NCG060257_MONITORING INFO_20181129

STORMWATER DIVISION CODING SHEET
NCG PERMITS .
PERMIT N0.
DOC TYPE
❑HISTORICAL FILE
MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted 11- _.O N
CERTIFICATE OF COVERAGE NO. NCG06�a� S-7 COLLECTION YEAR � jl
FACILITY NAME D a ���G L ACTIVITIES INCLUDE (check all that apply):
COUNTY R [ of p ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES f)l <SQQkco�_ - nE C. DPOHARGING TO SALTWATERS? ❑YES PNO
LABORATORY&_c,2C ) A Lab CerL-# L FILES
,10, PLEASE REMEMBER TO SIGN ON THE REVERSE 4
PartA: Stormwater Benchmarks and Monitoring Results
Total event roinfoll 2 or ❑ No discharge this perioce
Outmh I No.
Sample.Collected,
mo/dd/
TSS,
mg/L
pN,
Standard units
COD,
mg/L
Oil and Grease,
L
Fecal Colrforrn•,
Colonies per, 100 ml
Enterococca ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within,6.0 - 9.0
120
30
1000
Soo
r
1
<
t�
--
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 Myoutfalls. 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 gno
Part B: Vehicle Maintenance Area Monitoring Results: only,for facilities averaging > 55 gal of new motor oil/month.
Outfall Np.
Sample Collected; `
mo/dd/ •
OII and'Grease;
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
'Benchmark
-
30
100 or S0
6.0 — 9.0
-
1 Only applies to facilities that use/process meats.
3The tots l.precipitatlon.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.
if es complete Part B)
5WU-249 Last Revised: October 18, 2012
Page l :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 ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED'THE.DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL:OFFICE CONTACT NAME -
Mail an original and one copy o ahis DMR indudin .all."No Discharge" reports within 30 da s o recei t of the lab results for at end o
monitoring -period in the case o "No Dischar e" reportsJ to:
Division of Water Quality.
Attn: DWQCentral Files
1617-Mail Service Center
Ll Raleigh, NC 27699-1617
YOU MUST SIGN THIS'CERTIFIG4TION. 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,
ta.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."
vV1 GfiR0(----
(Signature
r2_/4 I i 1O
(Date
Additional copies of this form may be downloaded at: http,I/aortal.ncdenr.orp/web/walws/su/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted March 14, 2018
CERTIFICATE OF COVERAGE NO. NCG06 0257
FACILITY NAME MOM Brands
COUNTY Randolph
PERSON COLLECTING SAMPLES Al Spencer
LABORATORY Research and Analytical Lab Cert. # 34
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2018
RECE 1\1G[)
MAR 19 NIB
CENTRAL FILES
MAIR SECTION
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? DYES ®NO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall 1 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
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0-9.0
120
30
1000
500
1
03/01/2018
8.2
7.17
7
<5
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.
°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 R 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
100 or 50
6.0 — 9.0
-
1 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.
(if yes, complete Part B)
SWU-249 Last Revised: October 18, 2012
Page 1 of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
0 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 ❑ NO ❑
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 tar 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."
ature of Permittee)
mu?-10- �
(Date)
Additional copies of this form may be downloaded at: http://Portal.ncdenr.org/web/wq/­wslsu/npdessw#tab-4
S W U-249
Last Revised: October 18, 2012
Page 2of2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted May 12th 2Q17
CERTIFICATE OF COVERAGE NO. NCG06_0257_ 1 PLE COLLECTION YEAR 2017
FACILITY NAME MOM Brands R EG 1VOLITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Randolph 16 ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Al Spencer IAY��DISCHARGING TO SALTWATERS? [_]YES ®NO
LABORATORY Research and Analytical Lab Cert. # 34 I FILES
DWR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE �
Part A: Stormwater Benchmarks and Monitoring Results
Total event rainfall 24 S or ❑ No discharge this period3
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
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
500
1
04/25/17
<5
<5
C
EDI
5 Z011
z Only applies to facilities that use/process meats. CENTRAL FILES
total precipitation must be recorded using data from an on -site rain gauge. p }}�� +
s For sampling periods with no discharge at any outfalis. You must still submit this discharge monitoring report with a �teckmark�1h9NJ
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
100 or 50
6.0 — 9.0
-
1 Only applies to facilities that use/process meats.
2 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.
f if yes, complete Part Bj
SWU-249 Last Revised: October 18, 2012
Paee 1 of 2

t
.*`FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART It 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 ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copv of this DAM including all "No Dischar e" reports, within 30 days of receipt of the lab results for at end o
monitoring period in the case o "No Dischar e" 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."
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wcl/ws/su/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012
Page 2 of 2

;4
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted Jan 05 2018
CERTIFICATE OF COVERAGE NO. NCG06 0257
SAMPLE COLLECTION YEAR 2017
FACILITY NAME MOM Brands FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Randolph R r�F Q use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Al Spencer rD'ISCHfRGING TO SALTWATERS? [—]YES ❑X NO
LABORATORY Research and Analytical Lab Cert. #f 34 INN 0 9 2018
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
DIM-Z SECTION
Part A: Stormwater Benchmarks and Monitoring Results VIFORMATION PROCESSING Total event rainfall z •37 in 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
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0-9.0
120
30
1000
500
1
12/20/2017
21.2
6.63
37
<5
---
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.
'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.
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
100 or 50
6.0 — 9.0
-
r 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 anv 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
(if yes, complete Part B)
SWU-249 Last Revised: October 18, 2012
Page 1 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.
0 TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO X❑
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" re orts within 3U day s o receipt o the lab results or at end -of
monitorinq.1eriod 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 MUSTSIGN 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."
of Permittee)
o
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.ore/web/wq/ws/su/npdessw#itab-4
Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCGO60000
Date submitted December 14th 2016
CERTIFICATE OF COVERAGE NO.INCG06 0257 _ RECEIVE 1 AMPLE COLLECTION YEAR _ 2016
FACILITY NAME MOM Brands i is zuib FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Randolph ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES . Al Spencer CENTRAL FILESDISCHARGING TO SALTWATERS? [-]YES ©NO
LABORATORY Research and Analytical Lab Cert. # 34UVVR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall .35 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
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 - 9.0
120
30
1000
S00
i
09/02/2016 - invalid
<7.14
<
-
Within 60 days of last t
st
11/2912016
40
4.88
39
<5
-
' 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
100 or 50
6.0-9.0
-
1 Only applies to facilities that use/process meats.
2 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.
°See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(ifyes, complete Part B)
SWU-249 Last Revised: October 18, 2012
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 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑
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 for 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."
-Du, 1q-H,
(Date)
Additional copies of this form may be downloaded at: http:/Zportal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
SWU-249 Last Revised: October 18.2012
Page 2of2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT C�
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted a
CERTIFICATE OF COVERAGE NO. NCG06�S� SAMPLE COLLECTION YEAR �0I u
FACILITY NAME mC)n 5 r� I F� � I ;a"iLITY ACTIVITIES INCLUDE (check all that apply):
COUNTY , l(�1^ t �L �} - ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES A L SP�syC�-� iUL 2 �D&HARGING TO SALTWATERS? ❑YES ONO
LABORATORY?tcj_pQC\.4 Prlal irsi Lab Cert. # -_�L{ _...r.-,wi FILES
;e=
,`NR SECTION PLEASE REMEMBER TO SIGN ON THE REVERSE
Part A: Stormwater Benchmarks and Monitoring Results
Total event rainfall 1 . a or ❑ No discharge this period3
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
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or50
Within 6.0-9.0
120
30
1000
5o0
c,J
063c
-
—
I
on it i to
1lg .
La . S'7
1 l
C
1 Only applies to facilities that use/process meats.
2 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.
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
100 or 50
6.0 — 9.0
-
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 aU 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.
(ifyes, complete Part B)
SWU-249 Last Revised: October 18, 2012
Page 1 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 ❑ NO ❑
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 al! "No Discharge" reports, within 30 days of receipt of the lab results (or at end of
monitoring period in the case o "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."
�al S��
(Date)
Additional copies of this form may be downloaded at: http:Zlportal.ncdenr.org/web/wq/­ws/`­su/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted _ Qctnher 16 2015
CERTIFICATE OF COVERAGE NO. NCG06 0257_>_ SAMPLE COLLECTION YEAR 2015
FACILITY NAME MOM Brands r�ILITY ACTIVITIES INCLUDE (check all that apply):
V COUNTY Randolph r��j ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES a % TASCHARGING TO SALTWATERS? []YES [ENO
LABORATORY Research and Analytical Lab tab Cert. # 34 0L i
PLEASE REMEMBER TO SIGN ON THE REVERSE
GStJt1_8 O�
DwR
Part A: Stormwater Benchmarks and Monitoring Results Total event rainfall 1.5" 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
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0-9.0
120
30
1000
Soo
#�
October 2 2015
<5
5.85
22
<5
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.
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
100 or 50
6.0 — 9.0
-
1 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.
mow.
r
C002
ro
Mac
(if complete Part B)
SWU-249 Last Revised: October 18, 2012
Page 1 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 ❑ NO ❑
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an on inal and one co o this DMR including all "No Discharge" reports within 30 days of receipt of the lab results Lor at end o
monitoring period in the case of "No Discharge" reports:
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."
of Permittee)
5--,- t ) 6
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr ory,/wg bLwq/"ws/­5u/npdessw#tab-4
SWU-249 Lost Revised: October 18, 2412
Page 2 of 2

FlKWA
w,
"''~''ice
RCCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Ms. Katy Gillispie
Post Holdings, Inc.
20802 Kensington Blvd.
Lakeville, MN 55044
Dear Ms. Gillispie:
Donald R. van der Vaart
Secretary
July 17, 2015 RECEIVED
JUL 2 0 2015
CENTRAL FILES
DWR SECTION
Subject: NPDES General Permit NCG060257
Post Holdings, Inc.
Foi-merly MOM Brands Company
Certificate of Coverage NCG060257
Randolph County
Division personnel received your request to revise your stormwater permit Certificate of
Coverage to accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained in
the General Permit remain unchanged and in full effect. This revised Certificate of Coverage is
issued under the requirements of North Carolina General Statutes 143-215.1 and the
Memorandum of Agreement between North Carolina and the U.S. Environmental Protection
Agency.
If you have any questions or need further information, please contact the Stormwater Permitting
Program at [phone].
Sincerely,
3 _ ct
foATracyy avis, P.E., CPM, Director
Division of Energy, Mineral and Land Resources
cc: Winston-Salem Regional Office
Stormwater Permitting Program Files
Central Files
Division of Energy, Mineral, and Land Resources
Energy Section - Geological Survey Section • Land Quality Section
1612 Mail Service Center, Raleigh, North Carolina 27699-1612.919-707-9200 l FAX: [phone]
512 North Salisbury Street, Raleigh, North Carolina 27604 • Internet: htttp:Lportal.ncdenr.org/webllrl
An Equal Opportunity 1 Affirmative Action Employer — 50% Recycled 110% Post Consumer Paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF ENERGY, MINERAL, AND LAND RESOURCES
GENERAL PERMIT NO. NCG060000
CERTIFICATE OF COVERAGE No. NCG060257
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Post Holdings, Inc.
is hereby authorized to discharge stormwater from a facility located at:
MOM Brands
2525 Bank Street
Asheboro
Randolph County
to receiving waters designated as Haskett Creek, a class C water in the Cape Fear River Basin, in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth
in Parts I, II, III, and IV of General Permit No. NCG060000 as attached.
This certificate of coverage shall become effective July 17, 2015.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day July 17, 2015.
for Tracy E. Davis, P.E., Director
Division of Energy, Mineral, and Land Resources
By the Authority of the Environmental Management Commission

April 27, 2015
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, NC 27699-1612
RE: Change of Ownership Notification for Stormwater Certificate of Coverage No. NCG060257
We are submitting the enclosed application to inform you of a change in ownership of the
following MOM Brands Company facility:
MOM Brands Company Asheboro Plant
2525 Bank Street
Asheboro, NC 27203
The effective date of the change in ownership of the above listed facility is May 4, 2015. On that
date, Acquisition Sub, Inc., a Minnesota corporation ("Merger Sub"), will merge with and into
MOM Brands Company (the "Merger"), pursuant to the Agreement and Plan of Merger, dated as
of January 25, 2015, by and among Post Holdings, Inc, MOM Brands Company, Merger Sub,
and Shareholder Representative Services, LLC, a Colorado limited liability company. As a result
of the Merger, Post Holdings, Inc. will acquire all liability and coverage for the stormwater
permit referenced above. The name of the facility will not change, however, and MOM Brands
will continue to operate the facility and serve as the responsible party contact.
Please feel free to contact me if you have any questions or require any additional information to
approve the enclosed application.
Katy Gillispie
Corporate Environmental Manager
MOM Brands
(952)-322-8046
u�ftt © 20802 Kensington Boulevard
�'�J�' Lakeville, MN 55044
!nK<�
tel: [phone]
RECEIVED
APR 3 0 2015
DENR-LAND QUALITY
STORMVVATER PERN11TTING

ATA
Division of Energy, Mineral & Land Resources
Land -QualitySection/Stormwater Permitting
NCDLNR
National Pollutant Discharge Elimination System
r_
'w`'
PERMIT NAMEIOWNERSHIP CHANGE FORM
FOR AGENNUSEoNLYDate
RYear
M
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
N. C $o- N C I G 13 16. 13. a 1 T.
IL Permit status prior to requested change..
a. Permit issued to (company name): Mom so-n d 5
b. Person legally responsible. for permit.% M t t C C a "y1 a rlc-
F Mi Last
l�ja.rtt Maya9cr
Title
• 02.5 a2 5 ga H k 5'�-r� e- 't-
f Permit Holder Mailing Address
I S B.[�etro NC_ 2 12a3
city state• zip
3360-- 5S©a.
Phone, 1 Fax
c. Facility name (discharge): Monk srA.x►d s
d. Facility address:
Address
NG a7203
City state zip
e. Facility contact person: :r 5 a r 1Ji t.h ra.w {3 3.�)
First / MI / Last Phone
III. Please provide the following for the requested change (revised permit).
a. 'Request for change is a result of Change. in ownership of the facility
El Name.change. of the facility or owner
Ifolherplease esp1din:
b. Permit issued 'to (company name):
c. Person legally responsible for permit:
RECEIVED
AVR 3 0 201.5
DENR-LAND QUALITY
STORMWATER PERMITTING
d. Facility naive (discharge):
e. Facility address:
Title -
Permit Holder Mailing Address
city State zip
Phone _ - -- &mail Address
a 64k4 C.
Address
city state _ zip-
f. Facility contact person: h d C t.a vt'�,e_ _
First' M1 •Cs_ st
Phone &mail Address
IV. Permit contact information (if different from the person Iegally responsible for the permit)
Revised Jan. 27, 2014

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
Permit contact:
First MI Last
Title
Mailing Address
City State Zip
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
('�-If This completed application is required for both name change and/or ownership change
requests.
Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is re uired for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
1, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
C&M L-i 2--1 I 15
Signature Date
APPLICANT CERTIFICATION
I, , attest that this application for a namelownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
#iwA- 4 , 7V L-i Z't i
Signature bate
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jon, 77, 2014

EX 2.1 - Striker Merger Agreement
1'age 1 of 143
EX-2.1 2 ex21-strikermergeragreement.htm EXHIBIT 2.1 - AGREEMENT AND PLAN OF MERGER
AGREEMENT AND PLAN OF MERGER
BY AND AMONG
POST HOLDINGS, INC.,
ACQUISITION SUB, INC.,
MOM BRANDS COMPANY
AND
THE SELLERS' REPRESENTATIVE NAMED HEREIN
Exhibit 2.1
RECEIVE.[)
.Wli 17 ` 15
DF1IR-LAND QUALITY
STORMWATER PERMITTING
http://www.sec.gov/Archives/edgar/datall 530950/000153095015000010/ex2l-strikermerg... 6/10/201 a

'EX 2.1 - Striker Merger Agreement
Page 143 of 143
IN WITNESS WHEREOF, each Party has executed and delivered this Aorcement and Plan of Merger
effective as of the date first .written above.
POST HOLDINGS, INC.
ACQUISITION SUB, INC.
Bv: Is/ Diedre J. Grav
Name: Diedre J. Grav By: Isl Diedre,i. Grav
Title: SVP, General Counsel & Administration, Name: Diedre J. Gray
Secretary Title: Secretary
SHAREHOLDER REPRESENTATIVE
SERVICES LLC (solely in its capacity as Sellers"
MOM BRANDS COMPANY Representative as agent for and on behalf of Sellers)
By: /s/ Christopher J. Neugent By: Isl Mark B. Vogel
Name: Christopher J. Neugent Name: Mark B. Vogel
Title: President & Chief FNeCUtiwe Officer Title: Managing Director
http://www.sec.goy/Archives/edgar/data/1530950/000153095015000010/ex21-strikermerg... 6/10/2015

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT RECEIVED
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted July 14205 JUL 2 0 205
CERTIFICATE OF COVERAGE NO. NCG06 QZL _ SAMPLE COLLECTION YEAR 2015 CENTRAL FILES
FACILITY NAME Mom Brands FACILITY ACTIVITIES INCLUDE (check all that apply): DWR SECTION
COUNTY Randolph __ ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Al Spencer DISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY Research and Analytical Lab Lab Cert. # 34
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall 1 1.33 or n 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
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
Soo
233
5.9
51
<
1 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.
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
100 or 50
6.0 — 9.0
' 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.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
(if yes complete Part— 4B)!
SWU-249 Last Revised: October 18, 2012
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 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an oric
tinal and one copy of this DMR including all "Na Discharge" re orts within 30 days a recei t a the tab results or at end a
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."
re of Permittee}
.t Ln S
(Date)
Additional copies of this form may be downloaded at: http1/portal.ncdenr.org/web/wg/ws/su/npdessw#tab-4
Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted January 21, 2015
CERTIFICATE OF COVERAGE NO. NCG060257
FACILITY NAME MOM Brands
COUNTY Randolph
PERSON COLLECTING SAMPLES Al Spencer
LABORATORY Research & Analytical Lab Lab Cert. # 34
Part A: Stormwater Benchmarks and Monitoring Results
RECEj V42C14
ILILE COLLECTION
ACTIVITIES SNCLUDEYEAR OI
JAN 28 (check that apply):
v1
z0;5 ❑ use/process meats ❑ use animal fats/byproducts
CENTRAL fi11�EDISCHARGING TO SALTWATERS? ❑YES RNO
�WR .�Er. T1pn
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall' .25 or ❑ No discharge this period'
Outfali No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coliforml,
Colonies per 100 ml
Enterococci',
Colonies per 100 ml
Benchmark
-
100 or 504
Within 6.0 — 9.0
120
30
1000
500
#2
12-23-14
22.7
6.38
17.0
<5
' 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.
°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 Vino
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
100 or 504
6.0 — 9.0
-
' 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.
'See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
C�3
UNIC
(if yes, complete Part B)
SWU-249 Last Revised: October 18, 2012
Page 1 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 .
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
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 receipts 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."
(Signature of Permittee)
(Date)
Additional copies of this form may be downloaded at: b_ttEL.Hportal.ncdenr.org/web/wqlws/sulnpdessw#tab-4
SWU-249
Last Revised: October 18, 2012
Page 2 of 2

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted: April 30.2014
CERTIFICATE OF COVERAGE NO_.,NCG060257 SAMPLE COLLECTION YEAR 2014
FACILITY NAME MOM Brands FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Randolph ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Al Spencer DISCHARGING TO SALTWATERS? ❑YES ZLNO
LABORATORY Research & Analytical Lab Lab Cert. # 34
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall Z If SS 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
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
Soo
#2
04/07/14
204
6.64
17.0
<5
1 Only applies to facilities that use/process meats.
z 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.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes ❑ no (if yes, complete Part B)
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
100 or 50
6.0 — 9.0
-
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.
'ECEIVED
MAY 12 2014
CENTRAL FILES
DW018OG
SWU-249 Last Revised: October 18, 2012
Page 1 of 2

*FOR PART A AND PART 8 MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES 1N 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 ANYONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail am original
and one copy of
this DMR, including
all
"No Discharge" reports, within 30 days of receipt of the lab results for 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."
(Signature orf�rmittee)
1 J
(Date)
Additional copies of this form may be downloaded at: http;(/portal.ncdenr.org/web/wq/ws/su/npdessw#itab-4
SWU-249
Last Revised: October 18, 2012
Page 2 of 2