NCG060309_2021 DMR_20210930

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 (DMR) 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. NCG06 0309
Person Collecting Samples: Travis Williams
Facility Name: AdvancePierre Foods
Laboratory Name: Statesville Analytical
Facility County: Catawba
Laboratory Cert. No.: 440
Discharge during this period: ❑ Yes ❑✓ No (if no, skip to signature and date)
Has your facility implemented mandatoryTier response actions this sample period for any benchmark exceedances? ❑ Yes ✓❑ No
If so, which Tier (I, II, or III)?
A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR ❑✓ Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for outfalls with Industrial nrtivitipc _ Rn„rk—l— :„ ro..,,l
--l—ldrK 13a limit Of So mg/L. All other water classifications have a benchmark of 100 mg/L r, ��� y'vursery Areas (PNA)
Notes (optional): No discharge from outfalls 1 or 2.
"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 t possibility of fines and imprisonment for knowing violations."
l
Signature of Permittee or De gated Authorized9/30/2021
Individual Date
Email Address [e-mail]
Phone Number 402-250-3050