NCG060309_MONITORING REPORT_20210108

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG060000 Q
Food and Kindred'
Click here for instructions ,
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (DMR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCGO
Person Collecting Samples: Travis Williams
Facility Name: AdvancePieme Foods Laboratory Name: Statesville Analytical
Facility County: Catawba Laboratory Cert. No.: 440
Discharge during this period: 0 Yes ❑ No (if no, skip to signature and date)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances? ❑ Yes K No
If so, which Tier (1, 11, or III)?
Part A: Analytical Monitoring Requirements for Outfalls with Industrial Activities— Benchmarks in (Red)
Parameter
Parameter
Outfall 1
Outfall 2
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
Water Supply
No Flow
N/A
Date Sample Collected MM/DD/YYYY
12/17/2020
46529
24-Hour Rainfall in inches
0.07
00556
Oil & Grease in mg/L (30)
<5.38
C0530
TSS in mg/L (100 or 50*)
11.79
00400
pH in standard units (6.0-9.0)
6.67
31616
Fecal Coliform per 100 ml of
N/A
freshwater (1000)
61211
Enterococci per 100 ml of saltwater
N/A
(Sao)
00340
Chemical Oxygen Demand in mg/L
G2J
(120)
Part B: Vehicle & Equipment Maintenance Areas — Benchmarks in (Red)
Parameter
Parameter
Outfall
Outfall
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
N/A
Date Sample Collected MM/DD/YYYY
00S52
Non -Polar Oil & Grease in mg/L (15)
New Motor/Hydraulic Oil Usage in
NCOIL
gal/month
• Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HOW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L.
Notes (optional): Facility does not process meats, but assembles frozen meats into sandwiches.
"I certify by my signature below, 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 or Delegated Authorized Individual Date

Tyson -Claremont
Post Office Box 399
Claremont, NC 28610
Receive Date:
Reported:
For:
Comments:
Analytical Results
12117/2020
12/31/2020
Pierre Foods
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
201217-30-01 Chemical Oxygen APF-SW1 <25
mg/L HACH8000 12/23/2020 CL
Demand
201217-30-01 Oil and Grease APF-SW1 <5.38
mg/L EPA166 Re B 12/30/2020 CL
201217-30-01 TSS APF-SW1 11.79
mg/L SWWD4011 12/18/2020 CJE
Respectfully submitted,
& -*,q,jy6tI
Dena Myers
NC Cart #440,
NCDW Cart #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
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