NC0077615_Regional Office Historical File Pre 2018

1
1. . -os a entice,.
CERTIFIED MAILTM RECEIPT
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Postage
Certified Fee
7 Retum Receipt Fee
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7
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J
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Restricted Delivery Fee
(Endorsement Required)
MR HOMER PREVETTE
HOMER'S TRUCK STOP
PO BOX 5068
STATESVILLE NC 28687
swp/wb 1/24/07
•
l., Postmark
/, Here
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Form 3800, August 2006 (Reverse) PSN 7530-02-000-9047

NCDENR
W ATFi9Q Michael F. Easley, GoverirH l0r
G William G. Ross Jr., Secretary �
North Carolina Department of Environment and Natural Resources
_.I
Alan W. Klimek, P.E. Director
Division of Water Quality
January 23, 2007
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
7006 2760 0001 8493 0317
Mr. Homer Prevette
Homer's Truck Stop
Post Office Box 5068
Statesville, North Carolina 28687
Subject: Notice of Violation
Compliance Evaluation Inspection
Homer's Truck Stop
Stormwater Permit No. NCG080141
Iredell County, N.C.
Tracking #: NOV-2007-PC-0040
Dear Mr. Prevette:
Enclosed is a copy of the Compliance Evaluation Inspection Report for the inspection conducted at
the subject facility on January 11, 2007 by Mr. Wes Bell of this Office.
This report is being issued as a Notice of Violation (NOV) due to the numerous monitoring and
permit condition violations of the subject NPDES Permit and North Carolina General Statute (G.S.) 143-
215.1, as detailed in the Summary/Facility Site Review, Stormwater Pollution Prevention Plan,
Qualitative Monitoring, Analytical Monitoring, and Permit/Outfalls Sections of the attached report.
The Division of Water Quality may pursue enforcement actions for this and any additional violations.
Pursuant to G.S. 143-215.6A, ra civil penalty of not more than twenty-five thousand dollars
($25,000.00) may be assessed against any person who violates or fails to act in accordance with the terms,
conditions, or requirements of any permit issued pursuant to G.S. 143-215.1. Be advised that pursuant to
G.S. 143-215.88A, any person who intentionally or negligently discharges oil or other hazardous
substances, or knowingly causes or permits the discharge of oil in violation of G.S. 143-215.83, or who
fails to report a discharge as required by G.S. 143-215.85, or who fails to comply with the clean up
requirements of G.S. 143-215.84, shall incur, in addition to any other penalty provided by law, a penalty in
an amount not to exceed five thousand dollars ($5,000.00) for each such violation.
It is requested that a written response be submitted to this Office by February 13, 2007,
addressing the deficiencies noted in the Summary/Facility Site Review, Stormwater Pollution
Prevention Plan, Qualitative Monitoring, Analytical Monitoring, and Permit/Outfalls Sections of the
report. In responding, please address your comments to the attention of Ms. Marcia Allocco. The
requirements of your Stormwater Permit should be reviewed, updated, and properly implemented. All Onc
records and documentation required by the Permit must be kept on -site for a period of five years. Nortlina
Naturaura!!y
Mooresville Regional Office Division of Water Quality - Phone [phone] Customer Service
Internet: www.ncwaterquality.org 610 East Center Ave, Suite 301 Mooresville, NC 28115 Fax [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper

Mr. Homer Prevette
Page Two
January 23, 2007
The report should be self-explanatory; however, should you have any questions concerning this
report, please do not hesitate to contact Mr. Bell or me at [phone].
Sincerely,
Michael L. Parker
Acting Regional Supervisor
Surface Water Protection
Enclosure
cc: Iredell County Health Department
cc: NPS, Assistance & Compliance Oversight
WB

Compliance Inspection Report
Permit: NCG080141
SOC:
County: Iredell
Region: Mooresville
Effective: 09/01/02 Expiration: 08/31/07 Owner: Homer Prevette
Effective: Expiration: Facility: Homer's Truck Stop of Statesville LLC
306 Stamey Farm Rd
Statesville NC 28625
Contact Person: Homer Prevette Phone: [phone]
Directions to Facility:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
On -site representative
Related Permits:
Certification: Phone:
Bob Brawley - Phone: [phone]
Inspection Date: 01/11/2007 Entry Time: 11:45 AM Exit Time: 01:00 PM
Primary Inspector: Wesley N Bell (4,_ y.4„ej/ 1 / g? ,/ 7
Secondary Inspector(s): l
Marcia Allocco, I E
Phone: [phone]
Ext.231
Phone:
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit inspection Type: Transportation wNehicle Maintenance/Petroleum Bulk/Oil
Water. SeparatorStormwater Discharge COC
Facility Status: ❑ Compliant ■ Not Compliant
Question Areas:
Storm Water
(See attachment summary)
Page: 1

Permit: NCG080141 Owner - Facility: Homer Prevette
Inspection Date: 01/11/2007
Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
FACILITY SITE REVIEW:
The runoff from the fuel dispensing areas (diesel) is collected in a grated drainage system and directed through two
oil/water separators (in series) prior to being discharged into an unnamed tributary to Third Creek (tributary). A significant
amount of soil contamination (due to oil discharges) was observed around the second set of oil/water separator tanks
located behind the gravel parking lot. The soil contamination had migrated within two to five feet of the tributary; however,
no oil sheens were observed. The oil/water separators had not been pumped in over a year. The facility staff must
ensure the oil/water separators are properly operated and maintained at all times as required by the Permit.
Page: 2

Permit: NCG080141 Owner - Facility: Homer Prevette
Inspection Date: 01/11/2007
' Inspection Type: Compliance Evaluation Reason for Visit: Routine
Stormwater Pollution Prevention Plan
Does the site have a Stormwater Pollution Prevention Plan?
# Does the Plan include a General Location (USGS) map?
# Does the Plan include a "Narrative Description of Practices"?
# Does the Plan include a detailed site map including outfall locations and drainage areas?
# Does. the Plan include a list of significant spills occurring during the past 3 years?
# Has the facility evaluated feasible alternatives to current practices?
# Does the facility provide all necessary secondary containment?
# Does the Plan include a BMP summary?
# Does the Plan include a Spill Prevention and Response Plan (SPRP)?
# Does the Plan include a Preventative Maintenance and Good Housekeeping Plan?
# Does the facility provide and document Employee Training?
# Does the Plan include a list of Responsible Party(s)?
# Is the Plan reviewed and updated annually?
# Does the Plan include a Stormwater Facility Inspection Program?
Has the Stormwater Pollution Prevention Plan been implemented?
Comment: The permittee has not developed a'Stormwater Pollution Prevention Plan
as required by the Permit.
Qualitative Monitoring
Has the facility conducted its Qualitative Monitoring semi-annually?
Comment: No Qualitative Monitoring has been performed during the entire Permit
cycle. All qualitative monitoring shall be performed twice per year, once in the Spring
(April - June) and once in the Fall (September - November). The first qualitative
monitoring event during the coverage of the Permit must coincide with the initial
analytical monitoring event.
Analytical Monitoring
Has the facility conducted its Analytical monitoring?
# Has the facility conducted its Analytical monitoring from Vehicle Maintenance areas?
Comment: No analytical monitoring has been performed during the Permit cycle. The•
analytical monitoring (Oil/Water Separator discharge system) is to be conducted once
per year by a N.C. Certified Laboratory (including pH).
Permit and Outfalls
# Is a copy of the Permit and the Certificate of Coverage available at the site?
Yes No NA NE
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Page: 3

.ENDER: COMPLETE THIS SECTION
Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery Is desired.
Print your name and address on the reverse
so that we can return the card to you.
Attach this card to the back of the mailpiece,
or on the front if space permits.
. Article Addressed to:
--
MR HOMER PREVETTE
HOMER'S TRUCK STOP
PO BOX 5068
STT-ESVILLE NC 28687
''- swp/wb 1/24/07
COMPLETE THIS SECTION ON DELIVERY
A. Signs re
X
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4
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0 Addressee
B. Received by (Printed Name)
C. Date of Delivery
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IfYES,•enter deliveryYaddress below:
❑ Yes
❑ No
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❑ Retum Receipt for Merchandise
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4. Restricted Delivery? (Extra Fee) ❑ yes
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�' ._� North Carolina'Departmentof Environment: and Natural Resources
Division of Water Quality -thud OF aQ .
Michael F. Easley, Governor AIM ?`TE" J' m WiU,tat Ross,,1,lr., Secretary
January 10, 2006 ECORES11 - AM.VF 1 k; P.E., Director
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Homer Prevette
Homer's Truck Stop
306 Stamey Farm Road
Statesville, NC 28625
Dear Mr. Prevette:
JAN 1 8 2006
MEN Q. ! U9 T Y SECTION
Subject: Notice of Violation — Monitoring Requirements
NOV-2006-MV-0006
Homer's Truck Stop WWTP
NPDES Permit No. NC0077615
Iredell County
A review of the July 2005 self -monitoring report for the subject facility revealed the following
violations:
Pine Parameter Required Monitoring Frequency Failures to Report
001 Oil & Grease 2/Month 1
Remedial actions, if not already implemented, should be taken to correct any problems. The
Division of Water .Quality maypursue enforcement actions for these and any additional violations.
If you have questions concerning this matter, please do not hesitate to contact Mr. Richard
Bridgeman or me at 704/663-1699.
Sincerely,
D. Rex Gleason, P.E.
Surface Water Protection Regional Supervisor
cc: Point Source Branch
RMB
Mooresville Regional Office
610 East Center Avenue, Suite 301, Mooresville, North Carolina 28115
Phone: [phone] / Fax: [phone] / Internet: h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
NorthCarolina
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Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
All monitoring data and sampling frequencies do NOT meet permit requirements
I X I
Compliant
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc., and
a time table for improvements to be made.
This DMR is being amended due to the Oil & Grease was left on on the 19th.
"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."
G
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Permittee (Please print or type)
Permittee Address
n�l�"it�.l_ /-/%6 -gaySignature of Permittee** Date
3 of i e9 ,2i1tSjarec 14*
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00095 Conductivity'
00300 Dissolved Oxygen
00310 BOD5
00340 COD
00400 pH
00530 Total Susppended
Residue
00545 Settleable Matter
00556 Oil & Grease
00600 Total Nitrogen
00610 Ammonia Nitrogen
00625 Total Kjeldhal
Nitrogen
00630 Nitrates/Nitrites
00665 Total_Ph
— osphorous
00720 Cyanide 01037 Total Cobalt
00745 Total Sulfide 01042 Copper
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
Phone Number
PARAMETER CODES
00951 Total Flouride
01002 Total.Arsenic
01027 Cadium
01032. Hexavalent Chromiun
01034 Chromium
01045 Iron
01051 Lead
01067 Nickel
01077 Silver
01092 Zinc
01105 Aluminum
Permit Exp. Date .
31M-aiz a�
50060 Total
Residual
Chlorine
rY
—--32730-Total Phenolics-- ---81551-Xyiene --=- --
34235 Benzene
34481 Toluene
38260 MBAS
39516 PCBs
50050 Flow
31616 Fecal Coliform
01147 Total Selenium 71880 Formaldehyde
71900 Mercu
Parameter Code assistance may obtained by calling the Water Quality Compliance Group at [phone], extension 581 or 534.
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean: Use only units designated in the reporting facility's
permit for reporting data.
'ORC must visit facility and document visitation of facility as required per 15A NCAC 8A.0202 (b) (5) (B).
-If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 26.0506 (b) (2) (D).

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3
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I • TM
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Sent To
Nr7iit7rij
or PO Bo
City, Stal
i
Posta
Hemp
MR HOMER PREVETTE
HOMER'S TRUCK STOP
306 STAMEY FARM ROAD
STATESVILLE NC 28625
swp/rmb 1/10/06

Certified Mail Provides:
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• A record of delivery kept by the Postal Service for two years
Important Reminders:
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valuables, please consider Insured or Registered Mail.
in For an additional fee a Return Receipt may be requested to provide proof o1
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cle at the post office for postmarking. If a postmark on the Certified Mai
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IMPORTANT: Save this receipt and present it when making an inquiry.
Internet access to delivery information Is not available an mail
addressed to APOs and FPOs.
(esioney) goo eunr'oo*a uuol Sc

Michael F. Easley, Governor
ATA
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Homer Prevette
Homer's Truck Stop
306 Stamey Farm Road
Statesville, NC 28625
Subject:
Dear Mr. Prevette:
January 10, 2006
7003 2260 0001 3492 7679
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
Notice of Violation — Monitoring Requirements
NOV-2006-MV-0006
Homer's Truck Stop WWTP
NPDES Permit No. NC0077615
Iredell County
A review of the July 2005 self -monitoring report for the subject facility revealed the following
violations:
Pipe Parameter Required Monitoring Frequency Failures to Report
001 Oil & Grease 2/Month 1
Remedial actions, if not already implemented, should be taken to correct any problems. The
Division of Water Quality may pursue enforcement actions for these and any additional violations.
If you have questions concerning this matter, please do not hesitate to, contact Mr. Richard
Bridgeman or me at 704/663-1699.
Sincerely,
D. Rex Gleason, P.E.
Surface Water Protection Regional Supervisor
cc: Point Source Branch
RMB
Mooresville Regional Office
610 East Center Avenue, Suite 301, Mooresville, North Carolina 28115
Phone: [phone] / Fax: [phone] / Internet: h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
NorthCarolina
Natural!;

ENDER: COMPLETE THIS SECTION
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you.
Attach this card to the back of the mailpiece,
or on the front if space permits.
I. Article Addressed to:
MR HOMER PREVETTE
HOMER'S TRUCK STOP
306 STAMEY FARM ROAD
STATESVILLE NC 28625
swp/rmb 1/10/06
COMPLETE THIS SECTION ON DELIVERY
A. Signature
X
,❑ Agent
❑ Addressee
B. Received by (Prinfed Name) [C./ate,97ever
)
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
Service Type
Certified Mail
❑ Registered
❑ Insured Mail
u
❑ Express Mall
❑ Retum Receipt for Merchandise
❑ C.O.D.
4. Restricted Delivery? (Extra Fee)
❑ Yes
7003 2260 0001 3492, 7679
r5 Form 3811- Fetiruaiv 2004 Dometic Return Receipt
102595-02-M-154

UNITED STATES POSTAL SERVICE
First -Class Mai(
Postage & Fees`-Pbid
LISPS
Permit No. G-10
• Sender: Please print your name, address, an ZIPt4 in this box •
NCDENR
SURFACE WATER) ROTECTIO.N;
610 EAST CENTER AVE
SUITE 301 ;a:.2)
MCORESVILLE NC 28115 v
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Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P. E. Director
Division of Water Quality
Date: December 21, 2005
Homer Prevette
P 0 Box 5068
Statesville, NC 28687
Subject: Notice of Incomplete Discharge Monitoring Report NC0077615
Dear Permittee:
The purpose of this letter is to call your attention to problems with the recent submittal of the Discharge
Monitoring Report (DMR) from your facility. As you may know, the data recorded on your DMR is keyed
into the Division's database. Our data entry staff has informed me of problems with your recent DMR
submittal. Until these problems have been corrected, your DMR will be considered incomplete. Please
see the attached form along with a copy of the problem DMR for details regarding the DMR's deficiency.
Incomplete or illegible DMRs affect our staff's ability to provide a timely and effective evaluation of DMR
submittals. Please be aware that until the Division receives a corrected DMR, you may be considered
noncompliant with your NPDES permit and 15A NCAC 02B .0506, and you may be subject to further
enforcement action. Please take the necessary steps to correct the problems and submit two copies of the
amended DMR within fifteen (15) days of the date of this letter -to the following address:
Attention: Michele Phillips
Division of Water Quality
Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Future DMR submittals with the same or similar problems will be unacceptable. If you have any questions
about the proper completion of DMRs, please contact Michele Phillips at 919-733-5083 Ext. 534. Thank
you for your assistance in this matter.
Sincerely,
Michele Phillips
cc: Mooresville_Regional=Offce�
Central Files
evk. DEPT. OF ENVIRONMEtIr.
AND NATURAL RESOURCES
MOORESVILLE r,._ 3IONAL OFFICE
JAN 0 4 2006
ATER (ALIT Y SKIM
NoarthCarolina
Naturally
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, North Carolina 27699-1617 Phone: [phone] Customer Service
Internet: httpJ/h2o.enr.state.nc.us 512 N. Salisbury St. Raleigh, NC 27604 Fax: [phone]
An Equal Opportunity/Affirmative Action Employer

1,\\,),0
R
Notice of Incomplete Discharge Monitoring Report
Permit Number:. \" C 017 (PI b
Facility: i IY43(16 ntr L.- 5 iDip if' 51.7 .951/a€ i LLC
County: r12de i
DMR Month and Year: Y t b-- DOD
The Division of Water Quality deems the aforementioned DMR as incomplete due to the
following reason(s): (Please see the highlighted areas s on the attached DMR for
details.)
❑ The written values are illegible.
❑ The Average, Maximum, and/or the Minimum data points have been omitted.
❑ The Units of Measure have been omitted or are incorrect.
❑ The DMR Parameter Codes have been omitted.
id Other: •
-Cog.- -Ca e L.cbruv., inctYre ST,

■ • • - r - TM
n
J
r
'1
9
a
J
J
CERTIFIED MAILTM RECEIPT
(Dome'stic Mail Only; No Insurance Coverage Provided)
For delivery information visit our website at www.usps.come
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Retum Rec►ept Fee.
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Sent To
7atreei ;
or POE
City, St
MR HOMER PREVETT
HOMER'S TRUCK STOP
306 STAMEY FARM ROAD
STATESVILLENC 28625
rmb/no' 10/31/05:swp::;
t 1
�'..tea: )
Postmark _•; J
Here,- `'
'. ✓
„..... -

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AVA
NCDENR
North Carolina Department of Environment and
Michael F. Easley, Govemor
Division of Water Quality,
October 31, 2005
CERTIFIED MAIL CM # 7003 2260 0001 3492 9376
RETURN RECEIPT`REOUESTED
Mr. Homer Prevette
Homer's Truck Stop
306 Stamey Farm Road
Statesville, NC 28625
Dear Mr. Prevette:
Natural Resources
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
Subject: Notice of Violation — Monitoring Requirements
NOV-2005-MV-0058
Homer's Truck Stop WWTP
NPDES Permit No. ,NC0077615
Iredell County
A review of the May 2005 self -monitoring report for the subject facility revealed the following
violations:
Pine
001
001
Parameter
Oil & Grease
MBAS
Required Monitoring Frequency
2/Month
Monthly
Failures to Report
2
1
Remedial actions, if not already implemented, should be taken to correct any problems. The
Division of Water Quality may pursue enforcement actions for these and any additional violations.
If you have questions concerning this matter, please do not hesitate to contact Mr. Richard
Bridgeman or me at 704/663-1699.
Sincerely,
4./4-e.ztf\-
Ci
D. Rex Gleason, P.E.
Surface Water. Protection Regional Supervisor
cc: Point Source Branch
RMB
Mooresville Regional Office
610 East Center Avenue, Suite 301, Mooresville, North Carolina 28115
Phone: [phone] / Fax: [phone] / Internet: h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
NorthCarolina
,Naturally

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. Article Addressed to:
MR HOMER PREVETT -
HOMER'S TRUCK STOP
306 STAMEY FARM ROAD
STATESVILLE NC 28625
rmb/nov 10/31/05 swp
COMPLETE THIS SECTION ON DELIVERY
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UNITED STATES POSTAL SERVJE- IVO\
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PosraWWiFees-Paid
USPS------_:.—
Pefmit-No:
if
• Sender: Please print y011r-riame, address7awd ZIP-I:4 in -this box •
rn
m:3
1 NcriF,NR SloF
1..... ; 610 EAsiCl&ER AVE SUI 1
,. MOORESVILLE NC 28115
ccdo
rrni
(:00Z L 0 AON
92 A'
171
"'? 11 I 1 I I I I I 11 I 1 I I I I 1 I I I i I I I I 1 I III I I I I I I I II 1 I I I

fag
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North .Carolina Department of Environment and Natural Resources
Alan W. Klimek. P. E., Director
Division of Water Quality
July 18, 2005
Mr.Homer Prevette
Homer's Truck,Stop
Post Office Box 5068
'Statesville, NorthCarolina 28687
•
,Subject: -Compliance Evaluation Inspection
llomer's Truck Stop WWTP
• NPDES PermitNo. NC0077615
Iredell County, N.C.
Dear Mr. Prevette:
Enclosed is a copy of the Compliance EvEduatibn Inspection Report for the inspection
conducted at the subject facility on July 15, 2005 by Mr. Wes Bell ofthis Office. 'Please provide the
facility's -Operator -in -Responsible Charge of our findingsbyforwarding a copyof the enclosed report
to him.
The report should be self-explanatory; however, should you have any questions concerning
this report, please do not hesitate to contact Mr. Bell or me at [phone].
Sincerely,
D. Rex Gleason, P.E. •
Surface WaterProtection Regional Supervisor
Enclosure
cc: Iredell County Health Department
WB
NihCarolina
Aaturally
AVA
Fre-ENR
•N. C Division of Water Quality, Mooresville Regional Office, 610 East Center Avenue, Suite 301, Mooresville NC 28115 [phone] Customer Service
1-877-623-6748

United States Environmental Protection Agency
;EPA Washington, D.C. 20460
'Water Compliance Inspection Report
Form Approved.
OMB No. 2040-0057
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code 'NPDES yr/mo/day Inspection
1 ,U .2 '1 =.1 31 NC0077615 1 11 121 05/07/15 1 17
Type Inspector Fac Type
18 U 19151 20 U
I -1 l 7 `I 1 1 '1 1 1 1 1 I 1166
Remarks
21I 11 1 1 1 -I 1 111 11 =I :I 1 I I' I :I 1 1 1 '1 '1 1 1 1 1 '1 1 1 -1
Inspection -Work Days Facility Self -Monitoring Evaluation Rating B1 QA
67-1 1.5 1 '69 7011.1 • 711x1 7211.11
Reservod
731 1 'I 74 751 1 1 :1 1 1 1 1139
•
Section:B: FacilityData
:Name:and.Location of Facility Inspected(For'Industrial'Users.discharging to POTW,•also include
"POTW name and'NPDES permit•Number)
Homer's Truck Stop •
Stamey Farm Rd' At 140
Statesville NC 28677
EntryTime/Date
10:15 AM 05/07/15,
Permit:Effective .Date!
05/02/01 '
'.ExltTime/Date -
11:15 AM 05/07/15
-Permit Expiration Date
09/03/31
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
///
Harry Withers Myers//704-906-2191 /
Jerry L Rogers/ORC/704-872-4697/
-OtherFacility Data .
'Name, Address of Responsible OfficialTtlelPhone and Fax Number
Contacted
Homer. Prevette,PO"Box 5068 Statesville NC.28687//704-871-8008/
No
:Section C: Areas"Evaluated.During Inspection (Check only those areas -evaluated)
Permit . _.� FlowMeasurement Operations'& Maintenance`,$ Records/Reports
"Self -Monitoring. Program Sludge Handling Disposal' facility Site -Review 'Effluent/Receiving_Waters
Laboratory
SectionD: Summary'of Finding/Comments (Attach additional sheets of narrative and 'checklists as necessary)
(See .attachment -surnrnary-)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Wesley N Bell �/ l . / /re� MRO Yi4//704-663-1699 Ext.231/ J74
' J
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
Richard M Bridgeman 704-663-1699 Ext.264/
EPA Form 3560-3 (Rev 944) Previous editions are obsolete.

100000
■ 0 . ❑ ❑
❑ 0 0 0 D
EJIOPN
E
Q.
months or less). Has the permittee submitted a new application?
(If the present permit expire
Is the facility as described in the permit?
Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
E
E
0
U
0
0 0
O
pp
0000
0000
0000
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ai
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Are the bars adequately screening debris?
Is the screen free of excessive debris?
Is disposal of screening in compliance?
Is the unit in good condition?
m
E
E
0
0 0 0 0 0 0 0 0
O 0 0❑❑ 0 0 0
O 0000000
■ ■ ■ ■ ■ ■ ■ ■
Is the basin aerated?
m
E
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Is the basin`free of bypass lines or structures to the natural
Is the basin -free of excessive grease?
Are all pumps operable?
Are float controls operable?
Are audible and visual alarms operable?
❑❑❑o❑❑❑❑❑o❑
00000000000
00000000000
■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■
s the clarifier free of black and odorous wastewater?
s the site free of excessive buildup of solids in center well of circular clarifier?
Are weirs level?
s the site free of weir blockage?
0).
U
• 0
0 O
L
N
O
0
m
a)
0
m
a)
y
m
N
s scum removal adequate?
he site free of excessive floating sludge?
he drive unit operational?
he return rate acceptable (low turbulence)?
he overflow clear of excessive solids/pin floc?
N N N N

0
a
0
0
m
0
2
0 0 ❑ 0 ❑ ❑ 0
❑■ 0 0 0 0 1
10 0❑ 0 O 0 0
o i O■ u 1•1•O
Type of aeration system
Is the basin free of dead spots?
Are surface aerators and mixers operational
Are the diffusers operational?
Is the foam the proper color for the treatment process?
Does the foam cover less than 25% of the basin' s surface?
Is the DO level acceptable?
p 0 DOD
OD 0 0 •
DO 0 0 ❑
Are the tablets the proper size and type?
Number of tubes in use?
Is the level of chlorine residual acceptable?
Is the contact chamber free of growth, or sludge buildup?
❑ 0 0 ❑ 0 ❑
O O ❑ ■ 1 ■
0 O 0 ❑ ❑ ❑
■ ■ ■ ❑ ❑ O
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■ ■ ■ ■
0000
0000
Is flow meter used for reporting?
Is flow meter calibrated annually?
Is the flow meter operational?
(If units are separated) Does the chart recorder match the flow meter?
Comment: Instantaneous effluent flows are measured by the bucket and stopwatch method.
❑ ❑ ■ ❑ ❑
00000
O ❑ ❑ O ❑
■ ■ 0 ■ ■ • ■ • ■
Are all records maintained for 3 years (lab. reg. required 5 years)?
)
CC
0
0
v
0 p
n.
co
l0
0
«
c
0)
N
N
c
U
'5
U_
To
c
0)
Is the chain -of -custody complete?
Dates, times and location of sampling
Name of individual -performing the sampling
Dates of analysis

Record Keeping Yee No NA NF
Transported COCs
Are DMRs complete: do they include all permit parameters? 1.000
Has the facility submitted Its annual compliance report to users and DWQ? ❑ ❑ ❑ R
(If the facility is = or > 5 MGD permitted flow) Do they operate 24/7 with a certified operator on each shift? 0 ❑ "� ❑
Is the ORC visitation log available and current? 0 _❑ 0
Is the ORC certified at grade equal to or higher than the facility classification? •11000
Is the backup operator certified at one grade less or greater than the facility classification? DODD
Is a copy of the current NPDES permit available on site? 0 • 0 .❑
Facility has copy of previous -year's Annual Report on file for review? ❑ ❑ 0 .�
•:Comment:.DMRs .were reviewed from April 04:through March 05. No limit violations were reported. A copy of the Permit
is notkept:atthe treatment,plant; however, the ORC-keeps-a copy of"the Permit. The ORCandstaff incorporate a
commendable record keeping system. -
Fffllient'Sampling "Yes No 'NA NF
Is compositesampling flow proportional? .❑ "❑ R =:❑
Is sample collected below all treatment units? ❑ •❑ ❑
Is proper volume collected? 111 :❑ ❑" .❑
Is the tubing clean? ❑ -❑ 0
Is proper temperature set for sample storage (kept at 1.0 to 4.4 degrees Celsius)? : ❑ _❑ R 0
is the facility sampling performed as required by the permit (frequency, sampling type representative)? .ii❑ ❑ ❑
Comment:
-Fffluent Pipe Yes No NA NF
Is right of to the outfall properly maintained? M 0 0 .❑
'Are the receiving water free of foam other than trace amounts and other debris? ❑ .❑ 0
If effluent .(diffuser pipes are required) are they operating properly? =❑ :❑ ❑
Comment: The effluent.appeared slightly turbid with no foam. The receiving stream did not appear -to be negatively
impacted at time of: the inspection.

Homer's Truck Stop
Wastewater Treatment Plant
Annual Performance Report
For the Calendar
Year 2004
rit LIEFT. OF EN VIRONMKA
AND NATL RESOURM
fig OORESV Wet
JUN 1 7 2005
WATER CE:ITY SECTION

Homer's Truck Stop Wastewater Treatment Plant
Operator Responsible in Charge:
Jerry Rogers
Statesville Analytical, Inc.
122 Court St.
PO Box 228
Statesville, NC 28687
Contact Person:
Mr. Homer Prevette
PO Box 5218 Statesville, NC 28687
I. General
The treatment system is an existing 0.025 MGD wastewater
Treatment facility with the following components:
• Grease tank
• Grinder pump tank
• Flow equalization tank with bar screen
• Aeration basin
• Clarifier with sludge return
• Aerated sludge holding tank
• Chlorine contact basin with tablet chlorination
This facility is located at Homer' s Truck Stop located on Stamey
Farm Rd. at 1-40 Statesville, Iredell County. Discharge from the
Homer's Truck Stop Wastewater facility is received into Third Creek,
in the Yadkin --Pee Dee drainage Basin.

II. Compliance Performance:
The North Carolina Department of Environment and Natural
Resources (NCDENR) regulates the Homer's Truck Stop effluent
discharge under the National Pollutant Discharge Elimination System
(NPDES). The NCDENR issued to Homer's Truck Stop a NPDES
Permit that includes water quality limits and sampling and monitoring
requirements. The NPDES permits requires Homer's Truck Stop to
test for routine wastewater parameters of the treated water leaving the
wastewater facility. The monitoring frequency for these tests is set at
various intervals as set forth in the permit. During the period at which
Statesville Analytical was responsible for the plant operations for the
2004-year a total of tests were conducted. These tests were performed
on the treated wastewater as it was discharged to the creek. The
following table is a summary of the testing for the parameters that are
assigned Water Quality Standards by the NPDES Permit.
Parameter
Number
Tests
Required*
Number
Tests
Conducted
Average
Results
Monthly Permit
Limit
Flow
52
52
0.002 mg/L
0.025 MGD
Biochemical Oxygen
Demand (BOD)
52
52
2.7 mg/L
30.0 mg/L
Total Suspended Solids
(TSS)
52
52
9.2 mg/L
30.0 mg/L
Ammonia as Nitrogen
(NH3asN)
24
24
2.0 mg/L
No limit
Dissolved Oxygen
0
52
6.7 mg/L
N/A
Fecal Coliform
52
52
1
CFU/100mL
200 CFU/100
mL
Total Residual Chlorine
104
108
.49 mg/L
No limit
Temperature
52
53
14.8 °C
No limit
pH
52
53
Range 6.8 to
7.2
>=6, <9
Total Phosphorous
4
4
6.3 mg/L
No limit
Total Nitrogen
4
4
10.2 mg/L
No limit
Oil & Grease
24
24
6.4mg/L
30.0 mg/L
MBAS
12
12
.17 mg/L
No limit

III. Certification:
I have personally examined and am familiar with the information
submitted in this document. Based upon my inquiry of those
individuals immediately responsible for obtaining the information
reported herein, I believe that the submitted information is true,
accurate, and complete. I am aware that there are significant penalties
for submitting false information.
Signed this 0 day of "a/vL-e- , 2005
Mr. omer Prevette

Annual Performance Report
Notification Certification Form
Name of System:
NPDES#
I confirm that the Annual Performance Report has been correct and consmaed t with tble
to customers and that the information is ubmitted to the DWQ.
compliance monitoring data previously
The information was made available:
Posted on the Internet
Mailed the report to customers
Posted on the bulletin boardin
the
iew at
Document made available for
Certified By:
Name
Phone# % o 6 L Date 0 -°
,„0

NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
May 31, 2005
CERTIFIED MAIL 7000 1530 0002 2099 2415
RETURN RECEIPT REQUESTED
Mr. Homer Prevette
Homer's Truck Stop
P. O. Box 5068
Statesville, NC 28687
SUBJECT: NOTICE OF VIOLATION NOV-2005-LR-0045
Homer's Truck Stop WWTP
Iredell County
NPDES Permit NC0077615
Dear Mr. Prevette:
William G. Ross, Jr., Secretary
Alan W. Klimek,..F.E:,•Director
JUN 0 '1 200:5
This is to inform you that the Division of Water Quality has not received your discharge monitoring
report (DMR) for March 2005. Water quality regulations require that monthly monitoring reports shall be
filed no later than 30 days after the end of the reporting period for which the report is made. Failure to
submit reports as required will subject the violator to the assessment of a civil penalty of up to $25,000
per violation.
To prevent further action, including the assessment of a civil penalty, please submit the report to the
attention of Bob Sledge at the letterhead address within 15 days or notify this office as to any problem
preventing its timely receipt. You will be considered noncompliant with the self -monitoring requirements
of your NPDES permit until the report has been submitted.
This letter additionally provides notice that this office will recommend the assessment of civil penalties if
future reports are not received within the required time frame during the next twelve (12) reporting
months. The Division must take these steps because timely submittal of discharge monitoring reports is
essential to the efficient operation of our water quality programs. We appreciate your assistance in this
matter. If you have any questions about this letter or discharge monitoring reports, please contact Bob
Sledge at [phone], extension 547.
Sincerely, 44//
KL( ;(. e
Da id A. Goodrich, Chief
Point Source Branch
cc: Point Source Branch
Cgoores_vi11e Regional Offce�
Central Files
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 N. Salisbury St., Raleigh, North Carolina 27604
Phone: [phone] / FAX [phone] / Internet:: h2o.enr.state.nc.us
An Equal Opportunity/Affirmative Action Employer — 50% Recycled/10% Post Consumer Paper
NorthCarolina
7Vataralljt

Homer's Truck Stop
Wastewater Treatment Plant
Annual Performance Report
For the Calendar
Year 2003

Homer's Truck Stop Wastewater Treatment Plant
Operator ResponsibleinCharge:
Jerry Rogers
Statesville Analytical, Inc.
122 Court St.
PO Box.228
Statesville, NC 28687
Contact Person:
Mr. Homer Prevette
PO Box 5218
Statesville, NC 28687
General
The treatment system is an existing 0.025 MGD wastewater
Treatment facility with the following components:
• Grease tank
• Grinder pump tank
• Flow equalization tank with bar screen
• Aeration basin
• Clarifier with sludge return
• Aerated sludge holding tank
• Chlorine contact basin with tablet chlorination
This facility is located at Homer's Truck Stop located on Stamey
Farm Rd. at 1-40 Statesville, Iredell County. Discharge from the
Homer's Truck Stop Wastewater facility is received into Third Creek,
in the Yadkin --Pee Dee drainage Basin.

II. Compliance Performance:
The North Carolina Department of Environment and Natural
Resources (NCDENR) regulates the Homer's Truck Stop effluent
discharge under the National Pollutant Discharge Elimination System
(NPDES). The NCDENR issued to Homer's Truck Stop a NPDES
Permit that includes water quality limits and sampling and monitoring
requirements. The NPDES permits requires Homer's Truck Stop to
test for routine wastewater parameters of the treated water leaving the
wastewater facility. The monitoring frequency for these tests is set at
various intervals as set forth in the permit: During the period at which
Statesville Analytical was responsible for the plant operations for the
2003-year a total of tests were conducted. These tests were performed
on the treated wastewater as it was discharged to the creek. The
following table is a summary of the testing for the parameters that are
assigned Water Quality Standards by the NPDES Permit.
Parameter
Number
Tests
Required*
Number
Tests
Conducted
Average
Results
Monthly Permit
Limit
Flow
52
52
0.001 mg/L
0.025 MGD
Biochemical Oxygen
Demand (BOD)
52
52
3.5 mg/L
30.0 mg/L
Total Suspended Solids
(T$S)
52
52
14.4 mg/L
30.0 mg/L
Ammonia as Nitrogen
(NH3asN)
24
24
1.8 mg/L
No limit
Dissolved Oxygen
0
52
6.5 mg/L
N/A
Fecal Coliform
52
53
1
CFU/100mL
200 CFU/100
mL
Total Residual Chlorine
104
126
.53 mg/L
No limit
Temperature
52
52
15.1 °C
No limit
pH
52
52
Range 6.9 to
7.3
>=6, <9.
Total Phosphorous
4
5
3.2 mg/L
No limit
Total Nitrogen
4
5
7.3 mg/L
No limit
Oil & Grease
24
24
5.3 mg/L
30.0 mg/L
MBAS
12
14
.17 mg/L
No limit

III. Certification:
I have personally examined and am familiar with the information
submitted in this document. Based upon my inquiry of those
individuals immediately responsible for obtaining the information
reported herein, I believe that the submitted information is true;
accurate, and complete. I am aware that there are significant penalties
for submitting false information.
Signed this
day of , 2004
Mr. Homer Prevette

I -comer Prevette
Homer Prevette
P.O. Box 5068
Statesville, NC
Dear Permittee:
NCDENR
28687
Michael F. Easley
Governor
William G. Ross, Jr., Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
August 15, 2003
Subject: Renewal Notice
NPDES Permit NC0077615
Homer's Truck Stop
Iredell County
Your NPDES permit expires on March 31, 2004. Federal (40 CFR 122.41) and North Carolina (15A NCAC 2H.0105(e))
regulations require that permit renewal applications must be filed at least 180 days prior to expiration of the current permit. If
you have already mailed your renewal application, you may disregard this notice.
To satisfy this requirement, your renewal package must be sent to the Division postmarked no later than October 3,
2003. Failure to request renewal of the permit by this date may result in a civil assessment of at least $500.00. Larger penalties
may be assessed depending upon the delinquency of the request.
If any wastewater discharge will occur after March 31, 2004, the current permit must be renewed. Discharge of
wastewater without a valid permit would violate North Carolina General Statute 143-215.1; unpermitted discharges of wastewater
may result in assessment of civil penalties of up to $25,000 per day.
If all wastewater discharge has ceased at your facility and you wish to rescind this permit, contact Bob Sledge of the
Division's Compliance Enforcement Unit at [phone], extension 547. You may also contact the Mooresville Regional
Office at [phone] to begin the rescission process.
Use the enclosed checklist to complete your renewal package. The checklist identifies the items you must submit with
the permit renewal application. If you have any questions, please contact Valery Stephens at the telephone number or e-mail
address listed below.
Sincerely,
Charles H. Weaver, Jr.
NPDES Unit
cc: Central Files
`geioresville.RegiorialOffice W ater-Quality Section
NPDES File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 919 733-5083, extension 520 (fax) 919 733-0719
VISIT us ON THE INTERNET @ http://h2o.enr.state.nc.us/NPDES e-mail: [e-mail]

NPDES Permit NC0077615
Horner's Truck Stop
Iredell County
The following items are REQUIRED for all renewal packages:
❑ A cover letter requesting renewal of the permit and documenting any changes at the facility since
issuance of the last permit. Submit one signed original and two copies.
❑ The completed application form (copy attached), signed by the permittee or an Authorized
Representative. Submit one signed original and two copies.
❑ If an Authorized Representative (such as a consulting engineer or environmental consultant) prepares
the renewal package, written documentation must be provided showing the authority delegated to any
such Authorized Representative (see Part II.B.11.b of the existing NPDES permit).
❑ A narrative description of the sludge management plan for the facility. Describe how sludge (or other
solids) generated during wastewater treatment are handled and disposed. If your facility has no such
plan (or the permitted facility does not generate any solids), explain this in writing. Submit one signed
original and two copies.
The following items must be submitted by anv Municipal or Industrial facilities discharging
process wastewater:
Industrial facilities classified as Primary Industries (see Appendices A-D to Title 40 of the Code of Federal
Regulations, Part 122) and ALL Municipal facilities with a permitted flow ? 1.0 MGD must submit a
Priority Pollutant Analysis (PPA) in accordance with 40 CFR Part 122.21.
The above requirement does NOT apply to privately owned facilities treating 100%
domestic wastewater, or facilities which discharge non process wastewater (cooling
water, filter backwash, etc.)
PLEASE NOTE:
Due to a change in fees effective January 1, 1999, there is no renewal fee required with your
application package.
Send the completed renewal package to:
Mrs. Valery Stephens
NC DENR / Water Quality / Point Source Branch
1617 Mail Service Center
Raleigh, NC 27699-1617

�+3, !Pf - 0✓•
Michael F. Easley, Govemor
William G. Ross Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
AUG 1 4 2003
Mr. Homer Prevette
Homer's Truck Stop
P. O. Box 5068
Statesville, NC 28687
lc DDT. AND '=SC SRC `=
`'_4p-O�
cr
AUG 9 5 2003
: 'i
Subject: Remission Request of
Civil Penalty Assessment
NPDES Permit Number NC0077615
Homer's Truck Stop
Iredell County
Case Number LV-2003-0246
Dear Mr. Prevette:
I considered the information submitted in support of your request for remission in accordance
with G.S. 143-215.6A(f) and have decided to remit the entire civil penalty in the amount of
$1,085.45 and hereby close our case number LV-2003-0246.
Please be advised that a full reduction of the civil penalty assessment in no way precludes the
Division from taking future enforcement action against the subject facility should additional
violations occur.
If you have any questions about this letter, please do not hesitate to contact Bob Sledge at (919)
733-5083, extension 547.
Thank you for your cooperation in this matter.
Sincerely,
cc: [Mooresville. Reional_O.ffice
Enforcement File
Central Files
nrix
Alan W. Klimek, P.E.
Customer Service
1 800 623-7748
Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617
[phone] Fax: [phone]

June 24, 2003
MEMORANDUM
TO: Rex Gleason
FROM: Richard Bridgeman
SUBJECT: Request for Remission of Civil Penalty
Case No. LV-2003-0246
Homer's Truck Stop
NPDES Permit No. NC0077615
Iredell County
Homer's was assessed a civil penalty of $1085.45, including $85.45 in enforcement costs,
on 5/2/03. The case covers a TSR monthly average violation and a TSR daily maximum
violation, occurring during 1/03.
The permittee indicates that there was no discharge from the WWTP on the day the
sample was collected for which there was a daily maximum TSR violation, which was of a
magnitude which caused a monthly average TSR violation also. There was no discharge because
the plant's pipes were frozen. The operator, to meet minimum monitoring requirements, collected
the samples from the clarifier. According to the permittee, the pipes are now insulated. The
facility was in compliance during 2/03, 3/03, and 4/03 (latest DMR).
There have been 5 previous civil penalty assessments against Homer's, the last of which
was during 2001.
Within the framework of the remission factors, the perpiittee provided justification for
remission.
c ee-ems
..
to_e_

•;1

June 10, 2003
Mr. Homer Prevette
Homer's Truck Stop of Statesville, LLC
306 Stamey Farm Road
Statesville, NC 28687
Michael F. Easley, Govemor
William G. Ross Jr., Secretary
Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
NC DEPT. Or ENVIRONMENT -
AND NAT 'ESOURCES
ElOORESI- • '-1AL OFFICE
N 1 6 2003
Subject: Remission Request of WA et SEMs11,
Civil Penalty Assessment
Homer's Truck Stop WWTP
NPDES Permit Number NC0077615
Iredell County
Case Number LV 2003-0246
Dear Mr. Prevette:
The Division of Water Quality is in receipt of your request for remission of the civil penalty
assessed in the matter of the case noted above. Unfortunately, we did not find a completed form
waiving your right to an administrative hearing along with your letter when it arrived in this
office. As this is a necessary part of the remission request, we respectfully ask that you complete
the attached waiver form and return it to the attention of Bob Sledge at the letterhead address.
Oncethe completed waiver form is received, we can continue with the processing of your
request. Your request will be placed on the agenda of the Director's next scheduled enforcement
conference and you will be notified of the result.
If you have any questions about this matter, please contact Bob Sledge at [phone],
extension 547.
Sincerely,
TZ. oe, %(:11(
Shannon Langley, Supervisor
Point Source Compliance/Enforcement Unit
cc: Moo eSv lleaegional rOffice w/attachment§
Central Files w/attachments
Enforcement File w/original & 3 attachments
gam
Customer Service Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617
1 800 623-7748 [phone] Fax: [phone]

STATE OF NORTH CAROLINA
COUNTY OF IREDELL
•
DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
IN THE MA1 1hR OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINISTRATIVE HEARING AND
HOMER PRE'VETTE d/b/a Homer's Truck Stop ) STIPULATION OF FACTS
PERMIT NO. NC0077615 )
FILE NO. LV-2003-0246
Having been assessed civil penalties totaling $1,085.45 for violation(s) as set forth in the
assessment document of the Division Of Water Quality dated May 2, 2003, the undersigned, desiring
to seek remission of the civil penalties, does hereby waive the right to an administrative hearing in
the above -stated matter and does stipulate that the facts are as alleged in the assessment document.
The undersigned further understands that all evidence presented in support of remission of this civil
penalty must be submitted to the Director of the Division of Water Quality within 30 days of receipt
of the notice of assessment. No new evidence in support of a remission request will be allowed after
30 days from the receipt of the notice of assessment.
This the day of , 2003.
BY
ADDRESS
TELEPHONE

Homer Prevette
Homer's Truck Stop of Statesville, LLC
306 Stamey Farm Road "
Statesville, NC 28687 _ ..
4, 2003
Coleen Sullins
ter Quality Section Chief
'vision of Water Quality
617 Mail Service Center
Raleigh, North Carolina 27699-1617--..._ - -.
Dear Ms. Sullins:
This letter is in response to the letter received from D. Rex Gleason on May 2, 2003 reference remissions
request. The following information is submitted for your review:
The discharge monitoring report submitted for January 2003 (specific date January 24, 2003)- due to
extreme freezing weather there was no discharge from the waste plant. The frozen water could not flow and
the ORC sample was taken from the clarifier tank, not discharge water. No water was discharged into the
local streams (no incoming or discharge water). The lift station has a 20,000+ tank that holds everything.
Note a copy of weather report is attached for your review. By NCDENR standard policy and procedure no
sample is required if there is no discharge (per Rex Gleason).
The act of God (freezing weather) was beyond our control. There was no weather warning or indication that
the water would freeze. Three employees actively and diligently sought to remedy the frozen condition.
Nothing during this period was due to our omission or commission of the duties we are well aware of.
Reference to NCDENR policy, approved by the DENR Secretary, effective date September 1,1995 (revised
July 10, 2002), page 2, appears to justify a waiver for the above -cited date.
Since the cited incident, we have proactively wrapped the pipes from the lift station. Also during any cold
spells we use an elector magnetic heater to do all we can to prevent any freezing situations. Please be
reminded that this is an above ground facility.
Thank you for the opportunity of responding to this matter. If you need additional supporting information,.
please feel free to contact me at 704-871-8008.
Professionally,
Homer Prevette
AL,e-z/—(7
Attachment: Letter from Statesville Analytical, Inc., weather report
cc: D. Rex Gleason
" '
4T1
JUN - 4 2003

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Mr. Bob Brawley
Homer's Truck Stop
PO Box 5218
Statesville, NC "28687
May 15, 2003
RE: Adverse weather conditions affecting the WWTP at Homer's Truck Stop 2003
STATESVILLE
ANALYTICAL
Dear Bob,
Attached is the information on the adverse weather conditions for the month of
January for this year. I have also included February's data as well so you can see the
trend. The average low for the month of January for in our area is 29 to 30 ° F. The
records show that there were only a few days with temperatures above 30° F for the low.
The approved waste treatment plant design did not allow for weather this severe. I don't
know if the plant would have thawed by now without your help. The insulating and
heaters you installed worked well. Had we known the approved plant would not have
handled the extreme temperatures of this year's winter weather we could have planned to
have heaters there prior to the freeze. I want to thank you for all your hard work this
winter. Maybe next year will be better. Let me know if there is anything else you need.
Sincerely,
Dena Myers, President
Statesville Analytical, Inc.
•
P.O. Box 228 • Statesville, North Carolina 28687. 704/872/4697

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DIVISION OF WATER QUALITY - CIVIL PENALTY ASSESSMENT
VIOLATOR: /7/omc2'1 77 'ck f'Trs,
COUNTY: ZR
CASE NUMBER: L!/- 2 -O 2.06
ASSESSMENT FACTORS:
1) The degree and extent of batin to the natural resourem of the State, to the public health, or to private property
resulting frtyn the violation(s);
of Significant 0 Moderately Sicnificant n Significant ❑ Very Significant D Extremely Significant
2) The Duration and gravity of the vioiation(s);
YiNot Significant 0 Moderately Sis:niiicant 0 Significant 0 Very Significant 0 Extremely Significant
3) The effect on ground or surface water quantity or quality or on air quality;
2/Not Significant 0 Moderately Significant L Significant 0 Very Significant i7 Extremely Significant
4) The cost oft. ifying the damage;
E Not Significant 0 Moderately Significant 0 Simrincant 0 Very Significant 0 Extremely Significant
5) The amount of money saved }v noncompliance;
n Not Significant AlModerateiy Significant 0 Significant ❑ Very Significant 0 Exir„ureiy Significant
6) Whether the violation(s) was (were) committed willfully or intentionally;
ot Significant i7 Moderately Significant 0 Sieniiieant D Very Simiifleant .-xtremeiv Sinif cant
7) The prior record of the violator in complying or falling, to comply with programs over which the
Environmental Management Commission has regulatory authority; and
mot Significant 0 Moderately Significant 0 Simifirant a Very Significant 0 Extremely Significant
8) The cost toIie State of the enforcement procedures.
Not Significant 0 Moderately Significant n Sirmil:cant 0 Van- Significant Extremely Significant
0
0
()
0
2 2'cJ
Date D. Rex Gleason, P. E.
Water Quality Regional Supervisor
REMISSION FACTORS:
Whether one or more of the civil penalty assessment factors were wrongly applied to the detriment of the
petitioner;
Whether the violator promptly abated continuing environmental damage resultingfrom the violation(s);
Whether the violation(s) was (were) inadvertent or a result of an accident;
Whether the violator had been assessed civil penalties for any previous violations;
and
Whether payment of the civil penalty will prevent payment for the remaining necessary remedial actions
Date Alan W. Klimek, P.E.
Director

DWQ- - CIVIL ASSESSMENT REMISSION FACTORS CONSIDERATION
Case Number:_LV-2003-0246 Region_MRO County: Iredell
Assessed Entity: Homer's Truck Stop
()
()
()
()
()
Whether one or more of the civil penalty assessment factors were wrongly applied to the
detriment of the petitioner;
Notes:
Based on follow-up information provided by the permittee, no violation occurred
Whether the violator promptly abated continuing environmental damage resulting from the
violation;
Notes:
Whether the violation was inadvertent or a result of an accident;
Notes:
Whether the violator had been assessed civil penalties for any previous violations;
Notes:
Whether payment of the civil penalty will prevent payment for the remaining necessary
remedial actions.
Notes:
Decision (Check one)
Request Denied Full Remission 1 Partial remission
Amount remitted
Date Alan Klimek, P.E.

c1 STATE OF NORTH CAROLINA-- .,.
COUNTY OF IREDELL
v
c•,4i IN THE MAITER OF ASSESSMENT )
OF CIVIL PENALTIES AGAINST )
HOMER PREVETTE d/b/a Homer's Truck Stop )
PERMIT NO. NC0077615 )
,q`A
- DEPARTMENT (
AND NATUR U•.iA
I JI.LS�
-F ie r
WAIVER OF RIGi
ADMINISTRATI
STIPULATION OF FACTS
FILE NO. LV-2003-0246
Having been assessed civil penalties totaling $1,085.45 for violation(s) as set forth in the
assessment document of the Division Of Water Quality dated May 2, 2003, the undersigned, desiring
to seek remission of the civil penalties, does hereby waive the right to an administrative hearing in
the above -stated matter and does stipulate that the facts are as alleged in the assessment document.
The undersigned further understands that all evidence presented in support of remission of this civil
penalty must be submitted to the Director of the Division of Water Quality within 30 days of receipt
of the notice of assessment. No new evidence in support of a remission request will be allowed after
30 days from the receipt of the notice of assessment.
This the • /6
NC DEPT. OF ENVIRONNEr
AND NATURAL RESOURCES
CES
SIOORESV1U. F. "9 iC:NAL OFFICE
tiro i21-9
JUN 2 5 2003
.UT SUMW
J U N 1 9 2003
rry
day of
, 2003.
ko2gr`g 77rei.ed cS J74re,.chs1 . LCC
BY
ADDRESS
306 sT/rrey RR
-V54Tesv /1e, . 8'za6
TELEPHONE
7 - 87/-io0?

-. .
CERTIFIED MAIL RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
Postage
Certified Fee
Return Receipt Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
MR HOMER PREVETTE
HOMER'S TRUCK STOP OF STATESVILLE, LLC
PO BOX 5068
STATESVILLE NC 28687
wq/rmb 5/2/03

Certified Mail Provides:
■ A mailing receipt
■ 'A unique identifier for your mailpiece •
■ A signature upon delivery
■ A record of delivery kept by the Postal Service for two years
Important Reminders:
■ Certified Mail may. ONLY be combined with First -Class Mail or Priority Mail:
■ CerfifeCI Mail is not available for any class of international mail.
■ NO/ INSURANCE COVERAGE IS PROVIDED with Certified Mail. Fo
valuables, please consider Insured or Registered Mail.
■ For''an additional fee', a'Retum Receipt may be requested to provide proof o
•
' .delivery. To obtain Return Receipt service, please complete and attach a Returr
Receipt (PS Form 3811) to the article and add applicable postage to cover ttir
fee. Endorse mailpiece 'Return Receipt Requested". To receive a fee waiver fo
a duplicate return, receipt, a USPS postmark on your Certified Mail receipt is
required.
■ For an additional fee, delivery may be restricted to the addressee o
addressee's authorized agent. Advise the clerk or mark the mailpiece with tilt
endorsement "Restricted Delivery". -
■ If a postmark on the Certified Mail receipt is desired, please present the arti
cle at the post office for postmarking. If a postmark on the Certified Mai
. receipt is not needed, detach and affix label with postage and mail.
IMPORTANT: Save this receipt and present it when making an inquiry..
PS Form 3800, January 2001 (Reverse) 102595-01-M-104!

6411.121
1C�
/
fir :, C ver cr
'Mirth Carr.iina % ,:xatEutizaut&arc Rewurces
•
Nzrz Vit Klimek., E Dire
Q6us® afT tier Quality
Mav 2 2003
CERTIFIEDRECEIPT
•REQUESTED
i T U RECEI 1
Mr_ Homer Prevette
How s Truck Stop of Statesville_ LLC
P.O. Box 5068
306 Stamey Farm Rd_
Statesville, NC 28687
Dear Mr_ Prevette:
7001 2510 0004 8287 7262
SUBJECT: Notice of Violation and of Civil
Penalty for Violations ofN_C_ Gew ai Stye
14 215_1(aX6) and 'DES Pew No_ NO10 e 7615
Homers Truck Stop WWTP
Case No_ LV 03-246 .
Iredell County
This letter transmits a Notice of Violation and ant of dial pernity untie
S 1085.45 (S 1000.00 civil penalty 4- S85.45 enforcement costs) aaainst Mr_ Horn- e_
-III 1,OM
f
This aunt is based upon the following facts_ A reziew has beet coca:tinted of ie
discbarre monitoring report (DMR) steed by Mr_ How Prevette for the month of Truce
2003_ This review has shown the subject f v to be in vicAation of the discharge
found in NPDES Permit No. NC0077615_ The violations are .41? Alta dris
letter_
Based upon the above fare I conclude as a mattes oflaw that. Mr. Hots Pm -elite
violated the terms, conditions or icwileuxzats ofNPDES Pew No_ NCC077615 and North
Carolina dal Statute (G.S )143-215.1(aX6) iathe manner and extent shim!
A A civil penalty may be assessed. in accordance with the maxicaumS established by -CS 14=E
? 15.6A(a)(2)-
Based upon the above firsdirt s of fast and_ conclusions oflaw= marl imaccorcce with
authority provided by the Secretary of tie Department oflavironment andN-m:uraERetErces
the Dircctur of the Division of Water Quality, I_ D. Rex Win?,. Waater QuaRyRelgoT121
Supervisor for the Mooresville Region„ hereby make the folfovim civil penalty ,,
Mr_ Homer Prevette:
A •
(7=4)
=AX. (7C4) 5- -&.LO
Moccesvuu4m RegicraE C. 319 Matt Man Iltra-mwffe,, NC 2E1 is
1 Eaartaj74a

For /7 of the (1) -iiclation of G `_ 143-
215.1(a)(6) and NPDES Pmnit No_ NO3077615, by
disc into the wmers of the Sty in
violation of the pa—milr B v as Qe efflik-nt zit
for Tot1 Steed Rase_
For r of the one (1) violation. of G.S. 143-
215.1(a)(6) and LADES No.. NO1077615,
disrharaim wage into the waters ofthe State in
violation of the d ry maximum eft 1*
for Tot .I Steed R.
TOTAL. CIVIL Pl i TY
85.45 Enforcement cosz
66
9/J
� � TOTAL AMOUNT DUCE
P=suam to G.S. 143-215.6A(c), is determi6m the iTroirnt of :f-v I have t ke
into accoura the F• of Fcct and Conclusion ofla- wd the fazters s`t forth at G_S_ 14 B—
28'2.1(b)_ which are:
(1)
(S)
The dew= and exitnit of harm to the rattriai r� tra o.- of the Sr i to the 'pith 3
hem or to private property results gym! the Nioc
The duraam. and eg-Iviry of the violot
The ells t on ground or w ' - or r or on a uua3 _
The cost of rectifying the da rnm
The M13101211E of money saved by nonourrriiance
Whether the violations were comma wlJ1f4i1y or ::. a :14 1
The prior rccord of the violator in compivina or f to comply with p a
over which the Eminannaental41tal Coin si raulatory
and
The cols to the State of the enfot procedures
Witha thirty days oft pt of this notice you mtr-z do one of the follow e-
L Submit
1- 04
ent of the
Payne= mould be made direr.to tie order ofthe Dertate of Envirovir ,,t
and Natural Resource (do not inch ', 14- r fez ryk)_ Payrnea ofthe penalty-71
tot kreclase further entorc ;* tnta for any cuia. 1, r, or new ..,, ie/9i • r ,$)-
PIe<a submit paymmt to the arts on. of

Point Source CompliantmlEnforcenynr Unit
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Submit a written request for remission or mitigation indudbL a detailed
jcation for such request
A request for remission or mitistation is lied to consera.m of tbr
re onabl ness of the amount of the peroity wad is not the pro procedure for
contesting the accuracy of any of the statements comaineolin $ae aenit letter
B se a remission request forecloses the option of an .< a - - Item,
soh: a request twist be accompanied by a w L ei of your f<Yb ad n tsve
he`rin and a stipulation that there are no -rua1 or i fi . ir^ Bate_ You
t execute and return to this oil the ar :ed weer ae on fom and
a detailed statement w-lkh you believe esmblies whether:
(a) one or more ofthe civil penalty a moors CS_ 143 13-282.1(b)
were wrongfully applied to the deli 3 t of the pe ar
(b) the violator promptly abated corm en` i orrme-T;n1 c7.4,-,acre reoaking
from the violations;
(c) the violations were inadvutent or a =It of an ate-
(d) the violator had been assessed civil ,peralties for ti p� `uiocs violation;
(e) payment of the civil penalty will prevem payment for tl r:- g
necessary remedial actions_
Pi se submit this information to the att :ii on of
Ms_ Coleen Sulks
Water Quality Section Chief
Division of Water Qnar .
1 617 Mail Service Center
Ral i_ah.. North Carolina 27699-1617
P 5P note that all info oapresented st port of a.requeAt far rentissim_
trust to submitted in writing. The Director ofthe DivKrin of Waterwill
review the information during a bimonthly cari'i Prti inform you
of" decision in the matter ofthe wiff provide
delails regarding rase status, directions for payment aid o i ar
apreal of the penalty to the Environmental Nfarratmera Ce m ors Committee
on Cis Penalty Remissions. Please be tha the Go< ,"tee %soon, I t
consider information that was riot part of timca$ sir e~ t considered
by the Director and therefore_ it is very 1 1 t thatvau ../EaMite acomplete and .
tyro.m statement in support of your re -t or r: -s?c•

OR
3. Submit a written request for an adminiAramrc hearing:
If you NV-h. to cn est any ratement in this , e ,r FF-r-er you nnis-t rez
administrative f or This request must be in: tle Ros,J.y ofa tea petition boo
the Offof : 121erin2s and Chapier 150B of J
North CaroEna General Star"utes_ You ntrst
File your o petition with the
O of ► Ssinistrthj Hr =;rft os
6714 Mail Service Comer
R Iei h.. North Carolina 27699-61 14
and
Mail or h 3-de iv a copy of he petition to
Mr- Dan Oakley Gr of Couns
D ofEnviio a; a and Natural! R..curc
1601 M'ii Service Cmter
Raleish, North Caroiitm 27699-1601
Failure to exerc one of then option above w c1 by a c P-
stamp (not a poster k) indik.411.,a when we received Your r -eLg
referred to the Attorney C: ' eras Office with a request to a civil n to collecz
penalty.
Please be advised tat any c .viol nts» may be I ofa new
enforcement aeon, inc am Cr Ma additional penalty. If vau Eave a1.4a .- about this 3
penalty asset please eon- the Wa Quaky Sec o.n Mceresvffie 1�
Office at 7041663-1699.
/play Z 2•�
( Gate}
ATTACHMENTS
IiRem r- aa9 RE.
-Water Quaay,
Moore: a Rec o-m O
Dion of Water Q ini
cc: Water Qmlity R nal Su„ or , mt ' errt
CompliancelErtlorarms
Central Files wi rr-f-i ns
RMB

Attachment A
Mr_ low Prevwe
Homer's Track. Stop of States-v- e_ LLC
NPDES Permit No_ NC0071615
Case Xunbe UST 03-246
Twit Violations, January 2&13
Prate
Total S. Re1 ue
Pat
Total S R due
N4oMillv Av Eie Limit Irnolainqls
Reported Value
S6.8 *
Ant: 12
30_0
Lim'.
Reortea j✓akre
90a
* denotes assessment of civil penalty.
I uu
=5_0
U
t IL •

STATE OF NORTH CAROLIN a.
COUNTY OF IredeIl
IN THE MATTER OF ASSESSMENT
CIVIL PENAL 1'LES AGAINST
Mr. Homer Prevette
PERMIT NO. NC0077615
D- PARI` f OF E RONNIE T
ADD NTAI LA F RESOURCFS
C'FS
WAIVER DE RIGEL t TO AN OF
ADd 9. TTR ATIVE iLW. RING
AND STPUTLATIONT OF FACTS
FILE NO_ Lti QC--Z 6
Having been assessed civil pK-aakies totaTina far
violation(s) as set forth in the ate.-,-rreiir document of I s-F of Water Qua - dated
.
. the cmt£ : i , � = - s reiss ii fte 6.1
penalties, does hereby waive the right to an aduiuiraeive e acuv-e-sue n 'er amid
does stipulate that the facts are as a ed in the ? f.-�--emr- c:- -r:,r Tc.e ITT-rfergi-cr,v4--
understands that all evidence presented in support ot-L...0 of periaftv=st e
submitted to the Director of the Division of �- dav s ofres. it
of assessment. No new evidence in support of a i o r q I z be atie.e =Fy days
from the receipt of the notice of as sent
This the day of _ 2
BY
ADDRESS

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A (1). EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS - FINAL
Permit No. NC007
During the period beginning on the effective date of the permit and lasting until expiration, the Permittee is authorized to discharge from outfall(s) serial number 001
Treated Domestic Wastewater. Such discharges shall be limited and monitored by the Permittee as specified below:
EFFLUENT.CHARACTEIl2ISTICS ' J-
t '6:v ! i 2. .� ,�. r. J . }' :., ..i
s. 1• G; , G..+i:{. e {, J . r �. •' � '.'afP "'{ �'3jS':.
„ �I . t,r;•.x,.; r,� , :; �A,t .,�
.,. -�` �, ••�
.. . V .;:.'. 'i.DISCHARGE:LIMITATIONS 4''.•;r; :1 t?
;'s NiF;`,� 1MONITORING;'REQUIREMENTS'
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,
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'
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Flow (11,1GI))
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Instantaneous
1 or E
1301), 5-Day, 20°C
30.0 mg/L
45.0 mg/L
Weekly
Grab
E
Total Suspended Residue
30.0 mg/L
45.0 mg/L
Weekly
Grab
E
Oil and Grease
30.0 mg/L
- 60.0 mg/L
2/Month
Grab
E
NII3•N
2/Month
• Grab
I
Fecal Collform (t;eontetrIc mean)
200/100 ml
•
400/100 nil
Weekly
Grab
I;
Total Itcsltlunl Chlorine
2/Weelt
Grab
I;
Iemvrature
WeltlY
Grab
Total Nlirogen (NOg+NO+`ItN
— _�
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- Quarterly i terly
Grab
I:
MISA i
Monthly
(crab
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(frith
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1'1u:el�[
5a11111l@ I OOMIOfl $I 1 a Inllupnt, 1 A Montt
t+ 'I'htL 1,11 ahnil out Ito loan than (1,0 titAntlnrd tmita or drtialtir Than OM plantfard unila,

Case Number
LV
03
Fast Track Worksheet
246
Facility Name
Permit Number
Previous Case
in the Last
two years
Homer's Truck Stop
NC0077615
Yes
Statutory Maximun
per violation
Number of Assessments for previous 6 DMRs
• 1 O 20 0 3 0 40 O
1.00
$25,000
Total Assessment Factor =
1.00
Number Number
Total
Penalty/ Assessment
Violations Assessed Parameter Violation Violation Factor Total Penalty
1
I
TSR
Monthly Average
$750
1
$750.00
1
1
TSR
Daily Maximum
$250
2
Comments
1
Grand Total Penalty
Percent of the Maximum Penalty
Authorized by G.S. 143-215.6A.
$250.00
$1000.00
2.00
Review month = January 2003
Prepared by Richard Bridgeman

: COMPE ' S
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
■ Print your name and address on the reverse
so that we can return the card to you.
■ Attach this card to the back of the mailpiece,
or on the front if space permits.
. Article Addressed to:
MR HOMER PREVETTE
HOMER'S TRUCK STOP OF STATESVILLE, LLC
PO BOX 5068
STATESVILLE NC 28687
wq/rmb 5/2/03
J
COMPLETE THIS SECTION ON DELIVERY
A. Signature
X
-41111111-4.0
B. Received by (Printed Name)
E gnt
(� ■ Addresser
111,1
to
of Deliver)
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: ❑ No
\Service Type
Certified Mail
❑ Registered
❑ Insured Mail
❑ Express Mail
❑ Return Receipt for Merchandise
❑ C.O.D.
4. Restricted Delivery? (Extra Fee) ❑ Yes
cl—
(rrnni 7001 2510 0004 8287 7262
(fra
'S Form 3811, August 2001.
Domestic Return Receipt
102595-01-M-251

UNITED STATES POSTAL SERVICE
First' -Class Mail
Postage & Fs Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4_in-this-box
L)ENR
71k _
WATER QUALITY SEC i ON
919 NORTH MAIN STRPO'
i n
MOORESVILLE NC 28 11-711
dm r
, LA c

w•C)
HOMERS TRUCK STOP OF STATESVILLE LLC
P O BOX 5068
STATESVILLE, NC 28687
[phone].
FAX [phone]
..J es 13
Ref: Lerr e"
y, 63
, 1L(-aO63
.S k,eC : I i••ae. e.:eelcJ
.yc.e.t.drd awe raetno - , pc, a_ eN-J, aaoa
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t31swe.,rs NoCDV•45ad ra.r i L plr,��r
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a,A.l eS ZwSIP-e Q i , a .
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We-S,
A i i Le 1- : i r Sre+ i :Q, K1
s 1 thti z- Da Q-A-)-EA- r ti : eo v— e e, --P)e. e- s eq-[- -,
1C DEPT. OF ENVIRO 1I1E
A! D 6MATURAL RESOURCE
DCORPSV!LLE REG!ONAL OROC
ragN 9 7 2003
sECTON
7 1,4 .0.-JGS
/Jam.. v
7a�- S71- 8raog

-
• ••• •
,
7

Monthly Limit
MINIMUM
Comp.(C /Grab(G)
3
3
c
3
AVERAGE
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g
6,4
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in
0
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0
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ya.
Operator Time
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P
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o
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o
$
+
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S
+
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+
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o
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INF
r
8
8
N
`4
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1...)Q
•'
TEMPERATURE
CELCIUS
3
o
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A:,
V
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a
V
is
V
N
V
a.
V
L.iv
V
2
0
P H
$
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0
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0
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0
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3
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RESIDUAL
CHLORINE
4
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3
AMMONIA
NITROGEN
§
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:,
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a
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11
TOTAL
SUSPENDED
RESIDUE
g
p,
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a'
1
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$
FECAL
COLIFORM
(Geometric Mean)
w
1n
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0
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f
DISSOLVED
OXYGEN
1
N
0-
N
N
-
is)3
TOTAL
NITROGEN
$
.1
0V
V
.,
-
3
TOTAL
PHOSPHOROUS
3
Conductivity
EN I EK I'AKAMt I tK LA -WC
ABOVE NAME AND UNITS
BEL0W- - - -
�1
i
1
I
i 1
i
)-
1
i
1
O
0 N
A
N
01
0
N
O
IA
Oil & Grease
c)A��
L.
rA
MBAS
• n
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Facility Status: (Please check one of the following)
All monitoring data and sampling frequencies meet permit requirements
All monitoring data and sampling frequencies do NOT meet permit requirements
I x I
Compliant
Noncompliant
If the facility is noncompliant, please comment on corrective actions being taken in respect to equipment, operation, maintenance, etc.,
and a timetable for improvements to be made.
The flow, pH and temperature was left off the DMR for July 30, 2002.
"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 significantpenalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
AAD,v' fvedQTT -
Permittee (Please print oytype)
Signature of Permittee**
ate
Permittee Address
3o6sT it -Y Fray" Rd s" reskti;1/e. it!C
00010 Temperature
00076 Turbidity
00080 Color (Pt -Co)
00082 Color (ADMI)
00095 Conductivity
00300 Dissolved Oxygen
00310 BOD5
00340 COD
00400 pH
00530 Total Susppended
Residue
00545 Settleable Matter.
00556 Oil & Grease
00600 Total Nitrogen
00610 Ammonia Nitrogen
00625 Total Kjeldhal
Nitrogen
00630 Nitrates/Nitrites
01034
00665'Total-PFiosphorous— r -
00720 Cyanide 01037
00745 Total Sulfide 01042
00927 Total Magnesium
00929 Total Sodium
00940 Total Chloride
Phone Number
3 q-87/-etc 2
Permit Exp. Date
31M(-(?c't
PARAMETER CODES
00951 Total Flouride
01002 Total Arsenic
01027 Cadium
01032 Hexavalent Chromiun
Chromium
Total Cobalt
Copper
01045 Iron
01051 Lead
01067 Nickel 50060 Total
01077 Silver Residual
01092 Zinc Chlorine
01105 Aluminum
01147 Total Selenium 71880 Formaldehyde
31616 Fecal Coliform 71900 Mercury
32730-Total-P-heriolics_-- 81551_Xylene__ -_
34235 Benzene
34481 Toluene
38260 MBAS
39516 PCBs
50050 Flow
Parameter Code assistance may obtained by calling the Water Quality Compliance Group at [phone], extension 581 or 534.
The monthly average for fecal coliform is to be reported as a GEOMETRIC mean. Use only units designated in the reporting facility's
permit for reporting data.
*ORI;, must visit facility and document visitation of facility as required per 15A NCAC 8A.0202 (b) (5) (B).
**If signed by other than the permittee, delegation of signatory authority must be on file with the state per 15A NCAC 2B.0506 (b) (2) (D).

() 4AT�9P
v
Michael F. Easley, Governor
William G. Ross, Jr.,Secretary
North Carolina Department of Environment and Natural Resources
Alan W. Klimek, P.E., Director
Division of Water Quality
May 30, 2003
Mr.Homer Prevette
Homer's Truck Stop
Post Office Box 5068
Statesville, North Carolina 28687
Subject: Notice of Deficiency
Compliance Evaluation Inspection
Homer's Truck Stop WWTP
NPDES Permit No. NC0077615
Iredell County, N.C.
Dear Mr. Prevette:
Enclosed is a copy of the Compliance Evaluation Inspection Report for the inspection
conducted at the subject facility on May 20, 2003 by Mr. Wes Bell of this Office. Please provide
the facility's Operator -in -Responsible Charge of our findings by forwarding a copy of the enclosed
report to him.
It is requested that a written response be submitted to this Office by June 20, 2003,
addressing the deficiencies noted in the Records/Reports and Self -Monitoring Sections of the.
report. In responding, please address your comments to the attention of Mr. Richard Bridgeman.
The report should be self-explanatory; however, should you have any questions concerning
this report, please do not hesitate to contact Mr. Bell or me at [phone].
Sincerely,
D. Rex Gleason, P.E.
Water Quality Regional Supervisor
Enclosure
cc: Iredell County Health Department
WB
Mooresville Regional Office, 919 North Main Street, Mooresville, NC 28115
HONE [phone] Customer Service
=AX [phone] 1 800 623-7748
AlTewhi
KMENR

United States Environmental Protection Agency
EPA Washington, D.C. 20460
Water Compliance Inspection Report
Form Approved.
OMB No. 2040-0057
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection
1 Ltd 2 I C' 31
NC0077615 111 12 I 03/05/20 1 17
LJ LJ 1
Type Inspector Fac Type
18 L_ 19 _ 1 20 LJ
u LS J
I I I I I I I 1 I I I I I I166
Remarks
211 I I I I I I I I I I I I III I I I I I I I I I III I I I I
Inspection Work Days Facility Self -Monitoring Evaluation Rating B1 QA
67 1 1. s 1 69 70 LJ I ., I 71 12I 72 l„(
LI
Reserved
1 174 751
1 1 1 1 1 1 1 80
Section B: Facility
ty Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
POTW name and NPDES permit Number)
Homer's Truck Stop
Stamey Farm Rd At I -4 o
Statesville NC 28687
Entry Time/Date
01:00 PM 03/05/20
Permit Effective Date
99/10/01
Exit Time/Date
02:18 PM 03/05/20
Permit Expiration Date
04/03/31
Name(s) of Onsite Representative(s)Ttles(s)/Phone and Fax Number(s)
Jerry L. Rogers/ORC/704-878-0459/
Bob Brawley/Maintenance Supervisor/704-871-8008/
Dena Myers//704-872-4697/
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
Homer Prevette,PO Box 5068 Statesville NC 28687//704-871-8008/ No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit Flow Measurement Operations & Maintenance Records/Reports
Self -Monitoring Program Sludge Handling Disposal Facility Site Review Effluent/Receiving Waters
Laboratory
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
PERMIT:
The permit description adequately describes the facility.
RECORDS AND REPORTS:
DMRs, chain of custody forms, laboratory analyses, calibration data, Operator -in -Responsible Charge (ORC)
visitation log, process control data, and maintenance log were reviewed at the laboratory facilityof the
current contract operations firm. The records and reports were organized and well maintained. The
(cont.)
weekend visitations to the lift station were not documented to verify compliance with 15A North
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
Wesley N Bell van WQ//704-663-1699/704-663-6040
r-th.. thy 5/077/03
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.

NPDES yr/mo/day Inspection Type
NC0077615 11 12 03/05/20 17 18 t I
(cont.) 1
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Carolina Administrative Code (NCAC) 2H .0227.
FACILITY SITE REVIEW/OPERATIONS & MAINTENANCE:
The facility appeared to be adequately treating the wastewater and the surrounding grounds were well
maintained. The aeration basin appeared dark brown; however, the mixed liquor appeared to be well mixed
and adequately oxygenated. The process control program consists of dissolved oxygen and settleability
tests. This office recommends the inclusion of MLSS measurements to the process control program. Sludge
wasting is based on the settleability tests. The screenings are disposed at the county landfill. The
entire facility had been painted and addition railing and grating have been installed and reinforced.
The facility is staffed with appropriately certified operators. The ORC and staff were very
knowledgeable of the facility's treatment processes and equipment.
The back-up blower/motor unit and the drive chain unit of the clarifier were not operating properly at
the time of the inspection. In addition, portions of an electrical line was submerged in the aeration
basin. Please be advised that the NPDES Permit requires that the facility be properly operated and
maintained at all times. Note: Both inoperable treatment components were repaired and placed into
operation that same day.
All wastewater is pumped to the WNTP via lift station. The lift station is equipped with operational
audible and visual alarm systems and inspected seven days per week.
LABORATORY:
Statesville Analytical (Certification 4440) in Statesville, N.C. has been contracted. to provide
analytical support. All on -site field analyses are performed under the laboratory's certification. The
laboratory instrumentation utilized for field analyses appeared to be properly calibrated and well
maintained.
EFFLUENT/RECEIVING WATERS:
The facility was not discharging at the time of the inspection. The outfall location was heavily
vegetated, but accessible. The permittee and ORC must ensure that the outfall location is adequately
maintained for inspections of the receiving stream.
SELF -MONITORING PROGRAM:
Self -monitoring reports were reviewed for the period April 2002 through March 2003; inclusive. Daily
maximum TSR violations were reported on March 26, 2002 and January 24, 2003. A monthly average TSR
violation was reported for January 2003. All limit violations have been previously addressed by the
Division. No flow, pH, and temperature was reported for the week of July 28 through August 3, 2002.
Please resubmit an amended DMR if the above noted discrepancies were transcription errors.
All samples (reviewed at the laboratory) appeared to be properly preserved and meet the required holding
times.
FLOW MF.ASUREMENT:
The effluent is measured instantaneously by the bucket and stop watch method.
SLUDGE DISPOSAL:
Sludge is removed by Lentz Septic Tank Service, Inc. of Statesville, N.C. and disposed at the Town of
Mooresville Rocky River WWTP.

Annual Performance Report
Fvor
Notification Certification Form
Name of System:. ✓et»i e v:s nue e/i S i L L c 0-/As re 2 jize"Pi e -R4c
NPDES# /,/P pi S A/c oa 776/5
APR 2 8 2003
I confirm that the Annual Performance Report has been made available
to customers and that the information is correct and consistent with the
compliance monitoring data previously submitted to the DWQ.
The information was made available:
Posted on the Internet
y Mailed the report to customers
Posted on the bulletin board in the office
Document made available for review at
Certified By:
Name. >
Title au, ,v e
Phone# 2 '7/ 0.08-Date - y s- a 3
Div
DEW. ETLICASa
ND MP:TU AL RESOURCES
MOORESVILLE REGIONAL OFFICE
P..'. -7
MAY 0 6 2003

Homer's Truck Stop
Wastewater Treatment Plant
Annual Performance Report
For the Calendar
Year 2002

Homer's Truck Stop Wastewater Treatment Plant
Operator Responsible in Charge:
Jerry Rogers
Statesville Analytical, Inc.
122 Court St.
PO Box 228
Statesville, NC 28687
Contact Person:
Mr. Homer Prevette
PO Box 5218 -5 a 6
Statesville, NC 28687
I. General
The treatment system is an existing 0.025 MGD wastewater
Treatment facility with the following components:
• Grease tank
• Grinder pump tank
• Flow equalization tank with bar screen
• Aeration basin
• Clarifier with sludge return
• Aerated sludge holding tank
• Chlorine contact basin with tablet chlorination
This facility is located at Homer's Truck Stop located on Stamey
Farm Rd. at 1-40 Statesville, Iredell County. Discharge from the
Homer's Truck Stop Wastewater facility is received into Third Creek,
in the Yadkin --Pee Dee drainage Basin.
II. Compliance Performance:

The North Carolina Department of Environment and Natural
Resources (NCDENR) regulates the Homer's Truck Stop effluent
discharge under the National Pollutant Discharge Elimination System
(NPDES). ' The NCDENR issued to Homer's Truck Stop a NPDES
Permit that includes water quality limits and sampling and monitoring
requirements. The NPDES permits requires Homer's Truck Stop to
test for routine wastewater parameters of the treated water leaving the
wastewater facility. The monitoring frequency for these tests is set at
various intervals as set forth in the permit. During the period at which
Statesville Analytical was responsible for the plant operations for the
2002-year a total of tests were conducted. These tests. were performed
on the treated wastewater as it was discharged to the creek. The
WWTP achieved a Compliance level of 100% with its NPDES Permit
Requirements. The following table is a summary of the testing for the
parameters that are assigned Water Quality Standards by the NPDES.
Permit.
Parameter
Number
Tests
Required*
Number
Tests
Conducted
Average
Results
Monthly Permit
Limit
Flow
52
52
0.002 mg/L
0.025 MGD
Biochemical Oxygen
Demand (BOD)
52
53
3.15 mg/L
30.0 mg/L
Total Suspended Solids
(TSS)
52
53
11.93 mg/L
30.0 mg/L
Ammonia as Nitrogen
(NH3asN)
24
25
2.43 mg/L
No limit
Dissolved Oxygen
0
53
6.62 mg/L
N/A
Fecal Coliform
52 ,
53
2
CFU/100mL
200 CFU/100
mL
Total Residual Chlorine
104
124
.59 mg/L
No limit
Temperature
52
53
15.6 °C
No limit
pH
52
53
Range 7.1 to
7.5
>=6, <9
Total Phosphorous
4
4
1.9 mg/L
No limit
Total Nitrogen
4
4
2.9 mg/L
No limit
Oil & Grease
24
24
5.1 mg/L
30.0 mg/L
MBAS
12
12
.23 mg/L
No limit

There was no permit violations during this time period described
above.
III. Certification:
I have personally examined and am familiar with the information
submitted in this document. Based upon my inquiry of those
individuals immediately responsible for obtaining the information
reported herein, I believe that the submitted information is true,
accurate, and complete. I am aware that there are significant penalties
for submitting false information.
Signed this a /
?r -e4 i ce ._
re" vett
Mr. Homer P e
day of f4 `cam , 2003

Homer's Truck Stop
Wastewater Treatment Plant
Annual Performance Report
I For the Calendar
Year 2002

Homer's Truck Stop Wastewater Treatment Plant
Operator Responsible in Charge:
Jerry Rogers
Statesville Analytical, Inc.
122 Court St.
PO Box 228
Statesville, NC 28687
Contact Person:
Mr. Homer Prevette
POBox 5 -8 -5-494
Statesville, NC 28687
I. General
The treatment system is an existing 0.025 MGD wastewater
Treatment facility with the following components:
• Grease tank
• Grinder pump tank
• Flow equalization tank with bar screen
• Aeration basin
• Clarifier with sludge return
• Aerated sludge holding tank
• Chlorine contact basin with tablet chlorination
This facility is located at Homer's Truck Stop located on Stamey
Farm Rd. at 1-40 Statesville, Iredell County. Discharge from the
Homer's Truck Stop Wastewater facility is received into Third Creek,
in the Yadkin --Pee Dee drainage Basin.
II. Compliance Performance:

The North Carolina Department of Environment and Natural
Resources (NCDENR) regulates the Homer's Truck Stop effluent
discharge under the National Pollutant Discharge Elimination System
(NPDES). The NCDENR issued to Homer's Truck Stop a NPDES
Permit that includes water quality limits and sampling and monitoring
requirements. The NPDES permits requires Homer's Truck Stop to
test for routine wastewater parameters of the treated water leaving the
wastewater facility. The monitoring frequency for these tests is set at
various intervals as set forth in the permit. During the period at which
Statesville Analytical was responsible for the plant operations for the
2002-year a total of tests were conducted. These tests were performed
on the treated wastewater as it was discharged to the creek. The
WWTP achieved a Compliance level of 100% with its NPDES Permit
Requirements. The following table is a summary of the testing for the
parameters that are assigned Water Quality Standards by the NPDES
Permit.
Parameter
Number
Tests
Required*
Number
Tests
Conducted
Average
Results
Monthly Permit
Limit
Flow
52
52
0.002 mg/L
0.025 MGD
Biochemical Oxygen
Demand (BOD)
52
53
3.15 mg/L
30.0 mg/L
Total Suspended Solids
(TSS)
52
53
11.93 mg/L
30.0 mg/L
Ammonia as Nitrogen
(NH3asN)
24
25
2.43 mg/L
No limit
Dissolved Oxygen
0
53
6.62 mg/L
N/A
Fecal Coliform
52
53
2
CFU/100mL
200 CFU/100
mL
Total Residual Chlorine
104
124
.59 mg/L
No limit
Temperature
52
53
15.6 °C
No limit
pH
52
53
Range 7.1 to
7.5
>=6, <9
Total Phosphorous
4
4
1.9 mg/L
No limit
Total Nitrogen
4
4
2.9 mg/L
No limit
Oil & Grease
24
24
5.1 mg/L
30.0 mg/L
MBAS
12
12
.23 mg/L
No limit

There was no permit violations during this time period described
above.
III. Certification:
I have personally examined and am familiar with the information
submitted in this document. Based upon my inquiry of those
individuals immediately responsible for obtaining the information
reported herein, I believethat the submitted information is true,
accurate, and complete. I am aware that there are significant penalties
for submitting false information.
Signed this
Mr. Homer Prevette
day of 4,2r-'G , 2003

Homer's Truck Stop
Wastewater Treatment Plant
Annual Performance Report
For the Calendar
Year 2002

Homer's Truck Stop Wastewater Treatment Plant
Operator Responsible in Charge:
Jerry Rogers
Statesville Analytical, Inc.
122 Court St.
PO Box 228
Statesville, NC 28687
Contact Person:
Mr. Homer Prevette
PO Box 52+8- 6- S'
Statesville, NC 28687
I. General
The treatment system is an existing 0.025 MGD wastewater
Treatment facility with the following components:
• Grease tank
• Grinder pump tank
• Flow equalization tank with bar screen
• Aeration basin
• Clarifier with sludge return
• Aerated sludge holding tank
• Chlorine contact basin with tablet chlorination
This facility is located at Homer's Truck Stop located on Stamey
Farm Rd. at 1-40 Statesville, Iredell County. Discharge from the
Homer's Truck Stop Wastewater facility is received into Third Creek,
in the Yadkin --Pee Dee drainage Basin.
II. Compliance Performance:

The North Carolina Department of Environment and Natural
Resources (NCDENR) regulates the Homer's Truck Stop effluent
discharge under the National Pollutant Discharge Elimination System
(NPDES). The NCDENR issued to Homer's Truck Stop a NPDES
Permit that includes water quality limits and sampling and monitoring
requirements. The NPDES permits requires Homer's Truck Stop to
test for routine wastewater parameters of the treated water leaving the
wastewater facility. The monitoring frequency for these tests is set at
various intervals as set forth in the permit. During the period at which
Statesville Analytical was responsible for the plant operations for the
2002-year a total of tests were conducted. These tests were performed
on the treated wastewater as it was discharged to the creek. The
WWTP achieved a Compliance level of 100% with its NPDES Permit
Requirements. The following table is a summary of the testing for the
parameters that are assigned Water Quality Standards by the NPDES
Permit.
Parameter
Number
Tests
Required*
Number
Tests
Conducted
Average
Results
Monthly Permit
Limit
Flow
52
52
0.002 mg/L
0.025 MGD
Biochemical Oxygen
Demand (BOD)
52
53
3.15 mg/L
30.0 mg/L
Total Suspended Solids
(TSS)
52
53
11.93 mg/L
30.0 mg/L
Ammonia as Nitrogen
(NH3asN)
24
25
2.43 mg/L
No limit
Dissolved Oxygen
0
53
6.62 mg/L
N/A
Fecal Coliform
52
53
2
CFU/100mL
200 CFU/100
mL
Total Residual Chlorine
104
124
.59 mg/L
No limit
Temperature
52
53
15.6 °C
No limit
pH
52
53
Range 7.1 to
7.5
>=6, <9
Total Phosphorous
4
4
1.9 mg/L
No limit
Total Nitrogen
4
4
2.9 mg/L
No limit
Oil & Grease
24
24
5.1 mg/L
30.0 mg/L
MBAS
12
12
.23 mg/L
No limit

There was no permit violations during this time period described
above.
III. Certification:
I have personally examined and am familiar with the information
submitted in this document. Based upon my inquiry of . those
individuals immediately responsible for obtaining the information
reported.. herein, I believe that the submitted information is true,
accurate, and complete. I am aware that there are significant penalties
for submitting false information.
Signed this a J day of , 2003
/ic
Mr. omer Prevette

. , - • - x
n
7
7
3
1
u
3
3
CERTIFIED MAIL RECEIPT
(Domestic Mail Only; No Insurance Coverage Provided)
Postage
Certified Fee
Return Receipt Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
SE
si
or
�cf
\ ti _
`\ PI ,
L(,c
Postmark
Here
MR HOMER PREVETTE
HOMER'S TRUCK STOP
PO BOX 5068
STATESVILLE NC 28687 WQ

Certified Mail Provides:
IN A mailing receipt
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Important Reminders:
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• NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. Fo
valuables, please consider Insured or Registered Mail.
s For an additional fee, a Return Receipt may be requested to provide proof o
delivery. To obtain Return Receipt service, please complete and attach a Returi
Receipt (PS Form 3811) to the article and add applicable postage to cover thi
fee. Endorse mailpiece 'Return Receipt Requested". To receive a fee waiver fo
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• For an additional fee, delivery may be restricted to the addressee o
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• If a postmark on the Certified Mail receipt is desired, please present the arti
cle at the post office for postmarking. If a postmark on the Certified Ma
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IMPORTANT: Save this receipt and present it when making an inquiry.
PS Form 3800, January 2001 (Reverse) 102595-01-M-104

Michael F. Easley v
Govemor
William G. Ross, Jr.,Secretary
North Carolina Department of.Environmentand'Natural Resources
Alan W.,KIimek,:Director
:Division.of Water Quality
August 22, 2002
CERTIFIED "MAIL 7001 2510 0005 0288 0203
RETURN RECEIPT REQUESTED
Mr. Homer Prevette
Homer's Truck Stop
P.O. Box 5068
Statesville, NC 28687
Subject: Notice of Violation Effluent Limitations
Homer's Truck Stop WWTP
NPDES Permit No. NC0077615
Iredell County
Dear Mr. Prevette:
A review of the March 2002 self -monitoring report for the subject facility revealed a violation of
the following parameter:
Pipe Parameter Reported Value Limit
001 Total Suspended Residue
45.7 mg/L 45.0 mg/L FIN
Remedial actions,if not"already implemented, should be taken to correct anyproblems. The
Division of Water Quality may pursue enforcement actions for this and any additional violations. If the
violations are of a continuing nature, not related to operation and/or maintenance problems, and you
anticipate remedial construction activities, then you may wish to consider applying for a Special Order by
Consent. You may contact Richard"Bridgeman of this Office foradditional information.
If you have questionsconcerning this matter, please do not hesitate to. contact Mr..Bridgeman or
me at"704/663-1699.
Sincerely,
D. Rex Gleason, P.E.
Water Quality Regional Supervisor
cc: Point Source Compliance/Enforcment Unit
RMB
Customer Service
1 800 623-7748
Mooresville Regional Office, 919 North -Main Street, Mooresville, NC 28115 PHONE [phone]
FAX [phone]

ENDER: COMPLETE THIS SECTION
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item 4 if Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you.
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or on the front if space permits.
1. Article Addressed to:
MR HOMER PREVETTE
HOMERS TRUCK STOP
PO BOX 5068
STATESVILLE NC 28687
WQ
COMPLETE THIS SECTION ON DELIVERY
A. Signature
41.2.2.61 ❑ Agent
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DS Form 3811, August 2001
Domestic Return Receipt
102595-01-M-25(

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VtdNx
WATER QUALITY SECTION
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MOORESVILLE NC 28115
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se HOMER'S TRUCK STOP
siPO BOX 5068
or STATESVILLE NC 28687 WQ
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required.
• For an additional fee, delivery may be restricted to the addressee o
addressee's authorized agent. Advise the clerk or mark the mailpiece with thf
endorsement "Restricted Delivery".
• If a postmark on the Certified Mail receipt is desired, please present the arti
cle at the post office for postmarking. If a postmark on the Certified Mal
receipt is not needed, detach and affix label with postage and mail.
IMPORTANT: Save this receipt and present it when making an inquiry.
PS Form 3800, January 2001 (Reverse) 102595-01-M-104!

Michael F. Easley
Govemor
William G. Ross, Jr., Secretary
Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D., Acting Director
Division of Water Quality
March 19, 2002
`7c;c1 0b )b bDU5 G 7 'ie
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Mr. Homer Prevette
Homer's Truck Stop
Post Office Box 5068
Statesville, North Carolina 28687
Notice of Violation
Subject: Compliance Evaluation Inspection
Homer's Truck Stop WWTP
NPDES Permit No. NC0077615
Iredell County, NC
Dear Mr. Prevette:
Enclosed is a copy of the Compliance Evaluation Inspection Report for the inspection -- =
conducted at the subject facility on March 14, 2002 by Mr. Wes Bell of this Office. Please provide
the facility's Operator -in -Responsible Charge of our findings by forwarding a copy of the enclosed
report to him.
This report is being issued as a Notice of Violation (NOV) because of the continued failure
to provide the proper operation and maintenance as required by the subject NPDES Permit and
North Carolina General Statute (G.S.) 143-215.1 as detailed in the Facility Site Review/Operations
& Maintenance Section of the attached report. Pursuant to G.S. 143-215.6A, a civil penalty of not
more than twenty-five thousand dollars ($25,000.00) per violation, per day may be assessed against
any person who violates or fails to act in accordance with the terms, conditions, or requirements of
any permit issued pursuant to G.S. 143-215.1.
It is requested that a written response be submitted to this Office by April 10, 2002,
addressing the deficiencies noted in the Facility Site Review/Operations & Maintenance,
Laboratory, and Self -Monitoring Sections of the report. In responding, please address your
comments to the attention of Mr. Richard Bridgeman.
Customer Service
1 800 623-7748
Division of Water Quality 919 North Main Street Mooresville, NC 28115 Phone [phone]
Fax [phone]

Mr. Homer Prevette
Notice of Violation
Page Two
The report should be self-explanatory; however, should you have any questions concerning
this report, please do not hesitate to contact Mr. Bell or me at [phone].
Sincerely,
c-, D. Rex Gleason, P.E.
Water Quality Regional Supervisor
Enclosure
cc: Iredell County Health Department

US Environmental Protection Agency, Washington, D.C.,
Water Compliance Inspection Report
NC Division of Water Quality / Mooresville Regional
20460 A 7:5VA
OA.' 1416
Form Approved.
OMB No.2040-0057
Approval Expires 8-31-98
deiD ar4k9.
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Office
N..,,C:„..;DE,,,...NR.
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7.;.:
Transaction Code NPDES No. Yr/Mo/Day Inspection Type Inspector Facility Type
N 5 NC0077615 02/03/14 C S 2
Remarks:.
Inspection Work Days Facility Evaluation Rating BI QA Reserved
1.5 3 N N
Section B:iFacilify Data -•,.--- , -• .:,, ,;.y -
Name and Location of Facility Inspected:
Homer's Truck Stop of Statesville, LLC
Stamey Farm Road at 1-40
Statesville
Iredell County, North Carolina
Entry Time:
12:45 pm
Permit Effective Date:
99/10/01
Exit Time/Date:
3:30 pm
02/03/14
Permit Expiration Date:
04/03/31
Name(s) of On -Site Representative(s)/Title(s)/Phone No(s)/Fax No(s):
Ms. Dena Myers/Back-up ORC/704-872-4697
Mr. Harry Myers/Back-up ORC/704-872-4697
Name and Address of Responsible Official:
Mr. Homer Prevette .
Homer's Truck Stop
Post Office Box 5068
Statesville, North Carolina 28687
Title: Owner •
Phone No:
704-871-8008
Contacted?
No
SectiOn.C:AreasZvaluatediluringInspection (Chick,only-those areas,evaluatefl)
X Permit X Flow Measurement X Operations & Maintenance X Sewer Overflow
X Records/Reports X Self -Monitoring Program X Sludge Handling/Disposal Pollution Prevention
X Facility Site Review Compliance Schedules Pretreatment Multimedia
X Effluent/Receiving Waters X Laboratory Storm Water Other:
#3
• Section'D:;SummaryofFindings/Comments-
See •Attached Sheet(s) for Summary.
Name(s) and Signature(s) of Inspectors:
Wes Bell r „iy
Agency/Office/Telephone No:
NCDWQ/MOORESVILLE/[phone]
Date:
3/19/02
Date:
Signature of Management QA Reviewer:
Agency/Office/Phone & Fax No:
Date:
EPA Form 3560-3 (Rev. 9-94) Previous editions are obsolete

Homers Truck Stop WWTP
Page Two
The facility was last inspected by Wes Bell of this office on February 19, 2001.
PERMIT:
The permit authorizes for the continued operation of an existing 0.025 MGD wastewater
treatment facility consisting of a grease trap, grinder pump tank, flow equalization tank with bar
screen, aeration basin, clarifier with sludge return, aerated sludge holding tank, and a chlorine
contact basin with tablet chlorination.
The permit for this facility became effective on 10/1/99 and expires on 3/31/04.
RECORDS AND REPORTS:
The Operator -in -Responsible Charge(ORC) visitation log, daily operation and maintenance
log, process control data, and the calibration log were reviewed during the inspection. The records
and reports were organized and well maintained.
FACILITY SITE REVIEW/OPERATIONS & MAINTENANCE:
The facility appeared to be operating properly and the surrounding grounds were well
maintained. The aeration basin appeared dark brown; however, the mixed liquor appeared to be well
mixed and adequately oxygenated. The screenings are disposed at the county landfill.
Th back-up blower has not been put into operation and the facility has not been sandblasted
and painted. Note: The inoperable blower was noted in the previous inspection 2/19/01 and the need
of sandblasting and painting has been noted in several previous inspection reports (2/20/01, 8/12/99,
2/17/98, and 4/8/96). In addition, there are serious safety hazards regarding the WWTP's grating
and lack of grating/railing. The grating around the sludge return discharge line had been collapsed
from the ORC standing on it. There was no grating at the blower for the equalization basin to protect
the operator from falling into the equalization basin while performing maintenance on the blower.
The operator has to lean over the large hole to do any blower/motor maintenance. All grating shall
be inspected to insure the protection of the operators. In addition, the railings shall be reinforced and
constructed around the clarifier and other areas that pose fall hazards to the operator. Please be
advised that the NPDES Permit requires that the facility be properly operated and maintained at all
times. In addition, Subpart D, 1910.23(c), of 29 CFR Part 1910, which contains the Occupational
Safety and Health Standards for General Industry, specifies that "Every open -sided floor or platform
4 feet or more above adjacent floor or ground level shall be guarded by standard railing..."
All wastewater is pumped to the WWTP via lift station. The lift station is equipped with
audible and visual alarms and is visited five days per week. The pump station must be inspected 7/w
as required by 15A North Carolina Administrative Code (NCAC) 2H .0227 (effective 7/1/01).
A process control program consists of DO and settleability tests. Sludge wasting is based
on the settleability tests. The back-up ORCs were very knowledgeable of the treatment processes and
equipment used at the facility. The facility is staffed with one Grade II ORC. Certified back-up
operators have been designated and are available when the ORC is unable to visit the facility.
Rating: Unsatisfactory (This section is rated unsatisfactory due to the failures to correct the above
noted deficiencies at the WWTP)

'Homers Truck Stop WWTP
Page Three
LABORATORY:
Statesville Analytical (Certification it110) in Statesville, N.C. has been contracted to provide
analytical support. The laboratory was notevaluated during this inspection. The TRC meter and
thermometer appeared to be properly calibrated.
The calibration data revealed a variance of 0.2 - 0.3 for both the 4.0 and 10.0 buffers and the
check standard (7.0). The ORC and staff utilize a correction factor due to the inability of the pH
meter to be properly calibrated. A correction factor is not allowed for pH analysis. The
manufacturer of the pH meter should be contacted regarding the repair or replacement of the meter.
In addition, the ORC and staff should view the Division's Laboratory Certification Unit's website
that contains the technical guidance for field parameter testing (including proper .instrument
calibration and appropriate documentation) at www.esb.enr.state.nc.us/lab/field parmguide.htm. Mr.
Chet Whiting with the Division's Laboratory Certification Unit can be contacted at 704-663-1699
ext. 297 for additional guidance.
EFFLUENT/RECEIVING WATERS:
The facility was not discharging at the time of the inspection. The facility discharges into
Third Creek, which is a Class C water in the Yadkin -Pee Dee River Basin. The receiving stream did
not appear to be negatively impacted. The outfall location was well maintained and accessible.
A review of the DMRs have indicated numerous TRC values in excess of 284g/1. Be aware
that a stream action level of 17 Aug/1 has been established for total residual chlorine for chronic
toxicity effects. An action level of 28 ,ug/1 has been set as the maximum allowable effluent
concentration to protect the receiving stream against acute toxicity effects. Please maintain the total
residual chlorine concentration as row as possible, while still complying the fecal coliform limits.
SELF -MONITORING PROGRAM:
The facility began utilizing a new contract operational firm in late October 2001. The on -site
field parameters appeared to been collected and analyzed within the required holding times. Self -
monitoring reports were reviewed for the period January 2001 through December 2001, inclusive.
The following violations were reported:
Limit Violations:
- Daily maximum oil & grease exceeded on January 16*, 2001.
- Daily minimum pH exceeded on August 28, 2001.
- Monthly average oil & grease exceeded for January* 2001.
Note: * denotes NOV issuance or civil penalty assessment
Monitoring Violations:
- No effluent BOD, TSR, and fecal coliform was reported for the weeks of July 8 through July 14
and July 15 through July 21, 2001.
Only one oil & grease value was reported for July 2001.

Homers Truck Stop WWTP
Page Four
SELF -MONITORING PROGRAM cont'd:
The noncompliant box was not checked for the months of July and August 2001. If any limit
violations (including monthly, weekly, or daily) were reported or any monitoring frequencies not
adhered to as required by the permit, then the noncompliant box must be checked, and an
explanation of the corrective actions taken should be provided. In addition, the back of the June
2001 DMR (includes compliance status, permittee signature, etc. ) was not submitted to the
Division. Please resubmit amended DMRs if the above noted discrepancies were inadvertent errors.
FLOW MEASUREMENT:
Effluent flow is measured instantaneously by bucket and stop watch method.
SLUDGE DISPOSAL:
Sludge is removed by Lentz Septic Tank Service, Inc. of Statesville, N.C. and disposed at the
Town of Mooresville Rocky River WWTP.
SEWER OVERFLOW:
Please be advised that pursuant to Part II, Section E of your NPDES permit, and North
Carolina Administrative Code (NCAC) 15A 2B .0506 (a)(2), any failure of a collection system,
pumping station or treatment facility resulting in a bypass without treatment of all or any portion of
the wastewater shall be reported to the central office or the appropriate regional office (Mooresville
Regional Office 704-663-1699) as soon as possible but no later than 24 hours from the time the
permittee became aware of the bypass. Overflows and spills occurring outside normal business hours
may also be reported to the Division's Emergency Response personnel at 800-662-7956, 800-858-
0368, or 919-733-3300. A written report shall also be provided within five (5) days of the time of
the incident. The report shall contain a description of the bypass, andits cause; the period of the
bypass, including exact dates and times, and if the bypass has not been corrected, the anticipated time
it is expected to continue; and steps taken (or planned) to reduce, eliminate, and prevent recurrence
of the similar events. Any spill that reaches surface waters (i.e. any spill that reaches any water
already present in a conveyance, stream, ditch, etc...) or any spill greater than 1,000 gallons on the
ground that does not reach surface waters must be reported.
An adequate spill response for those spills reaching surface waters should include an
evaluation downstream of the point at which the spill enteredsurface waters to determine if a fish
kill occurred. The evaluation should also include the collection of upstream dissolved oxygenand
pH measurements for background information and dissolved oxygen and pH measurements at
multiple points downstream of the entry point to document any negative impact. Failure to report
the bypass of collection system, pumping station or treatment facility subjects violators to penalties
of up to $25,000.00 per day per violation.

ENDER: COMPLETE THIS SECTION
Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
Print your name and address on the reverse
so that we can return the card to you.
Attach this card to the back of the mailpiece,
or on the front if space permits.
. Article Addressed to:
MR HOMER PREVETTE
HOMER'S'TRUCK STOP
PO BOX 5068
STATESVILLE NC 28687 WQ
J
3-119 (a
COMPLETE THIS SECTION ON DELIVERY
A. Signature
B eceived • (Printed Name)
❑ Agent
❑ Addressee
C. Date of Delivery
3- 20 -oz
D. Is delivery address differe from item 1? 0 Yes
If YES, enter delivery address below: ❑ No
3. Service Type
® Certified Mail
0 Registered
❑ Insured Mail
0 Express Mail
0 Return Receipt for Merchandise
0 C.O.D.
4. Restricted Delivery? (Extra Fee)
0 Yes
7pg1:2510;i0CIPSi ClEARiii616T
S Form 3811, August 2001
Domestic Return Receipt
if
i' I
102595-01-M-25(

UNITED STATES POSTAL SERVICE
I First -Class Mail
IPostag & Fees Paid
LISPS
Permit No. G-10
• Sender: Please print your name, address, an&ZIP+4 in this box
lJlt✓1V1C ,�
WATER QUALITY SECTION cy y`
919 NORTH MAIN STREET x;
MOORESVILLE NC 28115 ::-"qE.
INJ
1
11111111111£1111£111111111111£11£i1.11111111111111111£ 1£1l 1?l1l

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
December 27, 2001
HOMER PREVETTE
HOMER'S TRUCK STOP
PO BOX 5068
STATESVILLE, NC 28687
Subject: NPDES Stormwater Permit Renewal
HOMER'S TRUCK STOP
COC Number NCG080141
Iredell County
Dear Permittee:
Your facility is currently covered for stormwater discharge under General Permit NCG080000. This permit expires
on August 31; 2002. The Division staff is currently in the process of rewriting this permit and is scheduled to have
the permit reissued by late summer of 2002. Once the permit is reissued, your facility would be eligible for
continued coverage under the reissued permit.
In order to assure your continued coverage under the general permit, you must apply to the Division of Water
Quality (DWQ) for renewal of your permit coverage. To make this renewal process easier, we are informing you in
advance that your permit will be expiring. Enclosed you will find a General Permit Coverage Renewal
Application Form. The application must be completed and returned by March 4, 2002 in order to assure continued
coverage under the general permit.
Failure to request renewal within this time period may result in a civil assessment of at least $250.00. Larger
penalties may be assessed depending on the delinquency of the request. Discharge of stormwater from your facility
without coverage under a valid stormwater NPDES permit would constitute a violation of NCGS 143-215.1 and
could result in assessments of civil penalties of up to $10,000 per day.
Please note that recent federal legislation has extended the "no exposure exclusion" to all operators of industrial
facilities in any of the 11 categories of "storm water discharges associated with industrial activity," (except
construction activities). If you feel your facility can certify a condition of "no exposure", i.e. the facilty industrial
materials and operations are not exposed to stormwater, you can apply for the no exposure exclusion. For additional
information contact the Central Office Stormwater Staff member listed below or check the Stormwater & General
Permits Unit Web Site at http://h2o.enr.state.nc.us/su/stormwater.html
If the subject stormwater discharge to waters of the state has been terminated, please complete the enclosed
Rescission Request Form. Mailing instructions are listed on the bottom of the form. You will be notified when the
rescission process has been completed.
If you have any questions regarding the permit renewal procedures please contact Mike Parker of the Mooresville
Regional Office at 704-663-1699 or Delonda Alexander of the Central Office Stormwater Unit at [phone],
ext. 584
Sincerely,
/3/ ` �242t J 8,09-vy ' 6�
1
. Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Mooresville Regional Office
N. C. Division of Water Quality 1617 Mail Service Center
Raleigh, NC 27699-1617 [phone]
NCDENR
Customer Service
1-800-623-7748

-NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 08-2019 (August 2019)
PERMIT VERSION: 5.0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: No
VERSION: 1.0
PERMIT STATUS: Active
am o qV COUNTY: Iredell
3
O C T 0 3 2019 ORC CERT NUMBER: 7144
RECEIVEDINCDENRIDWR
CEN I NAL FILES STATUS: Processed
DWR SECTION
OCT m72019
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO D�SCHAR OFFICE
el
Composite Sample Time
Total Composite Time
E
t.
-
e
O
Operator Time On Site
—
o
u
O
No Reporting Reason••••
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD - Conc
NH3-N-Cone
TSS - Cone
FCOLI BR
TOTAL N -
2400 clock
Hrs
2400 clock
Hrs
YBM
mgd
deg c
su
ug/1
mg/1
mg/1
mg/1
#/100m1
mg/1
1
1130
-1.5
Y
NOFLOW
2
1115
.75
Y
NOFLOW
3
4
5
1430
1.5
Y
NOFLOW
6
0630
1.0
Y
NOFLOW
7
0815
1.25
Y
NOFLOW
8
0830
2.0
Y
NOFLOW
9
1330
1.5
Y
NOFLOW
to
t1
12
1430
1.0
Y
NOFLOW
13
0745
1.25
Y
NOFLOW
14
0800
1.5
Y
NOFLOW
15
0815
1.75
Y
NOFLOW
16
0630
1.0
Y
NOFLOW
17
18
19
0815
.5
Y
NOFLOW
20
1300
1.0
Y
NOFLOW
21
0800
1.75
Y
NOFLOW
22
0930
1.5
Y
NOFLOW
23
0839
1.0
Y
NOFLOW
24
25
26
1230
1.25
B
NOFLOW
27
1015
.75
B
NOFLOW
28
1200
.75
B -
NOFLOW
29
1330
1.0
B
NOFLOW
30
1100
.75
B
NOFLOW
31
Monthly Average Limit:
0 025
30
30
200
Monthly Average:
-
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 5.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 08-2019 (August 2019) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
Dale
Composite Sample Time
Total Composite Time
E
F
7
a
—
p
Operator Time On Site
ORC On Site?••
z
a`
Z
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Conc
OIL•GESE
MBAS
2400 clack
Hrs
2400 clock
Hrs
Y/B/N
mg/1
mg/I
mg/I
I
1130
1.5
Y
NOFLOW
2
1115
.75
Y
NOFLOW
3
4
5
1430
1.5
Y
NOFLOW
6
0630
1.0
Y
NOFLOW
7
0815
1.25
Y
NOFLOW
8
0830
2.0
Y
NOFLOW
9
1330
1.5
Y
NOFLOW
Io
11
12
1430
1.0
Y
NOFLOW
13
0745
1.25
Y
NOFLOW
14
0800
1.5
Y
NOFLOW
15
0815
1.75
Y
NOFLOW
16
0630
1.0
Y
NOFLOW
17
18
19
0815
.5
Y
NOFLOW
20
1300 .
1.0
Y
NOFLOW
21
0800
1.75
Y
NOFLOW
22
0930
1.5
Y
NOFLOW
23
0839
1.0
Y
NOFLOW
24
25
26
1230
1.25
B
NOFLOW
27
1015
.75
B
NOFLOW
28
1200
.75
B
NOFLOW
29
1330
1.0
B
NOFLOW
30
1100
.75
B
NOFLOW
31
Mon hly Average Limit:
30
Monthly Average:
Dolly Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTFLR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

-NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 5.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 08-2019 (August 2019) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 09/27/2019
09/27/2019
ORC/Certifier Signature: Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
14-/
09/27/2019
Permittee/Submitter Signature:*** Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2024
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 managed 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.
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: Operators
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 07-2019 (July 2019)
PERMIT VERSION: 5.0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: No
VERSION: 1.0
RFC F.NE
PERMIT STATUS: Active
UNTY: Iredell
3
ORC CERT NUMBER: 7144,
SAP 05 2019
kAL FILE TATUS: Processed SEP �/
DWR SECTION 1 �J1
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCI-IIAR J
Ac/ROs
EGIONAL OFFICE
2
a
Composite Sample Time
E
F
.5
u
a
E=
Operator Arrival Titne
Operator Time On Site
_
o
14
O
m
L
S.
a
Z'
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
WeeklyWeekly
2 X week
Weekly2
X month
WeeklyWeekly
Quarterly_
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD-Cone
NH3-N - Coac
TSS-Cone
FCOLI BR
TOTAL N-
2400 clock
Hrs
2400 clock
Hrs
YIBIN
mgd
deg c
su
ug/1
mg/I
mg/1
mg/1
#/I00m1
mg/1
I
1515
.5
Y
NOFLOW
2
1230
1.00
Y
NOFLOW
3
1330
1.00
Y
NOFLOW
4
0830
.5
Y
NOFLOW
5
1230
.5
Y
NOFLOW
6
7
8
1330
.75
Y
NOFLOW
9
1230
1.00
Y
NOFLOW
1a
1100
1.00
Y
NOFLOW
11
1000
1.75
Y
NOFLOW
12
0915
1.5
Y
NOFLOW
13
14
15
1300
1
Y
NOFLOW
16
0930
1.5
Y
NOFLOW
17
1515
.5
Y
NOFLOW
18
0745
1
Y
NOFLOW
19
0945
.5
Y
NOFLOW
20
21
22
0915
.75
Y
NOFLOW
23
0930
1.75
Y
26.2
7.4
< 15
8.4
< 0.5
8
< 1
24
0915
1.25
Y
0.0064
25
0845
1.75
Y
23
26
0915
1.25
Y
27
28
29
1200
.5
Y
NOFLOW
30
1015
1.75
Y
NOFLOW
31
1215
1.75
Y
NOFLOW
Mon Illy Average Limit:
0.025
30
30
200
Monthly Average:
0.0064
26.2
11.5
8.4
0
8
I
Dilly Mailmum:
0.0064
26.2
7.4
23
8.4
0
8
0
Daily 3liaimum:
0.0064
26.2
7.4
0
8.4
0
8
0
""' No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 5.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 07-2019 (July 2019) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
pp
Composite Sample Time
Total Composite Time
Operator Arrival Time
V.
1.
C
p
ORC On Site?..
No Reporting Reason.***
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-CRSE
MBAS
2400 clock
Firs
2400 clock
Hn
Y/B/.i
mg/1
mg/I
mg/1
1
1515
.5
Y
NOFLOW
2
1230
1.00
Y
NOFLOW
3
1330
1.00
Y
NOFLOW
4
0830
.5
Y
NOFLOW
5
1230
.5
Y
NOFLOW
6
7
8
1330
.75
Y
NOFLOW
9
1230
1.00
Y
NOFLOW
10
1100
1.00
Y
NOFLOW
11
1000
1.75
Y
NOFLOW
12
0915
1.5
Y
NOFLOW
13
14
15
1300
1
Y
NOFLOW
16
0930
1.5
Y
NOFLOW
17
1515
.5
Y
NOFLOW
18
0745
1
Y
NOFLOW
19
0945
.5
Y
NOFLOW
20
21
22
0915
.75
Y
NOFLOW
23
0930
1.75
Y
10.9
<0.1
24
0915
1.25
Y
25
1
0845
1.75
Y
26
0915
1.25
Y
27
28
29
1200
.5
Y
NOFLOW
30
1015
1.75
Y
NOFLOW
31
1215
1.75
Y
NOFLOW
Mon hly Average Limit:
30
Monthly Average:
10.9
0
Daily Maximum:
10.9
0
Daily 5linimum:
10.9
0
"'• No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

•
NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 5.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 07-2019 (July 2019) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 08/29/2019
08/29/2019
ORC/Certifier Signature: Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
08/29/2019
Permittee/Submitter Signature:*** Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2024
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 managed 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.
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: Operators
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
r;ACILITY NAME: Origin Food Group, LLC
r
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 06-2019 (June 2019)
VERSION: 1.0
PERMIT VERSION: 5_0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: No
DWR SxEC �105�1
AUG 052019
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
STATUS: Processed
3
RCEIVED/NCDENR/DWR
AUG fl22019
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCH AR �� �!QROS
ln SVIC REGIONAL OFFIC
p
P.
F
y
21
Tg
tj
6
F
E
u
1:
Operator Arrival Time
Operator Time On Site
ORC On Site?**
No Reporting Reason'••'
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD - Cone
NH3-N-Cone
T58-Cone
FCOLI BR
TOTALN-
2400 clock
Hrs
2400 clock
Hrs
Y/BN
mgd
deg c
su
ug/1
mg/I
mg/1
mg/1
#/100m1
mg/1
1
2
3
1500
1.25
Y
4
0715
.5
Y
26
5
0745
3.75
Y
0.0025
23.1
7.16
< 15
4.6
1.79
23
< 1
30.5
6
0630
2.0
Y
7
0815
2.0
Y
<15
8
9
10
0900
1.0
Y
NOFLOW
it
1200
1.25
Y
NOFLOW
12
0530
.25
Y
NOFLOW
13
1045
.5
Y
NOFLOW
14
1030
.5
Y
NOFLOW
15
16
17
1315
1.0
Y
NOFLOW
18
1015
1.75
Y
NOFLOW
19
0630
1.25
Y
NOFLOW
20
0915
1.25
Y
NOFLOW
21
0645
1.0
Y
NOFLOW
22
23
24
1430
.5
Y
NOFLOW
25
0915
1.5
Y
NOFLOW
26
0630
1.75
Y
0.0025 -
24.3
7.43
< 15
7.9
< 0.5
30
< 1
27
0930
1.5
Y
28
0900
1.5
Y
29
30
Mon hly Average Limit:
0.025
30
30
200
Monthly.,verage:
0.0025
23.7
0
6.25
0.895
26.333333
1
30.5
Daily Maximum
0.0025
24.3
7.43
0
7.9
1.79
30
0
30.5
Daily Minimum:
0.0025
23.1
7.16
0
4.6
0
23
0
30.5
"" No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 5.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC:•Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 06-2019 (June 2019) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
C
F
le
y'
_t
E
t
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?••
1.
a
S.
2
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P-Corm
OIL-GRSE
MBAS
2400 clock
Hn
2400 clock
Hn
YB/N
mg/1
mg/1
mg/1
1
2
3
1500
1.25
Y
4
0715
.5
Y
5
0745
3.75
Y
2.4
< 5.26
0.15
6
0630
2.0
Y
7
0815
2.0
Y
8
9
10
0900
1.0
Y
NOFLOW
II
1200
1.25
Y
NOFLOW
12
0530
.25
Y
NOFLOW
13
1045
.5
Y
NOFLOW
14
1030
.5
Y
NOFLOW
15
16
17
1315
1.0
Y
NOFLOW
18
1015
1.75
Y
NOFLOW
19
0630
1.25
Y
NOFLOW
20
0915
1.25
Y
NOFLOW
21
0645
1.0
Y
NOFLOW
22
23
24
1430
.5
Y
NOFLOW
25
0915
1.5
Y
NOFLOW
26
0630
1.75
Y
6.02
27
0930
1.5
Y
28
0900
1.5
Y
29
30
Mon hly Average Limit:
30
htootbty Average:
2.4
3.01
0.15
Dilly Maximum:
2.4
6.02
0.15
Daily MIolmum:
2.4
0
0.15
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NI'DES PERMIT NO.: NC0077615 PERMIT VERSION: 5.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 06-2019 (June 2019) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 07/25/2019
07/25/2019
ORC/Certifier Signature: Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
y this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
ft. --A:•A
07/25/2019
Permittee/Submitter Signature:*** Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2024
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 managed 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.
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: Operators
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 5.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 06-2019 (June 2019) VERSION: 1.0 STATUS: Processed
Report Comments:
No flow on weeks 3 and 4

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 5.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
gIIWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 05-2019 (May 2019) VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7 EIVED/NCDENR/DWR
STATUS: Processed
JUL 8 2019
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHWRGEM Y IONAL OFFICE
C
Composite Semple Time
E2
P
"o
E
u°
B.
F'
Operator Arrival Time
Si
O
iE
p.o
O
2
',Aa
u
O
la
C
'o.
z
,Z
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab"
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD-Cone
NH3-N-Cone
TSS-Cone
FCOLI BR
TOTAL N-
2400 clock
Hrs
2400 clock
Hrs
YB/N
mgd
deg c
su
ug/1
mg/1
mg/1
mg/1
#/100m1
mg/1
1
1430
0.75
B
12
0930
0.50
B
3
1215
0.50
B
4
N
5
N
6
N
7
1045
1.0
B
8
1845
0.5
B
9
1345
1.0
B
10
1115
1.0
Y
11
1015
1.25
Y
12
N
13
1115
0.50
B
14
1130
1.0
Y
15
1345
0.5
Y
16
0845
1.0
Y
17
0730
0.75
Y
18
N
19
N
20
1100
1.0
Y
21
0845
1.0
Y
22
1200
1.0
Y
23
1045
1.0
Y
24
0615
0.75
Y
25
N
26
N
27
0830
0.25
Y
28
1245
1.25
Y
29
0630
0.5
Y
30
0845
1.5
Y
31
0745
1.0
Y
Mon hly Average Limit:
0.025
30
30
200
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 5.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 05-2019 (May 2019) VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
d
fi
I:F
d
E
0
U
Total Composite Time
6
_'.•C
—
F.
8*O
Operator Time On Site
—
e)
•
is
d
m
c'
A'O
Z
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-GRSE
MBAS
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mg/1
mg/1
mg/1
1
1430
0.75
B
2
0930
0.50
B
3
1215
0.50
B
4
N
5
N
6
N
7
1045
1.0
B
8
1845
0.5
B
9
1345
1.0
B
l0
1115
1.0
Y
11
1015
1.25
Y
12
N
13
1115
0.50
B
14
1130
1.0
Y
15
1345
0.5
Y
16
0845
1.0
Y
17
0730
0.75
Y
18
N
19
N
20
1100
1.0
Y
21
0845
1.0
Y
22
1200
1.0
Y
23
1045
1.0
Y
24
0615
0.75
Y
25
N
26
N
27
0830
0.25
Y
28
1245
1.25
Y
39
0630
0.5
Y
30
0845
1.5
Y
31
0745
1.0
Y
Mon hly Average Limit:
30
Monthly Avenge:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

r
NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 5.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 05-2019 (May 2019) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 06/19/2019
06/19/2019
ORC/Certifier Signature: Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I'certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
06/19/2019
Permittee/Submitter Signature:*** Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2024
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: Operators
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 04-2019 (April2019)
VERSION: 1.0
PERMIT VERSION: 5.0 F 131 E 0 PERMIT STATUS: Active
CLASS: WW-2 , COUNTY: Iredell
J
ORC: Dennis W Murdock JUN 0 4 .2019 ORC CERT NUMBER: 7144
ORC HAS CHANGED: Yes CEN'1-pL FILES
OWR SECTION
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
p
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Slte?••
is
c.
a
2,
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2Xweek
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
ROD -Cone
NH3-N - Conc
TSS -Conc
FCOLI BR
TOTAL N-
2400 clock
Hrs
2400 clock
Hrs
YB/N
mgd
deg c
su
ug/1
mg/1
mg/1
mg/1
#/100m1
mg/1
1
0700
0.5
Y
NOFLOW
2
0630
0.25
Y
NOFLOW
3
1400
0.5
Y
NOFLOW
4
0845
0.25
Y
NOFLOW
5
0815
0.75
Y
NOFLOW
6
N
NOFLOW
7
N
NOFLOW
8
0900
1.0
Y
NOFLOW
9
0700
1.25
Y
NOFLOW
to
0700
1.0
Y
NOFLOW
11
0700
1.0
Y
NOFLOW
12
0730
0.5
Y
NOFLOW
13
N
NOFLOW
14
N
NOFLOW
15
0730
1.25
Y
NOFLOW
16
0930
0.75
Y
NOFLOW
17
0730
1.0
Y
NOFLOW
18
0730
1.25
Y
NOFLOW
19
0700
0.25
Y
NOFLOW
20
N
NOFLOW
21
N
NOFLOW
22
1045
0.75
Y
NOFLOW
23
1045
4.0
Y
0.0138
15.9
7.54
< 15
6
7.73
76
< 1
34.09
24
1200
2.5
B
NOFLOW
25
1200
1.0
B
NOFLOW
26
0945 -
0.75
B
NOFLOW
27
N
NOFLOW
28
N
NOFLOW
29
1130
2.25
B
NOFLOW
30
1100
0.75
B
NOFLOW
Monthly Avenge Limit:
0.025
30
30
200
Monthly Average:
0.0138
15.9
0
6
7.73
76
1
34.09
Daily Maximum:
0.0138
15.9
7.54
0
6
7.73
76
0
34.09
Daily Minimum:
0.0138
15.9
7.54
0
6
7.73
76
0
34.09
'•"' No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday
RECEIVED/NCDENR/DWR
JUN 0 7 2010
WOROS
MOORESVILLE REGION!ni. nrmifE

NPDES PERMIT NO.: NC0077615 PERMIT. VERSION: 5.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC, HAS CHANGED: Yes
eDMR PERIOD: 04-2019 (April 2019) VERSION:' 1.0 '
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
it
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Sito?**
No Reporting Reason****
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-GRSE
MBAS
2400 clock
Hrs
2400 clock
Hrs
YBM
mg/1
mg/1
mg/1
1
0700
0.5
Y
NOFLOW
2
0630
0.25
Y
NOFLOW
3
1400
0.5
Y
NOFLOW
4
0845
0.25
Y
NOFLOW
5
0815
0.75
Y
NOFLOW
6
N
NOFLOW
7
N
NOFLOW
8
0900
1.0
Y
NOFLOW
9
0700
1.25
Y
NOFLOW
to
0700
1.0
Y
NOFLOW
1t
0700
1.0
Y
NOFLOW
12
0730
0.5
Y
NOFLOW
13
N
NOFLOW
14
N
NOFLOW
15
0730
1.25
Y
NOFLOW
16
0930
0.75
Y
NOFLOW
17
0730
1.0
Y
NOFLOW
18
0730
1.25
Y
NOFLOW
19
0700
0.25
Y
NOFLOW
20
N
NOFLOW
21
N
NOFLOW
22
1045
0.75
Y
NOFLOW
23
1045
4.0
Y
3.9
<5.05
<0.1
24
1200
2.5
B
NOFLOW
25
1200
1.0
B
NOFLOW
26
0945
0.75
B
NOFLOW
27
N
NOFLOW
28
N
NOFLOW
29
1130
2.25
B
NOFLOW
30
1100
0.75
B
NOFLOW
Monthly Average Limit:
30
Monthly Average:
3.9
0
0
Daily Maximum:
3.9
0
0
Daily Minimum:
3.9
0
0
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 5.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: Yes
eDMR PERIOD: 04-2019 (April 2019) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Non -Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 05/29/2019
05/29/2019
ORC/Certifier Signature: Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
05/29/2019
Permittee/Submitter Signature:*** Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2024
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 managed 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.
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: Operators
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 5.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: Yes
eDMR PERIOD: 04-2019 (April 2019) VERSION: 1.0 STATUS: Processed
Report Comments:
This plant did not have flow for several months. In April when flow was again present, the plant had inadequate microbial life in the aeration basin. This in turn caused the TSS
to exceed the daily maximum limit on April 23rd.

3
NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 03-2019 (March 2019)
PERMIT VERSION: 4.0 cFN PERMIT STATUS: Active
CLASS: WW-2 t COUNTY: Iredell
ORC: Dennis W Murdock MAY 0 7 2019 ORC CERT NUMBER: 7104CEIVED/NCDENR/DWR
ORC HAS CHANGED: NoCEiv j \` ILES
�j1A1
VERSION: 1.0 R SECTION SECT;Ot,a
STATUS: Processed
cllAY 1 3 20 19
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCH i IMviL-Y GIONAL OFFICE
3
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
61
8
U
p
No Reporting Reason••••
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD - Cone
NH3-N-Coat
TSS-Cone
FCOLI BR
TOTAL N-
2400 clock
Hrs
2400 clock
Hn
YB/N
mgd
deg c
su
ug/I
mg/1
mg/I
mg/1
#/100m1
mg/1
1
0800
0.25
B
2
N
3
N
4
0730
1.25
B
5
1030
0.75
B
6
1045
0.25
B
0845
0.25
B
S
0730
0.5
B
N
to
N
11
0915
0.5
B
12
0730
0.5
B
13
0900
0.25
B
14
0730
2.25
B
15
1315
0.5
B
16
N
17
N
18
0730
1.25
B
19
0815
0.25
B
20
0730
0.5
B
21
0730
0.5
B
22
0900
0.25
B
23
N
24
N
25
1515
0.5
B
26
1215
2.0
B
27
0900
0.75
B
28
0845
1.0
B
29
1215
1.0
B
30
N
31
N
Mon hly Average Limit:
0.025
30
30
200
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY =NoVisitation —Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 03-2019 (March 2019) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
2
Composite Sample Time
Total Composite Time
E
1.
T.
Q
e
p'
P.
`e
1-
a
p`
ORC On Site?"
No Reporting Reason••••
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-GRSE
MBAS
2400 clock
Hrs
2400 clock
tin
Y/B/N
mg/1'
mg/1
mg/1
1
0800
0.25
B
2
N
3
N
4
0730
1.25
B
5
1030
0.75
B
6
1045
0.25
B
7
0845
0.25
B
s
0730
0.5
B
9
N
to
N
11
0915
0.5
B
12
0730
0.5
B
13
0900
0.25
B
14
0730
2.25
B
15
1315
0.5
B
16
N
17
N
18
0730
1.25
B
19
0815
0.25
B
20
0730
0.5
B
21
0730
0.5
B
22
0900
0.25
B
23
N
24
N
25
1515
0.5
B
26
1215
2.0
B
27
0900
0.75
B
28
0845
1.0
B
29
1215
1.0
B
30
N
31
N
Mon hly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
«s«« No Reporting Reason: ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY= No Visitation —Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 03-2019 (March 2019)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
STATUS: Processed
SUBMISSION DATE: 04/19/2019
04/19/2019
ORC/Certifier Signature: Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
Ats-s
04/19/2019
Permittee/Submitter Signature:*** Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: Operators
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
I FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 02-2019 (February 2019)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: No
VERSION: 1.0
R C F i,/ PMIT STATUS: Active
MAR 2019 COUNTY: Iredell
G U ORC CERT NUMBER: 7144
CEN t real_ FILES
D\AIR SECTiOI
TATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES
Composite Sample Time
[Total Composite Time
Operator Arrival Time
Operator Time On Site
o
(.2p' p
No Reporting Reason`...
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
HOD -Cone
NH3-N-Cone
TSS - Conc
FCOLI BR
TOTAL N -
2400 clock
Hrs
2400 clock
ire
'MIN
mgd
deg c
su
ug/1
mg/1
mg/1
mg/l
#/100m1
mg/I
1
0730
0.5
B
pi'"
i-��
7 r r
2
N
r
8® �..o..
L L. t `i
L. L..
3
N
MAR
2,72,019
4
1430
0.5
B
5
0830
0.5
B
CENTRAL
t-
FILES
6
0700
0.25
B
D\'VR
SECTION
7
1015
0.25
B
8
0700
0.25
B
9
N
to
N
11
0830
0.75
B
12
1330
0.75
B
13
0645
0.5
B
14
0700
0.5
B
15
0730
0.25
B
16
N
17
N
1B
1400
0.25
B
19
0830
1.0
B
20
0715
1.0
B
21
0545
0.25
B
22
0630
0.25
B
73
N
24
N
25
0900
0.5
B
26
1215
1.0
B
27
0845
0.75
B
28
1145
0.25
B
Monthly Average Limit:
0.025
30
30
200
Monthly Average:
Daily Maximum:
Daily Minimum:
•"' No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 02-2019 (February 2019) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
p
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
11.
o°
U
0
No Reporting Reasonf11°
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Conc
OIL -CASE
MBAS
2400 dock
Hrs
2400 clock
Ws
Y/B/N
mg/1
mg/1
mg/1
1
0730
0.5
B
2
N
3
N
4
1430
0.5
B
5
0830
0.5
B
6
0700
0.25
B
7
1015
0.25
B
8
0700
0.25
B
9
N
10
N
11
0830
0.75
B
12
1330
0.75
B
13
0645
0.5
B
14
0700
0.5
B
15
0730
0.25
B
16
N
17
N
18
1400
0.25
B
19
0830
1.0
B
20
0715
1.0
B
21
0545
0.25
B
22
0630
0.25
B
23
N
24
N
25
0900
0.5
B
26
1215
1.0
B
27
0845
0.75
B
28
1145
0.25
B
Mon hly Average Limit:
— — -
30
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR=NoVisitation— AdverseWeather; NOFLOW = No Flow; HOLIDAY No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 02-2019 (February 2019) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 03/21/2019
03/21/2019
ORC/Certifier Signature: Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
03/21/2019
Permittee/Submitter Signature:*** Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: Dennis Murdock
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 02-2019 (February 2019) VERSION: 1.0 STATUS: Processed
Report Comments:
THIS FACILITY HAD NO FLOW FOR THE ENTIRE MONTH OF FEBRUARY.

NPDES PERMIT NO.: NC0077615
ACILITY NAME: Origin Food Group, LLC
PWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 01-2019 (January 2019)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: Yes
VERSION: 1.0
SAMPLING LOCATION: EFFLUENT
ECF
_ C PERMIT STATUS: Active
"a (C—'CY:Iredell
MAR 0 2 tit CERT NUMBER: 7144
RECEIVEDINCDENR/DVV '
CENT I k,LQ Fl
DWR SECTION -Us: Processed
ma 4 ' 2.1119
� I -
DISCHARGE NO.: 001 NO DISCHARGE*.
MOORESVILLE . UIONAL OFFICE
Composite Sample Time
E
1-
'"
u°
—
Operator Arrival Time
Operator Time On Site
_
o
u
O
e
§
Y
a
41'F=
Z
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW, •
TEMP-C
pH
CHLORINE
BOD - Conc
NH3-N-Conc
TSS - Conc
FCOLI BR
TOTAL N-
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mgd
deg c
su
ug/1
mg/1
mg/1
mg/1
tl/100m1
mg/1
1
N
HOLIDAY
2
0845
0.5
B
3
0730
0.25
B
4
0730
0.25
B
5
N
6
N
7
0930
0.25
B
8
1315
1.0
B
9
0730
0.25
B
10
1030
0.25
B
11
1330
0.5
B
12
N
13
N
14
0730
0.25
B
15
1000
0.25
B
16
0630
0.25
B
17
0945
0.25
B
18
0730
0.25
B
19
N
20
N
21
0730
0.25
B
22
1000
0.5
B
23
0900
0.25
B
24
0630
0.5
B
25
0730
0.25
B
26
N
27
N
28'
0930
1.0
B
29
1015
0.25
B
30
0730
0.25
B
31
0645
0.25
B
Mon Illy Average Limit:
0.025
30
30
200
Monthly Average:
Daily Maximum:
Daily Minimum:
* No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation— Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: Yes
eDMR PERIOD: 01-2019 (January 2019) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
p'
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?"
No Reporting Reason""
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-GRSE
MBAS
2400 clock
Hn
2400 clock
Hn
YB/N
mg/I
mg/I
mg/I
1
N
HOLIDAY
2
0845
0.5
B
3
0730
0.25
B
4
0730
0.25
B
5
N
6
N
7
0930
0.25
B
8
1315
1.0
B
9
0730
0.25
B
10
1030
0.25
B
11
1330
0.5
B
12
N
13
N
14
0730
0.25
B
15
1000
0.25
B
16
0630
0.25
B
17
0945
0.25
B
18
0730
0.25
B
19
N
20
N
21
0730
0.25
B
22
1000
0.5
B
23
0900
0.25
B
24
0630
0.5
B
25
0730
0.25
B
26
N
27
N
28
0930
1.0
B
29
1015
0.25
B
30
0730
0.25
B
31
0645
0.25
B
Mon hly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: Yes
eDMR PERIOD: 01-2019 (January 2019) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 02/20/2019
02/20/2019
ORC/Certifier Signature: Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
02/20/2019
Permittee/Submitter Signature:*** Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: Operators
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).
I

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: Yes
eDMR PERIOD: 01-2019 (January 2019) VERSION: 1.0 STATUS: Processed
Report Comments:
THIS FACILITY HAD NO FLOW FOR THE ENTIRE MONTH OF JANUARY.

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Donald G Zufall
GRADE: WW-4 �,I� �1L �ii L,.
eDMR PERIOD: 12-2018 (December 2018) VERSION: 1.0`NC1 SECTION t STATUS: Processed
ECTIOP! FEB 0 4 201.9
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISC ZGE*Y(NOS
6VI U� SVILLE REGIONAL OFFICE
ORC HAS CHANGED: Ye
1 I� E
c�-fie 1
{max.=.. /FD
JAN 2 5 2019
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 1002600
RE CEIVEDINCDE,NR/DWR
Composite Sample Time
F
E
d
71-1
F'
Operator Arrival Time
It
Di
OC
E
F
.0
Oee
li
O°
O
No Reporting Reason••'•
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab _
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD - Cone
NH3-N-Colic
TSS - Cone
FCOLI BR
TOTAL N -
2400 clock
Hrs
2400 clock
Hrs
YB/N
mgd
deg a
su
ug/I
mg/1
mg/1
mg/I
#/100m1
mg/1
1
N
2
N
3
1400
0.5
Y
NOFLOW
4
1300
0.5
Y
NOFLOW
5
1115
0.5
Y
NOFLOW
6
.
1015
0.5
Y
NOFLOW
7
1100
0.25
Y
NOFLOW
8
N
9
N
10
N
ENVWTHR
11
1145
0.25
Y
NOFLOW
12
1030
0.25
Y
NOFLOW
13
1030
1.5
Y
NOFLOW
14
1515
0.25
Y
NOFLOW
IS
N
16
N
17
1415
2.25
Y
NOFLOW
18
0945
1.75
Y
0.0117
6
0.67
7
< I
19
0730
2.5
Y
3.6
8.53
< 15
Z0
0730
1.75
Y
21
21
0745
1.0
Y
NOFLOW
22
N
23
N
24
N
HOLIDAY
25
N
HOLIDAY
26
0730
1.5
Y
NOFLOW
27
0730
0.25
Y
NOFLOW
28
0700
0.25
Y
NOFLOW
29
N
30
N
31
0730
0.25
Y
NOFLOW
Mon hly Average Limit:
0.025
30
30
200
!Monthly Average.
0.0117
3.6
10.5
6
0.67
7
1
Daily Maximum:
0.0117
3.6
8.53
21
6
0.67
7
0
• Daily Minimum:
0.0117
3.6
8.53
0
6
0.67
7
0
'•" No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Donald G Zufall ORC CERT NUMBER: 1002600
GRADE: WW-4 ORC HAS CHANGED: Yes
eDMR PERIOD: 12-2018 (December 2018) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
:f
Composite Sample Time
'Total Composite Time 1
Operator Arrival Time
Operator Time On Site
ORC On Site?••
4
v
3.
tz
,�
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-GRSE
MMBAS
2400 clock
Ho
2400 clock
Bra
Y/B/N
mg/1
mg/1
mg/1
1
N
2
N
3
1400
0.5
Y
NOFLOW
4
1300
0.5
Y
NOFLOW
5
1115
0.5
Y
NOFLOW
6
1015
0.5
Y
NOFLOW
7
1100
0.25
Y
NOFLOW
8
N
9
N
to
N
ENVWTHR
11
1145
0.25
Y
NOFLOW
12
1030
0.25
Y
NOFLOW
13
1030
1.5
Y
NOFLOW
14
1515
0.25
Y
NOFLOW
15
N
16
N
17
1415
2.25
Y
NOFLOW
18
0945
1.75
Y
6.6
0.23
19
0730
2.5
Y
20
0730
1.75
Y
21
0745
1.0
Y
NOFLOW
22
N
23
N
24
N
HOLIDAY
25
N
HOLIDAY
26
0730
1.5
Y
NOFLOW
27
0730
0.25
Y
NOFLOW
28
0700
0.25
Y
NOFLOW
29
N
30
N
31
0730
0.25
Y
NOFLOW
Monthly Average Limit:
30
Monthly Average:
6.6
0.23
Daily Maximum:
6.6
0.23
Daily Minimum:
6.6
0.23
"" No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation— Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-4
eDMR PERIOD: 12-2018 (December 2018)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Iredell
ORC: Donald G Zufall ORC CERT NUMBER: 1002600
ORC HAS CHANGED: Yes
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 01/14/2019
01/14/2019
ORC/Certifier Signature: Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
01/14/2019
Permittee/Submitter Signature:*** Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: Operators
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Donald G Zufall ORC CERT NUMBER: 1002600
GRADE: WW-4 ORC HAS CHANGED: Yes
eDMR PERIOD: 12-2018 (December 2018) VERSION: 1.0 STATUS: Processed
Report Comments:
THIS FACILITY HAD NO FLOW FOR THE ENTIRE MONTH OF DECEMBER EXCEPT FOR THE 18TH-20th.

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GI RADE: WW-3.
eDMR PERIOD: 11-2018 (November 2018)
PERMIT VERSION: i \ECE `ED
CLASS: WW-2 I
ORC: Dennis W Murdock JAN 0 �019
ORC HAS CHANGED: 1Jq.NT L FILES
VERSION: 1_0 DWR SECTION
PERMIT STATUS: Active
COUNTY: Iredell
3
ORC CERT NUMBER: 7144
RECEIVEDINCDENR/DWR
JAN 1 4 2019
STATUS: Processed
W ROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCWL'GIONALOFFICE
c
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Sim?•'
No Reporting Reason""
50050
00010
00400
50060
C0310
C06I0
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
HOD -Cone
MLIV-Cone
TSS-Cone
FCOLI BR
TOTAL N-
2400 clock
110
2400 clock
lira
YIOR7
mgd
deg c
su
ug/I
mg/1
Ing/1
mg/1
#/100m1
mg/I
1
1015
0.75
Y
2
0900
0.75
Y
3
N
4
N
5
0845
0.25
Y
6
0945
0.75
Y
7
0730
0.75
Y
8
0915
1.0
Y
9
0730
0.5
Y
to
N
11
N
12
0930
0.25
Y
13
1245
1.5
Y
14
0730
0.5
Y
15
0715
0.5
Y
16
0730
0.5
Y
17
N
18
N
19
0830
0.25
Y
20
0715
0.75
Y
21
0845
0.75
Y
22
HOLIDAY
23
0830
0.25
Y
24
N
25
N
26
1300
0.50
Y
27
1015
0.50
Y
28
0915
0.75
Y
29
1045
0.5
Y
30
I100
0.25
Y
Mon hly Average Limit:
0.025
30
30
200
Monthly Average:
Daily Maximum:
Daily 311nimum:
«sfs No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock
GRADE: WW-3.
eDMR PERIOD: 11-2018 (November 2018) VERSION: 1.0
ORC HAS CHANGED: No
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
t:
Composite Sample Time
E.
I:
E
v
71
t-'
E
F-
3
2
O
Operator Time On Site
ORC On Site?••
No Reporting Reason`•"
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
01L-CRSE
MBAS
2400 clock
Mrs
2400 clock
lire
Y!B/N
mg/I
tnt/I
mg/1
1
1015
0.75
Y
2
0900
0.75
Y
3
N
4
N
5
0845
0.25
Y
6
0945
0.75
Y
7
0730
0.75
Y
g
0915
1.0
Y
9
0730
0.5
Y
l0
N
u
N
12
0930
0.25
Y
13
1245
1.5
Y
14
0730
0.5
Y
15
0715
0.5
Y
16
0730
0.5
Y
17
N
18
N
19
0830
0.25
Y
20
0715
0.75
Y
21
0845
0.75
Y
22
HOLIDAY
23
0830
0.25
Y
24
N
25
N
26
1300
0.50
Y
27
1015
0.50
Y
28
0915
0.75
Y
29
1045
0.5
Y
30
1100
0.25
Y
Mon hly Average Limit:
J0
Monthly Average:
Daily 'Maximum:
Daily Minimum:
.ssr No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 11-2018 (November 2018) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 12/20/2018
12/20/2018
ORC/Certifier Signature: Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the pennittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
12/20/2018
Permittee/Submitter Signature:*** Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: Operators
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Pennittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 11-2018 (November 2018) VERSION: 1.0 STATUS: Processed
Report Comments:
THIS FACILITY HAD NO FLOW FOR THE ENTIRE MONTH OF NOVEMBER.

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 10-2018 (October 2018) VERSION: 1.0
REr,FivE:ERMIT STATUS: Active 3
COUNTY: Iredell
DEC 0 6 7I 18 ORC CERT NUMBER: 7144 RECEIVED/NCDENR/DWO
CEN i iP-`,L FILES
L-DWF SECTION STATUS: Processed
DEC 17 2018
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHAROWiff REGIONAL OFFIC
G
Composite Semple Time
Total Composite Time
Operator Arrival Time
1 Operator Time On Site
1 ORC On Site?"
No Reporting Reason••'•
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X tnonth
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pil
CHLORINE
BOD-Cone
N113-N-Cone
TSS-Cone
FCOLI BR
TOTALN-
2400 clock
Hn
2400 clock
Ho
VBIN
mgd
deg c
su
ut/I
mg/1
mg/1
mg/I
#/IOOmI
mg/1
I
1415
0.75
Y
NOFLOW
2
1200
0.75
Y
NOFLOW
3
1230
0.5
Y
NOFLOW
14
0730
0.75
Y
NOFLOW
5
0800
1.0
Y
NOFLOW
6
N
NOFLOW
7
N
NOFLOW
8
0845
0.75
Y
NOFLOW
9
0730
0.5
Y
NOFLOW
t0
0900
1.25
Y
NOFLOW
it
0730
1.25
Y
NOFLOW
12
0745
1.0
Y
NOFLOW
13
N
NOFLOW
14
N
NOFLOW
IS
0630
1.5
Y
0.003
17.4
7.61
< 15
6
<0.5
3.375
<1
1.57
16
0800
1.25
Y
NOFLOW
17
1230
1.75
Y
NOFLOW
18
0700
1.0
Y
NOFLOW
19
0700
1.0
Y
NOFLOW
20
N
NOFLOW
21
N
NOFLOW
22
0900
0.75
Y
NOFLOW
23
0900
0.75
Y
NOFLOW
24
1115
1.5
Y
NOFLOW
25
1700
0.25
Y
NOFLOW
26
0700
0.25
Y
NOFLOW
27
N
NOFLOW
28
N
NOFLOW
29
0700
1.0
Y
NOFLOW
30
1045
1.25
Y
NOFLOW
31
1015
0.25
Y
NOFLOW
Mon hly Average Limit:
0.025
30
30
200
Noothly Average:
0.003
17.4
0
6
0
3.375
1
1s7
Dolly maximum:
0.003
17.4
7.61
0
6
0
3.375
0
1.57
Daily Minimum:
0.003
17.4
7.61
0
6
0
3.375
0
L57
"""" No Reporting Reason: ENFRUSE = No Flow-Reuse/Rccycle; ENV WTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
QWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
TRADE: WW-3. ORC HAS CHANGED: No
DMR PERIOD: 10-2018 (October 2018) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
o
e
:
atF
U
E
_
E
1
1=
F
-
O
P.
O
B
C
O
ORC On Site?.*
No Reporting Reason.".
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-CRSE
MBAS
2400 clock
Ho
2400 clock
Hre
YB/N
-
mg/1
ing/I
mg/I
1
1415
0.75
Y
NOFLOW
2
1200
0.75
Y
NOFLOW
3
1230
0.5
Y
NOFLOW
4
0730
0.75
Y
NOFLOW
5
0800
1.0
Y
NOFLOW
6
N
NOFLOW
7
N
NOFLOW
8
0845
0.75
Y
NOFLOW
9
0730
0.5
Y
NOFLOW
10
0900
1.25
Y
NOFLOW
11
0730
1.25
Y
NOFLOW
12
0745
1.0
Y
NOFLOW
13
N
NOFLOW
14
N
NOFLOW
15
0630
1.5
Y
1.2
<5.05
0.3
16
0800
1.25
Y
NOFLOW
17
1230
1.75
Y
NOFLOW
18
0700
1.0
Y
NOFLOW
19
0700
1.0
Y
NOFLOW
20
N
NOFLOW
21
N
NOFLOW
22
0900
0.75
Y
NOFLOW
23
0900
0.75
Y
NOFLOW
24
1115
1.5
Y
NOFLOW
25
1700
0.25
Y
NOFLOW
26
0700
0.25
Y
NOFLOW
27
N
NOFLOW
28
N
NOFLOW
29
0700
1.0
Y
NOFLOW
30
1045
1.25
Y
NOFLOW
31
10I5
0.25
Y
NOFLOW
Mon lily Average Limit:
30
Monthly Average:
1.2
0
0.3
Dolly Maalmum:
1.2
0
0.3
Daily 311mmmn:
1.2
0
0.3
•*** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY=NoVisitation- Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
WNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
RADE: WW-3. ORC HAS CHANGED: No
MR PERIOD: 10-2018 (October 2018) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 11/28/2018
f
11/28/2018
ORC/Certifier Signature: Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
11/28/2018
ermittee/Submitter Signature:*** Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: Dennis Murdock
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell •
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 10-2018 (October 2018) VERSION: 1.0 STATUS: Processed
Report Comments:
This facility did not have flow for the entire month of October except for the 15th.

NPDES PERMIT NO.: IIIC007761 S
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 09-2018 (September 2018)
1
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: No
PERMIT STATUS: Active
6 F C E 1 V E Dn COUNTY: Iredell
NOV 07 2018
ORC CERT NUMBER: 7144
RECEIVED/iNCDEiNR/D1/UR
VERSION: 1.0 CENTRAL FILES STATUS: Processed
DWR SECTION
i\i U V 1 3 2018
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE tr?S
MOORESVILLE REGI
o
Composite Sample Time
E
"_
0
el
F
Operator Arrival Time
Operator Time On Site
ORC On Sltr?•e
a`
a
50050
00010
110400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
p11
CHLORINE
ROD -Cone
N113-N-Cone
TSS-Cone
FCOLI BR
TOTAL N-
2400 clock
11re
2400 clock
Hr
WW1
tngd
deg c
sn
ug/1
mg/1
tng/l
tng/I
#/100m1
mg/I
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Man hly Average Limit:
0.025
30
30
200
Monthly Average:
Doily Maximmn
Doily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENV WTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 09-2018 (September 2018) VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
Composite Sample Time
E r.
2.
EF
u
F=
0
u
C
O
_
E
C
O
ORC On Slle?••
ed
—
z
j
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-GRSE
MBAS
2400 clack
11rs
2400 clock
firs
WWI
tng/l
tnb/I
mg/I
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
ID
19
20
21
22
23
24
25
26
27
28
29
30
Man hly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
o Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; ]IOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.:INIC007761 t
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 09-2018 (September 2018)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: No
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 10/26/2018
10/26/2018
ORC/Certifier Signature: Chris Bitterman E-Mail:[e-mail] Phone ##:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the pennittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
10/26/2018
Permittee/Submitter Signature:*** Chris Bitterman E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME: Stateville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: Dennis Murdock
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/fonns.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Petntittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

'NPiDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 07-2018 (July 2018)
PERMIT VERSION: 4.0 CLASS:WW-2 RECEIVED
ORC: Dennis W Murdock SEP 04 2018
ORC HAS CHANGED: No
VERSION: 1.0 CEN I KAL FILES
DWR SECTION
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 714RECEIVED/NCDENR/DWR
STATUS: Processed
SEP 1 0 2E118
��p WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCI Y EGIONAL OFFICE
Composite Sample Time
Total Compositc Time
g
a
8.
o
It
71
o
1
F
at
o
ORC On Silo?••
No Reporting Reason••••
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600 '
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Recorder
Grab
Grab
Gab
Composite
Composite
Composite
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
HOD - Cone
NH3-N-Cone
TSS-Cone
FCOLI BR
TOTAL N-
2400 clock
Hrs
2400 clock
Hrs
YB/N
mgd
deg c
su
ug/1
mg/I
mg/I
mg/I
#/100m1
mg/I
1
2
0930
1.75
Y
3
0915
0.25
Y
4
0630
0.25
Y
5
1000
1
Y
6
1100
1.25
Y
7
8
9
0630
0.25
Y
1¢
1300
1.5
Y
1
1100
0.75
Y
11
0630
1
Y
i{
0630
0.25
Y
14
15
16
1315
1
Y
17
1130
1
Y
18
0815
0.5
Y
19
0745
1
Y
Z0
0800
0.75
Y
21
22
2?
1015
1
Y
24
0845
1.25
Y
25
1030
1
Y
26
1000
1
Y
27
1100
1
Y
28
29
30
1200
1.5
Y
31
1200
0.5
Y
Mon hly Average Limit:
0.025
30
30
200
I Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR=NoVisitation— AdverseWeather, NOFLOW = No Flow; HOLIDAY No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 07-2018 (July 2018) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
o
g
F
e
u'
Total Composilo Time
F
<
5
0
O
P.
y
CI
P.
FP.
s
0
O
_
-
o`
ucc
O
:
1
ee
•0
8
a
Z°
C0665
09556
38260 -
Quarterly
2 X month
Monthly
Composite
Composite
Composite
TOTAL P - Cone
OIL-GRSE
MBAS
2400 clock
Hrs
2400 cock
Hrs
WHIN
mg/1
mg/I
mg/1
1
2
0930
1.75
Y
3
0915
0.25
Y
4
0630
0.25
Y
5
1000
1
Y
6
1100
1.25
Y
7
8
9
0630
0.25
Y
10
1300
1.5
Y
11
1100
0.75
Y
12
0630
1
Y
13 .
0630
0.25
Y
14
15
16
1315
1
Y
17
1130
1
Y
18
0815
0.5
Y
19
0745
1
Y
20
0800
0.75
Y
21
22
23
1015
1
Y
24
0845
1.25
Y
25
1030
1
Y
26
1000
1
Y
27
1100
1
Y
28
29
30
1200
1.5
Y
31
1200
0.5
Y
Mon hly As emge Limit:
30
Monlhly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE =No Flow-Reuse/Recycle; ENVWTHR=NoVisitation— AdverseWeather, NOFLOW=No Flow; HOLIDAY=No Visitation — Holiday
4

-`NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 08/17/2018
GRADE: WW-3.
1
eDMR PERIOD: 07-2018 (July 2018)
COMPLIANCE STATUS: Compliant
08/13/2018
0 C/Certifier Signature: Thomas David Johnson E-Mail:[e-mail] Phone #:[phone] Date
Bthis signature, I certify that this report is accurate and complete to the best of my knowledge.
e permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
y information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
p ovided within 5 days of the time the permittee becomes aware of the circumstances.
I the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
08/17/2018
Permitlee/Submitter Sig fr ure:*** Heather Thomas Adams E-Mail:[e-mail] Phone #:[phone] Date
Plermittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
I 1Certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
td assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed 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
lowing violations.
EAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
I'ERSON(s) COLLECTING SAMPLES: operators
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE;: WW-3.
eDMR PERIOD: 06-2018 (June 2018)
PERMIT VERSION: 4.0 r� PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Iredell
ORC: Dennis W Murdock O C IY 04 2018 ORC CERT NUMBER: Fg4EIVEO/NCDEPIR1bWR
ORC HAS CHANGED: No C AI I kAL FILES O C T 8 2018
VERSION: 3.0 �W� SECTION STATUS: Processed
WQROS
MOORESVILLE REGIONAL OFFICE
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
F
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?"
=
e
a
e
I
a 8.
y'
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
, Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Recorder
Grab
Grab
Grab
Composite
Composite
Composite
Grab
Grab
FLOW
TEMP-C
pH
CIILORINE
BOD-Conc
NIU-N-Conc
TSS-Conc
FCOLI BR
TOTAL N -
2400 clock
lirs
2400 clock
Hrs
Y/BIN
mgd
deg c
su
ug/1
mg/1
mg/l
mg/1
#/100m1
mg/1
1
1130
0.25
Y
2
3
4
1015
1.75
Y
20.6
7.7
< 15
18
7.17
44
< 1
5
0915
0.75
Y
6
1000
1.75
Y
0.0046
<15
7
0630
0.5
Y
8
1000
1.25
Y
9
10
II
0630 •
1
Y
NOFLOW
12
0830
1
Y
NOFLOW
I
13
0630
0.5
Y
NOFLOW
14
0630
1
Y
NOFLOW
IS
1115
0.5
Y
NOFLOW
I
16
17
18
1015
1
Y
NOFLOW
19
1215
1
Y
NOFLOW
20
0630
0.5
Y
NOFLOW
21
0915
1.75
Y
NOFLOW
22
1115
1.25
Y
NOFLOW
23
24
25
1100
1
Y
NOFLOW
26
0900
1
Y
0.0016
24.6
7.7
< 15
7
5.94
18.667
< 1
30.27
27
945
2.25
Y
NOFLOW
28
1000
2
Y
NOFLOW
.
29
0630
0.75
Y
NOFLOW
30
Mon hly Average Limit:
0.025
30
30
200
3tonthly Average:
0.0031
22.6
0
12.5
6.555
31.3335
1
30.27
Daily Maximum:
0.0046
24.6
7.7
0
18
7.17
44
0
30.27
Daily Minimum:
0.0016
20.6
7.7
0
7
5.94
18.667
0
30.27
No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR=NoVisitation- AdverseWeather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 06-2018 (June 2018) VERSION: 3.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
O
E.
F-
E
h
.21
e
U
Total Composite Time
Operator Arrival Time
Operator Time On Site
•
1
N
u
O
No Reporting Reason••••
C0665
00556
38260
00630
Quarterly
2 X month
Monthly
Composite
Composite
Composite
Calculated
TOTAL P - Cone
OIL-GRSE
MBAS
NO2&NW
2400 dock
tars
2400 dock
ars
Y/B/N
mg/1
mg/I
mg/1
mg/1
1
1130
0.25
Y
2I
3
4
1015
1.75
Y
<5.21
0.17
5
0915
0.75
Y
6
1000
1.75
Y
7
0630
0.5
Y
s
1000
1.25
Y
9
10
11
0630
1
Y
NOFLOW
f
12
0830
1
Y
NOFLOW
1
13
0630
0.5
Y
NOFLOW
1
14
0630
1
Y
NOFLOW
15
1115
0.5
Y
NOFLOW
f
16
17
18
1015
1
Y
NOFLOW
19
1215
1
Y
NOFLOW
20
0630
0.5
Y
NOFLOW
21
0915
1.75
Y
NOFLOW
22
1115
1.25
Y
NOFLOW
23
24
25
1100
1
Y
NOFLOW
26
0900
1
Y
1.9
< 5.43 -
23.1
27
945
2.25
Y
NOFLOW
28
1000
2
Y
NOFLOW
29
0630
0.75
Y
NOFLOW
30
Man hly Average Limit:
30
Monthly Average:
1.9
0
0.17
-
23.1
Daily Maximum:
1.9
0
0.17
23.1
Daily Minimum:
1.9
0
0.17
23.1
** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615
I`ACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 06-2018 (June 2018)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: lredell
ORC: Dennis W Murdock ORC CERT NUMBER: 7144
ORC HAS CHANGED: No
VERSION: 3.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 09/13/2018
09/12/2018
ORC/Certifier Signature: Thomas David Johnson E-Mail:[e-mail] Phone 4:252-419-2199 Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
09/13/2018
Permittee/Subrnitt gnature:*** Heather Thomas Adams E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:., 6 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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 imprisomnent for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: operators
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there arc no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per I5A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the pemuttce, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDTR PERIOD: 06-2018 (June 2018)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: No
VERSION: 3.0
SAMPLING LOCATION: EFFLUENT
1\iE
OCT 04 201a
CENTRAL FILES
DWR SECTION
DISCHARGE NO.: 001
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7-I!4CE1VED/NCDENR/DWF
STATUS: Processed
OCT 8 2018
,ppggpp WQROS
NO DISCft9 � GIONAL OFFICE
tt
C
E
F
-
a
"
E
r.,
Total Composite Time
Operator Arrival Time
22
17,
O
fE
C
O
ORC On Slte?'•
le
a
a
5
Z
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Recorder
Grab
Grab
Grab
Composite
Composite
Composite
Grab
Grab
FLOW
TEMP-C
pil
CHLORINE
BOD - Conc
N113-N-Cone
TSS - Conc
FCOLI BR
TOTAL N-
2400 clock
Hrx
2400 clock
Hrs
YIB/N
mgd
deg c
su
ug/1
mg/I
mg/I
mg/1
#/100m1
mg/I
1
1130
0.25
Y
2
3
4
1015
1.75
Y
20.6
7.7
< 15
18
7.17
44
< 1
5
0915
0.75
Y
6
1000
1.75
Y
0.0046
< 15
7
0630
0.5
Y
8
1000
1.25
Y
9
10
11
0630
1
Y
NOFLOW
12
0830
1
Y
NOFLOW
13
0630
0.5
Y
NOFLOW
14
0630
1
Y
NOFLOW
15
1115
0.5
Y
NOFLOW
16
17
18
1015
1
Y
NOFLOW
19
1215
1
Y
NOFLOW
20
0630
0.5
Y
NOFLOW
21
0915
1.75
Y
NOFLOW
22
1115
1.25
Y
NOFLOW
23
24
25
1100
1
Y
NOFLOW
26I
0900
1
Y
0.0016
24.6
7.7
< 15
7
5.94
18.667
< 1
30.27
271
945
2.25
Y
NOFLOW
26
1000
2
Y
NOFLOW
29
0630
0.75
Y
NOFLOW
30
Mon hly Average Unlit:
0.025
30
30
200
Monthly Average:
0.0031
22.6
0
12.5
6.555
31.3335
1
30.27
Daily Maximum:
0.0046
24.6
7.7
0
18
7.17
44
0
30.27
Daily Minimum:
0.0016
20.6
7.7
0
7
5.94
18.667
0
30.27
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 06-2018 (June 2018) VERSION: 3.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
A
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
6.1
o`
U
0
No Reporting Reason""
C0665
00556
3826U
00630
Quarterly
2 X month
Monthly
Compositc
Composite
Compositc
Calculated
TOTAL P-Cone
OIL-GRSE
MBAS
NO2&NO3
2400 dock
Ilrs
2400 clock
Iirs
Y/B/N
tng/l
mg/1
mg/1
mg/1
1
1130
0.25
Y
2
3
4
1015
1.75
Y
<5.21
0.17
5
0915
0.75
Y
6
1000
1.75
Y
7
0630
0.5
Y
8
1000
1.25
Y
9
10
11
0630
1
Y
NOFLOW
12
0830
1
Y
NOFLOW
13'
0630
0.5
Y
NOFLOW
14
0630
1
Y
NOFLOW
15
1115
0.5
Y
NOFLOW
16
17
18
1015
1
Y
NOFLOW
19
1215
1
Y
NOFLOW
20
0630
0.5
Y
NOFLOW
21
0915
1.75
Y
NOFLOW
22
1115
1.25
Y
NOFLOW
23
24
25
1100
1
Y
NOFLOW
26
0900
1
Y
1.9
< 5.43
23.1
27
945
2.25
Y
NOFLOW
28
1000
2
Y
NOFLOW
29
0630
0.75
Y
NOFLOW
30
Mon hly Average Limit:
30
Monthly Average:
1.9
0
0.17
23.1
Dolly Maximum:
1.9
0
0.17
23.1
Daily Minimum:
1.9
0
0.17
23.1
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NTDES PERMIT NO.: NC0077615
I`ACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 06-2018 (June 2018)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Iredell
ORC: Dennis W Murdock ORC CERT NUMBER: 7144
ORC HAS CHANGED: No
VERSION: 3.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 09/13/2018
09/12/2018
ORC/Certifier Signature: Thomas David Johnson E-Mail:[e-mail] Phone 4:252-419-2]99 Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
Lk
09/13/2018
Permittee/Submitt Y1 ,' {gnature:*** Heather Thomas Adams E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:.? 6.Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: operators
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 06-2018 (June 2018)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: No
VERSION: 1.0
SAMPLING LOCATION: EFFLUENT
PERMIT STATUS: Active
REC A V DOUNTY: Iredell
3
ORC CERT NUMBER: 7144
AUG 06 2018 RvoEIJED/NCDEWRJ WA
CEN i NHL FILES STATUS: Processed AUG 7 3 zO l8
DWR SECTION
DISCHARGE NO.: 001 NO DISCH[, vl ‘Acetos
ECioNAL OFFICE
F
t?
v,
p
u
Total Composite Time
F
a
e
O
Operator Time On Site
1
m
'
o`
O
O
gg
d
m
_
.
C
L
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weeldy
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterl Y
Recorder
Grab
Grab
Grab
Composite
Composite
Composite
Grab
Grab
FLOW
-
TEMP-C
pH
CHLORINE
BOD -Conc
NH3-N-Cone
TSS - Conc
FCOLI BR
TOTAL N -
2400 clock
Hre
2400 clock
Hrs
Y/B/N
mgd
deg c
su
ug/I
mg/1
mg/I
mg/I
#/100m1
mg/1
1
1130
0.25
Y
2
3
4
1015
1.75
Y
20.6
7.7
0
18
7.17
44
< 1
5
0915
0.75
Y
6
1000
1.75
Y
0.0046
0
7
0630
0.5
Y
8
1000
1.25
Y
9
1
1
0630
1
Y
0
11
0830
1
Y
0
11
0630
0.5
Y
0
14
0630
1
Y
0
15
1115
0.5
Y
0
1
16
17
18
1015
1
Y
0
1,9
1215
1
Y
0
20
0630
0.5
Y
0
jIl
0915
1.75
Y
0
Y2
1115
1.25
Y
0
23
24
25
1100
1
Y
0
16
0900
1
Y
0.0016
24.6
7.7
0
37
945
2.25
Y
0
18
1000
2
Y
0
.9
0630
0.75
Y
0
0
Monthly Aremge Limit:
0025
30
30
200
Monthly Average:
0.000388
22.6
0
18
7.17
44
1
IMIY Minimum:
0.0046
24.6
7.7
0
18
7.17
44
0
Daily Minimum:
0
20.6
7.7
0
18
7.17
44
0
*** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 06-2018 (June 2018) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
Composite Sample Time
Total Composite Time
F
1
8
o
w
o
E
I
O
m
o°
a
Ocl
x
8
Z C
C0665
00556
35260
Quarterly
2 X month
Monthly
Composite
Composite
Composite
TOTAL P - Cone
OIL•GRSE
MBAS
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mg/1
mg/1
mg/1
1
1130
0.25
Y
2
3
4
1015
1.75
Y
5
0915
0.75
Y
6
1000
1.75
Y
7
0630
0.5
Y
a
1000
1.25
Y
9
:
10
11
0630
1
Y
12
0830
1
Y
13
0630
0.5
Y
14
0630
.1
Y
15
1115
0.5
Y
16
17
18
1015
1
Y
19
1215
I
Y
20
0630
0.5
Y
21
0915
1.75
Y
22
1115
1.25
Y
23
24
25
1100
1
Y
26
0900
1
Y
27
945
2.25
Y
28
1000
2
Y
29
0630
0.75
Y
30
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
No Reporting Reason: ENFRUSE No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY=No Visitation — Holiday

41
NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 06-2018 (June 2018)
OMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: No
VERSION: 10
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
STATUS: Processed
SUBMISSION DATE: 07/15/2018
07/15/2018
RC/Certifier Signature: Thomas David Johnson E-Mail:[e-mail] Phone #:[phone] Date
y this signature, I certify that this report is accurate and complete to the best of my knowledge.
e permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
y information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
rovided within 5 days of the time the permittee becomes aware of the circumstances.
f the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
he NPDES permit.
07/15/2018
ermittee/Submitter Suture:*** Thomas David Johnson E-Mail:[e-mail] Phone #:[phone] Date
ermittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
o assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed 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
owing violations.
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: operators
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
* * * Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 05-2018 (May 2018) VERSION: 1.0
PERMIT STATUS: Active
RECEIVL.DOUNTY: lredell
3
JUL 0 5 2018 ORC CERTNUMBER: IRMEIVED/NCDENR/DWR
CENikALALES
STATUS: Processed
DWR SECTION
JUL 16 2018
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISealibtq NEAIONAL OFFICE
2
A
6
i-
1.
_
E
U'
Total Composite Time
6P.
F
-
G
-
O
O
1:. se
-
(3'O
-
o
C
No Reporting Reason••••
50050
00010
00400
50060
CO3IO
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
\Veckly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD - Corm
NH3-N - Conc
TSS - Cnnc
FCOLI BR
TOTAL N-
2400 clock
Ilrs
2400 clock
Ilrs
'MIN
mgd
deg c
su
ug/l
mg/I
mg/I
mg/1
#/100m1
mg/1
0930
1.5
Y
NOFLOW
1000
.5
Y
NOFLOW
0830
1.25
Y
NOFLOW
4
1045
.5
Y
NOFLOW
5
NOFLOW
6
NOFLOW
7
1400
1.25
Y
NOFLOW
8
1100
.5
Y
NOFLOW
9
0915
1.25
Y
NOFLOW
10
0915
.75
Y
NOFLOW
II
1030
1.0
Y
NOFLOW
12
NOFLOW
13
NOFLOW
14
1345
1.0
Y
NOFLOW
15
1015
1.0
Y
NOFLOW
16
1130
1.25
Y
NOFLOW
17
1000
.5
Y
NOFLOW
18
1245
1.25
Y
NOFLOW
19
NOFLOW
20
NOFLOW
21
1015
.75
Y
NOFLOW
22
1130
1.0
Y
NOFLOW
23
0915
.75
Y
0.0013
22
8
0
34
6.27
32.8
< 1
24
0930
2.0
Y
NOFLOW
25
1030
2.5
Y
NOFLOW
26
NOFLOW
27
NOFLOW
28
NOFLOW
29
1015
.75
Y
NOFLOW
30
1230
1.25
Y
NOFLOW
31
1500
.5
Y
NOFLOW
Mon hly Average l.Imll:
0.025
30
30
200
Monthly Average:
0.0013
22
0
34
6.27
32.8
1
Deity Maximum:
0.0013
22
8
0
34
6.27
32.8
0
Daily Minimum:
0.0013
22
8
0
34
6.27
32.8
0
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock
GRADE: WW-3. ORC HAS CHANGED: No
VERSION: 1.0
eDMR PERIOD: 05-2018 (May 2018)
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
Dote
E.
F
I.
t`
V'
Total Composite Time
F
_
O
Operator Time On Site
ORC On Site?••
e<
y°
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P-Cone
OIL-GRSE
MBAS
2400 clock
Iln
2400 clock
Ilrs
YIBAS
mg/1
mg/I
mg/1
1
0930
1.5
Y
NOFLOW
2
1000
.5
Y
NOFLOW
3
0830
1.25
Y
NOFLOW
4
1045
.5
Y
NOFLOW
5
NOFLOW
6
NOFLOW
7
1400
1.25
Y
NOFLOW
8
1100
.5
Y
NOFLOW
9
0915
1.25
Y -
NOFLOW
10
0915
.75
Y
NOFLOW
11
1030
1.0
Y
NOFLOW
12
NOFLOW
13
NOFLOW
14
1345
1.0
Y
NOFLOW
15
1015
1.0
Y
NOFLOW
16
1130
1.25
Y
NOFLOW
17
1000
.5
Y
NOFLOW
18
1245
1.25
Y
NOFLOW
19
NOFLOW
20
NOFLOW
21
1015
.75
Y
NOFLOW
22
1130
1.0
Y
NOFLOW
23
0915
.75
Y
5.4
8.8
24
0930
2.0
Y
NOFLOW
25
1030
2.5
Y
NOFLOW
26
NOFLOW
27
NOFLOW
28
NOFLOW
29
1015
.75
Y
NOFLOW
30
1230
1.25
Y
NOFLOW
31
1500
.5
Y
NOFLOW
Mon hly Average 1.1mit:
30
Monthly Average:
5.4
8.8
Daily Maximum:
5.4
8.8
Daily Minimum:
5.4
8.8
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather, NOFLOW = No Flow; HOLIDAY =No Visitation - Holiday

NPbES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
'GRADE: WW-3. ORC HAS CHANGED: No
'DMR PERIOD: 05-2018 (May 2018) VERSION: 1.0 STATUS: Processed
1
eport Comments:
The Operator struggled to have enough flow to run the treatment plant and collect the required samples for the month. The Monthly average BOD was exceeded and the Monthly
lverage TSS was exceeded.

NPDF,S PERMIT NO.: NC0077615 PERMIT VERSION: 4_0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 05-2018 (May 2018) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Non -Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 06/25/2018
//14
O}RC/Certifier Signature: Thomas David Johnson E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
06/25/2018
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES petit.
06/25/2018
Permittee/SubmitterrSignature:*** Thomas David Johnson E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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
tcj assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
s II stem, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
a�curate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: operators
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
•
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 04-2018 (April 2018) VERSION: 1.0
PERMIT STATUS: Active
R E E R C CERT NUMBER: 7144 3
JUN ��,� RECEIVE67NCDENR/DWR
CEN r«e� ALE. TATUs: Processed JUN 11 2018
DWR SECTION
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO IDISIMARGEdetiOoFFIcE
G
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
w'
m
8
0
O
No Reporting Reason••`•
50050
00010
00400
50060
C0310
C0610
C0530 -
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
instantaneous
Grab
Grub
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pit
CHLORINE
BOD - Cone
N113-N-Cone
TSS - Cone
FCOLI BR
TOTALN-
2400 clock
Hrs
2400 clock
Hrs
YB/N
mgd
deg c
so
ug/1
mg/1
mg/1
nlg/I
N/I00m1
mg/1
t
2
13:30
1.5
Y
NOFLOW
3
9:00
2
Y
NOFLOW
4
10:30
.5
Y
NOFLOW
5
11:30
1
Y
NOFLOW
6
11:15
.75
Y
NOFLOW
7
8
9
9:30
.75
Y
NOFLOW
t0
10:00
1
Y
NOFLOW
It
9:30
1.5
Y
0.0005
11
7.4
< 15
7
8.74
18.167
< 1
12
11:30
.75
Y
13
10:15
1.5
Y
< 15
14
15
16
9:30
.5
Y
NOFLOW
17
12:00
1
Y
NOFLOW
18
6:30
.5
Y
NOFLOW
19
5:30
.25
Y
NOFLOW
20
5:30
.5
Y
NOFLOW
21
22
23
13:15
.75'
Y
NOFLOW
24
10:00
1
Y
NOFLOW
25
9:30
1.75
Y
NOFLOW
26
10:30
1.5
Y
NOFLOW
27
10:45
1.5
Y
NOFLOW
28
29
30
10:00
.5
Y
NOFLOW
Monthly Average Limit:
0.025
30
30
200
Monthly Average:
0.0005
11
0
7
8.74
18.167
I
Daily Maximum:
0.0005
11
7.4
0
7
8.74
18.167
0
Daily Minimum:
0.0005
11
7.4
0
7
8.74
18.167
0
No Reporting Reason: ENFRUSE No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; IIOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eD
R PERIOD: 04-2018 (April 2018)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: No
VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
g
G
E
F
y•g
76"u
E
U
E
6
ii
l2
Operator Arrival Time
y
O
P.
C
O
ORC On Site?••
No Reporting Reason••••
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P -Cone
OIL-GRSE
MBAS
2400 clock
firs
2400 clock
Iln
Y/B/N
mg/1
mg/1
mg/1
1
2
13:30
1.5
Y
NOFLOW
3
9:00
2
Y
NOFLOW
4
10:30
.5
Y
NOFLOW
5
11:30
I
Y
NOFLOW
6
11:15
.75
Y
NOFLOW
7
8
9
9:30
.75
Y
NOFLOW
to
10:00
1
Y
NOFLOW
II
9:30
I.5
Y
5.78
0.26
12
11:30
.75
Y
13
10:15
1.5
Y
14
15
16
9:30
.5
Y
NOFLOW
17
12:00
1
Y
NOFLOW
18
6:30
.5
Y
NOFLOW
19
5:30
.25
Y
NOFLOW
20
5:30
.5
Y
NOFLOW
21
22
23
13:15
.75
Y
NOFLOW
24
10:00
1
Y
NOFLOW
25
9:30
1.75
Y
NOFLOW
26
10:30
1.5
Y
NOFLOW
27
10:45
1.5
Y
NOFLOW
28
29
30
10:00
.5
Y
NOFLOW
Monthly Average Limit:
30
Monthly Average:
5.78
0.26
Daily Maximum:
5.78
0.26
Daily Minimum:
5.78
0.26
No Reporting Reason: ENFRIJSE = No Flow-Reuse/Recycle; ENVWTHR=NoVisitation— AdverseWeather; NOFLOW = No Flow; HOLIDAY=No Visitation — Holiday

NPDES 1ERIVIIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
e i MR PERIOD: 04-2018 (April 2018)
COMPLIANCE STATUS: Compliant
ORC/Certifier Signature: Tho
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dennis W Murdock
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
STATUS: Processed
SUBMISSION DATE: 05/30/2018
05/24/2018
David Johnson E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
y information shall be provided orally within 24 hours from the time the pennittee became aware of the circumstances. A written submission shall also be
p ovided within 5 days of the time the permittee becomes aware of the circumstances.
I the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
05/30/2018
Permittee/Submitter Signature % ** Thomas David Johnson E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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
tol assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
s
a
stem, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
curate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
owing violations.
LAB NAME: Statesville Analytical Holdings
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: D. Murdock
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Ui e only units of measurement designated in the reporting facility's NPDES,permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
* 1 ORC on Site?: ORC must visit facility and document visitation of facility as iequired per 15A NCAC 8G .0204.
* 1 * Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3'
eDMR PERIOD: 03-2018 (March 2018)
VERSION: 1.0
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Dennis W Murdock
RECEIVED
APR 3 0 2018
ORC HAS CHANGED: No
CENI f rutL FILES
DWR SECTION
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
RECEIVED/NCDENR/DWR
MAY 07 2018
STATUS: Processed
w a(
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DIS IEt:R NAL OFFICE
h.el''
1:d
U
E
F
-
B
F'
Operator Arrival Time
w
O
E
1"
14
O
u
a
O
9
F.
Z
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD - Conc
NH3-N - Conc
TSS - Cons
FCOLI BR
TOTAL N-
2400 clock
Hra
2400 clock
Hn
Y/B!N
mgd
deg c
su
ug/1
mgll
mg/I
mg/1
#/100m1
mg/1
1
9:15
.5
Y
NOFLOW
2
9:45
.25
Y
NOFLOW
3
4
5
9:30
.25
Y
NOFLOW
6
10:00
1.5
Y
NOFLOW
7
10:00
2
Y
NOFLOW
8
11:30
I
Y
NOFLOW
9
9:30
.75
Y
NOFLOW
10
III
121
ENVWTHR
13
,
13:15
.75
Y
NOFLOW
1I
10:15
.75
Y
NOFLOW
1
10:15
.25
Y
NOFLOW
1
13:45
.25
Y
NOFLOW
1
18
19
9:30
.75
Y
NOFLOW
20
11:00
I
Y
NOFLOW
21
9:30
2.5
Y
NOFLOW
22
11:00
1
Y
NOFLOW
23
11:30
1.5
Y
NOFLOW
24
4
26
9:30
1
Y
NOFLOW
27
10:30
.5
Y
NOFLOW
28
9:30
.75
Y
NOFLOW
29
10:45
1.75
Y
NOFLOW
30
10:15
1
Y
NOFLOW
31
Monthly Average Limit:
0.025
30
30
200
Monthly Avenge:
Daily Maximum:
Daily Minimum:
••' No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
GRADE: WW-3 ° ORC HAS CHANGED: No
eDMR PERIOD: 03-2018 (March 2018) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
Date
Composite Sample Time
u'
a
2
e
a
.<
•
2Grab
e
O
Operator Time On Site
ORC On Site?••
•
'
m
a
.0
a
y'.
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
TOTAL P - Cone
OIL-GRSE
MBAS
2400 clock
Hrs
2400 clock
Hrs
YBMN
mg/1
mgll
mg/1
1
9:15
.5
Y
NOFLOW
2
9:45
.25
Y
NOFLOW
3
4
5
9:30
.25
Y
NOFLOW
6
10:00
1.5
Y
NOFLOW
7
10:00
2
Y
NOFLOW
e
11:30
1
Y
NOFLOW
9
9:30
.75
Y
NOFLOW
la
n'
12
ENVWTHR
13
13:15
.75
Y
NOFLOW
14
10:15
.75
Y
NOFLOW
15
10:15
.25
Y
NOFLOW
If
13:45
.25
Y
NOFLOW
I'
1F
19
9:30
.75
Y
NOFLOW
20
11.00
1
Y
NOFLOW
21
9:30
2.5
Y
NOFLOW
22
11:00
1
Y
NOFLOW
23
11:30 .
1.5
Y
NOFLOW
71
4
26
9:30
1
Y
NOFLOW
27
10:30
.5
Y
NOFLOW
28
9:30
.75
Y
NOFLOW
29
10:45
1.75
Y
NOFLOW
30
10:15
1
Y
NOFLOW
31
Monthly Average Limit
30
Monthly Average:
Daily Maximum:
Daily Minimum:
••
•• No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3°
eDMR 1 ERIOD: 03-2018 (March 2018)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Iredell
ORC: Dennis W Murdock ORC CERT NUMBER: 7144
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 04/12/2018
04/05/2018
ORC/Certifier Signature: Dennis Murdock E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
Permit Expiration Date: 03/31/2019
I bertify, 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 managed the
s stem, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
a curate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violations.
04/12/2018
Permittee/Submitter Signature: ** Irian Foor E-Mail:[e-mail] Phone #:[phone] Date
P I rmittee Address: 306 Stamey Farm Rd Statesville NC 28677
LAB NAME: SAH
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: D. Murdock
CERTIFIED LABORATORIES
PARAMETER CODES
P�rameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-3.
eDMR PERIOD: 02-2018 (February 2018)
PERMIT VERSION: 4.0 RECEIVED PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Iredell
ORC: Dennis W Murdock APR 0 5 2018
ORC HAS CHANGED: NOCENITRAL FILES
DWR SECTION
VERSION: 1.0
STATUS: Processed
ORC CERT NUMB viEeLivED/NCDENR/CIWI$
APR 0 9 ZO13
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISMAIRENg*:RMNAL OFFICE
1
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?.•
No Reporting Reason••••
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMRC
pH
CHLORINE
BOD - Cone
NH3-N - Cone
TSS - Conc
FCOLI 8R
TOTAL N -
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mgd
deg c
su
ug/1
mg/I
mg/1
mg/1
#/100m1
mg/1
1
11:30
5.0
Y
2
15:00
.33
Y
3
4
5
10:45
1
Y
6
10:00
1.75
Y
7
9:00
1.25
Y
84
10:00
1.08
Y
9
8:00
3.5
Y
to
1i
12
10:15
.5
Y
13
12:45
1.75
B
1.
10:15
.25
B
Is
10:00
1
B
11
11:45
.5
B
1
17
18
19
10:00
1
B
20
10:00
.5
B
21
8:45
.75
B
22
9:15
4.5
B
23
10:15
2
B
2
26
9:15
1.75
B
27
9:45
5.25
B
28
8:30
4.5
B
Mon hly Average Limit:
0.025
30
30
200
Monthly Average:
Daily Maximum:
Daily Minimum:
>'>• No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock
GRADE: WW-3. ORC HAS CHANGED: No
eDMR PERIOD: 02-2018 (February 2018) VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7144
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
elF
Composite Sample Time
Q
F
8
d
'3
Operator Arrival Time
Operator Time On Sitc
ORC On Site?••
g
CCdI.Iq
9
t
'p.
8
2
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P•Cone
OIL-GRSE
MBAS
2450 clock
Firs
2400 clock
Bra
Y!B!N
mall
mg/I
mg/I
11:30
5.0
Y
15:00
.33
Y
I
°-
10:45
1
Y
6
10:00
1.75
Y
1
9:00
1.25
Y
8
10:00
1.08
Y
9
8:00
3.5
Y
to
1t
12
10:15
.5
Y
t1
12:45
1.75
B
1
10:15
.25
B
1
10:00
1
B
1
11:45
.5
B
17
18
19
10:00
1
B
20
10:00
.5
B
21
8:45
.75
B
22
9:15
4.5
B
23
10:15
2
B
2.
25
2E
9:15
1.75
B
I
271
9:45
5.25
B
i
28
8:30
4.5
B
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
"'• No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

4
Z

GRADE: WW-3.
eDMR PERIOD: 02-2018 (February 2018)
NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Dennis W Murdock ORC CERT NUMBER: 7144
s ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Com.liant CONTACT PHONE #: [phone] SUBMISSION DATE: 03/20/2018
03/19/2018
ORC/Certifier Signature: Dennis Murdock E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
rovided within 5 days of the time the permittee becomes aware of the circumstances.
f the facility is noncompliant, please attach a lisof corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
he NPDES pe
03/20/2018
Permi'ttee/Submitter Sign'!*** Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
1
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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
tl assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
sl lstem, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
ccurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
nowing violations.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical Hidings
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: C. Robinson
PARAMETER CODES
ameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
U e only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* o Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin good Group LLC
GRADE: WW-2
eDMR PERIOD: 01-2018 (January 2018)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Casey Nicole Robin§oil C E I V E D
ORC HAS CHANGED: No FEB 22 2018
CENTRAL FILES
DWR SECTION
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DIES
5 LLE REGIONAL OFFICE
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 1004753
RECEIVED/NCDENR/DWR
STATUS: Processed
VERSION: 1.0
MAR 5 2018
Date
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?••
5
a
C
a
a
Z
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly.
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
5H
CHLORINE
BOD-Cone
NH3-N-Cone
TSS - Conc
FCOLI BR
TOTAL N -
2400 clock
Hn
2400 clock
Hn
YIBIN
mgd
deg c
su
ug/I
mg/1
mg/I
mg/I
#/100m1
mg/I
1
HOLIDAY
2 I
13:25
.33
B
I
13:20
.33
Y
4 I
12:15
.33
Y
I
1
9:25
.33
B
e
9:10
.33
B
12:55
.25
Y
to I
12:45
.33
B
I
t1
7:35
.33
B
12
9:30
.33
B
13
.
14I
151
HOLIDAY
16
9:00
.33
B
17
ENVWTHR
18!
-
ENVWTHR
19,
12:05
.33
B
20
21
22
14:40
.33
Y
23
12:15
.25
Y
24
8:50
.42
Y
22((
9:45
.25
Y
u
9:30
.5
Y
I
I
28
29
13:25
.58
Y
J0
13:30
1
Y
?1
13:20
.33
Y
IMonthly Average Limit:
0.025
30
30
200
IMonthly Average:
IDaily Maximum:
Daily Minimum:
No Reporting Reason: ENFRUSE No Flow-ReuselRecycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 01-2018 (January 2018)
LAMPLING LOCATION: EFFLUENT
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Casey Nicole Robinson
ORC HAS CHANGED: No
VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 1004753
STATUS: Processed
DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
o'
Composite Sample Time
Total Composite Time
F
t
QGrab
O
Operator Time On Site
ORC On Site?••
No Reporting Reason....
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
TOTAL P - Conc
OIL-GRSE
MBAS
2400 clock
Ars
2400 clock
Ars
Y/BM
mgll
mg/1
mg/I
1
HOLIDAY
2
13:25
.33
B
3
13:20
.33
Y
4 ,
12:15
.33
Y
5
9:25
.33
B
6
7
8 1
9:10
.33
B
9 I
12:55
.25
Y
l0 ;
12:45
.33
B
11
7:35
.33
B
12 ,
9:30'
.33
B
13 ;
14:
15 ,
HOLIDAY
161
9:00
.33
B
171
ENVWTHR
18I
ENVWTHR
19l
12:05
.33
B
I
20,
21
22
14:40
.33
Y
23
12:15
.25
Y
2t
8:50
.42
Y
25
9:45
.25
Y
26
9:30
.5
Y
I
27
28
29
13:25
.58
Y
30
13:30
1
Y
31
13:20
.33
Y
Monthly Average Limit:
30
Monthly Average
Daily Maximum:
i
Daily Minimum:
!••• No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

OWNER NAME: Origin Food Group LLC
•
GRADE: WW-2 -
eDMI PERIOD: 01-2018 (January 2018)
COIVPLIANCE STATUS: Compliant
11
ORC/Certifia'r
By
NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
ORC: Casey Nicole Robinson ORC CERT NUMBER: 1004753
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 02/13/2018
•
02/13/2018
ignature: Casey Robinson E-Mail:[e-mail] Phone #:[phone] Date
his signature, I certify that this report is accurate and complete to the best of my knowledge.
Th permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of t
e the permittee becomes a are of the circumstances.
If the facility is noncom. i. ' , please attach a list of corre : ve actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the
PeIrmittee/Submitter Signature:*** ian Foor E-Mail:[e-mail] Phone #:[phone] Date
I
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed the
sy tem, 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.
NPDES permit.
02/13/2018
LAB NAME: Statesville Analytical Holdings
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: T. Robinson
CERTIFIED LABORATORIES
PARAMETER CODES
rameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
se only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*j No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
*+* ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
* ** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

3
NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 12-2017 (December 2017)
PERMIT VERSION: 4.0
CLASS: WW-2
RP DIVED
ORC: Casey Nicole Robinson FEB0 1 2 o
ORC HAS CHANGED: No [7I
-CENTRAL FILES
OWR SECTION
VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 1004753
RECEIVED/NCDENR/DWR
STATUS: Processed
FEB 5 2018
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHASvl �LEREG REGIONAL OFFICE
C
Composite Sample Time
Total Composite Time
I
a
i
2
.Et
=
Iii
o
PI
6'O
II,9
CI.
z
e
z
t
II
Z
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C '
pH
CHLORINE
HOD - Cone
NH3-N - Cone
TSS - Cone
FCOLI BR
TOTAL N -
2400 clock
Hn
2400 dock
Hn
WHIN
mgd
deg c
su
ug/1
mg/I
mg/1
mg/I
2/lo0ml
mg/I
1
11:25
.33
Y
2
4
11:00
.33
Y
5
12:10
.33
B
6
12:00
.33
Y
7
16:00
.33
Y
8
14:00
.33
Y
9
10
II
11:50
.5
Y
12
14:00
.25
Y
13
13:00
.5
Y
14
10:00
.25
Y
15
9:30
.25
Y
16
17
18
12:00
.33
Y
19
11:45
.25
Y
20
14:30
.25
Y
21
12:25
.17
B
22
8:45
.25
Y
23
24
25
HOLIDAY
26
-
HOLIDAY
27
HOLIDAY
28
14:40
.33
B
29
11:55
.33
B
30
31
Monthly Avenge Limn:
0.025
30
30
200
Monthly Average:
Daily Maximum.
Daily Minimum:
•••• No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Casey Nicole Robinson ORC CERT NUMBER: 1004753
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 12-2017 (December 2017) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
O
Composite Sample Time
Total Composite Time
1-
�
E
a
-
O
Operator Time On Site
ORC On Site?"
•
�9 9
5
t
Z
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-CRSE
MBAS
2400 clock
Hn
2400 clock
Hn
MIN
mg/1
mg/1
mg/1
1
11:25
.33
Y
2
3
--
4
11:00
.33
Y
5
12:10
.33
B
6
-
12:00
.33
Y
7
16:00
.33
Y
8
14:00
.33
Y
9
10
11
11:50
.5
Y
12
14:00
.25
Y
13
13:00
.5
Y
14
10:00
.25
Y
15
9:30
.25
Y
16
17
18
12:00
.33
Y
19
11:45
.25
Y•
20
14:30
.25
Y
21
12:25
.17
B
22
8:45
.25
Y
23
24
25
HOLIDAY
26
HOLIDAY
27
HOLIDAY
28
14:40
.33
B
29
11:55
.33
B
30
31
Mon hly Average Limit:
30
Monthly Avenge:
Daily Maximum:
Daily Minimum:
•••• No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: W1V-2
eDMR PERIOD: 12-2017 (December 2017)
COMPLIANCE STATUS: Compliant
ORC/Certifier
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Iredell
ORC: Casey Nicole Robinson ORC CERT NUMBER: 1004753
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 01/22/2018
01/16/2018
gnature: Casey Robinson E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided-within-5--days-of the -time the permittee-be
If the facility is noncompliant, please attach a list
the NPDES permit.
Permittee/Submitter Signature:***
omesaware of -the -circumstances. -
corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
01/22/2018
rian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical Holdings
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: C. Robinson
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME Origin Food Group LLC
GRADE: WW-2
'DMR PERIOD: 11-2017 (November 2017)
PERMIT VERSION: 4.0
CLASS: WW-2 RFCRVPD
ORC: Casey Nicole Robigspt� 1, y .2018
ORC HAS CHANGED: No Y
VERSION: 1.0 DVVR SECTION
INFORMATION PROCESSING UNIT
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBEHl'®/RICDENR/l7WR
STATUS: Processed
3
JAN 1 6 2018
WOROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO Diseistagm IFERONAL rov Irp
Composite Semple Time
Total Composite Time
fi
F
'�
.6
...96.
6'O
Operator Tinto On Site
8I.
u
•
•
a
a
iz
:14C
Z
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD - Cone
NH3-N-Cone
TSS-Cone
FCOLI BR
TOTAL N -
2400 clock
Hrs
2400 clock
Hrs
Y/BIN
mgd
deg c
su
ug/1
mg/1
mg/1
mg/1
4/100m1
mg/I
1
10:45
.25
B
2
11:05
.25
B
3
10:20
.25
B
4
5
6
8:45
.25
Y
7
9:40
.33
Y
S
12:45
.25
Y
9
8:00
.25
Y
10
HOLIDAY
11
12
13
11:40
.25
Y
14
11:55
.25
Y
15
15:40
.25
Y
16
16:35
.25
Y
17
15:35
.33
Y
18
19
20
11:15
.33
B
21
12:45
.25
Y
22
7:55
.25
B
23
HOLIDAY
24
HOLIDAY
25
26
27
12:00
.33
Y
28
13:30
.25
Y
29
13:15
.25
Y
30
14:05
.25
Y
-
Monthly Avenge Limit:
0.025
30
30
200
Monthly Avenge:
Daily Maximum:
Daily Minimum:
•••• No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW.= No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME 1 Origin Food Group LLC ORC: Casey Nicole Robinson
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 11-2017 (November 2017) VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 1004753
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
q
A
I.
ou
u
Total Composite Time
1p
a
a
O
v.
8
i-
O
€
O
No Reporting Rraron••••
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P- Cone
OIL-GRSE
MBAS
2400 clock
Hn
2400 clock
Hn
Y/DIN
mg/I
mg/I
mg/I
1
10:45
.25
B
2
11:05
.25
B
3
10:20
.25
B
4
5
6
8:45
.25
Y
7
9:40
.33
Y
8
12:45
.25
Y
9
8:00
.25
Y
to
HOLIDAY
It
12
13
11:40
.25
Y
14
11:55
.25
Y
15
15:40
.25
Y
16
16:35
.25
Y
17
15:35
.33
Y
i8
19
20
11:15
.33
B
21
12:45
.25
Y
22
7:55
.25
B
23
HOLIDAY
24
HOLIDAY
23
26
27
12:00
.33
Y
28
13:30
.25
Y
29
13:15
.25
Y
30
14:05
.25
Y
Monthly Avemge Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimom:
No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR=No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAMg: Origin Food Group LLC
GRAVE: WW-2
eDMR PERIOD: 11-2017 (November 2017)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Casey Nicole Robinson
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: (004753
STATUS: Processed
SUBMISSION DATE: 12/15/2017
12/14/2017
ORC/CertifieSignature: Casey Robinson E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within-5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of c
the NPDES perm
ective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
12/15/2017
Permittee/Submitter Signature:*** ian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical Holdings
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: C. Robinson
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
* ** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNEI; NAME: Origin Food Group LLC
GRADE: WW-2
1
eDMR PERIOD: 10-2017 (October 2017)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Harry Withers Myers
ORC HAS CHANGED: Yes
VERSION: 1.0
�, PERMIT STATUS: Active
VBOUNTY: Iredell
ORC CERT NUMBER: 987023
NOV 3 0 2017
COENWRTRALSECTEOFILES
N STATUS: Processed
3
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES
G
F
e`
E.
u
Total Comp:mile Time
=
IZ
O
Operator Time On Site
8
O
s
'p
m
I
a
c0
.
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD - Cone
NH3-N-Cone
TSS - Cone
FCOLI BR
TOTAL N -
2400 clock
Hn
2400 clock
Hn
Y/BIN
mgd
deg c
su
ugll
mg/I
mg/1
mg/1
S/100m1
mg/I
1
2
10:25
.33
Y
..
3
8:40
.25
Y
4
9:00
.25
Y
5
9:50
.25
Y
6
11:50
.33
Y
7
8
9
13:40
.33
Y
to
9:15
.25
Y
It
11:05
.25
Y
12
12:50
.25
Y
13
9:15
.33
Y
14
15
16
9:00
.25
Y
t7
8:20
.33
Y
18
--
13:00
.25
Y
19
9:15
.42
Y
20
14:55
.25
Y
21
22
23
9:10
.25
Y
24
11:30
.25
Y
25
11:25
.25
Y
26
9:30
.25
Y
27
12:15
.25
Y
28
29
30
15:35
.33
Y
31
-..
13:15
.25
Y
Monthly Avenge Limit:
0.025
30
30
200
Monthly Avenge:
Daly Maximum:
Daily Minimum:
I' No Reporting Reason: ENFRUSE = No Flow-Regse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Harry Withers Myers
GRADE: WW-2 ORC HAS CHANGED: Yes
eDMR PERIOD: 10-2017 (October 2017) VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 987023
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
o
Composite Sample Time
I.
Ea
u°
F'
1
a
@
O
y
o
F
O
w'
8
u
O
•
c
z
i
a
a
2
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab '
TOTAL P - Conc
OH.-CRSE
MBAS
2400 clock
Hn
2400 clock
Bn
YIBIN
mg/l
mg/1
mg/l
1
2
10:25
.33
Y
3
8:40
.25
Y
4
9:00
.25
Y
5
9:50
.25
Y
6
11:50
.33
Y
7
8
9
13:40
.33
Y
to
9:15
.25
Y
11
11:05
.25
Y
12
12:50
.25
Y
13
9:15
.33
Y
14
15
16
9:00
.25
Y
17
8:20
.33
Y
18
13:00
.25
Y
19
9:15
.42
Y
20
14:55
.25
Y
21
22
23
9:10
.25
Y
24
11:30
.25
Y
2.5
11:25
.25
Y
26
9:30
.25
Y
27
-
12:15
.25
Y
28
29
30
15:35
.33
Y
31
13:15
.25
Y
Monthly Avenge Limit•.
30
Monthly Avenge:
Daily Maximum:
Daily Minimum:

NPD'ES4PE13r�V1IT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 10-2017 (October 2017)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Harry Withers Myers
ORC HAS CHANGED: Yes
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 987023
STATUS: Processed
SUBMISSION DATE: 11/17/2017
ORC/Certifier gnature: Casey Robinson E-Mail:[e-mail]
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
11/09/2017
Phone #:[phone] Date
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES pe
Permittee/Submitter Signature:***
or E-Mail:[e-mail] Phone
11/17/2017
#:704-768-9000 Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical Holdings
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: C. Robinson
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAM,: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 09-2017 (September 2017)
SAMPLING LOCATION:
PERMIT VERSION: 4_0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: Yes O C T 2 0 2017
VERSION: 1.0
RECEIVED
PERMIT STATUS: Active
COUNTY: Iredell
3
RECEIVED/NCDENR/DWR
ORC CERT NUMBER: 7752
OCT 302017
STATUS: Processed
WQROS
MOORESVILLE REGIONAL OFFICE
EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES
CENTRAL FILES
DWR SECTION
p
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?"
C
IWeekly
c.
z
lg
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pil
CHLORINE
BOD-Cone
NI13-N-Cone
TSS-Cone
FCOLI BR
TOTAL N-
2400 clock
lira
2400 clock
Hrs
Y/B/N
mgd
deg c
su
ug/1
mg/1
mg/1
mg/I
#/100m1
mg/1
1
13:30
.33
Y
3
4
HOLIDAY
5
8:35
.33
Y
6
12:50
.25
Y
7
13:00
.25
Y
8
14:45
.25
Y
9
10
II
13:10
.25
Y
12
12:05
.33
Y
13
14:00
.25
Y
14
12:25
.33
Y
15
16:50
.33
Y
16
17
18
9:20
.17
Y
19
14:20
.25
Y
-
20
10:50
.33
Y
21
9:30
.25
Y
n2
9:25
.25
Y
23
24
25
13:05
.25
Y
26
12:50
.5
Y
27
12:55
.25
Y
28
7:50
.33
Y
29
12:45
.25
Y
30
.—.. -. -�- Monthly Average Limit:
0.025
,
30
30
200
Monthly Average:
•
Dolly Marhmm:
Doily Dinimnm:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers
GRADE: WW-2 ORC HAS CHANGED: Yes
eDMR PERIOD: 09-2017 (September 2017) VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
o
g
F
y
Al
`
U
.8
F
u
h
Operator Arrival Time
.8•
C
g
F
O
ORC On SRO..
yo
U
ii.
a
t
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P.. Cone
011.GISE
MBAS
2400 clock
Iln
2400 clock
lira
MIN
mg/1
mg/1
mg/1
1
13:30
.33
Y
2
3
4
HOLIDAY
5
8:35
.33
Y
6
12:50
.25
Y
7
13:00
.25
Y
8
14:45
.25
Y
9
10
11
13:10
.25
Y
12
12:05
.33
Y
13
14:00
.25
Y
14
12:25
.33
Y
15
16:50
.33
Y
16
17
18
9:20
.17
Y .
19
14:20
.25
Y
S0
10:50
.33
Y
21
9:30
.25
Y
22
9:25
.25
Y
23
24
25
13:05
.25
Y
26
12:50
.5
Y
27
12:55
.25
Y
28
7:50
.33
Y
29
12:45
.25
Y
30
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
* No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAMF: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 09-2017 (September 2017)
COMPLIANCE STATUS: Compliant
ORC: Jerry L Rogers
ORC HAS CHANGED: Yes
VERSION: 1_0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 10/11/2017
10/11/2017
ORC/Certi1ti r Signature: Casey Robinson E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee beco
If the facility is noncompliant, please attach a list of
the NPDES permit.
Permittee/Sub
aware of the circumstances.
ctive actions being taken and a time -table for improvements to be made as required by part II.E.6 of
10/11/2017
Signature:*** Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical, Holdings
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: C. Robinson
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 08-2017 (August 2017)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: Yes
VERSION: 1.0 CENTRAL FILES
DWR SECTION
RECEIVED
OCT 1 G 2017
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
RECEIVED/NCDENR/DWR
STATUS: Processed
OCT 232017
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YESROS
MOORESVILLE REGIONAL OFFICE
Date
y
e'
ua
F
e
u�
c
F`
Operator Arrival Time
Operator Time On Site
_
o°
z
o
a
2
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD-Con
NH3-N-Cone
TSS - Conc
FCOLI BR
TOTAL N -
2400 dock
Ho
2400 clock
Ilrs
Y/B/N
mgd
deg c
su
ug/I
mg/I
mg/1
mg/I
#/100m1
mg/1
1
13:10
.17
Y
2
12:10
.17
Y
3
10:30
.17
Y
4
14:20
.17
Y
5
6
7
14:00
.17
Y
8
13:50
.17
Y
9
14:30
.17
Y
to
14:10
.17
Y
11
10:50
.17
Y
12
13
14
14:50 '
.17
Y
15
14:00
.17
Y
16
10:40
.17
Y
17
14:20
.17
Y
18
7:30
.17
Y
19
20
21
10:55
.25
Y
22
9:45
.5
Y
23
-
9:00
.25
Y
24
11:40
.25
Y
25
8:30
.25
Y
26
27
28
14:00
.25
Y
29
11:30
.25
Y
30
15:30
.42
Y
31
_,
ir
14:15
.25
Y
MaohlyAverageLlmlt:
0.025
30
30
200
Monthly Average:
Daily Maximum:
Daly M6aimum:
•••' No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: Nd0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: Yes
eDMR PERIOD: 08-2017 (August 2017) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
G
A
1
U
i
o
e`
u
F'
A.
A.
-E,
O
h
Ow
Q
t
O
y.
O°
O
o
d
a
le
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grabd
TOTAL P - Cone
oIL-GHSE
MBAS
2400 dock
Hrs
2400 clock
Hra
Y/BIN
mg/1
mg/1
mg/1
1
13:10
.17
Y
2
12:10
.17
Y
3
10:30
.17
Y
4
14:20
.17
Y
5
6
7
14:00
.17
Y
8
'
13:50
.17
Y
9
14:30
.17
Y
10
14:10
.17
Y
11
10:50
.17
Y
12
13
14
14:50
.17
Y
15
14:00
.17
Y
16
10:40
.17
Y
17
14:20
.17
Y
18
7:30
.17
Y
19
20
21
10:55
.25
Y
22
9:45
.5
Y
23
9:00
.25
Y
24
1 L:40
.25
Y
25
8:30
.25
Y
26
27
28
14:00
.25
Y
29
11:30
.25
Y
30
15:30
.42
Y
31
14:15
.25
Y
Mon hly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
sasNoReporting Reason: ENFRUSE=NoF1ow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME:.Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 08-2017 (August 2017)
COMPLIANCE STATUS: Compliant
6Low
RC/Certifie
10
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: Yes
VERSION: 1.0
CONTACT PHONE #: [phone]
'Rolomvcw
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 09/27/2017
09/22/2017
Signature: Jerry Rogers E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach,: list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES peyptit.
Permittee/Submitter
09/27/2017
Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical Holdings
'CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers & C. Robinson
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

•
NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAMV: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: Yes
eDMR PERIOD: 08-2017 (August 2017) VERSION: 1.0 STATUS: Processed
Report Comments:
Mr. Rogers retired as of August 18th, in process of getting the Operator Designation Forms changed.

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 07-2017 (July 2017)
PERMIT VERSION: 4_0REg,��
CLASS: WW-2
,� L 1 V
ORC: Jerry L Rogers A U G 2 9 2017
ORC HAS CHANGED: NoCENTRAL FILES
VERSION: lA DWR SECTION
PERMIT STATUS: Active
COUNTY: Iredell
3
ORC CERT NUMBER: 7752
RECEIVED/NCDENR/DWI
STATUS: Processed
SEP - 5 Z017
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISGRARLCAti;EVESIONAL OFFICE
Dato
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
•
`y
o°
re
0
�°
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TENINC
pH
CHLORINE
BOD-Cone
NI13-N-Cone
TSS - Cone
FCOLI BR
TOTALN-
2400 clock
Mrs
2400 clock
Eire
Y/B!N
mgd
deg a
su
ug/1
mg/I
mg/1
mg/1
#/l001nl
mg/1
1
2
13
9:50
.17
Y
14
HOLIDAY
5
8:10
.17
Y
6
7:20
.17
Y
7
13:50
.17
Y
8
9
10
15:50
.17
Y
11
13:20
.17
Y
12
14:00
.17
Y
13
7:15
.17
Y
14
10:20
.17
Y
15
16
17
14:50
.17
Y
18
13:20
.17
Y
19
10:40
.17
Y
20
10:30
.17
Y
21
10:10
.17
Y
22
23
24
13:50
.17
Y
25
13:40
.17
Y
26
14:00
.17
Y
27
10:30
.17
Y
28
14:00
.17
Y
29
30
31
13:50
.17
Y
Mon hly Average Limit:
0.025
30
30
200
Monthly Average:
Daily Mosimmn:
Doily Minimum:
ssr► No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 07-2017 (July 2017) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
G
Composite Sample Time
Total Composite Time
-a
a`
8
O
C
F
e
O
ORC On Site?"
a
I
„o.
a
z°
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL•GRSE
MBAS
2400 clock
nre
2400 clock
nrs
It/BIN
mg/1
mg/I
mg/I
1
2
9:50
.17
Y
4
HOLIDAY
5
8:10
.17
Y
6
7:20
.17
Y
7
13:50
.17
Y
8
9
10
15:50
.17
Y
11
13:20
.17
Y
12
14:00
.17
Y
13
7:15
.17
Y
14
10:20
.17
Y
15
16
17
14:50
.17
Y
18
13:20
.17
Y
19
10:40
.17
Y
20
10:30
.17
Y
21
10:10
.17
Y
22
23
24
13:50
.17
Y
25
13:40
.17
Y
26
14:00
.17
Y
27
10:30
.17
Y
28
14:00
.17
Y
29
30
31
13:50
.17
Y
Mon My Average Limit:
30
Monthly Average:
Dolly Maximum:
Dolly Midmam:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WY✓W-2
eDMR PERIOD: 07-2017 (July 2017)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
COMPLIANCE STATjJ : Compliant CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 08/14/2017
08/10/2017
ORC/Certij/r Si,'nafure: Jerryy/Rogers E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
'provided within 5 days of the time the permittee becomes e of the circumstances.
If the facility is noncompliant ase attach a list of c ecti actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
P
08/14/2017
PermitteefSubnlftter Signature:*** Bri4n Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES'PERMIT.NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
PERMIT VERSION: 4.0
PERMIT STATUS: Active
RECEIVE OUNTY: Iredell
3
IllV•1\L`R
GRADE:
eD MR
1!L11.1G.
WW-2
V31%1tI ruuLL V1 VLL11 LLl,
VRI..
ORC
VERSION:
EFFLUENT
JUI 1y L 1\VSGIJ
JU1 27 2017 VRI.l.GR111
;�jy ENTRAL FILESSTATUS:
'7W i SECTION
NO.: 001 NO
uovoDL'R;/p�YaliCt
Processed
Y CU/IVC,UtNF�/DWF
U L 2017
WQROS
L GIONAL OF
(June 2017)
HAS CHANGED: No
1.0J
DISCHARGE
pp
A UJ
PERIOD:
SAMPLING
06-2017
LOCATION:
DISCI
1
o
1
col
IT
tJ'
Total Composite Time
i
<
5
?
O
Operator Time On Site
a
iti
o
U
O
No Reporting Reason•"•
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
PH
CHLORINE
HOD - Cone
N013-N-Cone
TSS - Cone
FCOLIBR
TOTAL N -
2400 clock
11rs
2400 clock
Ws
Y/B/N
mgd
deg a
su
ug/1
mg/1
mg/1
mg/1
#/100m1
mg/1
1
14:20
.17
Y
2
14:40
.17
Y
3
4
5
7:25
.17
Y
6
14:40
.17
Y
7
14:30
.17
Y
8
7:30
.17
Y
9
13:30
.17
Y
to
II
12
15:20
.17
Y
13
14:10
.17
Y
14
14:30
.17
Y
15
_
7:30
.17
Y
16
14:20
.17
Y
17
18
19
7:20
.17
Y
20
15:00
.17
Y
21
_.
15:50
.17
Y
22
11:20
.17
Y
23
13:40
.17
Y
24
25
26
10:20
.17
Y
27
15:20
.17
Y
28
13:40
.17
Y
29
14:40
.17
Y
30
13:50
.17 .
Y
Mon hly Average Limit:
0.025
30
30
200
Monthly Average:
Daily Maximum:
Daily Minimum:
FICE
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
dRADE: WW-2
DMR PERIOD: 06-2017 (June 2017)
COMPLIANCE STATUS: Compliant
ORC/Certifier
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Iredell
ORC: Jerry L Rogers ORC CERT NUMBER: 7752
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 07/17/2017
07/11/2017
e: Jerry Rq(ers E-Mail:[e-mail] Phone #:[phone] Date
y this signature, I certify that this report is accurate and complete to the best of my knowledge.
he permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
'Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes awre of the circumstances.
If the facility is no s mpliant, please attach a list of corre ti e actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES p
07/17/2017
Permit P ubmitter Signature:*** Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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
Ito assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed 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.
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

GRADE: WW-2
!eDMR PERIOD: 06-2017 (June 2017)
NPDES'PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
o
Composite Sample Time
Total Composite Time
9
F
n
F
<
O
Operator Time On Site
ORC On Site?••
'v
eo
E
e.
z`
y°
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P • Cone
OIL-GRSE
MOAS
2400 clock
lln
2400 clock
Ilra
MN
mg/1
mg/1
mg/1
1
14:20
.17
Y
2
14:40
.17
Y
3 _
-_
4
5
7:25
.17
Y
6
14:40
.17
Y
7
14:30
.17
Y
8
7:30
.17
Y
9
13:30
.17
Y
10
11
12
15:20
.17
Y
13
14:10
.17
Y
14
14:30
.17
Y
15
7:30
.17
Y
16
14:20
.17
Y
17
18
19
7:20
.17
Y
20
15:00
.17
Y
21
15:50
.17
Y
22
11:20
.17
Y
23
13:40
.17
Y
24
25
26
10:20
.17
Y
27
15:20
.17
Y
28
13:40
.17
Y
29
14:40
.17
Y
30
13:50
.17
Y
Mon hly Avenge Limit:
30
Monthly Avenge:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NCO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 05-2017 (May 2017)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
SAMPLING LOCATION: EFFLUENT
PERMIT STATUS: Active
COUNTY: Iredell
RECE VE CERTNUMBER 7Z52ED/NCDENR/DWR
JUN 2 1 Z017 wit/
STATUS: Processed J U N 2 6 2017
CENTRAL FILES
DWR SECTION WQROS
DISCHARGE NO.: 001 NO DISC3HAWateRkF IAi OFFICE
Date
12
5
e`
U
F
e
E
u
9
F
F
I
8"O
EZ
pp
O
F
1
m
6
O
•
�j
i
Ca
.
L
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
IN
CHLORINE
BOD - Cone
NH3-N-Cone
TSS - Cone
FCOLI BR
TOTAL N-
2400 clock
Hre
2400 clock
Hr.
WEN
mgd
deg c
su
ug/1
mg/1
mg/1
mg/1
#/100m1
mg/1
1
15:10
.17
Y
2
8:00
.17
Y
3
15:20
.17
Y
-----
-- - --
- -
4
11:00
.17
Y
5
11:30
.17
Y
6
7
8
11:00
.17
B
9
8:52
.15
B
10
15:20
.17
Y
11
14:10
.17
Y
12
15:10
.17
Y
13
14
15
15:00
.17
Y
16
13:20
.17
Y
17
15:00
.17
Y
18
15:20
.17
Y
19
—
14:20
.17
Y
20
—
21
22
16:40
.17
Y
23
14:20
.17
Y
24
8:20
.17
Y
25
14:40
.17
Y
26
14:20
.17
Y
27
28
29
HOLIDAY
30
-
16:20
.17
Y
31
15:20
.17
Y
Mon hly Average Limit:
0.025
30
30
200
Monthly Average:
Dolly Maximum:
Daily Minimum:
No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 05-2017 (May 2017) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
s
A
Composite Sample Time
E
E
u°
s
et
Operator Arrival Time
`E
F
E
8'
y
m
8
O
•
e
A
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P-Cone
OIL-GRSE
MBAS
2400 dock
Hre
2400 clock
Hre
Y/B!N
mg/1
mg/1
mg/1
1
15:10
.17
Y
2
8:00
.17
Y
3
15:20
.17
Y
-
— ' -- — - — --
4
11:00
.17
Y
5
11:30
.17
Y
6
7
8
11:00
.17
B
9
8:52
.15
B
i0
15:20
.17
Y
i1
14:10
.17
Y
12
15:10
.17
Y
13
14
15
15:00
.17
Y
16
13:20
.17
Y
17
15:00
.17
Y
18
15:20
.17
Y
19
14:20
.17
Y
20
21
22
16:40
.17
Y
23
14:20
.17
Y
24
8:20
.17
Y
25
14:40
.17
Y
26
14:20
.17
Y
27
28
29
HOLIDAY
30
16:20
.17
Y
31
15:20
.17
Y
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily MWmum:
No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY No Visitation - Holiday

OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 05-2017 (May 2017)
COMPLIANCE STATUS: Compliant
ORC/Certifier Sig
NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
r_.
ORC: Jerry L Rogers ORC CERT NUMBER: 7752
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 06/14/2017
06/09/2017
Jerry Rogersi=Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee be omes aware -of the circumstances..- - - -- -- - - - -- - -
If the facility is noncompliant, please attach a 1. t of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES pe , it.
06/14/2017
PermitteeLfittbmitter Sign ur- ** Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
]FACILITY NAME: Origin Food Group, I✓LC CLASS: WW-2
OWNER NAME:'Origin Food Group LLC ORC: Jerry L Rogers
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 04-2017 (April 2017) VERSION: 1.0
PERMIT STATUS: Active
COUNTY: IrOdell
ORC CERT NUMBER/ IVEDIIVCDENRIC�ViIk
STATUS: Processed
MAY 2 2 2017
WOROS
OORESVILLE REGIONAL OFFICE
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES
2
C
g
—
h
"
B`3
U'
g
F
H`
ti
F'
F
—
$
3.
E
O
ti
0
F
4
O
- t.
r
o
u
re
O
No Reporting Reason••"
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Grab
Weekly
Grab
Quarterly
Grab
Instantaneous
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD-Cone
N113-N-Cone
TSS-Cone
FCOLI BR
TOTAL N -
2400 clock
Hn
2400 clock
M
Y/BIN
mgd
deg a
su
ug/1
mg/1
mg/1
mgA
1
*
t(�mA¢/�l ��'^^'° 1 gj#/I00m1
D
2
„ �-x CJ
3
14:20
.17
Y
M b4T
8 /
I I /
4
14:10
.17
Y
5
0:00
.17
Y
CEN
DWR
y �;�
I-RAL FI
6
15:00
.17
Y
SEC) IONS
7
14:40
.17
Y
8
9
10
15:50
.17
Y
11
12:10
.17
Y
12
12:50
.17
Y
13
13:20
.17
Y
14
HOLIDAY
15
16
17
14:30
.17
Y
18
13:50
.17-
Y
19
14:55
.17
Y
20
8:20
.17
Y
21
14:30
.17
Y
22
23
24
15:00
.17
Y
25
14:20
.17
Y
26
15:00
.17
Y
27
14:50
.17
Y
28
14:40
.17
Y
29
30
i
Monthly Avenge Limit:
0025
30
30
200
Monthly Average:
Daily Maximum:
Daly Minimum:
s►ar No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 04-2017 (April 2017) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
O
y
u'
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site..
Fl
ec
kGrab
o
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
TOTAL P - Caoc
OIL-GRSE
MBAS
2400 clock
Hrs
2400 clock
Hrs
Y/301
mg/I
mg/I
mg/I
1
2
3
14:20
.17
Y
4
14:10
.17
Y
5
8:00
.17
Y
6
15:00
.17
Y
7
14:40
.17
Y
8
9
10
15:50
.17
Y
11
12:10
.17
Y
12
12:50
.17
Y
13
13:20
.17
Y
14
HOLIDAY
15
16
17
14:30
.17
Y
18
13:50
.17
Y
19
14:55
.17
Y
20
8:20
.17
Y
21
14:30
.17
Y
22
23
24
15:00
.17
Y
25
14:20
.17
Y
26
15:00
.17
Y
27
14:50
.17
Y
28
14:40
.17
Y
29
30
Monthly Average Limit:
30
Monthly Average:
Dolly Maximum:
Dolly Minimum:
'**" No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 04-2017 (April 2017)
COMPLIANCE STATUS: Compliant
ORC/Certifier Signat
PERMIT VERSION: 4.0 PERMIT STATUS: Active
CLASS: WW-2 COUNTY: Iredell
ORC: Jerry L Rogers ORC CERT NUMBER: 7752
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
CONTACT PHONE #: [phone] SUBMISSION DATE: 05/05/2017
05/04/2017
RogersylbIail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a st of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES p it.
Permittee/Submitter Signatu
05/05/2017
** Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 03-2017 (March 2017)
VERSION: 1.0
PERMIT VERSION: 4.0 RECEIVED PERMIT STATUS: Active
CLASS: WW-2 APR �� �.� COUNTY:Iredell RECEIVED/NCDENR/DUNK
19
ORC: Jerry L Rogers ORC CERT NUMBER: 7752
ORC HAS CHANGED: No CENTRAL FILES
DWR SECTION
STATUS: Processed
APR 242017
WQRO
MOORESVILLE REGIONAL OFFICE
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 ' NO DISCHARGE*: YES
O
Composite Sample Time
Total Composite Time
Operator Arrival Time
in2
F
O
ORC On Site?**
la
C
m
E
ez
Z
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pI1
CHLORINE
HOD -Conc
N113-N - Cone
TSS - Conc
FCOLIHR
TOTAL N -
2400 clock
Ilra
2400 clock
Ilra
YB/N
mgd
deg c
su
ug/1
mg/1
mg/1
mg/1
#/100m1
mg/1
1
14:00
.17
Y
2
8:00
.17
Y
!3
14:40
.17
Y
4
5
6
15:00
.17
Y
7
15:00
.17
Y
8
8:00
.17
Y
'
9
14:40
.17
Y
10
14:40
.17
Y
11 '
12
13
15:10
.17
Y
14
8:00
.17
Y
75
15:30
.17
Y
16
15:20
.17
Y
17
14:40
.17
Y
18
19
20
I5:00
.17
Y
21
10:50
.17
Y
22
15:30
-.17
Y
23
11:10
.17
Y
24
14:50
.17
Y
25
26
27
15:00
.17
Y
28
14:40
.17
Y
29
15:00
.17
Y
30
14:50
.17
Y
31
8:10
.17
Y
Monthly Avenge Limit:
0.025 .
30
30
200
Monthly Avenge:
_ Daily Maximum:
- _ Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY= No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 03-2017 (March 2017) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
u
F
11
I.
h
li
"
E
U
g
k7e.
o
I.
u
9
F'
a
M
1
O
Operator Time On Site
—
o
u
O
No Reporting Reoson••••
C0665
00556
36260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Conc
OIL-GRSE
MBAS
2400 clock
lire
2400 clock
Ms
Y/BN
mg/1
mg/I
mg/I
1
14:00
.17
Y
2
8:00
.17
Y
3
14:40
.17
Y
4
5
6
15:00
.17
Y
7
15:00
.17
Y
8
8:00
.17
Y
9
14:40
.17
Y
10
14:40
.17
Y
11
12
13
15:10
.17
Y
14
8:00
.17
Y
15
15:30
.17
Y
16
15:20
.17
Y
17
14:40
.17
Y
18
19
20
15:00
.17
Y
21
10:50
.17
Y
22
15:30
.17
Y
23
I L:10
.17
Y
24
14:50
.17
Y
25
26
27
15:00
.17
Y
28
14:40
.17
Y
29
15:00
.17
Y
30
14:50
.17
Y
31
8:10
.17
Y
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME:Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 03-2017 (March 2017) VERSION: 1.0 STATUS: Processed
COMPLIANCE STATUS: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 04/12/2017
ORC/Certifier Signat
Ig ei s �MMail:[e-mail] Phone #:[phone] Date
04/07/2017
o
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
I the NPDES
04/12/2017
Permittee/Submitter Signature:*** Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.r,NC0077615
FACILITY MAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 02-2017 (February 2017)
PERMIT VERSION: 4_0
CLASS: WW-2
ORC: Jerry L Rogers
PERMIT STATUS: Active
RECEIVERUNTY: Iredell
MAR 2 2017 ORC CERT NUMBER: 7752ECEIVED/NCDENR1bWF$
ORC HAS CHANGED: No CENTRAL. FILES
VERSION: 1.0 MR SECTION STATUS: Processed
MAR 2 7 2017
WQROS
MOORESVILLE RFGIORAL OFFICE
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YE
A
Composite Sample Time
i
"
e`
u
F'
§
@
O
Operator Time On Site
Vl
o
cc
O
o
I
e.
Z
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD-Cone
NH3-N - Corr
TSS - Cane
FCOLI BR
TOTAL N -
2400 clock
firs
2400 clock
Hrs
Y/B/N
mgd
deg c
su
ug/1
mg/1
mg/1
mg/1
#/100mI
mg/1
1
14:10
.17
Y
2
—
14:40--. -
.17
Y
3
11:30
.17
Y--
4
5
6
15:00
.17
Y
7
8:20
.17
Y
8
15:10
.17
Y
9
14:40
.17
Y
la
14:30
.17
Y
11
12
13
15:00
.17
Y
14
8:20
.17
Y
15
.-
15:30
.14
Y
_
-
16
8:20
.17
Y
17
15:15
.17
Y
18
19
_,
.,
20
7:30
.17
Y
21
14:40
.17
Y
22
14:40
.17
Y
23
14:40
.17
Y
24
13:30
.17
Y
25
26
27
15:20
.17
Y
28
-_-
14:50
.17
Y
Monthly Average Limit:
0025
30
30
200
- Monthly Average:
Daily Marimum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR=NoVisitation—AdverseWeather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.,NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 02-2017 (February 2017) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time Oa Site
•
t.a
8t
U
O
:
ala
9
Y
Z
C0665
00556
38260
.
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-GRSE
MBAS
2400 clock
lira
2400 clock
lira
Y/B/N
mg/1
mg/1
mg/1
1
14:10
.17
Y
2
14:40
.17
Y
3
11:30
.17
Y
4
5
6
15:00
.17
Y
7
8:20
.17
Y
8
15:10
.17
Y
9
14:40
.17
Y
10
14:30
.17
Y
tl
12
13
15:00
.17
Y
14
8:20
.17
Y
15
15:30
.14
Y
16
8:20
.17
Y
17
15:15
.17
Y
l8
19
20
7:30
.17
Y
21
14:40
.17
Y
22
14:40
.17
Y
23
14:40
.17
Y
.
24
13:30
.17
Y
25
26
27
15:20
.17
Y
28
14:50
.17
Y
Monthly Avenge Limit:
30
Monthly Avenge:
Dolly Maximum:
Daily Mloimum:
•"` No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.a NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 02-2017 (February 2017)
COMPLIANCE STATUS: Compliant
ORC/Certifier f'gnatu,,fe: Jerry Rog
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
ONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 03/10/2017
03/09/2017
E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a
the NPDES pe
orrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
03/10/2017
Permie'i'1? mitter SignaiZtLe:*** B,fian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 01-2017 (January 2017)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
PERMIT STATUS: Active
RE C E I V E DCOUNTY: Iredell
r:d162017
ORC CERT NUMBER: 7752
RECEIVED/NCDENRIDWR
CENTRAL FILES STATUS: Processed
"IR SECTION
ftB 20 Z017
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: ViDSOS
MOORESVILLE REGIONAL OFFICE
A
Composite Sample Time
€F
E
B
u'
e
F
1
8 —
O
Operator Time On Site
ORC On Sitc?•*
a
5
I
�`n
z
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
HOD - Cone
NI13-N - Cane
TSS - Cone
FCOLI BR
TOTAL N-
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mgd
deg c
su
ug/1
mg/1
mg/1
mg/1
9/100m1
mg/I
1
12
HOLIDAY
3
-
9:30
.17
Y -
--—
---
_
-
—-
4
15:50
.17
Y
.5
15:40
.17
Y
6
10:50
.17
Y
7
8
9
16:00
.17
Y
10
12:00
.17
Y
11
16:40
.17
Y
12_
10:50
.17
Y
13
8:20
.17
Y
14
15
16
HOLIDAY
17
16:20
.17
Y
18
8:00
.17
Y
19
14:40
.17
Y
20
8:10
.17
Y
21
22
23
15:20
.17
Y
24
14:10
.17
Y
25
12:30
.17
Y
26
15:20
.17
Y
27
14:00
.17
Y
28
29
30
15:20
.17
Y
31
14:30
.17
Y
Mon blyAverage Limit:
0 025
30
30
200
Monthly Average:
Daily Maximum:
Daily Minimum:
*"" No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENV WTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 01-2017 (January 2017) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
G
F
y
1
O
Total Composite Time
Operator Arrival Time
Operator Time On Site
y
91
8Grab
O
m
a`
Z
C0665
00556
38260
Quarterly
2 X month
Monthly
GrabGraba
TOTALP -Conc
OILGRSE
MBAS
2400 clock
Hrc
2400 clock
Hrs
Y/B/N
mg/1
mg/1
mg/1
1
2
HOLIDAY
3
9:30
.17
Y
4
15:50
.17
Y
5
15:40
.17
Y
6
10:50
.17
Y
7
8
9
16:00
.17
Y
10
12:00
.17
Y
11
16:40
.17
Y
12
10:50
.17
Y
13
8:20
.17
Y
14
15
16
HOLIDAY
17
16:20
.17
Y
18
8:00
.17
Y
19
14:40
.17
Y
20
8:10
.17
Y
21
22
23
15:20
.17
Y
24
14:10
.17
Y
25
12:30
.17
Y
26
15:20
.17
Y
27
14:00
.17
Y
28
29
30
15:20
.17
Y
31
14:30
.17
Y
Mon lily Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

1,PDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 01-2017 (January 2017)
COMPLIANCE STATUS: Comp ant
PERMIT VERSION: 4_0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 02/07/2017
RC/Certifier Jerry Rogers -Mail:[e-mail]
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
02/07/2017
Phone #:[phone] Date
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
ry information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
_vided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective ctions being taken and a time -table for improvements to be made as required by part lI.E.6 of
the NPDES permit.
Permittee/Submitter Signature:***
02/07/2017
or E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed
Ito assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed 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.
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 12-2016 (December 2016)
PERMIT VERSION: 4.0
CLASS: WW-2
RECEIVED
ORC: Jerry L Rogers FU 02 Z6' 17
ORC HAS CHANGED: o
VERSION: 1.0 CENTRAL FILES STATUS: Processed
DWR SECTION WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHWEVIfigEGIONAL OFFICE
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7RgCEIVED/NCDENR/DWR
FEB -6 2017
q
Composite Sample Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
11
P.
51
o
0
0
Y
C
re'
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pll
CHLORINE
BOD - Cone
NI13-N- Corm
TSS - Coac
FCOLI BR
TOTAL N -
2400 clock
Hrs
2400 clock
firs
Y/B/N
mgd
deg c
su
ug/1
mg/1
mg/1
mg/1
#/100m1
mg/1
I
15:20
.17
Y
2
14:20
.17
Y
3
4
5
15:30
.17
Y
6
9:20
.17
Y
7
15:30
.17
Y
8
14:40
.17
Y
9
7:50
.17
Y
io
11
12
15:30
.17
Y
13
9:35
.17
Y
14
15:20
.17
Y
15
8:00
.17
Y
16
14:20
.17
Y
17
18
19
13:50
.17
Y
20
14:00
.17
Y
21
14:20
.17
Y
22
13:50
.17
Y
23
HOLIDAY
24
25
26
HOLIDAY
27
HOLIDAY
28
10:20
.17
Y
29
8:00
.17
Y
30
11:20
.17
Y
31
Moo hly Average Molt:
0.025
30
30
200
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENV WTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Jeny L Rogers
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 12-2016 (December 2016) VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
Composite Sample Time
1-.
"
9
u
F
"
E
<
2
O
8
3
F
t
0.
O
ORC On Site**
No Reporting Reason"`•
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab:61:
TOTAL P-Cone
OIL-GRSE
MBAS
2400 clock
Ilrs
2400 clock
nrs
Y/B/N
mg/1
mgfl
mg/
1
15:20
.17
Y
2
14:20
.17
Y
3
4
5
15:30
.17
Y
6
9:20
.17
Y
7
15:30
.17
Y
8
14:40
.17
Y
9
7:50
.17
Y
10
I1
12
15:30
.17
Y
13
9:35
.17
Y
14
15:20
.17
Y
15
8:00
.17
Y
16
14:20
.17
Y
17
18
19
13:50
.17
Y
20
14:00
.17
Y
21
14:20
.17
Y
22
13:50
.17
Y
23
HOLIDAY
24
25
26
HOLIDAY
27
HOLIDAY
28
10:20
.17
Y
29
8:00
.17
Y
30
11:20
.17
Y
31
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR= No Visitation —Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation— Holiday

NPDES PERMIT NO.: NC0077615
FACILITY N: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 12-2016 (December 2016)
COMPLIANCE STATUS: pliant
ORC/Certifier ''gnat e: Jerry Roge
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
ONTACT PH
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
#: 7048724697 SUBMISSION DATE: 01/23/2017
01/17/2017
E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of co ective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
01/23/2017
Permittee/Submitter Signature:*** Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO. •NC0077615
'3rig
FACILITY NAME:in Food Group, LLC
OWNER NAME: QJrigin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 11-2016 (November 2016)
PERMIT VERSION: 4_0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
PERMIT STATUS: Active
RE C E V E D COUNTY: Iredell
ORC CERT NUMBER: 7752
DEC 2 1 2016
CENTRAL FILES STATUS: Processed
DWR SECTION
3
RECEIVED/NCDENR/DWR
DEC 3 0 2016
SAMPLING. LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YESNQROS
MOORESVILLE REGIONAL OPP/I
A
Composite Sample Time
(:9.
1
g
u
o
[+
F
f.
a
E
O
P
`II
H
E
O
6 •
U
O
No Reporting Reason"...
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
PH
CHLORINE
BOD-Cone
NH3-N-Cons
TSS-Cone
FCOLI BR
TOTAL N-
2400 clock
Hos
2400 clock
Hra
Y/BEN
mgd
deg c
su
ugf
me
mg/1
mg/1
#/100m1
mg/I
1
14:40
.17
Y
2
8:50
.17
Y
3
14:30
.17
Y
---- -
- --
—
— -----
4
7:50
.17
Y
5
6
7
7:50
.17
Y
8
9:20
.17
Y
9
14:50
.17
Y
10
8:00
.17
Y
11
HOLIDAY
12
13
14
15:00
.17
Y
15
9:20
.17
Y
16
14:20
.17
Y
17
-•.
8:00
.17
Y
18
J-
14:20
.17
Y
19
20
21
15:20
.17
Y
22
9:20
.17
Y
23
8:00
.17
Y
24
HOLIDAY
25
HOLIDAY
26
27
28
15:50
.17
Y
29
-
14:00
.17
Y
30
14:40
.17
Y
Monthly Average Limit:
0.025
30
30
200
Monthly Average:
Dolly Maximum:
Dolly Minimum:
•'•' No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: W0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 11-2016 (November 2016) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
P.
A
Composite Sample Time
e P.
E.
u°
a
140
Operator Arrival Time
h
f
a
nu
6
u
O
No Reporting Reason....
C0665
00556
38260
Quarterly _
2 X month
Monthly
Grab
Grab
Grab
TOTAL P-Cone
OIL-GRSE
MBAS
2400 clock
Hi"
2400 clock
Hn
Y/B1N
mg/1
mg/1
mg/1
1
14:40
.17
Y
2
8:50 .
.17
Y
!3
14:30
.17
Y
__
4
7:50
.17
Y
5
6
7
7:50
.17
Y
8
9:20
.17
Y
9
14:50
.17
Y
10
8:00
.17
Y
11
HOLIDAY
12
13
14
15:00
.17
Y
15
9:20
.17
Y
16
14:20
.17
Y
17
8:00
.17
Y
18
14:20
.17
Y
19
20
21
15:20
.17
Y
22
9:20
.17
Y
23
8:00
.17
Y
24
HOLIDAY
25
HOLIDAY
26
27
28
15:50
.17
Y
29
14:00
.17
Y
30
14:40
.17
Y
Monthly Avemge Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.': NC0077615
•
FACILITY NAME: Origin Food Group, LLC
OWNER NANYE:?'Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 11-2016 (November 2016)
COMPLIANCE STATUS: Compliant
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 12/12/2016
12/07/2016
ORC/Certifier ' fnattyfe:'1err y' Ro'Ors E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
12/12/2016
Permittee/Su.mitter Signature* Brian Foor
E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
ACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752ECEIVEDINCDENRJDWR
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 10-2016 (October 2016) VERSION: 1.0
STATUS: Processed
NOV 212016
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHAiRGrEVYiE-Sz5GIor•1AL OFFICE
O
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?**
No Reporting
Reason***"
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD -Conc
NH3-N - Cone
TSS - Cone
FCOLI BR
TOTAL N -
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mgd
deg c
su
ug/1
mg/1
mg/1
mg/I
6/100m1
mg/1
1
2
3
I5:50
.17
Y
�-
il
4
9:00
.17
Y
L
7d L1Pd
c- N
D
5
11:30
.17
Y
NOV
16201E
6
14:40
.17
Y
7
7:30
.17
Y
CENTRAL
FII FR
8
DWR SECTION
9
10
7:45
.17
Y
11
14:00
.17
Y
12
12:00
.17
B
13-
14:30
.17
Y
-
'14
14:20
.17
Y
15
16
17
15:30
.17
Y
18
12:50
.17
Y
19
—
16:00
.17
B
20
-
1000
.17
B
21
10:17
.13
B
22
23
24
7:55
.17
Y
25
8:00
.17
Y
26
8:10
.17
Y
27
14:20
.17
Y
28
14:20
.17
Y
29
30
31
7:30
.17
Y
Monthly Average Limit:
0.025 .
30
30
200
Monthly Average:
Daily Maximum:
Daily Minimum:
•" No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR=No Visitation - Adverse Weather, NOFLOW = No Flow; HOLIDAY =No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
1 ACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
WNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
&RADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 10-2016 (October 2016) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
i.
II
rn
n
O
U
a
O
No Reporting
Reason••••
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Conc
OIL-GRSE
MBAS
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mg/1
mg/l
mg/I
1
2
3
15:50
.17
Y
4
9:00
.17
Y
5
11:30
.17
Y
6
14:40
.17
Y
7
7:30
.17
Y
8
9
10
7:45
.17
Y
11
14:00
.17
Y
12
12:00
.17
B
13
14:30
.17
Y
14
14:20
.17
Y
15
16
17
15:30
.17
Y
18
12:50
.17
Y
19
16:00
.17
B
20
1000
.17
B
21
10:17
.13
B
22
23
24
7:55
.17
Y
25
8:00
.17
Y
26
8:10
.17
Y
27
14:20
.17
Y
28
14:20
.17
Y
29
30
31
7:30
.17
Y
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
'•" No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 10-2016 (October 2016) VERSION: 1.0 STATUS: Processed
COMPLIANCE: Compliant CONTACT PHONE #: [phone] SUBMISSION DATE: 11/08/2016
11/08/2016
ORC/Certifier Signure: ' erry Rogers Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list .li corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES pe
11/08/2016
Permittee/Su.mitter Signa * Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
CERTIFIED LABORATORIES
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
!FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 09-2016 (September 2016) VERSION: 1.0
PERMIT STATUS: Active /
COUNTY: Iredell
ORC CERT NUMBER: 7752
RECEIVEDINCDENR/DWR
STATUS: Processed
OCT 242016
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCI.'NALOFFICE
i
0
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?**
No Reporting
Reason****
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD - Cone
NH3-N - Cone
TSS - Cone
FCOLI BR
TOTAL N -
2400 clock
Hrs
2400 clock
Hrs
YB/N
mgd
deg c
au
ug/l
mg/1
mg/1
mg/1
#/100m1
mg/1
1
11:20
.17
Y
2
14:10 -
.17
Y
3
,^ --
:,..VE
Jei9
D
4
5
HOLIDAY
OCT
2016
6
10:10
.17
Y
CENTRAL
7
16:00
.17
Y
DWR SECTION
FILES
8
10:30
.17
Y
9
14:30
.17
Y
10
11
12
15:00
.17
Y
13
13:10
.17
Y
14
7:30
.17
Y
15
13:40
.17
Y
16
7:20
.17
Y
17
18
19
15:20
.17
Y
20
9:30
.17
Y
21
14:30
.17
Y
22
14:40
.17
Y
23
13:20
.17
Y
24
25
26
7:20
.17
Y
27
13:40
.17
Y
28
15:20
.17
Y
29
7:20
.17
Y
30
14:00
.17
Y
Monthly Average Limit:
0.025
30
30
200
Monthly Average:
Daily Maxhnum:
Daily Minimum:
* No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 09-2016 (September 2016) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
Date
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?`•
No Reporting
Reason""
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-GRSE
MBAS
2400 clock
Hrs
2400 clock
Hrs
YB/N
mg/1
mg/I
mg/I
1
11:20
.17
Y
2
14:10
.17
Y
4
5
HOLIDAY
6
10:10
.17
Y
7
16:00
.17
Y
8
10:30
.17
Y
9
14:30
.17
Y
10
11
12
15:00
.17
Y
13
13:10
.17
Y
14
7:30
.17
Y
15
13:40
.17
Y
16
7:20
.17
Y
17
18
19
15:20
.17
Y
20
9:30
.17
Y
21
14:30
.17
Y
22
14:40
.17
Y
23
13:20
.17
Y
24
25
26
7:20
.17
Y
27
13:40
.17
Y
28
15:20
.17
Y
29
7:20
.17
Y
30
14:00
.17
Y
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 09-2016 (September 2016)
COMPLIANCE: Compliant
ORC/Certifier Sign
re: J
rry
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 10/05/2016
• (i 10/05/2016
-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
_provided within 5_days of the time the permittee becomes_aware_of-the-circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES pe t.
Permit'ee/Subm
0 7`t
10/05/2016
nature:*** Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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 subinitting false information, including the possibility of fines and imprisonment for
knowing violations.
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

3
NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group b,LC ORC: Jerry L Rogers
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 08-2016 (August 2016) VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
RECEIVED/N O D E N R /DIN R
SEP 26 Zulo
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCE*•ems
sV LLE REGIONAL C'zPrCE
a'
A
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Sitc?**
No Reporting
Reason****
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD - Conc
NH3-N - Cone
TSS - Conc
FCOLI BR
TOTAL N -
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mgd
deg c
su
ug/1
mg/1
mg/1
mg/1
#/100m1
mg/1
1
7:20
.17
Y
,
2
13:20
.17
Y
G'"+ors-+ ,-1fr
0 Tt gl
3
14:10
.17
Y
irV' a
s7 iv I
--
4
7:30
.17
Y
5
10:30
.17
Y
SEP
1 9 2L16
6
CR\r
PA!_ i PL
ES
7
DWF;
SECTION
8
14:50
.17
Y
9
13:40
.17
Y
10
11:45
.25
B
11
11:45
.17
B
12
11:45
.17
B
13
14
15
7:50
.17
Y
16
13:20
.17
Y
17
7:30
.17
Y
18
10:20
.17
Y
19
12:30
.17
Y
20
21
22
14:40
.17
Y
23
8:50
.17
Y
24
- -
I1:10 '
.17
Y
25
7:20
.17
Y
26
10:30
.17
Y
27
28
29
7:10
.17
Y
30
14:10
.17
Y
31
14:30
.17
Y
Monthly Average Limit:
0.025
30
30
200
Monthly Average:
Daily Maximum:
-
Daily Minimum:
'
**** No Reporting Reason; ENFRUSE = No Flow-Reuse/Recycle; ENV WTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group I.LC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 08-2016 (August 2016) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
O
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?**
No Reporting
Reason****
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-GRSE
MBAS
2400 clock
Hrs
2400 clock
Ara
Y/B/N
mg/1
mg/1
mgll
I
7:20
.17
Y
2
13:20
.17
Y
3
z-`--
14:10 — —
_
.17
-
Y —
4
7:30
.17
Y
5
10:30
.17
Y
6
7
8
14:50
.17
Y
9
13:40 -
.17
Y
10
11:45
.25
B
11
-
11:45
.17
B
12
11:45
.17
B
13
14
15
7:50
.17
Y
16
13:20
.17
Y
17
7:30
.17
Y
18
10:20
.17
Y
19
12:30
.17
Y
20
21
.
22
14:40
.17
Y
23
8:50
.17
Y
24
11:10
.17
Y
25
7:20
.17
Y
26
10:30
.17
Y
27
28
29
7:10
.17
Y
30
14:10
.17
Y
31
14:30
.17
Y
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
i
eDMR PERIOD: 08-2016 (August 2016)
COMPLIANCE: Compliant
ORC/Certifier Signat
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 09/12/2016
ail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of -the circumstances: A written submission shall also be
provided-within-5-days of the time the permittee becomes aware of the circumstances.
the NPDES permit.
If the facility is noncompliant, please attach a list of cf ective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
-4
Rogers
Permittee/Submitter Sig .lure:*** Irian Foor E-Mail:bfoor@originfood rou con Phone #:[phone]/2016
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019 p Date
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 managed 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.
09/08/2016
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters
for entire monitoring period. P ers on the DIVER
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers
GRADE: WW-2 ORC HAS CHANGED: No
DMR PERIOD: 07-2016 (July 2016) VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
—3
ORC CERT NUMBR52
ECEIVED/NCDENR/DWR
STATUS: Processed A U 1, 3 2 016
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DIDISratiMEV`RffirAAL OFFICE
A
A
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?**
No Reporting
Reason****
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
pH
CHLORINE
BOD - Cone
NA3-N-Cone
TSS - Cone
FCOLI BR
TOTAL N -
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mgd
deg c
su
ug/I
mg/1
mg/I
mg/1
#/100m1
mg/1
1
10:10
.17
Y
-
F rd.:.Ei®ant
AUG
18 2OI6
3
--
_----'—
- --
4
HOLIDAY
5
15:50
.17
Y
6
15:45
.17
Y
CENTRAL
nwR
riLEs
sECTIOJ
7
7:50
.17
Y
8
14:20
.17
Y
9
10
11
14:40
.17
Y
12
13:20
.17
Y
13
7:40
.17
Y
14
10:20
.17
Y
15
13:00
.17
Y
16
17
18
7:20
.17
Y
19
13:50
.17
Y
20
9:00
.17
Y
21
13:00
.17
Y
22
13:20
.17
Y
23
24
25
7:10
.17
Y
26
12:20
.17
Y
27
9:40
.17
Y
28
10:10
.17
Y
29
13:20
.17
Y
30
31
Monthly Average Limit:.
0.025
30
30
200
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
—r
FACILITY NAME: Origin Food Group; LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
'GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 07-2016 (July 2016) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
O
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?**
No Reporting
Reason****
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OH,-GRSE
MBAS
2400 clock
Hrs
2400 clock
Hrs
YB/N
mg/I
mg/1
mg/I
1
10:10
.17
Y
2
4
HOLIDAY
5
15:50
.17
Y
6
15:45
.17
Y
7
7:50
.17
Y
8
14:20
.17
Y
9
10
11
14:40
.17
Y
12
13:20
.17
Y
13
7:40
.17
Y
14
10:20
.17
Y
15
13:00
.17
Y
16
17
18
7:20
.17
Y
19
13:50
.17
Y
20
9:00
.17
Y
21
13:00
.17
Y
22
13:20
.17
Y
23
24
25
,
7:10
.17
Y
26
12:20
.17
Y
27
9:40
.17
Y
28
10:10
.17 -
Y
29
13:20
.17
Y
t
30
31
Monthly Average Limit::
30
Monthly Averages.
Daily Maximums.
Daily Minimum:
* No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Qrigin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers
GRADE: WW-2
eDMR PERIOD: 07-2016 (July 2016) VERSION: 1.0
COMPLIANCE: Compliant CONTACT PHONE #: [phone]
ORC HAS CHANGED: No
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 08/04/2016
08/04/2016
ORC/Certifier
gna
ure: Jerry fl(ogers E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
08/04/2016
Permittee/Submitter Sign'a4trfe:*** Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical, Inc.
CERTIN1ED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO:: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active 3
FACILITY NAME: Origin Food Group, LLC CLASS: W W-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 05-2016 (May 2016) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES
q
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?"
m
f 1
a 10
cC m
Z rX
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2Xweek
Weekly
2Xmonth
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
PH
CHLORINE
BOD - Conc
NH3-N-Cone
TSS - Conc
FEC COLI
TOTAL N -
2400 dock
Hrs
2400 dock
Hrs
Y/B/N
mgd
deg c
su
ug/1
mg/1
mg/1
mg/1
i1/100m1
mg/I
1
2
15:50
.17
Y
3
9:30
.17
Y
4
I5:50
.17
Y
5
8:20
.17
Y
R E
C ®�97
v D
6
2
7
JUN
0
201G
8
CFNTRAL
FILES
9
16:20
.17
Y
DVhIR
SFCTION
10
8:00
.17
Y
11
9:40
.17
Y
RECEIVED/NCDEN?/DWR
12
11:20
.17
Y
13
... -
.11:20
.17 -
Y ..
JUN
(j
2 8 Z316
14
... . "..,..
15
"
WQROS
.. .
16.•
-- -
15:50
.17
Y
MCORESVILLE
REGIONAL
OFFIC
17 "
... . .
.
9:30
18
16:00
.17
Y
_
19
14:30
.17
Y
20
15:30 "
.17
Y
21
22
23
15:50
.17
Y
24
9:30
.17
Y
25
11:20 -
.17
Y
26
10:50
.17
Y
27
14:20
.17
Y
28
29
30
HOLIDAY
31
-
-
9:50 .
.17
Y
.. " ' Monthly Average Limit:
0.025
30
30
200
Monthly Average:
. Daily Maximum:
Daily Minimum:
ssss No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENV WTHR = No Visitation - Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 05-2016 (May 2016) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
Date
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?""
No Reporting
Reason""""
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Conc
OIL-GRSE
MBAS
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mg/1
mg/1
mg/1
1
2
15:50
.17
Y
3
9:30
.17
Y
4
15:50
.17
Y
5
8:20
.17
Y
6
7
8
9
16:20
.17
Y
10
8:00
.17
Y
11
9:40
.17
Y
12
11:20
.17
Y
13
11:20
.17
Y
14
15
16
15:50
.17
Y
17
9:30
.17
Y
18
16:00
.17
Y
19
14:30
.17
Y
20
15:30
.17
Y
21
22
23
15:50
.17
Y
24
-
9:30
.17 .
Y
25
11:20
.17
Y
26
10:50
.17
Y
27
14:20
.17
Y
28
29
30
HOLIDAY
31
9:50
.17
Y
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
•"" No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENV WTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2
eDMR PERIOD: 05-2016 (May 2016)
COMPLIANCE: Compliant
ORC/Certifier
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
STATUS: Processed
SUBMISSION DATE: 06/08/2016
06/03/2016
Jerry Roger:-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
--provided within 5 days of the time the permittee becomes aware of the circumstances. _ _ _
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES pe
bmitter Signture:*
06/08/2016
Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677
Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

3
NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 5 EIVED/NCDENRIDWR
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 04-2016 (April 2016) VERSION: 1.0
STATUS: Processed
MAY 242016
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCIIARGE1:140GloNaL OFFICE
a
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
u
m
e
O
U
C:
O
No Reporting
Reason****
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week .
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
PH
CHLORINE
BOD - Conc
NH3-N - Conc
TSS - Conc
FEC COLT
TOTAL N -
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mgd
deg c
su
ug/l
mg/1
mg/1
mg/1
/1/100m1
mg/1
1
8:00
.17
Y
2
_
3
4
15:20
.17
Y
5
9:30
.17
Y
6
15:20
.17
Y
7
8:00
.17
Y
8
14:10
.17
Y
9
10
11
15:50
.17
Y
12
14:30
.17
Y
13
8:20
.17
Y
14
14:40
.17
Y
15
11:50
.17
Y
16
17
18
15:50
.17
Y
19
12:20
.17
Y
20
8:50
.17
Y
21
13:50
.17
Y
22
9:50
.17
Y
23
24
25
8:00
.17
Y
26
9:40
.17
Y
27
5:00
.17
Y
28
8:10
.17
Y
29
14:20
.17
Y
30
Monthly Average Limit:
0.025
30
30
200
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather; NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday
RECEIVED
MAY 192016
CENTRAL, FILES
DWR SECTION

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 04-2016 (April 2016) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
Date
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?"
No Reporting
Reason""
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-GRSE
MBAS
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mg/I
mg/I
mg/I
1
8:00
.17
Y
2
3
4
15:20
.17
Y
5
9:30
.17
Y
6
15:20
.17
Y
7
8:00
.17
Y
8
14:10
.17
Y
9
10
11
15:50
.17
Y
12
14:30
.17
Y
13
8:20
.17
Y
14
14:40
.17
Y
15
11:50
.17
Y
16
17
18
15:50
.17
Y
19
12:20
.17
Y
20
8:50
.17
Y
21
13:50
.17
Y
22
9:50
.17
Y
23
24
25
8:00
.17
Y
26
9:40
.17
Y
27
5:00
.17
Y
28
8:10
.17
Y
29
14:20
.17
Y
30
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NA1 TE: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 04-2016 (April 2016)
COMPLIANCE: Compliant
ORC/Certifier
atur
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 05/11/2016
05/09/2016
Jerry Rogue/ E-Mail:[e-mail] Phone #:[phone] Date
y this signature, I certify that this report is accurate and complete to the best of my knowledge.
e permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
'provided within 5 days of the time the permittee becomes aware of the circumstances.
+If the facility is noncompliant, please attach a 'st of corrective actions being taken and a time -table for improvements to be made as required by part lI.E.6 of
rthe NPDES permit.
05/11/2016
Permittee/Submitter Sign:. *** Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: O in -Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers
GRADE: WW-2 ORC HAS CHANGED: No
VERSION: 1.0
eiDMR PERIOD: 03-2016 (March 2016)
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752 RECEIVED/NCDENR/DWR
MAY 2 2U16
STATUS: Processed
WQROS
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARRFT'cE(LE REGIONAL OFF
r
C
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?••
No Reporting
Reason**"
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
PH
CHLORINE
BOD - Cane
NH3-N-Cone
IRS -Cone
FEC COLI
TOTAL N-
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mgd
deg c
su
ugf
mg/1
mg/1
mg/I
#/100m1
mg/1
1
8:15
.17
Y
2
15:00
.17
Y
_
3
11:50
.17
Y
4
14:10
.17
Y
5
6
7
15:50
.17
Y
8
9:20
.17
Y
9
14:30
.17
Y
10
11:50
.17
Y
11
16:40
.17
Y
12
13
14
14:00
.25
B
15
12:50
.17
B
16
15:20
.17
Y
�y
RP ' F
\fE
17
13:50
.17
Y
�l
D
18
,
14:30
.17
Y
APR 22
2016
19
20
R
21
15:50
.17
Y
INRORMAD1O
OCESSING
UNIT
22
13:50
.17
Y
23
11:30
.17
Y
24
_ ..
.__
13:50
.17
Y
25
HOLIDAY
26
27
28
13:40
.17
Y
29
_
17:10
117
Y
30
10:30
.5
Y
31
_
_14:30
.17
Y
Monthly Average Limit:
0.025
30
30
200
Monthly Average:
Daily Maximum:
Daily Minimum:
* * ** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY =No Visitation — Holiday

NPDES PERMIT NO.: NC00776,15 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: OriinFood Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 03-2016 (March 2016) VERSION: 1.0
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
STATUS: Processed
O
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
Vi
e
0
U
0
No Reporting
Reason""""
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Cone
OIL-GRSE
MBAS
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mg/1
mgll
mg/l
1
8:15
.17
Y
2
15:00
.17
Y
3
11:50
.17
Y
4
14:10
.17
Y
5
6
7
15:50
.17
Y
8
9:20
.17
Y
9
14:30
.17
Y
10
11:50
.17
Y
11
16:40
.17
Y
12
13
14
14:00
.25
B
15
12:50
.17
B
16
15:20
.17
Y
17
13:50
.17
Y
18
14:30
.17
Y
19
20
21
15:50
.17
Y
22
13:50
.17
Y
23
11:30
.17
Y
24
13:50
.17
Y
25
HOLIDAY
26
27
28
13:40
.17
Y
29
17:10
.17
Y
30
10:30
.5
Y
31
14:30
.17
Y
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
""` No Reporting Reason: ENFRUSE =No Flow-Reuse/Recycle; ENVWTHR = No Visitation — Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Ori in Food Group, LLC
OWNER NAME: Origfn Food Group LLC
GRADE: WW-2
eDMR PERIOD: 03-2016 (March 2016)
COMPLIANCE: Compliant
ORC/Certifier
tu�Jerry R
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 04/13/2016
P orally within 24 hours from the time the permittee became aware of the circumstances
rovided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach al' corrective actions being taken and a time -table for improvements to
the NPDES .ermit.
s E-Mail:[e-mail] Phone #:[phone]/201e
Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be rovided
. A written submission shall also be
be made as required by part II.E.6 of
iIermittee/Submitter Signatur . Brian Foor E-Mail:bfoor@originfoodgr+up.com Phone #:[phone]
permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019 Date
I (certify, under penalty of law, that this document and all attachments were prepared under my direction or sue '
t - assure that qualified personnel ro erl P rvision in accordance with a system designed
P p y gather and evaluate the information submitted. Based on my inquiry of the person or persons who managed the
s stem, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
a curate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
owing violations.
L' B NAME: Statesville Analytical Inc.
C RTIFIED LAB #: 440
P RSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
04/13/2016
PARAMETER CODES
ameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*lNo Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the ar
for entire monitoring period. p ameters on the DMR
* ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 02-2016 (February 2016)
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
SAMPLING LOCATION: EFFLUENT
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 77,5pCEIVEb/NCDENR/bWR'
STATUS: Processed
APR 5 2016
WQROS
DISCHARGE NO.: 001 NO DISCRAWV?E+ SGIONAL OFF➢CIT
4
4
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ki00
iri
O
L.)
a
O
•. s
Z. c
tX a
d
Z a
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C ,
PH
CHLORINE
BOD - Conc
NH3-N - Conc
TSS - Conc
FEC COLT
TOTAL N -
2400 clock
Hrs
2400 clock -
Hrs
Y/B/N
mgd
deg c
su
uW/I
mg/1
mg I
mg/1
#/100m1
mg/1
1
16:00
.17
Y
12
9:40
.17
Y
4
10:00
.17
Y
5
14:20
.17
Y
6
7
8
16:00
.17
Y
9
11:00
.17
Y
10
8:20
.17
Y
11
10:50
.17
Y
12
13:50
.17
Y
13
14
15
16:20
.17
Y
16
8:20
.17
Y
17
15:20
.17
Y
18
8:00
.17
Y
19
11:20
.17
Y
20
21
22
15:50
.17
Y
23
9:30
.17
Y
24
11:30
.17
Y
25
13:50
.17
Y
26
8:10
.17
Y
27
28
29
8:00
.17
Y
Monthly Average Limit:
0.025
30
30
200
_
Monthly Average:
Daily Maximum:
Daily Minimum:
**** No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENVWTHR=NoVisitation— AdverseWeather, NOFLOW = No Flow; HOLIDAY = No Visitation — Holiday
RECEIVED
MAR 2 A 2Ii;5
CENTRAL FILES
nWR SECTION

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAVE: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 02-2016 (February 2016) VERSION: 1.0
STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
a
C
Composite Sample
Time
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?**
No Reporting
Reason****
C0665
00556
38260
Quarterly
2 X month
Monthly
Grab
Grab
Grab
TOTAL P - Conc
OIL-GRSE
MBAS
2400 clock
Hrs
2400 clock
Hrs
Y/B/N
mg/1
mg/1
mg/1
1
16:00
.17
Y
2
9:40
.17
Y
3
- -
--
8:20
.17
Y
- -
- - - - - _ - -. —.- _ _._ -�
_ -- -- l - -
- � -
4
10:00
.17
Y
5
14:20
.17
Y
6
7
8
16:00
.17
Y
9
11:00
.17
Y
10
8:20
.17
Y
11
10:50
.17
Y
12
13:50
.17
Y
13
14
15
16:20
.17
Y
16
8:20
.17
Y
17
15:20
.17
Y
18
8:00
.17
Y
19
11:20
.17
Y
20
21
22
15:50
.17
Y
23
9:30
.17
Y
24
11:30
.17
Y
25
13:50
.17
Y
26
8:10
.17
Y
27
28
29
8:00
.17
Y
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
*** * No Reporting Reason: ENFRUSE = No Flow-Reuse/Recycle; ENV WTHR = No Visitation - Adverse Weather, NOFLOW = No Flow; HOLIDAY = No Visitation - Holiday

NPDES PERMIT NO.: NC0077615
FACILITY NAME: Origin Food Group, LLC
OWNER NAME: Origin Food Group LLC
GRADE: WW-2
DMR PERIOD: 02-2016 (February 2016)
COMPLIANCE: Compliant
ORC/Certifie
ure: Jerry
PERMIT VERSION: 4.0
CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: 1.0
CONTACT PHONE #: [phone]
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 03/10/2016
03/09/2016
ers E-Mail:[e-mail] Phone #:[phone] Date
y this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee bacomes aware of the -di cu'mstances. - — - -
If the facility is noncompliant, please attach
the NPDES permit.
E
t of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
03/10/2016
Permittee/Submitter Signatur Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
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 managed 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.
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

1
NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2
OWNER NAME: Origin Food Group LLC ORC: Jerry L Rogers
t
GRADE: WW-2 ORC HAS CHANGED: No
eDMR PERIOD: 01-2016 (January 2016)
VERSION: 1.0
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBERRE 3 IVED/NCDENR/DWR
STATUS: Processed
MAR 2016
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*05ESs
MOORESVILLE REGIONAL OFFICE
u
A
Composite Sample
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?••
No Reporting Reason
50050
00010
00400
50060
C0310
C0610
C0530
31616
C0600
Weekly
Weekly
Weekly
2 X week '
Weekly
2 X month
Weekly
Weekly
Quarterly
Instantaneous
Grab
Grab
Grab
Grab
Grab
Grab
Grab
Grab
FLOW
TEMP-C
PH
CHLORINE
BOD - Conc
NH3-N - Conc
TSS - Conc
FEC COLI
TOTAL N -
2400
Hrs
2400
Hrs
Y/B/N
mgd
deg c
su
ug/1
mg/I
mg/1
mg/1
#/100m1
mg/I
1
2
3
4
15:50
.17
Y
5
9:20
.17
Y
6
15:50
.17
Y
7
8:00
.17
Y
8
14:00
.17
Y
9
10
11
16:10
.17
Y
12
8:25
.17
Y
13
14:10
.17
Y
14
11:25
.17
Y
15
13:40
.17
Y
16
17
18
No Violation - Holiday
19
16:40
.17
Y
20
16:20
.17
Y
21
8:10
.17
Y
22
13:30
.17
Y
23
24
25
14:20
.17
Y
26
11:20
.17
Y
27
10:15
.17
Y
28
10:40
.17
Y
29
15:20
.17
Y
30
31
Monthly Average Limit:
0.025
30
30
200
•" Monthly Average:
Daily Maximum:
Daily Minimum:
Monthly Avg % Removal (85%):
RECEIVED
FEB .2 2 2016
CENTRAL FILES
DWR SECTION

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0 PERMIT STATUS: Active
FACILITY NAME: Origin Food Group, LLC CLASS: WW-2 COUNTY: Iredell
OWNER NAME: -Origin Food Group LLC ORC: Jerry L Rogers ORC CERT NUMBER: 7752
ORC HAS CHANGED: No
VERSION: 1.0 STATUS: Processed
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: YES (Continue)
GRADE: WW-2
eDMR PERIOD: 01-2016 (January 2016)
O
Composite Sample
Total Composite Time
Operator Arrival Time
Operator Time On Site
ORC On Site?••
I,I No Reporting Reason
C0665
38260
00556
Quarterly
Monthly
2 X month
Grab
Grab
Grab
TOTAL P - Cone
MBAS
OIL-GRSE
2400
Hrs
2400
Hrs
YB/N
mg/1
mg/I
mg/1
1
2
3
4
15:50
.17
Y
5
9:20
.17
Y
6
15:50
.17
Y
7
8:00
.17
Y
8
14:00
.17
Y
9
10
11
16:10
.17
Y
12
8:25
.17
Y
13
14:10
.17
Y
14
11:25
.17
Y
15
13:40
.17
Y
16
17
18
No Visitation - Holiday
19
16:40
.17
Y
20
16:20
.17
Y
21
8:10
.17
Y
22
13:30
.17
Y
23
24
25
14:20
.17
Y
26
11:20
.17
Y
27
10:15
.17
Y
28
10:40
.17
Y
29
15:20
.17
Y
30
31
Monthly Average Limit:
30
Monthly Average:
Daily Maximum:
Daily Minimum:
Monthly Avg % Removal (85 %):

NPDES PERMIT NO.: NC0077615 PERMIT VERSION: 4.0
FACILITY NAME: Ori§in Food Group, LLC CLASS: WW-2
ORC: Jerry L Rogers
ORC HAS CHANGED: No
VERSION: I_0
COMPLIANCE: Compliant CONTACT PHONE #: [phone]
OWNER NAME; Origin Food Group LLC
GRADE: WW-2
eDMR PERIOD: 01-2016 (January 2016)
ORC/Certifier
PERMIT STATUS: Active
COUNTY: Iredell
ORC CERT NUMBER: 7752
STATUS: Processed
SUBMISSION DATE: 02/09/2016
02/08/2016
: Jerry Rog4jfs E-Mail:[e-mail] Phone #:[phone] Date
By this signature, I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant, please attach a list of corrective actions being taken and a time -table for improvements to be made as required by part II.E.6 of
the NPDES permit.
COMMENTS:
Permittee/Sub
02/09/2016
e:*** Brian Foor E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address: 306 Stamey Farm Rd Statesville NC 28677 Permit Expiration Date: 03/31/2019
, 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 managed 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.
LAB NAME: Statesville Analytical, Inc.
CERTIFIED LAB #: 440
PERSON(s) COLLECTING SAMPLES: J. Rogers
CERTIFIED LABORATORIES
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit [phone] or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
* No Flow/Discharge From Site: Check this box if no discharge occurs and, as a result, there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
** ORC on Site?: ORC must visit facility and document visitation of facility as required per 15A NCAC 8G .0204.
*** Signature of Permittee: If signed by other than the permittee, then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).