last Revised: March 27, 2018
Page 2 of 2

For: Ingredion, Inc.
4501 Overdale Road
Winston-Salem, NC 27107
Attn: Pamela Bradsher
Client Sample ID: Outfall 001
Site: Ingredion, Inc
Parameter
COD
Hydrocarbon O&G
pH
Total Suspended Solids
Method
EPA 410.4
EPA 1664 Revision B/Silica Gel
SM 4500 H+13-2011
SM 2450 D-2011
6,83
Report of Analysis
4/22/2020
iSSS1111#14'r, ,
St.
CC
NC #34
NC #37701 Z
;o
D AIA
Lab Sample ID: 80947-01
Collection Date: 4/1412020 13:00
Units Rep Limit Analyst Analysis..Date/Time
mg/L 5 HW 4120/2020
mg1L 5
Std. Units
37.0 mg/L 5
EE 4/15/2020
LP 4/1612020 1646
AW 4/15/2020
NA = not onalyzed
R0. Box 473 106 Short Street Kernersvilte, North Carolina 27284 Tel: [phone] Fax. [phone] www.randalabs.com Page 1

w:.
4;501 Overdale Road, Winston-Salem, NC 2.710'7-6145
TEL [phone] FAX [phone]
CHAIN OF CUSTODY RECORD
REGULATORY CLASSIFICATION
PROJECT NO.
----.CLIENT NAME _
PRETREATMENT ❑ NPDES 0 DRINKING WATER ❑ OTHER ❑
REQUESTED PARAMETERS REMARKS / PRESERVATION
Jinc1 �Z�
Ingredion Incorporated
SAMPLERS: (SIGNATURE)
(PRINT)
r
a
a
}
w
ALL SAMPLES ARE TO BE CHILLED
m
w
w
WITH ICE. GRAB SAMPLE #1 & #2 ARE
c�
SAMPLE ID
DATE
TIME
LOCATION
U
o
U
z w
¢
z
TO BE LOWERED TO A pH of 2.0 OR
LESS WITH SULFURIC ACID. SAMPLE
O0
a_ OJ ¢
5
OU
z g O
a c1
Qp
#3 IS NOT ph ADJUSTED. ALL
SAMPLES ARE COOLED
p 1
p It 11
d
�0„
=
TO <4 C.
��.�(-��
01,z
Ua0O
z
o
C I1� Z��
/
0 1'FALL
p
o� c
GRAB # 1
001
G
1
X
Must be a glass container
l %
��ll/f ��1
13Ct-1
OUTFALL
GRAB # 2
001
1
X
Analysis must b
conducted within 30
')��!�
�_?��?
QU I'FAI.I.
\
(`
minutes of colle
the Field Analys
ion in accordance with
guide and documented
GRAB # 3
✓
001
V
l�
1
X
X
as such.
RELINQUISHED BY: (SIGNATURE)
DA-rE
'11ME
RECEIVED
BY:
DATE
TIME
LAB USE ONLY
Samples < 4 C
Samples Preserved
Holding Time ^
r
Lab Remarks: -��
Other _
Checked By.
Effective: 3/22/2019
WS-ENV-F-610.001 Supersedes: 8/29/2012

C vir""mnlenta`
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit bos:Hdeg.nc.gov/about/divisions/energy-mineral-land-
resources/energy-mineral-land-permits/stormwater-permits/npdes-industrial-sw#tab-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:
Date of InspectionOzW//
Time of Inspection: 43 6V
Total Event Precipitation (inches):
I
r_____________________________________________________________________________ ____________________________________
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. The 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 Defy 60)
1. Outfall Description:
Outfall No. 1 Structure (pipe, ditch, etc.): Pipe
Receiving Stream:
South fork of Muddy Creek
Describe the industrial activities that occur within the outfall drainage area:
Manufacturer of High Fructose Corn Syrup, Dry Starch, and animal feed Co -products
Page 1 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: Z4Z 44J&na)
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): A 10A I
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy:
0 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
0 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where 1 is no solids and 5 is extremely muddy:
1D 2 3 4 5
7. Is there any foam in the stormwater discharge? o Yes No.
8. Is there an oil sheen in the stormwater discharge? oYes )i(No.
9. Is there evidence of erosion or deposition at the outfall? Q Yes 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 03/28/2018

STORMWATER STORM EVENT DATA RECORD
Outfall No. 001
Date
Time(')
interval
(minutes)
Actual
Time
(Hr: Min.)
Sample
Designation
Sample Container
Label
Rain
Gauge
Record
(inch)(2)
Storm Begins
zllahov d
0
Storm '2)Ended
IQ
Valve Opened
0��wo ON
0-30")
Q
Grab 1
Grab No. 1
0-30")
0d �n� iQ
Grab 2
Grab No. 2
0-30(')
�� C Qpp�
Grab 3
Grab No. 3
No. of hours since previous measurable rain (0.1 inches) 7 hrs.
Pond Depth Reading to nearest 0.5 feet
pH of Grab 3 sample - �S
Samples collected by
Rain gauge reading taken by In"k Sri
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-61D-002_— - ---- __-Effective: 12/17/2012-_ -- --