NCG060020_MONITORING INFO_20191122

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STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
NCG V U '� D
DOC TYPE
❑J HISTORICAL FILE
❑" MONITORING REPORTS
DOC DATE
❑
YYYYMMDD

T
Tyson
November 18, 2019
North Carolina Department of Environment, Health and Natural Resources
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617 RECEIVED
f- e /
RECEIVE®
Subject: General Permit No. NCG060000
Tyson Farms, Inc. - Wilkesboro Complex NOV 2 2 2019
COC NCG060020 CEN f REAL FILES
Wilkes County DWR SECTION
Dear Madam or Sir:
Enclosed are two copies of the required storm water sampling results.
For the outfalls Covered under the above subject permit and certificate of coverage.
Tyson Farms, Inc. Storm water sampling Period 2 semi-annual monitoring. Data receive for
PRISM labs indicated parameters was above the benchmark for Wilk-01 and Wilk-02 for COD.
Tyson Foods, Inc. has made significant improvements to reduce the concentrations of the
parameter of concern.
Please contact me at 336- 651.3836 should you have any questions.
n erely,
Jam Brown
Complex Environment Manager
Tyson Farms Inc. Fresh Retail Division 704 Factory Wilkesboro, N.C. 28697
336-651-3836 336.838.2171 Fax: [phone] w .tysonfoods.com

SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
For North Carolina Division of Water Quality General Permit No NCG060000
Date submitted: November 18, 2019
CERTIFICATE OF COVERAGE NO. NCG060020
FACILITY NAME Tyson Farms Inc.
Wilkesboro Complex
COUNTY Wilkes
PERSON COLLECTING SAMPLES James Brown
LABORATORY Prism Labs ` Lab Cert. # 402
Part A: Storm water Benchmarks and Monitoring Results
SAMPLE COLLECTION YEAR 2019
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 11 Z 1 20
Outfall No.
Benchmark
WILK - 01
Sample Collected,
Mo./dd./yr.
-
10/30/2019
TSS,
mg/L
100 or SW
82
pH,
Standard units
Within 6.0-9.0
6.95
COD,
mg/L
120
140
rani.
Oil and Grease,
mg/L
30
7.2
or No discharge
Fecal Coliform',
Colonies per 100 ml
1000
100
this penoa-
Enterococcir,
Colonies per 100 ml
500
NA
WILK-02
30/30/2019
76
7.08
130
5.2
100
NA
WILK - 03
30/30/2019
64
6.77
85
5.0
400
NA
.., ..rr..�� ... �..'I.— .—La. c/ F^ V� menu.
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 fadlitiac avaraeinn � cc e�i ..s. ., . _ai—__.
Km, complete Part B)
Outfall No.
Sample Collected,
Mo./dd./yr.
r - -♦
Oil and Grease,
mg/L
•—p..,�
Non Polar Oil &
Grease/TPH
mg/L
_ rr Vu, v, „a:.. „IVIVI
TSS,
mg/L
Vllr 111 Vllll 1.
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
15
100 or 504
6.0 — 9.0
_
WILK -01
10/30/2019
5.0
7.2
82
6.95
630
ON a lies to
f 'I t' th t
y pp aci i ies a 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.
S WU-249
Last Revised: October 18, 2012
Page I of 2

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1REQUIREMENTS. 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 0
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."
1 (-
(Date)
Additional copies of this form may be downloaded at: http://portal.ncdenr.org/web/wq/ws/­su/npdessw#tab-4
SWU-249 Last Revised: October 18, 2012
Page 2 of 2

W-Ky�
NCD NR
Stormwater Discharge Outfall (SDO)
. Qualitative Monitoring Report
Forguidance on filling out thisjorm, please visit: http_//aortal ncdenr org/we /wq/ws/c mpde w#tab 4
Permit No: N/C/G/0/6/0/0/0/0 or Certificate of Coverage No. N/C/G/0/6/0/0/2/0
Facility Name: Tyson Farms Inc
County: Wilkes
Phone No: 336.838.2171
Inspector: lames Brown
Date of Inspection: 10/30/2019
Time of Inspection: 109"S"'r -
Total Event Precipitation (inches): 1.20
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 "measureablestorm 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 "measureablestorm 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 s"ure, I certify th"this report is accurate and complete to the best of my knowledge:
(Signature oUPermittee or
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No. llk-0 Structure (pipe, ditch, etc.) Pt 0,e—
ReceivingStream: i cLtb Uc-eV-,
Describe the industrial activities that occur within the outfall drainage area: L'.\fe haul *%C a
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L: Sh l,'
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): 1 - L..L
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear and
5 is very cloudy:
1 4) 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:
1 69 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 e) 3 4 5
7. Is there any foam in the stormwater discharge? Yes pap/
B. Is there an oil sheen in the stormwater discharge? Yes J
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
SWU-242, Last modified 10/25/2012

PWi
NCD NR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out thisform, please visit: http;//portal.ncdenr.QEg/web/wq/ws/su/npdessw#tab-4
Permit No: N/C/G/0/6/0/0/0/0 or Certificate of Coverage No. N/C/G/0/6/0/0/2/0
Facility Name: Tyson Farms Inc.
County: Wilkes
Phone No: 336.838.2171
Inspector: James Brown
Date of Inspection: 10/30/2019
Time of Inspection: �°d• 0 9rfA
Total Event Precipitation (inches): 1.20
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
U✓ Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureablestorm 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 "measureablestorm 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 tms signal I certify that thi ,gport is accurate and complete to the best of my knowledge:
(Signature of PUmittee or Designee)
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No.\ , 'UA Structure (pipe, ditch, etc.) �;_br_
Receiving Stream: �U�Qmesa Tr` wk.lrH 4o w f
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: L k' Shy
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): I t Sh}
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear and
5 is very cloudy:
1 (0 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:
1 0 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 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
SWU-242, Last modified 10/25/2012

��A
NCD NR
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
Forguidance on filling out this form, please visit: gip;//portal ncdenr org/web/wq/ws/sit/npdessw#tab 4
Permit No: N/C/G/0/6/0/0/0/0 or Certificate of Coverage No. N/C/G/0/6/0/0/2/0
Facility Name: Tyson Farms Inc
County: Wilkes
Phone No: 336.838.2171
Inspector: James Brown
Date of Inspection: 10/30/2019
Time of Inspection:
Total Event Precipitation (inches): 1.20
Was this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
V/ Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or "measureablestorm event" (requirements vary, depending on the permit).
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be performed during
"representative storm event" or during a "measureablestorm 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 tms signature, 1 certify that this report is accurate and complete to the best of my knowledge:
ittee or
Pagel of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description: (�
Outfall No..\4: W'�-0 31 Structure (pipe, ditch, etc.) `
Receiving Stream: (L11✓iCionetA by}ecy 'J-o
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _ U< 11E
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): L;�V'}
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear and
5 is very cloudy:
1 t 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:
1 t21 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes F/
9. Is there evidence of erosion or deposition at the outfall? Yes /1
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

Wilkesboro Storm Water Calu. Sheet
Date 10/30/2019
Rain Begin: 12:00 PM light on and off
Run off started 12:15 AM
Grab Samples: 12:35 PM
Rain at end of
Storm Event: 1.20
Sampling Point # 1 Drainage Area = 140,800 Ft 2
Q = CIA
1 = 1.20 " (Total)
C = 1.0
Q = 1.0(1.20/12)(140,800-7.5)/1,000,000
0.106 MG
Sampling Point # 2 Drainage Area = 578,250 Ft 2
Q = CIA
1 = 1.20 " (Total)
C= 1.0
Q = 1.0(1.20/12)(578,250-7.5)/1,000,000
0.434 MG
Sampling Point # 3 Drainage Area = 43,560 Ft 2
Q = CIA
1 = 1.20 " (Total)
C = 1.0
Q = 1.0(1.20/12)(43,560-7.5)/1,000,000
0.033 MG

GBRISM
'7UWAATORIE$ IW
Full -Service Analytical 8
Environmental Solutions
Tyson Farms, Inc. -Wilkesboro, INC
James Brown
704 Factory Street
Wilkesboro, NC 28697
NC Certification No. 402
NC Drinking Water Can No. 37735
SC Certification No. 99012
Project: Stormwater
Lab Submittal Date: 10/31/2019
Prism Work Order: 9110019
Case Narrative
11/14/19 10:42
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
Terri W. Cole
Project Manager
Data Qualifiers Key Reference
Reviewed By Terri W. Cole
Project Manager
HT Sample received and analyzed outside of the hold time.
BRL Below Reporting Limit
MDL Method Detection Limit
RPD Relative Percent Difference
* Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and
reporting limit indicated with a J.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0643
Phone: 704IS29-6364- Toll Free Number: 1-8001629-6364 - Fax: [phone] Page 1 of 6

GP R I S M I %vino men al Solutions
s
Environment el Solutions
Sample Receipt Summary
11/14/2019
Prism Work Order: 9110019
Client Sample ID
Lab Sample ID
Matrix
DatelTime Sampled
Date/Time Received
SW Wilk-01
9110019-01
Water
10/30/19 12:35
10/31/19 17:45
SW Wilk-02
9110019-02
Water
10/30/19 12:40
10/31/19 17:45
SW Wlk-03
9110019-03
Water
10/30/19 13:00
10/31/19 17:45
Samples were received in good condition at 1.6 degrees C unless otherwise noted.
This report should not be reproduced, except in its entirety, without the written consent of Pnsm Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0543
Phone: [phone]-Toll Free Number: l-8001529-6364- Fax: [phone] Page 2 of 6

4P R FUloa Analyticals
EnAranimental Solutions S M
V'.....,e....­
Laboratory Report
11/14/2019
Tyson Farms, Inc. -Wilkesboro, NC
Project: Stormwater
Client Sample ID: SW Wilk-Ot
Attn: James Brown
Prism Sample ID: 9110019-01
704 Factory Street
Prism Work Order: 9110019
Wilkesboro, NC 28697
Sample Matrix: Water
Time Collected: 10/30/19 12:35
Time Submitted: 10/31/19 17:45
Parameter
Result Units Report
MDL Dilution Method Analysis Analyst Batch
Limit
Factor Date/Time ID
General Chemistry Parameters
Chemical Oxygen Demand
140
mglL
50
10 1
'SM6220 D
1116/19 11:14
SLS
PSK0114
Oil B Grease (SGT-HEM)
7.2
mg/L
5.0
1.6 1
'16646
11/12/19 9:16
SLS
P91(0230
Total Suspended Solids
82
mg/L
25
0.70 1
'SM2640 D
1114119 14:56
CBM
P911(0053
Microbiological Parameters
Fecal Coliforms
BRLHT
CFU/100 ml
100
1
`SM9222 D
10/31/19 18:08
BMS
P91<0079
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240643 - Charlotte, NC 28224-0643
Phone: [phone]-Toll Free Number: l-8001629-6364- Fax: [phone] Page 3 Df 6

aP R I S M Full-9orvice Analyl do 4
EnNranmental Solutions
'%uaw�ronicx,xc
Tyson Farms, Inc. -Wilkesboro, NC
Attn: James Brown
704 Factory Street
Wilkesboro, INC 28697
Project: Stormwater
Sample Matrix: Water
Laboratory Report
11/14/2019
Client Sample ID: SW Wlk-02
Prism Sample ID: 9110019-02
Prism Work Order: 9110019
Time Collected: 10/30/19 12:40
Time Submitted: 10/31/19 17:45
Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch
Limit Factor Date/Time ID
General Chemistry Parameters
Chemical Oxygen Demand
130
mg1L
50
t0 1 'SM6220 D
1116119 11:14
SLS
P91<0114
Oil B Grease (HEM)
7.1
mg/L
6.0
1.7 1 '1664B
11/12119 9:16
SLS
P91(0229
Total Suspended Solids
76
mg/L
12
0.70 1 'SM2640 D
1114119 14:56
CBM
P9K0061
Microbiological Parameters
Fecal Coliforms
BRLHT
CFU/100 ml
100
1 'SM9222 D
10/31/19 18:08
BMS
P9K0079
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0643
Phone: [phone] - Toll Free Number: 1.8001629-6364 - Fax: [phone] Page 4 of 6

IsPIS M I Fue-Service at Solutio sEnvironmental eolutlonn 4i
Laboratory Report
11/14/2019
Tyson Farms, Inc. -Wilkesboro, NC
Project: Stormwater
Client Sample ID: SW Wilk-03
Attn: James Brown
Prism Sample ID: 9110019-03
704 Factory Street
Prism Work Order: 9110019
Wilkesboro, INC 28697
Sample Matrix: Water
Time Collected: 10/30/19 13:00
Time Submitted: 10/31/19 17:45
Parameter
Result Units Report
MOIL Dilution Method Analysis Analyst Balch
Limit
Factor Date/Time ID
General Chemistry Parameters
Chemical Oxygen Demand
66
mg/L
50
10 1 'SM6220 D
1116119 11:14
SLS
P91(0114
Oil & Grease (HEM)
BRL
mg/L
5.0
1.7 1 -1664B
11/12/19 9:15
SLS
P91<0229
Total Suspended Solids
64
mg/L
12
0.70 1 'SM2540 D
11/4119 14:66
CBM
P9K0053
Microbiological Parameters
Fecal Colifonns
400 HT
CFUI100 ml
10
1 'SM9222 D
10/31/19 18:08
BMS
P91(0079
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, INC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/629-6364- Fax: [phone] Page 5 Df 6

CHAIN OF CUSTODY RECORD LAB USE ONLY
__ -
`- Full -Service Analytical 8 '- - -
ISM Solutions PAGE_ OF OUOTE 0 TO ENSURE PROPER BiLLIMO: $ampIB51NTACT Up0r18rr1v01?
YES NO NI
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p
/JILJ�O�s J Environmental
®VlAHO..IEa iNc
_ _
Received ON WET ICE? . - -,
.
---
to
449 Springbrook Road • Charbtte, INC 28217 Project Name:
Short Hold Analysis: (Yes) (No) UST Project: (Yes) (NO) PROPER PRESERVATIVES indicated?
"tl
Phone 704I529-6364 • Fax: [phone]e Received WITHIN HOLDING TIMES? .
-Please ATTACH any project specific reporting (OC LEVEL I It III IV) c
^✓-
N
`� /' CUSTODY SEALS INTACT? -.
Client Company Name: —), MIS 1C • provisions and/or OC Requirements
- --- —
—' --
Report To/Co ntad Name: wn Invoice To: VOLATILE$ rec'd W/OUT HFADSPACE?
_ 1
Report`in Address: (--+a I T Address: PROPER CONTAINERS used?_' � �'
r TEMP:•4herm-ID,-lf r II'7.._Observed: l_t:.'C4 Ctirti , 711
C
. 1
Phone �iA.4al•.3$3(a Fax (Yes) (No): rat. 3 Purchase Order NoMilling Reference TO BE FILLED IN BY CLIENTISAMPLING
PE_ ONNEL
Email Address: lr�m 9 fi 4� Requested Due Date ❑ 1 Day O 2 Days ❑ 3 Days O 4 Days ❑ 5 Days Certification: NELAC_ DoD_
FL_ NC
EDD Type: PDF cel � Other -Working Days" ❑ 6-9 Days O Standard 10 days O Rusn Work Must Be
y �Ex 9 Pre -Approved SC OTHER
NIA
Site Location Name: Samples received after 14:00 will be processed next business day.
r�1' is based on business days, excluding weekends and holidays. Water Chlorinated: YES— NO —
Site Location Physical Address: r:t Turnaround
lime
(SEE REVERSE FOR TERMS a CONDRmNS REGARDING SERVICES on Sample Iced U Collection: YES—
P
NO —
RENDERED BY PRISM LABORATORIES, INC. TO CLIENT)
TIME
MATRIX
SAMPLE CONTAINER
ANALYSIS REQUESTED
ANALYSIS
I
PRISM
CLIENT
GATE
COLLECTED
(SOIL,
PRESERVA-
TIVES
REMARKS
LAB
ID NO.
SAMPLE DESCRIPTION
COLLECTED
MILITARY
WATER OR
-TYPE
NO.
SIZE
i
HOURS
SLUDGE)
SEE BELOW
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_
I
Sampler's Signature Sampled By (Print Name) t: - Affiliallm- �rSur�
j
Upon relinquishing, this Ch n of Custody is your authorizatlon for Prism to proceed with the analyses as requested above. Any changes must be
There will be charges for any changes after analyses have been Initialized.
_
submitted in writing to the Prism Project Manager.
Additional Comments:
Site Hrtivat Time:
I
y. IS"-
y. _
I
O,m
'Site Departure Time:
. (slgnanxe
/ ~
BY (SiPmNrel
_ _
Field Tech Fee:
I
By:(signawre) Racolwd a E Dam
S-
. ..,.•
Mileage:
_
I.
AT-FO
ont NOTE p SAMPLE COOLERS SHOULD BE TAPED SHUT WRH Gya luDY EALS FOR SPORTA TOIT- E LABORATORY. COC Gn>D No.
SAMPLES ARE NW ACCEPTED AND VERIFIED AGAINST COC)jN`I"LRECEEDATTHEtABORATDRY
N
/ Il
❑ Fed Ex D UPS ❑ Hee4vered FieM rer
ME Service ❑ OUCERCLA
SOLIDWASTF❑
1❑
�M�yiyL�ar>
$WATER.
NPOES:❑ NC ❑ SC ❑ NC ❑ Sc ❑LIST.R C ❑ SCTER: LI NC
❑ NC ❑SCE. (❑p NRCA❑ SC O❑ NC ❑ SC I ❑ NC SC I O NC ❑ Sc
n ❑ ❑ ❑
❑ _ ue...w c.......,I
'CONTAINER TYPE CODES: A=Amber C = Clear G= Glass P = Plastic; TL =Teflon-Lmed Cap UhlUINAL

/ T l
Tyson
November 18, 2019
North Carolina Department of Environment, Health and Natural Resources
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
Gene.a; Peu N ��/•-�unnnn
'ii it 1. V. 1I IG'ivvvw
Tyson Farms, Inc. - Wilkesboro Complex
COC NCG060020
Wilkes County
Dear Madam or Sir:
Enclosed are two copies of the required storm water sampling results.
For the outfalls Covered under the above subject permit and certificate of coverage.
Tyson Farms, Inc. Storm water sampling Period 2 semi-annual monitoring. Data receive for
PRISM labs indicated parameters was above the benchmark for Wilk-01 and Wilk-02 for COD.
Tyson Foods, Inc. has made significant improvements to reduce the concentrations of the
parameter of concern.
Please contact me at 336- 65L')83_6 should you have any questions.
Complex Environment Manager
Tyson Farms Inc. Fresh Retail Division 704Factory Wilkesboro, N.C. z8697
336-651-3836 336.838.2171 1`ax: 33.651.3867 w tysonfoodsxom

CERTIFICATE OF COVERAGE NC
FACILITY NAME Tyson Farms In
Wilkesboro Complex_
COUNTY Wilkes
PERSON COLLECTING SAMPLES
LABORATORY Prism Labs
Part A: Storm water Bench
RMWATER DISCHARGE MONITORING REPORT
Sion of Water Quality General Permit No. NCG060001
Date submitted: November 18, 2019
SAMPLE COLLECTION YEAR 2019
FACILITY ACTIVITIES INCLUDE (check all that apply):
® use/process meats ❑ use animalfat:s/byproducts
DISCHARGING TO SALTVVATERS? DYES ZNO
b Cert. H 402 PLEASE REMEMBER TO SIGN ON THE REVERSE i
and Nloniteirinp Rpadtc 7.....1,.,.,.... _..:_r._u2 ., _ r-1 .
Outfall No.
Sample Collected,
TSS,
-------
pH,
_
COD,
Oil and:Grease,
U cv� uuucufye
Fecal Col'form',
cncs penoa'
Mo./dd./yr..
-
mg/L
°. Standard units
mg/L
mg/L-
Colonies per 100 mh,
Enteracocci'
Colonies per 10(1.ml
Benchmark,
"- -
;100iir50^.-
Within6.0-9.0
120
,?t0
1000:
�.500
WILK-01
10/30/2019
82
6.95
_140
7.2
100
_
NA
WILK-02
_ 10/30/2019
76
7.09
130
5.2
_
NA
WILK-03
10/30/2019
64
6.77
85
____100__
5.0
400
Nq
l nnly annli.< to
fac.,.H c ...A......
_... _,.,....._ 1-- ....,. a 1, rn
zThe total precipitation must be recc
3 For sampling periods with no discha
4See General Permit text,Table 3 ider
Did this facility perform Vehicle
Part B: Vehicle Maintenance
.eau.
d using data from an on -site rain gauge.
at any outfalls. You must still submit this discharge monitoring report with a checkrnark here.
ing the especially sensitive receiving water classifications where the more protective benchmark applies.
Activities using more than 55 gallons of new motor oil per month? © Yes El no
Monitorint: Results: only for facilities nupmaina � cc ..1 na .....«,.. -;1 r .L
(if yes, complete Fart B)
Outfall No.
Sample Collected
Mo:/dd./yr.,
.' ;Oil avid Grease, .
mg/L
._e...0
t Non Polar Oil &
Grease/TPH
mg/L
_.. o...
-TSS
mg/L
New Motor Oil iUsage,
Annual average jai/mo
Benchmark
-
30 -
15
100 or 504WILK-01
10/30/2019
5.0
7.2
82
qHd
630nnly
annlipc to farilit. ttiat
_, __ __ .__... _.__ ...... ....... r..�...,., .:a.o.
The total precipitation must be recorded using data from an on -site rain gauge.
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.
S W U-249
Last Revised: October 18, 2012

*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1REQUIREMENTS. 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 EXCEEDENCFS FOR,THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑i
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."
(Date)
Additional copies of this form may be downloaded at: httl2://portal.nc(lenr.org/web/wq/ws/su/npdesswtttab-4
SWU-249 Last Revised: October 18, 2012
Pale 2 of 2

NCDENR
Stormwater Discharge Outfall (SDO)
nlla�ifail'1�7P �lln itnl-ipir ij n3+,....}
Furyuiu'aiiceoriimingour tnisform,pieasevisit: htw://nortalncdenrorg/web/wq/ws/su/nndesswutaba
Permit No: N/C/G/0/6/0/0/0/0 or Certificate of Coverage No. N/C/6/0/6/0/0/2/0
Facility Name: Tyson Farms Inc
County: Wilkes
Phone No: 336.838.217i
Inspector: lame5 Brown
Date of Inspection: 10/ 30/ 2019
Time of Inspection: 35 Pn'
Total Event Precipitation (inches): 1.20
Was this a "Representative Storm Event" or "ivieasureable Storm Event" as defined by the permit?
(See information below.)
9Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event"or "measureable storm event"(reo„irempritc„a.,, rione ,4;.q t
Qualitative monitoring requirements vary. Most permits require qualitative monitoring to be performed during
"representative storm even" 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 hat 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 perm ittee obtains approval from the local DWQ
Regional Office.
I certify tha4this report is accurate and complete to the best of my knowledge:
(Signature oUPermittee or Designee)
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description: (�
Outfall No.wikk -C Structure (pipe, ditch, etc.) t D r
Receiving Stream: Lll1nahtr.cl lt'.h,-}g'� }c, C'at uce-�
Describe the industrial activities that occur within the outfall drainage area: L\J ilpul Tarr a
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: _ L: ,h F-
3. Odor: Describe any distinct odors that the discharge may have (Le, smells strongly of oil, weak
chlorine odor, etc.): V. :�i"}
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clearand
5 is very cloudy:
1 tJ 3 4 5
5. Floating Solids: Choose the numberwhich best describes the amountOfflaatirig solids inthe
stormwater discharge, where 1 is no solids and 5 is the surface covered with floating solids:
1 d' 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stonnwaterdischarge, where 1 is no solids and 5 is extremely muddy:
1 /P/ 3 4 5
7. Is there any foam in the stormwater(Iischarge? Yes
8. Is there an oil sheen in the stormwaterdischarge? 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
SWU-242, Last modified 10/25/2012

NC®ENR
Stormwater Discharge Outfall (SDO)
dill alilr7ti�>n Mng7i#..3-i �.n D.�s,....}
For go idunce on f1iiing out thisform, please visit: htti)://i)ortal.ncdenrQrR/web/`wo/ws/Su/nndeccw#tab-4
Permit No: N/C/G/0/6/0/0/0/0 or Certificate of Coverage No. N/C/G/0/6/0/0/2/0
Facility Name: Tyson_Farms Inc.
County: Wilkes
Phone No: 336.030.21 i 1
Inspector: lames Brown
Date of Inspection: 10/30/2019
T.., r 1 d Y
iIY�
Me of Inspection: I � .
Total Event Precipitation (inches): 1.20
Was this a "Representative Storm Event" or "ivleasureable Storm Event" as defined by the permit?
(,Seee information below.)
Se
Yes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or"mP.asoreablestorm agent"rrangirnmentS'✓^r' '1—e ;----ueper �Ttitj.
--, �.r �r
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
reouirement 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 sign acute, I certify that this rbport 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.��'�, Structure (pipe, ditch, etc.) `
Receiving Stream:��1�ri(1i1lCc; Tr'lr �-.-tr Z Ls ttCC
Describe the industrial activities that occur within the outfall drainage area: br e-- L
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(light, medium, dark) as descriptors: --"VA;
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly of oil, weak
chlorine odor, etc.): _ ( i Shk
4. Clarity: Choose the number which best describes the clarity of the discharge, where I is clear and
5 is very cloudy:
I 0 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:
I 3 4 5
6. Suspended Solids: Choose the number which best describes the amountof suspended solids in
the stormwater discharge, where is no solids and 5 is extremely muddy:
I 3 4 5
7. Is there any foam in the stormwater discharge? Yes
8. Is there an oil sheen in the stormwater discharge? Yes N'd
9. Is there evidence of erosion or deposition at the outfall? Yes Vol
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

MC®ENR
Stormwater Discharge Outfall (SDO)
011aii¢?tfix7n ?Annitnri"r
Forguidunce on fiiiing out this form, please visit: h=:ZZportal,ncdenr.org/weh/wo/ws/sil/Untiur i a
Permit No: N,/C/G/0/6/0/0/0/0 or Certificate of Coverage No. N/C/G/0/6/0/0/2/0
Facility Name: Tyson arms Inc
County: Wilkes
Phone No: 336.838.2171
Inspector: James Brown
Date of inspection: 10/30/2019
Time or inspection:
Total Event Precipitation (inches): 1.20
VAVas this a "Representative Storm Event" or "Measureable Storm Event" as defined by the permit?
(See information below.)
VYes ❑ No
Please verify whether Qualitative Monitoring must be performed during a "representative storm
event" or"mea.Sureoblesrnrmovant"/ren„irgmonr��,.,.,, r
i. y--.. ,.,y, acrw...."y vn tuc perramij.
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 ofifiermittee or
Page 1 of 2
SWU-242, Last modified 10/25/2012

1. Outfall Description:
Outfall No..\: Structure (pipe, ditch, etc.)
Receiving Stream: Ut\AGcnr_c-( ' %C' b_t}: v -4' 'Dj `tZ.e;�
Describe the industrial activities that occur within the outfall drainage area:
2. Color: Describe the color of the discharge using basic colors (red, brown, blue, etc.) and tint
(fight, medium, dark) as descriptors:E
3. Odor: Describe any distinct odors that the discharge may have (i.e., smells strongly ofoil, weak
chlorine odor, etc.): L.;Sh}
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear and
5 is very cloudy:
f t 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:
1 �7 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:
r
1 3 4 5
7. Is there any foam in the stormwater discharge? Yes yy�
8. Is there an oil sheen in the stormwater discharge? Yes INh
9. Is there evidence of erosion or deposition at theoutfall? Y''e44s1s 4Nd
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
sW11-242, Last modified 10/25/2012

Wilkesboro Storm Water Calu. Sheet
tlato 11I.M19nlo
Rain Begin 12:00 PM light on and off
Run off started 12:15 AM
Grab Samples 12:35 PM
Rain at and of
Storm Event: 1.20
Sampling Point # 1 Drainage Area = 140,800 Ft 2
Q = CIA
1 = 1.20 " (Total)
C = 1.0
Q = 1.0(1.20/12)(140,800*7.5)/1,000,000
0.106 MG
Sampling Point # 2 Drainage Area = 578,250 Ft 2
Q = CIA
1 = 1.20 " (Total)
C=1.0
Q = 1.0(1.20/12)(578,250-7.5)/1,000,000
0.434 MG
Sampling Poin: # 3 Drainage Area = 43,560 Ft 2
Q - C1A
I = 1.20" (Total)
C=1.0
Q = 1.0(1.20/12)(43,560`7.5)/1,000,000
0.033 MG

hoAaePNTOPIEa INC
Full -Service Analytical &
Environmental Solutions
Tyson Farms, Inc. -Wilkesboro, NC
James Brown
704 Factory Street
Wilkesboro, NC 28697
NC Certification No. 402
NC Drinking Water Can No. 37735
SC Certification No. 99012
Project: Stormwater
Lab Submittal Date: 10/31/2019
Prism Work Order: 9110019
Case Narrative
11/14/19 10:42
This data package contains the analytical results for the project identified above and includes a Case Narrative, Sample
Results and Chain of Custody. Unless otherwise noted, all samples were received in acceptable condition and processed
according to the referenced methods.
Data qualifiers are flagged individually on each sample. A key reference for the data qualifiers appears at the end of this case
narrative.
Please call if you have any questions relating to this analytical report.
Respectfully,
PRISM LABORATORIES, INC.
o�/vu;re�Ce�
Terri W. Cole
Project Manager
Data Qualifiers Key Reference
HT
Sample received and analyzed outside of the hold time.
BRL
Below Reporting Limit
MDL
Method Detection Limit
RPD
Relative Percent Difference
r
Reviewed By Terri W. Cole
Project Manager
Results reported to the reporting limit. All other results are reported to the MDL with values between MDL and
reporting limit indicated with a J.
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240643 - Charlotte, NC 29224-0643
Phone: [phone] - Toll Free Number: 1-900I629-6364 - Fax: [phone] Page 1 of 6

^ Full-bervloe Analytical A
APR I S M I Envimnmental Solutlea.
mwgvu.o...a.icx
Client Sample ID
Lab Sample ID
Matrix
SW Wilk-01
9110019-01
Water
SW Wlk-02
9110019-02
Water
SW Wilk-03
9110019-03
Water
Samples were received in good condition at 1.6 degrees C unless otherwise noted.
Sample Receipt Summary
11/14/2019
Prism Work Order: 9110019
Daterrime Sampled
10/30/19 12:35
10/30/19 12:40
10/30/19 13:00
Daterrime Received
10/31/19 17:45
10/31/19 17:45
10/31/19 17:45
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
"It Springbrook Road - P.O. Box 240643 - Charlotte, NC 28224-0643
Phone: [phone]- Toll Free Number: 1-8001529-6364 - Fax: [phone] F Page 2 of 6

K R I S M I Full-6ervlce Analytical 8
Laboratory Report
Environmental 601vllnni 11/14/2019
Tyson Farms, Inc. -Wilkesboro, NC
Project: Stormwater
Client Sample ID: SW Wdk-01
Attn: James Brown
Prism Sample ID: 9110019-01
704 Factory Street
Prism Work Order: 9110019
Wilkesboro, NC 28697
Sample Matrix: Water
Time Collected: 10/30/19 12:35
Time Submitted: 10/31/19 17:45
Parameter
Result Units Report
MDL Dilution Method Analysis Analyst Batch
Limit
Factor Date/Time ID
General Chemistry Parameters
Chemical Oxygen Demand
140
mg/L
60
10 1 'SM5220 D
1116119 11:14
SLS
P91(0114
Oil & Grease (SGT-HEM)
7.2
mg/L
5.0
1.6 1 '1664B
11112/19 9:16
SLS
P9K0230
Total Suspended Solids
82
mg/L
25
0.70 1 `SM2640 D
1114/19 14:56
CBM
P9K0063
Microbiological Parameters
Fecal Coliforms
BRLHT
CFU/100 not
100
1 'SM9222 D
10/31/19 18:08
BMS
P91<0079
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, INC 28224-0543
Phone: [phone] - Toll Free Number: 1-800/629.6364-Fax: [phone] Page 3 of 6

P R I S M Fii-sa, , a nnaiyucai 4
Environmental Solutions
7�mu,onrtx„c
Laboratory Report
11/14/201 s
Tyson Farms, Inc. -Wilkesboro, INC Project: Stormwater Client Sample ID: SW Wlk-02
Attn: James Brown Prism Sample ID: 9110019-02
704 Factory Street Prism Work Order: 9110019
Wilkesboro, NC 28697 Sample Matrix: Water Time Collected: 10/30/19 12:40
Time Submitted: 10/31/19 17:45
Parameter Result Units Report MOIL Dilution Method Analysis Analyst Batch
Limit Factor Datefrime ID
General Chemistry Parameters
Chemical Oxygen Demand
130
mg/L
50
10 1 'SM6220 D
1116/19 11:14
SLS
P9K0114
Oil & Grease (HEM)
7.1
mglL
5.0
1.7 1 '16648
11/12/19 9:16
SLS
P9K0229
Total Suspended Solids
76
mg/L
12
0.70 1 'SM2640 D
11/4/19 14:55
CBM
P91(0053
Microbiological Parameters
Fecal Coliforms
BRLHT
CFU/100 ml
100
1 'SM9222 D
10/31/19 18:08
BMS
P9K0079
This repon should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240643 - Charlotte, NC 28224-0643
Phone: [phone] - Toll Free Number: 1-800/529.6364 - Fax: [phone] Page 4 of 6

n \
/�P R I S M I irmanalytical Environmental
4
Env ranmenentel Solutions
G'�.mn.+wu. ixc
Tyson Farms, Inc. -Wilkesboro, NC
Atim James Brown
704 Factory Street
Wilkesboro, NC 28697
Project: Stormwater
Sample Matrix: Water
Laboratory Report
11/14/2019
Client Sample ID: SW Wilk-03
Prism Sample ID: 9110019-03
Prism Work Order: 9110019
Time Collected: 10/30/19 13:00
Time Submitted: 10/31/19 17:45
Parameter Result Units Report MDL Dilution Method Analysis Analyst Batch
Limit Factor Dale/Time ID
General Chemistry Parameters
Chemical Oxygen Demand
85
mg/L
60
10 1 'SM5220 D
1116119 11:14
SLS
P9K0114
Oil & Grease (HEM)
BRL
mg/L
5.0
1.7 1 '1664B
11/12/19 9'.15
SLS
P9K0229
Total Suspended Solids
64
mg/L
12
0.70 1 'SM2640 D
1114/19 14:66
CBM
P91(0053
Microbiological Parameters
Fecal Colifonns
400 HT
CFU/100 ml
10
1 'SM9222 D
10131/19 18:08
BMS
P91(0079
This report should not be reproduced, except in its entirety, without the written consent of Prism Laboratories, Inc.
449 Springbrook Road - P.O. Box 240543 - Charlotte, NC 28224-0643
Phone: [phone] - Toll Free Number: 1-8001529-6164 - Fax: [phone] Page 5 of 6

?
CHAIN OF CUSTODY RECORD
LAB USE ONLY 7
'
a R Full -Service Analytical S
- "' - YES-' NO IN
�',l
/J P^0. I Environmental Solutions PAGE_ OP _ DUOTE a To ENSURE PROPER RILLINO:
Samples INTACT Upon eRlvel?, - JL,_
,'
.\ISM
®�ueorumsiss
Rece'Ned SON WE710E? -.. . ✓'_-
(D
Project Name:
449 Spdngbrook Road - Charlotte, NC 28217
Short Hold Analysis: (Yes) (No) UST Project: (Yes) (NO)
PROPER PRESERVATIVES Indicated2 ,
-
m
On
Phone 71W529b364 Fax: 7Du525-atD9
-Please ATTACH any project specific reporting (QC LEVEL 1 II 111 IV)
Received WITHIN HOLDING TIMES? -tJY
ti
9C:
Client Company Name: i' fn5 * • provisions and/or QC Requirements
1 CUSTODY SEALS INiaC7? —
ReportTo/Contact Name:_ Invoice
To:
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Phone-3-& Fax (Yes) (No):SL. 3M Purchase Order No./Billing Reference TO BE FILLED IN BY CLIENTISAMPLING,PE_ ONNEL
Email Address:. krrrlPc =5 - Qf a m4 a, q'soN %0o, Requested Due Date ❑ I Day O 2 DeY$ ❑ 3 Days 0.4 Days ❑ 5 Days Certification: NELAC_ DoD FL_ NC
EDD Type: PDF cal ✓ Other
yp J,�Ex "Working
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Site Location Name: n -. Samples received after 14:00 will be processed next business day.
• r:t $ Turnaround time is based on business days, excluding weekends and holidays.
Water Chlorinated: YES— NO —
Site Location Physical Address:
(SEE REVERSE FOR TERMS a CONDITIONS REGARDING SERVICES Sample Iced V Collection: YES NO —
P Upon
RENDERED BY PRISM LABORATORIES, INC. TO CLIENT)
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CLIENT
DATE
TIME
COLLECTED
MATRIX
(SOIL,
SAMPLE CONTAINER
PRESERVA-
TIMES
ANALYSIS REQUESTED -
REMARKS
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PRISM
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ID NO.
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Sampler's Signature Sampled By (Print Name) t: - AfflliaUofitun
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Upon relinquishing, this Ch n of Custody is your authorization for Prism to proceed with the analyses as requested above. Any changes must be _
submitted in Writing to the Prism Project Manager. There will be charges
for any changes after analyses. have been Initialized.
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Additional Comments: Site Arrival Time:
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Site Departure Time:
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Field Tach Fee:
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ItlpmenC NOTE ALL SAMPLE COOLERS SHOULD BE TAPED SKI IT
SAMPLES ARE NOT ACCEPTED AND VERIFIED AGAINST COC/UNn1.
CUSTODY FOR ir1ANBPoRfATI TD E LA TORY. COC Grwp No.
RECEVEDATTNELABORATORY
❑ Fad Ex O UPS O Hand-0 Wemd FWd Service D Other
NPDES: UST: GR OWATER: DRINKING WATER: SOLID WASTE: RCRA: CERCLA LANDFILL HER:
❑NC❑SC ❑NC ❑SC ❑ C OSC I ❑❑NC ❑SC
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-CONTAINER TYPE CODES: A= Amber C = Clear G= Glass P = Plastic; TL = Teaort-Lined Gap VUA = Volatile CrganiG Ajiaryaia (Aefv ..ow . ,.w, UHIUINAL