NCG060043_MONITORING INFO_20190403

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/VU&U��Dy3
DOC TYPE
❑HISTORICAL FILE
2-'MONITORING REPORTS
DOC DATE
❑ aUI i OH n 3
YYYYMMDD

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING RE
for North Carolina Division of Water Quality General Permit No. NCG
Date submitted 3/27/2019
CERTIFICATE OF COVERAGE NO. NCG060043
FACILITY NAME: Ingredion Incorporated
COUNTY: Forsyth
PERSON COLLECTING SAMPLES: Sandy Warwick
LABORATORY: R and A Laboratories, Inc Lab Cert. # NC34
Part A: Stormwater Benchmarks and Monitoring Results
ioo FIvP `
APR p 3 2019
SAMPLE COLLECTION YEAR: 2019 DU ? itAL FILE ;-
FACILITY ACTIVITIES INCLUDE (check all that appl9:SECTION
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? ❑YES ®NO
PLEASE REMEMBER TO SIGN ON THE REVERSE -->
Total event rainfall Z: 0.5" 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 504
Within 6.0 — 9.0
120
30
1000
500
1
3/7/2019
<5
7.5
29
<5
f 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? 0 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 504
6.0 — 9.0
-
(ifyes, complete Part Bj
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.
5WU-249 Last Revised: March 27, 2018
pauP. I of 7

*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 OUTFALLTRIGGER 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 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, INC 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)
27 a0�
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdesswl#tab-4
S W U-249
Last Revised: March 27, 2018
Pace ) nf7

RESEARCh & ArWyirkAl
TOR ES LAboRA I NCO
Report of Analysis
3/21/2019
A N A
For: Ingredion, Inc.
4501 Overdale Road
Winston-Salem, NC 27107
r Cc Cl)
NC 934 ZI -
Attn: Pamela Bradsher
INC437701
4,"ll 1 illiOl
Client Sample ID: Outfall 001
Lab Sample ID:
63940-01
Site: Ingredion, Inc
Collection Date:
3/712019 MOO
.;Method:
Result'Units
R;'Iil 'J�n�lit.�Afialygis.Dateffime
coo
EPA 410.4
29
mg1L
5
HW 3/1112019
Hydrocarbon O&G
EPA 1664 Revision BiSilica Gel
<5
mg/L
5
EE 3/1412019
pH
SM 4500 H+13-2000
6.60
Std. Units
AB 31812019 1635
Total Suspended Solids (TSS)
SM 2540 0-1997
<5
mg/L
5
AW 3112/2019
NA = nor anolyzed
P,O Box 473 106 Short Street Kernersville, Narth Carolina 27284 Tel: [phone] Fax: [phone] vNjw.randalabs.com Page 1

®
fngredion_
4501 Overdale Road, Winston-Salem, NC 27107-6145
TEL [phone] FAX [phone]
CHAIN OF CUSTODY RECORD
REGULATORY CLASSIFICATION
PROJECT ND.
CLIENT NAME
PRETREATMENT ❑ NPDES ® DRINKING WATER E] OTHER 0
Ingredion Incorporated
R
REQUESTED PARAMETERS REMARKS! PRESERVATION
SAMPLERS'. (SIGNATURE)
{PRINT]
aw
a
W
ALLSAMPLESARETO BECHILLED
p
w
w
Wfi'H ICE. GRAB SAMPLE 01 S R2 ARE
SAMPLE ID
DATE
TIME
LOCATION
o
~
_ �,
F
,�
70 BE LOWERED TO A pH p1 2.0 OR
O
o
rc
LESS WITH SULFURIC ACID. SAMPLE
g g F
0
B3lS NOT ph ADJUSTED. ALL
u.
O a
u LL x
aOO
O
iI " i� o
d
z
—
N
m
O
x
Q
SAMPLES ARE COOLED TO <4 C.
OU001
GRAB fI1
S�
G
1
X
OUTFALL
F Q
GRAB # 2
v�
001
X
•A�
1
OUTFALL`
y,q1 }�
TtY 1
Analysis must be condueW -AKi% 30
dancewrch
minut!'✓'
ftHeso! atysi g d a and
the Fleld AnalyWs guide asb Cacumentsd
GRAB # 3
✓'�
rev
001
1
X
X
as such.
G�
RELIN U Y: SIGNATURE
DATE
TIME
R
CEIVED BY:
PATE
TIME
LAB USE ONLY
Samples � 4 C �5 r
Samples Preserved
Hddrg Time
I3r.03
l4
7
r �f
V_
Lab Remarks;
0axr
Checked By:
WS-ENV-F-610.001 Effective: 812912012

STORMWATER STORM EVENT DATA RECORD
Outfall No. 001
Date IW
me
!,Actual
Sample R'a 4
Sample Container`
Rain
interval.
Tisrie
. • Designation w
Labels
;Gauge -
(minutes)
(Mr:.Min.)
_
Record
..
: : s
z1
(inch).
Storm;Begins
<
"' �ifi
..s.=_ . -.e
�. �� ��,..�.�:`�
_ h_.
0
' 7
Storm"T Envied
i
�`'�
VY���(J ✓
u4�i8w�t��s�;
Opened
'd/ n�s
� �"
,Valve ,�., ,
., }«
_�. , =>a �� :.
Grab 1
Grab No. 1
Grab 2
Grab No. 2slim
r0 �306)
0-30
Grab 3
Gram No. 3
No. of hours since previous measurable rain (0`.1 l 1 inches) hrs.
Pond Depth Reading to nearest 0.5 feet `5/7�
pH of Grab 3 sample 1
Samples collected by _��/1� /hfztI_J( '
Rain gauge reading taken by �Za4AU
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 on filling out this form, please visit hgps://deg.nc.pov/about/divisions/enerizy-mineral-land-
resources/enemy-mineral-land-permits/stormwater-perm itslnpdes-industrial-sw#tab-4
Permit No.: N/CI0/6/0/0/0/0/0/ 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 Inspection: J/ //c,CV / `i
Time of Inspection: ..., _z(at2o
Total Event Precipitation (inches): a�12
------------------------------------------------------------------------------------------------------------------------------
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
i 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.
-----------------------------------------------------------------------------------------------------------------------------------------' ----
Sy this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
1. Outfall Description:
Outfall No. 1 Structure (pipe, ditch, etc.): Pipe
Receiving Stream:
South fork of Muddv 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 l of 2
5WU-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: 4
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): A. Z-
4. Clarity: Choose the number which best describes the clarity of the discharge, where l is clear
and 5 is very cloudy:
l 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:
01 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:
] 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 '4No.
9. Is there evidence of erosion or deposition at the outfall? o Yes �"o.
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, Eastmodilied 03/29/2018

Ingredion
Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Semi -Annual Stormwater Monitoring 2018
To whom it may concern:
REC-11 V ["
AUG 15 2018
CENTRAL R-ES
J AIR SECTIONN
Ingredion incorporated
45oi Overdaie Road
Winston-Salem, NC 27107
United States
t:'+i 336 785 o85o
w: ingredion.com
81612018
On 6/22/18, Ingredion performed semi-annual quantitative sampling of its stormwater detention pond as
required in NPDES general permit NCG060000 (CoC NCG060043) to monitor for presence of non-
stormwater during period January 1 — June 30. The COD (chemical oxygen demand) measured higher
than the 120 mg/L benchmark value, at 184 mg/L.
We investigated the elevated result and had followed up with another sample when we thought the COD
was below benchmark again. We suspect that the elevated COD was due to a significant amount of
vegetation that had grown in the bottom of the pond during May -June period when the pond was empty.
With a storm event filling the pond with water again, the decay of that vegetation may have elevated the
level of nutrients to the water at the time our sample was collected and impacted COD negatively. The
latest sampling from July 25t" resulted in a below benchmark 88 mg/L COD.
Attached are the supporting documentation and, although we're technically in the 2nd half of the 2018
year, we still intend to submit another semi-annual sample for the record before the end of this year. Any
further questions may be forwarded to me at [phone], or christopher.lynch(a,ingredion.com. Thank
YOU.
Sincerely,
)
Christopher Lynch, EHS Man er, Ingredion
Attachments:
o Semi -Annual Stormwater Discharge Monitoring Report
a Qualitative Monitoring Report
o Stormwater Storm Event Data Record
o Report of Analysis, R&A Laboratories, Inc.
o Chain of Custody Record

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 Zy I g
FACILITY NAME —Ingredion Incorporated FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Forsyth ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES CH,2tS-T00Hatz- L"'f DISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY QCA tA6S iPJC • Lab Cert. # •3L}
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Part A: Stormwater Benchmarks and Monitoring Results
Torol event rainfall Z 1.4y" or ❑ No discharge this period3
Outfall No.
:.
°Sample Collected,-
r
mo/dd/yr
r TSS; . .'
,.,
mg/L
pH,;rt"
Standard Unitsa`,
COD,
a m L -
g/
Oil:and Grease,
- ' - mg/L ., w -
Fecal Coliform •;
_ .
Colonies'per:100.n�1
1=nterococci.;
Colonies pet 100 ml .:
Benchmark -
,....=.' ..`-
100.or 50', ".
.Within 6.0. -e9 0
a .,120 ' :: e
3t] ...;...
w 1060 _ '-
50b .
r2 . 7_1
< 5
—
2 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.
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
NeviMotor Oil Usage,
Annual average gal/mo
Benchrnark
30
100 or 504
6.0 — 9.0
e
(i'f yes, complete Part B)
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.
SWU-249 Last Revised: March 27, 2018
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 ANYONE OUTFALL? YES ❑ NO C�
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
il
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."
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.o,rglwe,bLwq/ws/su/npdessw#tab-4
SWU-249 Last Revised: March 27, 2018
Pac,e 2 of 2

FnV ironmen tot
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit his://deq.nc.gov/about/divisions/energy-mineral-land-
resourceslenergy-m i sera I -land -perm its/stormwater-perniitslnpdes-industrial-sw#tab-4
Pert -nit 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: C%f215'rb?Hr'_t� !-�li.7Gf'i
Date of Inspection:
Time of Inspection
-7/ 25 / t
4 -- 30 e--\-
Total Event Precipitation (inches): I ' `179
-------------------------------------------------------------------------------- ---------------------------------------
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
outfali. 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 DEML-R
Regional Office.
----------------------------------------------------------------------------------------------------------------------------------------------
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Sign -ire of P,6{mittee or
1. Outfall Description:
Outfall No. 1
Receiving Stream:
Structure (pipe, ditch, ctc.): Pipe
South fork of Muddv 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 niodiiicd 03/2812019

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L K-W'F- \l`� L(o k-J
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): f'lyrJQ
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear
and 5 is very cloudy: ���
( 1 J 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:
]5 2 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
7
8
(1) 2 3 4 5
Is there any foam in the stormwater discharge? O Yes /Xo.
Is there an oil sheen in the stormwater discharge? 0Yes ( No.
Is there evidence of erosion or deposition at the outfall? O Yes �O. No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe LQ-- —ez- *-'!�> CL�
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 modil ed 03/2812018

H1ESCARC& ANA Y1riCA[
LA ORAIFORiES, kC.
For: Ingredion, Inc.
4501 Overdale Road
Winston-Salem, NC 27107
Attn: Pamela Bradsher
Report of Analysis
8/1/2018
�tit��:�rrrrN
w � Q
v� NC U34 z; cn
NC :t3770"!
M
A0VIO:`'`�
Client Sample ID: Outiall 001
Lab Sample ID:
53912-01
Site: Ingredion, Inc
Collection Date:
7/25/2018
16:25
Parameter
Method
Result
Units
Rep Limit Analyst Analysis Datenime
cbi)
EPA 410.4
88
mg/L
5
FIW
7/2712018
Hydrocarbon O&G
EPA 1664 revision l3/Silica Gel
<5
rng/L
5
EE
7/30/2018
pH
SM 4500 H+13-2000
6.77
Std. Units
AP
7/27/2018 1164
Total.Suspended Solids (TSS)
SM 2540 D-1997
21.5
mg/L
5
SK
7/31/2018
NA = not cnoiy,.ecd
P.O. Box 473 106 Short Street Kernersville, Borth Carolina 27264 _ Tel: [phone]� Fax: [phone] vmv. ra nda labs. com _ Page 1

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 0 DRINKING WATER © OTHER ❑
REQUESTED PARAMETERS REMARKS / PRESERVATION
Ingredion Incorporated
SAMPLERS: (SIGNATUR )
(PRINT)
u2
r
to
w
ALL SAMPLES ARE TO BE CHILLED
m
no'
F
�!
w U
z
to
WITH ICE. GRAB SAMPLE #1 & #2 ARE
TO BE LOWERED TO A 2.0 OR
SAMPLE ID
DATE
TIME
LOCATION
o
z h w
z
pH or
LESS WITH SULFURIC ACID. SAMPLE
za o
g g F
oU
#3 IS NOT ph ADJUSTED. ALL
O u 1i
O a
o
—�
v1
O
=
SAMPLES ARE COOLED TO e4 C.
U u_ T
U Q 0 0
Z
q
U
n.
OUTFALL
GRAB # 1
001
G
1
X
7/2�I1�
+ 257►'►1
OUTFALL
GRAB # 2
r
001
G
1
X
Analysis must be conducted within 30
/ Z�,i
7
1'f `= 7i7
OUTFACE
/
minutes of collection in accordance with
the Field Analysis guide and documented
GRAB # 3
001
G
1
X
X
as such.
RELINQUISHED BY: S TURE
DATE
TIME
R
EIVED
BY:
DATE
TIME
LAB USE ONLY
Samples < 4 C
Samples Preserved
Holding Time
r
V I ) I
I
Lab Remarks:
Other
Checked By:
WS-ENV-F-610.001 Effective: 8/29/2012

STORMWATER STORM EVENT DATA RECORD
Outfall No. 001
Date 7/zs// 8
Tirime�i�
" Actual
'" Sample'','
Sample Container
Rain
interval
Time
Designation
Label
Gauge
f :{minu.tes) . p:.
(Hr Min.)
;,';
Record
...'
(incH){z}.
Storm Begins
�8
`a^?.3'G
°'.`? sy
0
.., „ : , r.t.., • E}
"i§;??tt? s u.'...:_Lt . r
.h9a.:E: ...;:a.?3?;?� S .�€v„!
Storm(z� Ended
4�
dd
ValveOpened
3 5 5Ph\
�`
0=30f'}
; } 2s PM
Grab 1
Grab No. 1
g e�
a
0=30{'�` �'
PrA
Grab 2
Grab No. 2
0-300) " . �:
�4-: 2S P
Grab 3
Grab No. 3��a
No. of hours since previous measurable rain (0.1 inches)
Pond Depth Reading to nearest 0.5 feet
pH of Grab 3 sample
6•-7-7
Samples collected by C"ais Vi,.J`
Rain gauge reading taken by L� ?eRsa�^'eA_
Comments:
r
10
NOTES:
(1) Time interval after valve is opened and discharge begins.
hrs.
(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

%i)
Ingredion
Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
RE: Semi -Annual Stormwater Monitoring
To whom it may concern:
JUL 13 2018
i T=fa i i<<1t_ FILES
D'VVR SECTION
Ingredion Incorporated
4501 Overdale Road
Winston-Salem, NC 27107
United States
t: [phone]
w: ingredion.com
7/6/2018
On June 22, 2018, Ingredion performed semi-annual quantitative sampling of its stormwater detention
pond as required in NPDES general permit NGG060000 (CoC NCG060043) to monitor for presence of
non-stormwater during period January 1 — June 30. The COD (chemical oxygen demand) measured
higher than the 120 mg/L benchmark value, at 184 mg1L. Per our SWP3 protocol, stormwater retained in
our detention pond shall not be released unless measuring under the benchmark level.
Ingredion will follow the Tier 1 protocol for investigation and will report when COD level returns under the
permit benchmark. Any further questions may be forwarded to me at [phone], or
christopher.lynch _.ingredion.com. Thank you.
Sincerely,
( L�� ��
Christopher Lynch, EHS Manager, Ingredion
Attachments:
o Semi -Annual Stormwater Discharge Monitoring Report
o Qualitative Monitoring Report
o Stormwater Storm Event Data Record
o Report of Analysis, R&A Laboratories, Inc.
o Chain of Custody Record

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted _7/6/2018
CERTIFICATE OF COVERAGE NO. NCG060043
FACILITY NAME _Ingredion Incorporated
COUNTY Forsyth
PERSON COLLECTING SAMPLES: Sandy Warwick
LABORATORY: R&A Laboratories, Inc. Lab Cert. #: NC#34
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR: 2018
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? []YES ®NO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event roinfoll z or ❑ No discharge this period'
Outfall No:
Sample Collected;
-mn /dd/yr '
i55,
ring/L
pHP
Standard units
COI],
=' - mg/L
oil and Grease, R
.mg/L `
:Fecal Coliform ,
Colonies.per 100 nil
Enterococci ;^
Colonies per 100 ml
Benchmark .
_ -
.. D0 or 50
�i1 4,
Within 6.0 - 9.0 �
". 120
30
--1000'
Soo "_
001
6/22/2018
14.7
6.4
184
<5
N/A
N/A
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,
ma/dd/Yr
` -oil and,Grease, . ,;
mg/L
e TSS,
mg/L M
„pH, X
_. . Standard units
New,Motor Oil Usage;
Annual:averagegal/.mo
Benchm6iik
30 ". `'
100 or 504
6.6 ="9:0
(ifyes, complete Part B)
I 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.
SWU-249 Last Revised: March 27, 2018
Pa.ae 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 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 a!! "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."
(Signature of Permittee)
71&/E
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
S WU-249
Last Revised: March 27, 2018
Page 2 of 2

h n vironnt en taf
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling ow this form, please visil littps:lldeq.nc.i ov/about/divisions/er, er�y-mineral-land-
resources/enervy-m i nera1-1 and -perm itslstormwater-perill its/npdes-i nd ustria I-sw#tab-4
Permit No.: NIC101610/010/0101 or Certificate of"Coverage No.: N/CIG/0/6/0/0/4/3
facility Name: Ingredion Incorporated
County: Forsyth Phone No. 336-785-0850
Inspector:
Date of Inspection:
Time of Inspection:
I
Total Lvent Precipitation (inches): 6 5J
----------------------------------------------------------------------------------------------------------------------------
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. '['he previous measurable storm event must have been at least 72 hours prior. The 72-1101.11• storm
interval does not apply if the permittee is able to document that a shorter interval is representative Cot -
local storm events during the sampling period, and the permittee obtains approval from the local DI MLR
Regional Off ice.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or
1. Outfall Description:
Outfall No. 1 Structure (pipe, ditch, etc.): Pipe
Receiving Stream:
South fork of Muddv 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 I of-2
SWU-242, Last modiricd 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: _I' C� 1,17k )in A) _
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): �,in/r __,0 y't�Q
4. Clarity: Choose the number which best describes the clarity of the discharge, where l is cleat -
and 5 is very cloudy:
C 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 l is no solids and 5 is extremely muddy:
0 2 3 4 5
7. Is there any foam in the storrn water discharge? Q Yes No.
8. Is there an oil sheen in the stormwater discharge? oYes X No.
9. Is there evidence of erosion or deposition at the outfall? a Yes XN- o
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.
lage2of2
SWU-242, Last modiGcd 03/29/2018

STORMWATER STORM EVENT DATA RECORD
Outfall No. 001
Date
Time('.)
Actual
Sample
'Sample Container
Rain
interval
Time
Designation
Label
Gauge
(minutes),
(Hr:-Min.)
Record
2
<
P,
e.
1
j
inc
,Storm
o Ended
Y
.St-Ended
OO Z
Valve Opened,."
.r
0=`30
Lr
Grab 1
Grab No. 1
0-30"7
30 f
Grab 2
Grab No. 2
���
72
3
0-30(1)
Grab 3
Grab No. 3
No. of hours since previous measurable rain (0.1 inches)2_ hrs.
Pond Depth Reading to nearest 0.5 feet 2 0
pH of Grab 3 sample .
r`�.,�,�
Samples collected by c_xur�G, �u�IGC
Rain gauge reading taken by
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

KESEARCh & ANA YTiCA
00
LAORATORhSr INC*
For: Ingredion, Inc.
4501 Ovordale Road
Winston-Salem, NC 27107
Attn: Pamela Bradsher
Report of Analysis
7/3/2018
��y11t1l+11r,
ANAty
r �r
r i`n NC934 z.v' y
y NIC 937701
f D A 1111%
Client Sarimple ID: Outtall 001 Lab Sample ID: 52444-01
Site: Ingredion, Inc Collection Date: 6/22/2018 14:30
Parameter Method Result Units Rep Limit Analyst -Analysis DatelTime
Hydrocarbon O&G EPA 1664 Revision'D/Silica Gel <5 mg11- 5 E=E 6/27/2018
ClientZample]D: OutfaII 001 Lab Sample ID: 52444-02
Site: Ingredion, Inc Collection Date: 6/22/kII8 14:30
Paramcter —_— — Method Result Units Rep.Limit Analyst Analysis DatelTime
COD EPA 410.4 184 mg/L 5 JF 6/22/2018
Client.Sampie ID: Outfall 001 Lab Sample•ID: 52444.03
Site: lhgredion, Inc Collection Date: 6/22/2018 14:30
Parameter Method result Units Rep Limit An. alyst Analysis DatelTime
pH �SM 4500 H+8-2000 6.65 Std.'Units AP 6/26/2018 1336 -
Total Suspended Solids (TSS) SM 2540 0-1997
14:7 mg/L 5 AW 6129f2018
NA = not onolyzed
P.p. Box 473 106 Short Street Kemersville, North Carolina 27284
:2i C�l'c1 i3:l5i� •''1�
Tel: [phone] Fax: [phone] bwnv,randalabs. corn Page 1

z LZ `f j ©l
­02
RA
Vie)
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 I] DRINKING WATER ❑ OTHER ❑
REQUESTED PARAMETERS REMARKS I PRESERVATION
Ingredion Incorporated
SA PLERS: (SIGNATURE)
(PRINT)
a
a
U)
ALL SAMPLES ARE TO BE CHILLED
F=
w
w
WITH ICE. GRAB SAMPLE #1 & #2 ARE
SAMPLE 1D
DATE
TIME
LOCATION
2
~
w Cr
a
6
TO BE LOWERED TO A pH of 2.0 OR
v
O p
z m y
z
LESS WITH SULFURIC ACID. SAMPLE
IL O ¢Z
FQ g g
U
m
#3 IS NOT ph ADJUSTED, ALL
z
O FI IF
Z a. (9 O
O II FI li
Q
v�
V)
O
=
SAMPLES ARE COOLED TO <4 C.
UtLr
Ua a
Z
O
F-
U
a
aalz�
,I
�T�
OUTFALL
GRAB # 1
001
G
1
X
"PI22;0��
I�
OUTFALL
GRAB # 2
001
G
1
X
Analysis must be conducted within 30
N
eIrr
OUTFALL
minutes of collection in accordance with
Analysis documented
//
I7�
the Fleid guide and
GRAB # 3
001
G
1
X
X
as such.
R INOUISHED
BY: (SIGNATURE)__DATE
TIME
RECEIVED BY:
DATE
TIME
LAB USE ONLY
Samples < 4 C
Samples Preserved
Holding Time
-6
�t
I�
325-_7
��
o zzrL
15' 2-
Lab Remarks:
Other
Checked By:
WS-ENV-F-610.001
Effective: 8/29/2012

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted �11/10/2017 1
CERTIFICATE OF COVERAGE NO. NCG060000 SAMPLE COLLECTION YEAR'�t_�� 7 — 02,ry-q/�
FACILITY NAME Ingredion Incorporated FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Forsyth ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Sandy Warwick DISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY: R and A Laboratories, Inc Lab Cert. # NC34
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall . Sn 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"a
500
1
10/26/2017
18
6.8
48
<5
F(-;FwF-n
NUT
1 4111/
1 Only applies to facilities that use/process meats. DWR SECTION
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.
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.
(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 ATTHE 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 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."
(Signature of Permitt
�7
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq ws/su/npdessw#tab-4
SWU-249 Last Devised: October 18, 2012
Page 2 of 2

RESEARCh&ANA1YTiCA1 Report of Analysis
LA O RAT®R E S, INC. 11 /7/2017
�IJd
►�`� & Mky
/r,�i
For: Ingredion, Inc.
�J„G�,..�•• .T i
4501 Overdale Road
oa rro��,
Winston-Salem, NC 27107
,��`°
Nca34 °cn
Attn: Pamela Bradsher
NC937701 =
:C,, o,0'!Fc1oq`;
jf
41tED1A911V.
Client Sample ID: Outfall 001
Lab Sample ID:
41958-01
Site: Ingredion, Inc
Collection Date:
10/26/2017 7:48
Parameter
Method
Result
Units
Rep Limit Anal st Analysis Datea
_ r� .. , , ime
._._—
COD
EPA 410A
48
mg/L
5
SK 10/27/2017
Hydrocarbon O&G
EPA 1664 Revision B/Silica
<5
mg/L
5
AW 10/31/2017
Gel
pH
SM 4500 H+B-2000
6.86
Std. Units
AP 10/27/2017 1606
Total Suspended Solids (TSS)
SM 2640 0-1997
18.0
mg/L
5
AA 10/30/2017
NA = not anofyzed
P.O. Box 473 106 Short Street Kemersviile, North Carolina 27284 Tei: 336-996-2841 Fax: [phone] www.randalabs.com Page 1
C3I CL�� :;@SiG 71C1

MVP
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 I] DRINKING WATER ❑ OTHER ❑
REQUESTED PARAMETERS REMARKS I PRESERVATION
Ingredion Incorporated
SAMPLERS: (SIGNATURE)
(PRINT)
f
a
a
ALL SAMPLES ARE TO BE CHILLED
F
w
w
w
WITH ICE. GRAS SAMPLE #1 & #2 ARE
TO BE LOWERED TO A 2.0 OR
SAMPLE 1D
DATE
TIME
LOCATION
N
~ I—
L)
Z w
a
pH of
U
O p
y
z
LESS WITH SULFURIC ACID. SAMPLE
a O Q
0
jz g S
O1
Q
0
#31S NOT ph ADJUSTED, ALL
SAMPLES ARE COOLED TO <4 C.
z
vo $ O
z
O
y
v
OUTFALL
GRAB # 1
001G
1
X
jOf
l 4�
�� 5
OUTFALL
GRAB # 2
V
001
G
1
X
/
Analysis must be conducted wilhin 30
OUTFALL
✓
minutes orcollectionaccordance with
the Field Annalysissisguide and documented
GRAB # 3
001
G
1
X
X
as such.
R INQUISHED BY: SIGNATURE
DATE
TIME
RECEIVED
BY:
DATE
TIME
LAB USE ONLY
Samples e 4 C
Samples Preserved
Holding Time
Q
Q�
/c� • �2c� ! 7
r✓ •' vs
/b' /
0 L I
I
R t
LaU Rem rks:
Other
Checked By:
WS-ENV-F-610.001 Effective: 8/2912012

STORMWATER STORM EVENT DATA RECORD
Outfall No. 001
Date Id017
Time(')
Actual
Sample
Sample Container
Rain
..interval
Time
Designation
.,Label
Gauge
;° (minutes)"
Min;)
Record
"Jidch)R)
Storm Begins
(o Z2
R�
'
Storm(z) Ended
�31
max$ "�
• J�
/O 7
.
Valve Opened0115
; �
�3
f
0-30("
Grab 1
Grab No. 1
0-
4 S
Grab 2
Grab No. 2
0-30(')
Grab 3
Grab No. 3°
No. of hours since previous measurable rain (0.1 inches) hrs.
Pond Depth Reading to nearest 0.5 feet 5 ,!5
pH of Grab 3 sample (0. ?
Samples collected by pY'A/?04 L-r i,a
Rain gauge reading taken by 1 r � o Q r t� 4 r) r`
Comments:
DC
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

CZu�aliry
Stormwater Discharge O.utfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit https:I/deq.nc.gov/about/divisions/energy-minei-aI4and-
resources ener -mineral-landpermits stormwater ermits n p des- industrial-sw#tab -4
Permit No.: N/C/ 0/6/0/0/0/0/0/ or Certificate of Coverage No.:
Facility Name: Ingredion Incorporated
County: Forsyth Phone No.: 336-78S-0850
Inspector: Sandy Warwick
Date of Inspection: 10/25/2017
Time of Inspection: 1300
Total Event Precipitation (inches): 1.5
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 of Q—asignee)
1. Outfall Description:
Outfall No.: 001 Structure (pipe, ditch, etc.): Pipe
Receiving Stream: South fork of Muddy Creek
Describe the industrial activities that occur within the outfall drainage area: Manufacture of High
Fructose Corn Syrup, Dry Starch, and Animal Feed Co -Products.
Pagel of 2
SWll-242, Last modified 07/28/2017

2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: light brown
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): None
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
1 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:
1 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:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes o.
8. Is there an oil sheen in the stormwater discharge? Yes N .
9. Is there evidence of erosion or deposition at the outfall? Yes No
10. Other Obvious Indicators of Stormwater Pollution:
List and describe: None
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 07/28/2017

%i)
Ingredion
November 10, 2017
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Stormwater Sampling Results
Ingredion Incorporated
4501 Overdale Road
Winston-Salem, NC 27107
United States
t: +t 336 785 0850
w: ingredion.com
Please find attached the "STORMWATER DISCHARGE OUTFALL (SDO) MONITORING REPORT" covering
the 2" d half of 2017, for our facility located in Winston-Salem, NC.
if you need any additional information or if I can be of any other assistance, please contact me at
[phone].
Sincerely,
Dave Cluskey
Plant Manager
Attachment

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
!v G()- 0 (P cx>z(�3 Date submitted: 5-10-2017
CERTIFICATE OF COVERAGE NO. NC-GO60000 SAMPLE COLLECTION YEAR: Year 5 Period 1
FACILITY NAME: Ingredion Incorporated Winston-Salem, NC p 1` /OF ►ILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY Fors h [� E 1� 1.:. ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES: Hassan Nunn MAY J_ G Z0110DISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY: R&A Laboratories Lab Cert. #NC#34
CENiRAk. t=1Li`S
DWR SECTION
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall z 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
S00
1
04/24/2017
22.5
6.2
67
<5
' Only applies to facilities that use/process meats.
The total precipitation must be recorded using data from an on -site rain gauge.
a 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
-
' 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.
(if yes, complete Part Bj
SWU-249 Last Revised: October 18, 2012
pnoe 1 of?

*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 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" reportsi 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)
c5� C7 oZO -7
(pate)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdesswl#tab-4
SWU-249
Last Revised: October 18, 2012
PaaP '7 of

RESEARCh & ANA[yTiCA1
L.AbORATORfES, INC.
For: ingredion, Inc.
4501 Overdale Road
Winston-Salem, NC 27107
Attn: Pamela Bradsher
Report of Analysis
5/4/2017
`tea .,,......,..,, . '�.
•�,� L C1y1• ." i
r •.
NC #34 y•
NC #37701 a
Client Sample ID: Stormwater Discharge Valve Lab Sample ID: 33840.01
Site: ingredion, Inc Collection Date: 4124/2017 9:45
arameter Method Result Units Rep Limit Anal s Analysis Datealme
COD EPA 410.4 67 mg/L 5 BR 4/27/2017
Hydrocarbon O&G EPA 1664 Revision B/Silica a5 mg/L 5 JF 4/28/2017
Gel
pH SM 4500 H+3-2000 6.2 Sid. Units 4/24/2017 0945
Total Suspended Solids (fSS) SM 2540 D-1997 22.5 mg/L 5 AA 4/25/2017
NA m not analyzed
1.0. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] www,randalabs.com Page 1
of coa basic Od

15 RESEARCh & ANAIyTICA[
LAbORATQRIES, INC.
Analytical / Process Consultations
Phone [phone]
CHAIN OF CUSTODY RECORD -"
I WATER 1 WASTEWATER 1 misc. I
ZgWANY �^ JOB NO.
ph L
H
x
z
Z
o • ,
Z2p
lam ,T.ti my O
Q�y Spv O•�
� � Jc C? � sac ? �~
d O
tirO
`� BOA-' Q�m ���
m�a� O Q` OOQr�O` QO
ti REQUESTED ANALYSIS
STREE ADDRESS P OJECT
��LJ! /�' L-�-/%F/1<►' �`
CI , STATE, ZIP SE PRINT)
,, % / SA PLEB NAME (PL2LjkJA/
!
/V L- ! Q ry �JkA
CONTACT PHONE SAMPLER SIGNATURE
SAMPLE NUMBER
{LAB USE ONLY)
DATE TIME
COMP
GRAB
TEMP
oC
REs
ICI
OtMl+t eye
p� Ig«Rm
SAMPLE LOCATIONII.D.
t ab ; s5
zy
sV,24L.SS
>�1 Q �-C
RELI QUISHED BY DATElfME
kATEmME
REC E1VEj
BY
REMARKS:
Ac-e-
SAMPLE TEMPERATURE AT RECEIPT °C
RELINQUISHE6 BY
RECEiveb BY

STATE. ZIP
(LAB USE 1
RESEARCh & ANA[yTICA1
LkoRATORlES, INC.
Analytical / Process Consultations
Phone [phone]
I JOB NO.
IVCr ,2,7/o "1
PHONE
DATE TIME CO GRAB TEMP RES CK
'C MgtiF (y
CHAIN'OF CUS
WATER I WA
�U"
��
SE PRIM)
(PL
UAJA
v,
z
\Qm`'
gam`,
z0� ��~ k, '
TURF
S 0ap �Qc0 C.) 0
C9 Q• Q• Q•
/
SAMPLE LOCATION I I.D.
RELI QUISHED BY DATEMME RECEIVE B REMARKS:
r
RELINQUISHED BY I R EIVElb BY
�'�[/ SAMPLE TEMPERATURE AT RECEIPT (/� �J' °C

STORMWATER STORM EVENT DATA RECORD
Outfall No. 001
Date April 24, 2017
Time(')
Actual
Sample
Sample Container
Rain
interval
Time
Designation
Label
Gauge
(minutes)
(Hr: Min.)
Record
(inch)(')
Storm Begins
4/21/17 @ 0600
Y;
0
Storm Ended
4/24/17 @ 0700
Valve Opened
08:15 AM
�'
."
0-3011)
09:16 AM
Grab 1
Grab No. 1
0-30(')
09:23 AM
Grab 2
Grab No. 2
yy'.Aj
0-3011)
09:22 AM
Grab 3
Grab No. 3
No. of hours since previous measurable rain (0.1 inches) 72 hrs.
Pond Depth Reading to nearest 0.5 feet 7 ft. Full
pH of Grab 3 sample 6_2
Samples collected by: Hassan Nunn
Rain gauge reading taken by: Meghan Proctor
Comments: None, sample clear and free of any observed
pollution
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

; AJ
�c®TR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: http; f deilr.orglweb/w ws/su/npdessw#tab-4
Permit No.: N/C/ 0/ 6/ 0/ 0/ 0/ 0/ 0/ or Certificate of Coverage No.:
Facility Name: Ingredion Incorporated
County: F rs t
Inspector: ,, MV-,_,
Date of Inspection:
Time of Inspection: �' 30 AM
Total Event Precipitation (inches):
one No. 336-785-0850
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfali Description:
Outfall No. 001 Structure (pipe, ditch, etc.) Pine
Receiving Stream: South fork of Muddy Creek
Describe the industrial activities that occur within the outfall drainage area:
Manufacture of High Fructose Corn Syrup, Dry Starch and Animal Feed Co-Porducts
2. Color: Describe the color of the
(light, medium, dark) as descriptors: L
3. Odor: Describe any
weak chlorine odor, etc.): _
using basic colors (red, brown, blue, etc.) and tint
A 1 _ , r /
ct odors that the,discharge may have (i.e., smells strongly of oil,
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 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:
a2 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:
0 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
B. is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious Indicators of Stormwater Pollution:
List and describe /l10--' z/) 4,�. a't—
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 10/25/2012

Site: INGREDION INCORPORATED - WINSTON-SALEM
4
Month: ri Year . OIL I
DATE
RAINFALL (inches)
MEASURED BY
COMMENTS
1
..-.- ......... _____._.._
4
5
t. 5
6
7
8
9
OV
10
11
12
13
14.
15
16
17
18
law
19'
21
5
22
s.�
�tJyL3
2 3
"�
J
24
25
26
27
28
29
30
31
.Revision history can be found in Intelex metadata
In reciion Incorporated
Effective Date
Pa e #
Doc # WS-OA-F-455.026
10/31/201 E
1 of 1
Return completed form to the Lab Manager for record storage. Print a new form as needed. This form tinted on 4I1/2017.

POND RELEASE RECORD
Date
Time
pH
COD
Level
10pen/Closed
Valve
Flag
Up/Down
Initials
J
y
,
v w�
3 7
3 .-So
Lf j $ ! 7
V. 10
e-
0 tor4

0 Ingredion
•
0
October 21, 2016
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Stormwater Sampling Results
Ingredion Incorporated
4501 Overdale Road
Winston-Salem, NC 27107
United States
w: ingredion.com
N C. �- 06ao y3
Please find attached "Stormwater Discharge Outfall (SDO) Monitoring Report" covering the second half
of 2016, Year 4 Period 2, Sample #8 for the Winston-Salem, NC facility.
The attached Report of Analysis show a slightly elevated COD of 155mg/L versus permit limit of
120mg/L. With this being the first permit exceedance resulting from the first valid sampling results that
are above a benchmark value, or outside of the benchmark range, for any parameter at any outfall, the
site has been instructed to follow guidance outlined under Tier I of NPDES General Permit NCG060000.
If you need any additional information or if I can be of any other assistance, please contact me at
[phone].
Sincerely,
Dave Cluskey
Plant Manager
cc: Hassan Nunn
cc: David Brau
A c- C E'/
Z016
ST RW� �R QUAC17y
ps_RMjrr1Nc

e SEMI-ANNUAL STORMWATER DWHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted: 10-21-2016
CERTIFICATE OF COVERAGE NO. NCG060000
FACILITY NAME: Ingredion Incorporated Winston-Salem, NC
COUNTY Forsyth
PERSON COLLECTING SAMPLES: Terrell Britton
LABORATORY: R&A Laboratories Lab Cert. #NC#34
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR: Year 4 Period 1
FACILITY ACTIVITIES INCLUDE (check all that apply):
❑ use/process meats ❑ use animal fats/byproducts
DISCHARGING TO SALTWATERS? ❑YES ®NO
PLEASE REMEMBER TO SIGN ON THE REVERSE -->
0
Total event rainfall 2 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 I,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
500
1
09/29/2016
27.2
5.S3
155
<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
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 5046.0
— 9.0
-
vC
(if yes, complete Part B)
Only applies to facilities that use/process meats. o' O� I
ZThe total precipitation must be recorded using data from an on -site rain''�4'%z
,
3 For sampling periods with no discharge at a� outfalls, you must still submit tFi�se monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water c�. ass" ons where the more protective benchmark applies.
SWU-249 Last Revised: October 18, 2012
Papa f of i

• • •
*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENT. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE SAME OUTFALLTRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART li 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 2-NO ❑
REGIONAL OFFICE CONTACT NAME: Glen White [phone]
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."
(Signature of Permittee)
/0-a/-1 0/6
(Date)
Additional copies of this form may be downloaded at: http:l/portal.ncdenr.org/web/wq/ws/su/npde_s_sw#tab-4
S W U-249
Last Revised: October 18, 2012
Pace 7 of 7

` RESEARCh & ANALYTICAL
w
LAbORATORIES, INC.
'or: Ingredion, Inc.
4501 averdale Road
Winston-Salem, NC 27107
Ittn: Pamela Bradsher
Repolrt of Analysis
10/11/2016
��iru.rrrrf�
`�,.••G�i� 1�Li&##**
CC
m NC #34 x� .
r
%S NC t137701
Jf
i�f� ��, •���ECt4Q'�f �5 `,
lient Sample ID: Stormwater Pond Lab Sample ID: 25180-01
ite: Ingredion, Inc Collection Date: 9/29/2016 11:36
Parameter Method Result Units Ren Limit Analyst Analysis DatelTime
;OD EPA 41 DA 155 mg/L 5 KIN10/5/2016
iydrocarbon O&G EPA 1664 Revision BlSilica <5 mglL 5 ON 9/30/2016
Gel
H SM 4500 H+13-2000 5.83 Sid. Units AP 9/30/2016
'at*pended Solids (TSS) SM 2540 D-1997 27.2 mg/L 5 AW 10/4/2016 1000
NA = not anolyzed
•
1.0. Box 473 106 Short Street Kemersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page 1
71 coa Wsie v1d

EN RESEARCh & ANA[YfiCAI
LABORATORIES, INC.
Analytical / Process Consultations
-Phone [phone]
CHAIN OF CUSTODY RECORD 40
WATER ! WASTEWATER I MISC.
•
... • • .
QUESTED ANALYSIS
�� y
.
NM
MENE
MINA
EN
mmm■mmmm■
_-■�■■--MINEENEME
■■....■........
�_■■ME
■■N-
m.m..■mo■m.■...
=MENEM==
■EMENNEE■E■■
■ENS
SEMEN=
■..m....m■o.
m..
_-■■■■--
■.........■....
_-■O■■-�
����......■..■.
_-■N■■--
■.�...■....■,..
_-■■■■--
■■..■....■■■...
REUNQUISHED BY
SAMPLE TEMPERATURE AT RECEIPT cc
oilr
I

•
0
0
STORMWATER STORM EVENT DATA RECORD
Outfall No. 001
Date ...qfaf I 1 �
Actual' ..
Sample,,,,:.
Sample Container
Rain
}i..Msnterval,..
Time , ,;
Designation
Lab_ ei.
Gauge
(rnInutes)
;
{Hr" Min j
Record
,
{2l
l�)
nCi
4Storm Begins
law" ��Do
� `f�
"�``��� �
0
rr��'
tea. �. x .
�����~�
Storm{ Ended�f
o(v3u?.
S i
y.}x
ssss�..
�'r
:
a. ;•. {v. x .. ! .?.. ,ry
r�,.nxGtk :�..�.i
_.f&...N 'k .a.d'
,
✓' + .T" s''[ i9 iT;:.. -
Y
Valve`.Opened,.
MirV fX5
9 it 1 1
d SY! T 114{g
r F
s l PA
_��
.h-fi_.t. S. .?X{r.
.: ys.:, 'M1*k'�
0-30(')
Grab 1
Grab No. 1M,{
0-30"),
� �
Grab 2
Grab No. 2
� �;� `°s��,��,��
0-30i'i
1
Grab 3
Grab No. 3w
w
No. of hours since previous measurable rain (0.1 inches)
Pond Depth Reading to nearest 0.5 feet :3, 5
pH of Grab 3 sample 9.
Samples collected by 1, 1Y_,e U ) f i j4C2t1
Rain gauge reading taken by P (0j *
rS.
Comments:
r� 1fi oom 4.,, Co�aL iniAAOdAr
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

0
•
;A
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: btlp:./.Iportal.ncdenr.org/web/wq/­ws/su/`npdessw#tab--A
Permit No.: or Certificate of Coverage No.:
Facility Name: Ingredion Incorporated
County: Forsyth Phone No. 336-785-0850
Inspector:
Date of Inspection: 19 Al
Time of Inspection: ��s
Total Event Precipitation (inches): /I 6
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
eyes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
a�
(Signature of Permittee or Designee)
SwU-242, Last modified 10/25/2012
Pagel of 2

1. Outfall Description:
Outfall No. 001 Structure (pipe, ditch, etc.) Pipe
. Receiving Stream: South fork of Muddy Creek
Describe the industrial activities that occur within the outfall drainage area:
Manufacture of High Fructose Corn Syrup, Dry Starch, and Animal Feed Co-Porducts .
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: C� W;Wt' 111!W -fir4
3. Odor: Describe any, distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): NOS
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 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:
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:
CD 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? 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 10/25/2012

RAINFALL RECORD LOG
i
Site: INGREDION INCORPORATED - WINSTON-SALEM
Month: � f Year r Ln
_DATE
RAINFALL (Inches)
ME R D BY
COMMgNTS
1
7. 2
4
3
O
-4�
4
>>.
' ILJ
5
L�
-6
EV7
8
yn
9
1
10
12
C`
13-
14-
15
16
18
22_
,"
20
0_
r
21
t�
P
22
23
24
�.
25
26
— 27�
29
30
1
31
Revision history can be found in Intelex metadata
Ingredion Incorporated
Doc # WS-QA-F-455.026
Effective Date
—1013112012
1 of 1
_
Return completed form to the Lab Manager for record storage. Print a new form as needed. This form printed on 91212016.

POND RELEASE RECORD
•
•
0

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT A�6
for North Carolina Division of Water.Quality General Permit No. NCG060000
Date submitted: 5-31-2016
CERTIFICATE OF COVERAGE NO. NCGO60000 "-' SAMPLE COLLECTION YEAR: Yea r4 Period 1
FACILITY NAME: Ingredion Incorporated Winston-Salem, NC FACILITY ACTIVITIES INCLUDE (check all that apply):0
COUNTY Forsyth ❑ use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES: Hassan Nunn DISCHARGING TO SALTWATERS? ❑YES ®NO
LABORATORY: R&A Laboratories Lab Cert. #NC#34 70
Part A: Stonmwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall I or ❑ No discharge this period3
Outfalll 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 SO
Within 6.0 — 9.0
120
30
1000
500
1
05/02/2016
14.8
6.06
57
<5
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 g_gy 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.
outfail 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
-
4
I °
1 Only applies to facilities that use/process meats. CENTRAL FILES
2The total precipitation must be recorded using data from an on -site rain gauge. ❑WR SECTION
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
Poop 1 of �p

*FOR PARTA 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 of this DMR, including all "No Discharge" reports, within 30 days of receipt of the lab results_jor 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)
6V-13/&70/b
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw4#tab-4
SWU-249 Last Revised: October 18, 2412
Paop 7 of 7

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
C/111 Date submitted -/6 - 2als-
r , (_)(�q ()C)LL3
CERTIFICATE OF COVERAGE NO. NCGO60000
FACILITY NAME Ingredion Incorporated
COUNTY Forsyth
PERSON COLLECTING SAMPLES: Hassan Nunn
LABORATORY: R&A Laboratories, Inc. Lab Cert. # NC#34
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR
69.1 FACILITY ACTIVITIES INCLUDE (check all that apply): Ktu t i v t V
❑ use/process meats ❑ use animal fats/byproduct EP 2 2 2�15
DISCHARGING TO SALTWATERS? DYES ®NO
CENTRAL FILES
PLEASE REMEMBER TO SIGN ON THE REVERSE 4 DWR SECTION
Total event rainfall 21.05 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
08/20/2015
6.8
7.53
57
<5
Only applies to facilities that use/process meats.
z The total precipitation must be recorded using data from an on -site rain gauge.
3 Fox sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark here.
4'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 5o
6.0 — 9.0
-
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.
(ifyes. complete Part B)
a�"
■NNUM
SWU-249 Last Revised: October 18, 2012
Papa i of

*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 at/ "No Dischame" reports, within 30 days of receipt of the fah 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
11
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)
Z/�(n .2o /.5,
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/su/npdessw##tab-4
S W U-249
Last Revised: October 18, 2012
Pnaq ') of')

RESEARCh & ANA1yTICA[ Report of Analysis
LA ORATOR1ESi INC. 8/28/2015
Aft
For: Ingredion, Inc.,
4.'
4501 Overdale Road c •�� �:.
Winston-Salem, NC 27107 f3 NC#34 �� r
NC#37701
Attn: Pamela Bradsher
ti
D
Client Sample ID: Grab #1 Outfall 001 Lab Sample ID: 8072-01
Site: Ingredion, Inc Collection Date: 8/20/2015 8:10
Parameter Method sul U��,s ep Limit al st Analysis Date/Time
Hydrocarbons, Oil & Grease EPA 1664 Revision A/Silica <5 mg/L 5 JB 8/26/2015
Gel
Client Sample ID:
Site:
Grab 92 Outfall 001
Ingredlon, Inc
Lab Sample ID: 8072-02
Collection Date: 8/20/2015 8:10
ra ter
Method
Resul
units
Rep.Wln Analyst Analysis DaLeMme
COD
EPA 410A
57
mg1L
5 KN 8/21/2015
Client Sample ID:
Site:
Grab #3 Outfail 001
Ingredion, Inc
Lab Sample ID: 8072-03
Collection Date: 8/20/2015 8:11
Parameter
Method
Result
Units
Ron J_ Anal st Analvele Date[Time
PH SM 4500 H+B-2000
Total Suspended Solids (TSS) SM 2540 0-1997
7,53
6.8
Std. Units AP 8/20/2015
mg/L 5 JB 8/21/2015
NA = not analyzec
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284
ral cot basic Od
al: 336-996-2841 Fax! 336.996-0326 www.randalabs.com Page

0Z-0)
O-Z
03
�U
Ingredion_
4501 Overdale Road, Winston-Salem, NC 27107-6145
TEL [phone] FAX [phone]
CHAIN OF CUSTODY RECORD
REGULATORY CLASSIFICATION
PROJECT NO.
CLIENT NAME
PRETREATMENT 0 NPDES 0 DRINKING WATER 0 OTHER
REQUESTED PARAMETERS REMARKS 1 PRESERVATION
�' �
SAMPiF�iS: SIGHATLAW
(P�7
6 SA,' ,
SAMPLE ID
DATE
TIME
LOCATION
O
a
al
v
2
u
f, ~
a O
O � ��
u. x
CL
w v y �
3
O ai'�
C7
�
z
F
v
d
coW
.5
J
O
w
O
U
Q
ALL BARE TO BE GFffftID
WITH ICE. GRAB SAMPLE #1 & 92 ARE
TO BE LOWERED TO A pH of 2.0 OR
LESS YOM SULFURIC ACID_ SAMPLE
IS NOT ph ADJUSTED. ALL
SAMPLES ARE COOLED TO <4 C.
RAB # 1
OUTFALL
001
G
1
X
GRAB # 2
jr 2E / -5
y
d '• �Q I`��
OUTFALL
001
G
1
X
RAS # 3
ZL� /�
, /% /Q/�
OUTFALL
001
G
1
X
X
Analysis must be conducted WrUlhr 30
minutes of Co0ection in aooandanoe wtfh
the Field Analysis guide and documented
as SUCK
RE NQUISHED
BY: SIGNATURES
DATE
TIME
RECEIVED
BY:
DATE
TIME
LAB USE ONLY
Samples <4 C a
Samples Preserved
Holding Time
Other
.�
5A
F2_6
,
I IF
Lab Remarks:
Ghee4d By
1A1C FNV-F_'i1().QD1
Effective: 8/29/2012

STORMWATER STORM EVENT DATA RECORD
Outfall No. 001
Date
Time(')
Actual
Sample
Sample Container
Rain
interval
Time
Designation
Label
Gauge
(minutes)
(Hr: Min.)
Record
(inch)(')
Storm Begins
�S- C}1. dp
rlie
ba'r,
0
Storm(Z)Ended
Valve Opened
0-30�'�
?0 VlloAY
Grab 1
Grab No. 1
0-30 car
y, S-4w
Grab 2
Grab No. 2
Y
Grab 3
Grab No. 3
No, of hours since previous measurable rain (0.1 inches) hrs.
Pond Depth Reading to nearest 0.5 feet
PH of Grab 3 sample G • 3
Samples collected by8_'f_SSA'V &L'6�
Rain gauge reading taken by r
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

A
�
MCDEWdR
Stormwater Discharge Outfall (00)
Qualitative Monitoring Report
Forguidance on f iiling out this farm, please visit:
Permit No.: N/�/.Il/�/�/4/•Q/Q/Q/ or Certificate of Coverage No.:
Facility Name: Ingredion Incorporated
County: Forayth Phone No. 336-785-08 0
Inspector: ,u
Date of Inspection: D �_55
Time of Inspection:
Total Event Precipitation (inches): _ -1/
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below,)
E Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be^
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred, A single storm event may contain up to 10 consecutive hours of no
precipitation.
A "measurable storm event" is a storm event that results in an actual discharge from the
permitted site outfail. 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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2017

1. Outfall Description:
-Qutfall No. = Structure (pipe, ditch, etc.) Pine
Receiving Stream:
Describe the industrial activities that occur within the outfall drainage area:
Manufacture of Hf2b Fructose Colm Syrup. D13E Starch. and Animal Feed Co-Porducts
2. Color; Describe the color of the di
(light, medium, dark) as descriptors: -A
3. Odor: Describe any d
weak chlorine odor, otc,): _Z
using basic colors (red, brown, blue, etc.) and tint
odors that the discharge may have (i.e., smells strongly of oil,
4. Clarity: Chooso the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
© 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:
© 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:
0 2 3 4 5
7. Is there any foam in the stormwater discharge?
8. Is there an oil sheen in the stormwater discharge?
Yes
Yes
9. Is there evidence of erosion or deposition at the outfall?
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Yes < N o
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
5WU-242, East modified 10/25/2012

RAINFALL RECORD LOG
Site: INGREDION INCORPORATED - WINSTON,-SALEM
Month: Year
'MEASURED
BY°
1
A
•
Revision history cnn bA fnunrl in IniAlow ma+arlain
1n redion Incur grated
Effective Date
page #
Doc # WS-QA-F-455.026
10/31/2012
1 of 1
Return com feted form tolhe Lab Manager for record store e. print a neW orm as•needod. This form printed on $1112015.

POND RELEASE RECORD
P/A If AM

%i)
Ingredion
May 11, 2015
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Stormwater Sampling Results
Ingredion incorporated
4501 Overdale Road
Winston-Salem, INC 27107
United States
w: ingredion.[om
I4'EFCE1V
MAY z �D
2615
cj�NITDWR �fiL FJL E ,
iEonr
Please find attached "Stormwater Discharge Outfall (SDO) Monitoring Report" covering the first half of
2015, Year 3 Period 1, for the Winston-Salem, NC facility.
If you need any additional information or if I can be of any other assistance, please contact me at
[phone]
Sincerely,
Ray Doogan
Plant Manager
cc: Hassan Nunn
cc: Alan lirik

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted ':5 " /f '"� dfs
CERTIFICATE OF COVERAGE NO. NCG060000
FACILITY NAME Ingredion Incorporated
COUNTY Forsyth
PERSON COLLECTING SAMPLES: Hassan Nunn
LABORATORY: R&A Laboratories, Inc. Lab Cert. # NC#34
Part A: Stormwater Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR
f . FACILITY ACTIVITIES INCLUDE (check all that apply):
J(v,�"� ❑ use/process meats Fuse animal fats/byproducts
¢ DISCHARGING TO SALTWATERS? []YES ®NO
RECEIVEL) PLEASE REMEMBER TO SIGN ON THE REVERSE 4
MAY I Total event rainfall 21.05 or ❑ No discharge this period3
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
'T COD, -.
tt�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
04/20/2015
25.2
6.72
50
<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
-
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.
(ifyes, complete Part B)
SWU-249 last Revised: October 18, 2012
Paap 1 of?

*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 It 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 or at end o
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: http:/Iportal.ncdenr.org/web/wq/ws/su/npdessw#tab-4
S W U-249
Last Revised: October 18, 2012
Pave ? of

RESEARCh & ANA1yTICA1 Report of Analysis
LAbORATORIESF INC. 5/4/2015
�'J'gI 11Sol#,
For: Ingredion, Inc.
.M`�"-
C►�,b .Y�C1+:
4501 Overdale Road
Winston-Salem, NC 27107
NC#34 i�tn
Attn: Hassan Nunn
w NC #3770'1
103
Client Sample ID: Grab #1 Outfall 001
Lab Sample ID: 3186-01
Site: Ingredion, Inc
Collection Date: 4/20/2015 14:00
< •,«r �:•z•w X' •, �a �r rw=r� iJd � 5 t+, =::h , r c
)Paiamete'r � y r i `?,Method; i1 ;
-c:r° xp'� r ; r �,
ask I ^s",4 Rep'Limit:.Analyst,"nalyss' Datiaji L
Result `Ai
i � Jr ?_ ,,,
Oil & Grease EPA 1664 B
<5 mg/L 5 JB 4/23/2015
Client Sample ID: Grab #2 Outfall 001
Lab Sample ID: 3186-02
Site: Ingredion, Inc
Collection Date: 4/20/2015 14:00
Parameter "6' ` ` ,C` 4Meffi°od i }p"` p1� ''_ r � �f
Result ` ,,t lJnits t` +x Rep Limit,'' Analystt;Analy`sis QatelT�me:x.
;�'ju,
97 4�,RIV, i„� h;7} a G�} Lt , tr fk n
7r'«
COD EPA 410.4
50 mg/L 5 KN 5/1/2015
Client Sample ID: Grab #3 Outfall 001
Lab Sample ID: 3186-03
Site: Ingredion, Inc
Collection Date: 4/20/2015 2:03
� r wwff r
� Methods �,
1' ,
Result • rnts ,Re�..Limit��:Analyst•�Analvsis QatelTime:
-
.'�;,o.,. � �*,
.�)..
Total Suspended Solids (TSS) SM 2540 D-1997
25.2 mg/L 5 JB 4/22/2015
pH SM 4500 H+B-2000
6.72 Std. Units AP 4/22/2015 1626
NA = not analyzed
P.O. Box 473 106 Short Street Kernersville, North Carolina 27284 Tel: [phone] Fax: [phone] www.randalabs.com Page 1
ral coa basic v1d

Qw
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 0 DRINKING WATER ❑ OTHER ❑
REQUESTED PARAMETERS REMARKS 1 PRESERVATION
Ingredion Incorporated
SAMPLERS: (SIGNATURE)
(PRINT)
r1
1-2 W_ 11
a w
a
ALL SAMPLES ARE TO BE CHILLED
F
w
w
WITH ICE. GRAB SAMPLE #1 & #2 ARE
SAMPLE ID
DATE
TIME
LOCATION
o
~
Z F
F
TO BE LOWERED TO A pH of 2.0 OR
O p
_ (0 ur
5
Z
LESS WITH SULFURIC ACID. SAMPLE
CL Z
2_j 2
¢
� F
Z a
O
U
0
#3 IS NOT ph ADJUSTED. ALL
O It m
C7 O
O ii is n
o
y
sn
0
O
=
SAMPLES ARE COOLED TO <4 C.
Uu_z
UaC70
Z
O
U
n
Z
OUTFALL
✓
GRAB # 1
/-
001
G
1
X
GRAB # 2
`7f % / Sr
/n
OUTFALL
001
G
1
X
Analysis must be conducted within 30
minutes of collection in accordance with
OUTFALL
the Field Analysis guide and documented
GRAB # 3
001
G
1
X
X
as such.
RE .INQUISHED BY: SIGNATURE
DATE
TIME
CEIV BY:
DATE
TIME
LAB USE ONLY
Samples < 4 C 1
Samples Preserved
Holding Time
Lab Remarks:
Other
Checked By:
1
WS-ENV-F-610.001
Effective: 8/29/2012

STORMWATER STORM EVENT DATA RECORD
Outfall No. 001
Date 7`- �� ` / -5—
Time(')
Actual
Sample
Sample Container
Rain
interval
Time
Designation
Label
Gauge
(minutes)
(Hr: Min.)
Record
(inch)(')
Storm Begins
/(� iS-/ 3U
:.
,;
0
Storm"' Ended
4
Valve Opened
S-IV
0-30111
:Od
Grab 1
Grab No. 1
R.
0-3011)190
Grab 2
Grab No. 2
�' r
0-3011
p
Grab 3
Grab No. 3
No. of hours since previous measurable rain (0.1 inches) hrs.
Pond Depth Reading to nearest 0.5 feet
pH of Grab 3 sample � - 7'9
Samples collected by Aq3-5RV N(Ihi7
Rain gauge reading taken by—Tz 17ia—
ents:
+777
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

fi�A
AM==
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: httl2;://12ortal.ncdenr,org/web/wq/ws/su/ni2dessw#tab-4
Permit No.: N/-C/Q/or Certificate of Coverage No.:
Facility Name: Ingredion Incorporated
County: Fors h
Inspector: 55.
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): "' ' OS
one No. 336-785-0850
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
F-<Yes ❑ No
Please verify whether Qualitative Monitoring must he performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 001 Structure (pipe, ditch, etc.) Pipe
Receiving Stream: South fork of Muddy Creek
Describe the industrial activities that occur within the outfall drainage area:
Manufacture of High Fructose Corn Syrup, Dry Starch, and Animal Feed Co-Porducts
2, Color: Describe the color of the discha
(light, medium, dark) as descriptors: //a aj
using basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
2 3 4 5
S. 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:
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:
1 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes No
B. Is there an oil sheen in the stormwater discharge? Yes es
9. Is there evidence of erosion or deposition at the outfall? 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 10/25/2012

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
Date submitted
CERTIFICATE OF COVERAGE N . NCGO 000 tf y'CJ SAMPLE COLLECTION YEAR
FACILITY NAME Ingredion Inc ed ��FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY _ Forsyth _ + ` ❑use/process meats U use animal fats/byproducts
�
PERSON COLLECTING SAMPLES: Hassan Nunn E1V HARGING TO SALTWATERS? ❑YES ®NO
LABORATORY: R&A Laboratories, Inc. Lab Cert. # NC#34 SEP 0 9 2014
PLEASE REMEMBER TO SIGN ON THE REVERSE �
CENTRAL FILES
Part A: Stormwater Benchmarks and Monitoring Results DWR SECTION Total event rainfall z 1.05 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
08/12/2014
47.0
5.96
95
<5.0
2 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
-
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 ate+ 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.
IMP
(if yes, complete Part B)
SWU-249 Last Revised: October 18, 2012
paop. I of 7

*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 (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)
�LB h
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/weblwg/ws/su/npdessw#tab-4
S W U-249
Last Revised: October 19, 2012
Paoe ') of

RESEARCh & ANA[yTICA1
LABORATORIES, INC.
Analytical/Process Consultations
i i tyred ion
4501 Overdaie Road
Winston-Salem, NC 27107-6145
Attn: Hassan Nunn
Otite Sample Collected : 08/12/14
Date Sample Received : 08/12/14
Date Sample Analyzed : 08/12/14
Date of Report : 08/28/14
Analyses Performed by : SK -AP
ANAL),p
,%� ......
'• .•••.
io
c� NC y:`��
.. #34 ;
Lab Sample Number Lab Sample Number Lab Sample Number
-------------------- -------------------- --------------------
792092 792093 792094
Parameter Storet # Results Results Results
Oil 8 Grease (00556) <5.0 mg/l
COD -HIGH (00340)
TSS (00530)
pH (00400)
Clients Sample Source
Number
Time Collected (Hrs)
95 mg/ l
47.0 mg/l
5.96 Std. Units
---------------------------------------- --------------------
GRAB #1 GRAB #2 GRAB #3
1013 1013 1014
P.O. Box 473 • 106 Short Street • Kernersville, North Caro€ina 272B4 • 336-996-2641 • Fax [phone]
www.randalabs.com

')i2Mz
Del_;
AM
C
0
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 IF] DRINKING WATER ❑ OTHER ❑
REQUESTED PARAMETERS REMARKS / PRESERVATION
[ngredion Incorporated
SAMPLERS: (SIGNATURE)
(PRINT)
453hn: Aj h
� w
a
Cn
w
ALL SAMPLES ARE TO BE CHILLED
w
WITH ICE. GRAB SAMPLE #1 & #2 ARE
SAMPLE ID
DATE
TIME
LOCATION
2
~
w V
¢
w
TO BE LOWERED TO A pH of 2.0 OR
C)
N p
O
z u) w
z
a
LESS WITH SULFURIC ACID. SAMPLE
a� Z
=
F g F
a
C)cn
#3 IS NOT ph ADJUSTED. ALL
LL
C' II 11
z (7 O
11 11 13
p
((}
o
SAMPLES ARE COOLED TO <4 C.
c� U. z
UcL00
z
o
Q
n
��'�!� .
OUTFALL
�``
GRAB # 1
/Z /
001
G
1
X
•O /Z I .
Q
��
OUTFACE
`
✓
GRAB # 2
001
G
1.
X
Analysis must be conducted within 30
OUTFACE
minutes of collection in accordance with
the Field Analysis guide and documented
G
,� ��
GRAB # 3
D01
G
1
X
X
as such.
RE INQUIS
BY: SIGNATURE
DATE
TIME
RECEIV
D
Y:
DATE
TIME
-LAB USE ONLY
Samples < 4 C 1
Samples Preserved
Holding Time
-40
Lab Remarks:
Other
Checked By:
WS-ENV-F-610.001
Effective: 8/29/2012

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 0 DRINKING WATER ❑ OTHER ❑
REQUESTED PARAMETERS REMARKS / PRESERVATION
Ingredion Incorporated
SAMPLERS. (SIGNATURE)
(PRINT)
C�
Cl
a
a
ALL SAMPLES ARE TO BE CHILLED
Er
F
w
ur
WITH ICE. GRAB SAMPLE 41 & #2 ARE
SAMPLE ID
DATE
TIME
LOCATION
co
CL
2
OU
F- `-
w c2
<
co
w
TO BE LOWERED TO A pH of 2 0 OR
C7
Z
¢ " N =
z
�
LESS WITH SULFURIC ACID. SAMPLE
O11
g F
0
#3 IS NOT ph ADJUSTED. ALL
O =
O l C7 O
o
O
z
SAMPLES ARE COOLED TO <4 C.
CJu-2
Ud(70
z
O
H
C)
a
�Q �7
ALL
OU001
/
GRAB # 1
I4
G
1
X
_
��
�'�
OUTFALL
GRAB # 2
001
G
1
X
Analysis must be conducted within 30
minutes of collection in accordance with
/
��
OUTF=ALL
the Field Analysis guide and documented
GRAB # 3
/�
001
G
1
X
X
as such.
RE INQUIS
BY: (SIGNATURE)
DATE
TIME
RECEIV
D Y:
DATE
TOE
/� -LAB USE ONLY
L� n &
Samples < 4 C
Samples Preserved
Holding Time
'c� .IM
Lab Remarks:
Other
Checked By:
W S-ENV-F-610.001
Effective: 8/29/2012

STORMWATER STORM EVENT DATA RECORD
Outfall No. 001
Date
Time(l)
interval
(minutes)
Actual
Time
(Hr: Min.)
Sample
Designation
Sample Container
Label
Rain
Gauge
Record
(inch)1')
Storm Begins
• �j
0
Storm"' Ended
Valve Opened
-o'e
0-30("
��
Grab 1
Grab No. 1
0-30")
Grab 2
Grab No. 2
0-301")
/�,¢
Grab 3
Grab No. 3
No. of hours since previous measurable rain (0.1 /inches) hrs.
Pond Depth Reading to nearest 0.5 feet / T -
pH of Grab 3 sample 6 • !20
Samples collected by ftA:554�1 ALIAl
Rain gauge reading taken by AT 2_7-
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

Aij'A
NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form, please visit: htt• /./nortal.ncdenr.org/webJwq /wsIsm /nodessw#tab-4
Permit No.: Q/ 0/ 0/ or Certificate of Coverage No.:
Facility Name: Ingredion Incorporated
County: Forsyth
Inspector: SSA
Date of Inspection:
Time of Inspection:
Total Event Precipitation (inches): /• DJ -
Phone No. 336-785-085.0
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
2"Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event" is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, 1 certify that this report is accurate and complete to the best of my knowledge:
(Signature of Permittee or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 001 Structure (pipe, ditch, etc.) Pine
Receiving Stream: South fork of Muddy Creek
Describe the industrial activities that occur within the outfall drainage area:
Manufacture of High Fructose Corn Syrupy Starch. and Animal Feed Co-Porducts
2. Color: Describe the color of the
(light, medium, dark) as descriptors: J
using basic colors (red, brown, blue, etc.) and tint
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): /UD adbr
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
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:
(10 2 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes
9. Is there evidence of erosion or deposition at the outfall? Yes
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
5WU-242, Last modified 10/25/2012

AN
Ingredion
September 8, 2014
Division of Water Quality
Attn: DWQCentrai Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Stormwater Sampling Results
Ingredion Incorporated
45oi Overdale Road
Winston-Salem, NC 27107
United States
w: ingredion.com
Please find attached "Stormwater Discharge Outfall (SDO) Monitoring Report" covering the second half
of 2014, for the Winston-Salem, NC facility.
If you need any additional information or if I can be of any other assistance, please contact me at
[phone]
Sincerely,
/_ 1; (-- - - � �"
Ray Doogan
Plant Manager
cc: Hassan Nunn
cc: Alan Jirik

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCG060000
NC&C/_CLC
Date submitted (
CERTIFICATE OF COVERAGE NO. NCGO60006 3 SAMPLE COLLECTION YEAR
FACILITY NAME _Ingredion Incorporated
COUNTY Forsyth
PERSON COLLECTING SAMPLES: Mark Jordan
LABORATORY: R&A Laboratories, Inc. Lab Cert. # NC#34
Part A: Stormwater Benchmarks and Monitoring Results
DECEIVED
MAY 4 6 2014
FACILITY ACTIVITIES INCLUDE (check all that apply): CENTRAL FILES
❑ use/process meats ❑ use animal fats/byproducts DWO/BOG
DISCHARGING TO SALTWATERS? ❑YES ®NO
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall 1 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 Coliform ,
Colonies per 100 ml
Enterococci ,
Colonies per 100 ml
Benchmark
-
100 or 50
Within 6.0 — 9.0
120
30
1000
Soo
1
04/09/2014
10.0
7.39
33
<5.0
1 Only applies to facilities that use/process meats.
s 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
-
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
PaoP I of"?

*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 ❑
1F YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an on final and one copy of this DMR includin oil "No Discharge" re orts within 30 days of receipt of the lab results or at end o
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."
(Signature of Permittee)
s 12,/
(Date)
Additional copies of this form may be downloaded at: http:/Zportal.ncdenr.org/web/`wq/wsZsu/npdessw#tab-4
5 W U-249
Last Revised: October 18, 2012
Pane? n f ?

RESEARCh & ANA[yTICAI
LABORATORIES, INC.
Analytical/Process Consultations
Ingredion
4501 Overdale Road
Winston-Salem, NC 27107-6145
Attn:
Date Sample Collected : 04/09/1.4
Date Sample Received 04/09/14
Date Sample Analyzed 04/09/14
Date of Report 04/25/14
Analyses Performed by SK -CW
Lab Sample Number
--------------------
782724
---------------------------------------------------------------------------------
-------------------------------------------------------------------------------
Parameter Storet # Results
Oil & Grease (00556) <5.0 mg/1
TSS (00530) 10.0 mg/1
COD -HIGH (00340) 33 mg/1
pH (00400) 7.39 Std. Units
--------------------
Clients ;ample Source GRAD #1-3
Number OUTFALL 001
Time Collected (Hrs) 1245
P.O. Box 473 • 106 Short Street • Kernersville, North Carolina 27284 • 336-996-2841 • Fax [phone]
www.randalabs.com

IN
%Q)
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 IXI DRINKING WATER ❑ OTHER ❑
REQUESTED PARAMETERS REMARKS / PRESERVATION
Ingredion Incorporated
SAMPL RS'
( IG TURE)
(PRINT)
a W
a
ALL SAMPLES ARE TO BE CHILLED
P
w
w
WITH ICE. GRAB SAMPLE #1 & #2 ARE
SAMPLE ID
DATE
TIME
LOCATION
m
d
0
w "
0 ~
a
w
z
TO BE LOWERED TO A Hof 2.0 OR
O
U
o
b
z F
LESS WITH SULFURIC ACID. SAMPLE
a Q
d g F
Ov
#3 IS NOT ph ADJUSTED. ALL
x
O p n
z a 08
D u n n
o
y
cn
0
x
SAMPLES ARE COOLED TO <4 C.
Uu_T
Ua 00
z
O
N
U
a
G
5
OUTFALL
J
GRAB # 1
/ q&
12--J
001
G
1
X
f
)�
OUTFALL
Y
GRAB#2
1�
001
G
1
X
Analysis must be conducted within 30
OUTFALL
j
minutes of collection in accordance with
y� G
i Z
the Field Analysis guide and documented
GRAB It 3'
l `J
001
G
1
X
X
as such.
R LI QU H Y: IGNATURE
TE
TIME
RECE
VED BY:
DATE
TIME
LAB USE ONLY
UL
Lt
o
Samples < 4 C
Samples Preserved
Holding Time
Lab Remarks:
Other
Checked By;
WS-ENV-F-610.001
Effective: 8/29/2012

STORMWATER STORM EVENT DATA RECORD
Outfall No. 001
Date q 1h 111
�1i ��3 ;�
7ime��1 h
a�` , � :; a � ,
j Actual
> i t t {� > �
Sam�le�
� �s n ss, t'•r �r` �
Sample Container=,fx�
� zx
Rain
�>"
intervals ,Tune
x n
Designafion
�`' �f.
Label
-
-� Gauge
(minutes)'�'
;�
t-s Record '
�ft �t ": 'ski �� } ,SX
�3�2 .5 } � 4 �;fi }✓
dx y� k
t P a
�� ? "F� �4'k_ t �3 -"v y4 t� +�.tl �'i
;
�Tr i �2�
<N�-
Y
K�.$
✓ f.
a,.
Storm Beginsf
-sx
Milk
:, k z
m
0
>5`E.�
- i 7 00
e �
s
�
I
�n a a€a`
•
F .f s
Valve Opened
,,, We6,-,v _ £
t.
,
Ma
�:.30
7�� .�, e
s �fE;e_ u'
030{�t
Z4
Grab 1
Grab No. 1
-0 30�1� � � �
ej ��
Grab 2
Grab No. 2
17,4S
Grab 3
Grab No. 3
y = 3
No. of hours since previous measurable rain (0.1 inches) '7 hrs.
Pond Depth Reading to nearest 0.5 feet S
pH of Grab 3 sample 6,1
Samples collected by P ,4 O P"bh 0.J
Rain gauge reading taken by 1z IlQs o
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-I=-610.002 Effective: 12/17/2012

ox
Ingredion-
4501 Overdafe Road, Winston-Salem, NC 27107-6145
TEL [phone] FAX [phone]
CHAIN OF CUSTODY RECORD
REGULATORY CLASSIFICATION
PROJECT NO.
CLIENT NAME
PRETREATMENT ❑ NPDES 191 DRINKING WATER ❑ OTHER ❑
REQUESTED PARAMETERS REMARKS / PRESERVATION
.
Ingredion Incorporated
SAMPL RS- ( IG TURE)
(PRINT)
er
3DRA�tj
4ujQ
Lo
w
w
ALL SAMPLES ARE TO BE CHILLED
WITH ICE. GRAB SAMPLE #1 & #2 ARE
}
TO BE LOWERED TO A of 2.0 OR
SAMPLE ID
DATE
TIME
LOCATION'
~ r
w
¢
u4]
pH
W o
O
z N w
2
LESS WITH SULFURIC ACID, SAMPLE
a Q
F< g 3
fl
#3 IS NOT ph ADJUSTED. ALL
w 2
O is
On c90
0
�_
O
S
SAMPLES ARE COOLED TO <4 C.
Uu. a:00-00
Z
O
U
a
G
12-` 15'
OUTFALL.
J
GRAB # 1
7 q
001
G
1
X
aj
� r-f
) Z`q
OUTFALL
✓
GRAB # 2
1
001
G
1
X
Analysis must be conducted within 30
OUTFACE
J
minutes of collection in accordance with
9 f
Z�
y
the Field Analysis guide and documented
GRAB # 3
r
001
G
1
X
X
as such.
R LE QU H Y: IGNATURE
TE
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Checked By:
WS-ENV-F-610.001 Effective: 8/29/2012

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NCDENR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: http://portal.ncdenr.org/web/wq./w5/,�iu./­jipdessw#tab-4
Permit No.: N/C/ 0/ b/ 0/ 0/ 0/ 0/ 0/ or Certificate of Coverage No.:
Facility Name: Ingredion Incorporated
County: Forsyth Phone No. 336-785-0850
Inspector: M69K -:� o KD614
Date of Inspection: 419114
Time of Inspection: 11 :1e a wt -
Total Event Precipitation (inches): jf 3 15
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureable storm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be
performed during a "representative storm event" or during a "measureable storm event." However,
some permits do not have this requirement. Please refer to these definitions, if applicable.
A "representative storm event' is a storm event that measures greater than 0.1 inches of rainfall
and that is preceded by at least 72 hours (3 days) in which no storm event measuring greater than
0.1 inches has occurred. A single storm event may contain up to 10 consecutive hours of no
precipitation.
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 DWQ Regional Office.
By this signature, I c r if hat this report is accurate and complete to the best of my knowledge:
(Signature of rermittee or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. 001 Structure (pipe, ditch, etc.) Pine
Receiving Stream: South fork of Muddy Creek
Describe the industrial activities that occur within the outfall drainage area:
Manufacture of High Fructose Corn Syrup. -Dry -Starch, -and -Animal Feed Co-Porducts
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors:.
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil,
weak chlorine odor, etc.): ND dAn ✓
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is
clear and 5 is very cloudy:
Q 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:
0 2 3 4 5
7. is there any foam in the stormwater discharge? Yes No
8. Is there an oil sheen in the stormwater discharge? Yes
9. is there evidence of erosion or deposition at the outfall? Yes
10. Other Obvious indicators of stormwater Pollution:
List and describe tAnqP
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 10/25/2012

Ingredion
May 5, 2014
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
RE: Stormwater Sampling Results
Ingredion incorporated
4So1 Overdale Road
Winston-Salem, NC 27107
United States
w: ingredion.com
Please find attached "Stormwater Discharge Outfall (SDO) Monitoring Report" covering the first half of
2014, for the Winston-Salem, NC facility.
If you need any additional information or if I can be of any other assistance, please contact me at
[phone]
Sincerely,
i
Ray Doogan
Plant Manager
cc: Hassan Nunn
cc: Alan Jirik