NCG060295_2021 DMR_20210527

NCDEQ Division of Energy, Mineral and Land Resources
Stormwater Discharge Monitoring Report (DMR) Form for NCG060000
Food and Kindred
Click here for instructions
Complete, sign, scan and submit the DMR via the Stormwater NPDES Permit Data Monitoring Report (DNIR) Upload form within
30 days of receiving sampling results. Mail the original, signed hard copy of the DMR to the appropriate DEMLR Regional Office.
Certificate of Coverage No. NCG061 0 2 9 5 Person Collecting Samples: Robert Jackson
Facility Name: Mountaire Farms Inc. - Lumber Bridge Processing Plant Laboratory Name: Cameron Testing Services, Inc.
Facility County: Robeson Laboratory Cert. No.: 645
Discharge during this period: 0 Yes 0 No (if no, skip to signature and dote)
Has your facility implemented mandatory Tier response actions for any benchmark exceedances? ❑■ Yes ❑ No
If so, which Tier (I, II, or III)? III
Part A. Analytical Monitoring Requirements for Outfalls with Industrial Activities— Benchmarks in (Red)
Parameter Parameter Outfall 1 outfall 2 Outfall 3 Outfall Outfall
Cade
N/A Receiving Stream Class C;Sw C;Sw C;Sw
N/A Date Sample Collected MM/DD/YYYY
46529 24-Hour Rainfall in inches
00556 Oil & Grease in mg/L (30)
C0530 TSS in mg/L (100 or 50*)
00400 pH in standard units (6.0--9.0)
31616 Fecal Coliform per 100 ml of
freshwater (1000)
61211 Enterococci per 100 ml of saltwater
(500)
00340 Chemical Oxygen Demand in mg/L
(120)
Part B: Vehicle & Equipment Maintenance Areas — Benchmarks in (Red)
Parameter Parameter Outfall2 Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class C;Sw
N/A Date Sample Collected MM/DD/YYYY
00552 Non -Polar Oil & Grease in mg/L (15)
NCOIL New Motor/Hydraulic oil Usage in
gal/month
* Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA)
have a benchmark TSS limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L.
Notes (optional): April 2a21
"I certify by my signature below, under penalty of law, that this document and all attachments were prepared under my direction or
supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for
gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am
aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for
knowing violatoN."
Signature of Permittee or Delegated Authorized Individual
Date