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Home My WebLink AboutNCG060020_DMR_20211018NCDEQ 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. NCG060020 Person Collecting Samples: James Brown Facility Name:Tyson Farms, Inc. Laboratory Name: Statesville Analytical Facility County: Wilkes Laboratory Cert. No.:N.C. # 440 Discharge during this period: Yes No (if no, skip to signature and date) Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? Yes No If so, which Tier (I, 11, or III)? A copy of this DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR QYes No Date Uploaded: Analytical Monitoring Requirements for Outfalls with Industrial Activities— Benchmarks in (Red) Parameter Parameter Outfall Outfall Outfall Outfall Code .N/A Receiving Stream Class Wilk-01 Wilk-02 N/A Date Sample Collected MM/OD/YYYY joutfall 46529 24-Hour Rainfall in inches C0536 TSS in mg/L(100 or So*) Fnvi! pH in standard units (6.0-9.o FW, � 00400 6.8 —8.5 SW) 00556 Oil & Grease in mg/L (30) U 2021 31616 Fecal Coliform per 100 ml of W nston-Salem freshwater (if required) (1000) Enterococci per 100 ml of saltwater Re 7aional office 61211 (if required) (500) ---- Chemical Oxygen Demand in mg/L 00340 (120) Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average Estimated New Motor/Hydraulic Oil NCOIL Usa a in al/month 00552 Non -Polar Oil & Grease in mg/L (15) . 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 FW (Freshwater) SW (Saltwater) Notes (optional): "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 violations." /) z2jLc Ltt 10/08/2021 or Delegated Authorized Individual Date jarries.s.brown@tyson.com Email Address 336-651-3836 Phone Number 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. NCG060021 Person Collecting Samples: James Brown Facility Name:Tyson Farms, Inc. Roaring River Feed Mill Laboratory Name: Statesville Analytical Facility County: Wilkes Laboratory Cent. No.: N.C. # 440 Discharge during this period: 0 Yes ONo (if no, skip to signature and date) Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances7 Yes No If so, which Tier (I, II, or III)? A copy oMis DMR has been uploaded electronically via https://edocs.deg.nc.gov/Forms/SW-DMR Yes; ✓ No Date Uploaded: Analytical Monitoring Requirements for Outfalis with Industrial Activities — Benchmarks in (Red) Parameter Parameter Outfall Outfall Outfall Outfall Outfall Code N/A Receiving Stream Class RRIV-01 RRIV-02 RRIV-04 N/A Date Sample Collected MM/DD/YYYY 46529 24-Hour Rainfall in inches C0530 TSS in mg/L (100 or 50') pH in standard units (6.0 — 9.0 FW, G0400 6.8-8.s SW) 00556 Oil & Grease in mg/L (30) Fecal Coliform per 100 ml of 31616 freshwater (if required) (1000) 61211 Enterococci per 100 ml of saltwater (if required) (500) Chemical Oxygen Demand in mg/L 00340 (120) Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average Estimated New Motor/Hydraulic Oil NCOIL Usage in gal/month 00552 1 Non -Polar Oil & Grease in mg/L (15) • 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 FW (Freshwater) SW (Saltwater) Notes (optional): "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 thepossibility of fines and Imprisonment for knowing violations." 10/08/2021 of Permittee or Delegated Authorized Individual Date james.s.brown@tyson.com Email Address 336-651-3836 Phone Number 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 DM 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. NCG060020 Person Collecting Samples: James Brown Facility Name: Tyson Farms, Inc. Laboratory Name: Statesville Analytical Facility County: Wilkes Laboratory Cert. No.;N.C. #440 Discharge during this period: Yes No (if no, skip to signature and date) Has your facility implemented mandatory Tier response actions this sample period for any benchmark exceedances? El Yes No If so, which Tier (I, II, or III)? A copy of thWDMR has been-Uploadedelectronically via http5://edocs.-deg.nc.gov/F6rms/5W-DMR Yes E]No Date Uploaded: Analytical Monitoring Requirements for Outfalls with Industrial Activities— Benchmarks in (Red) Parameter Parameter Outfall Outfall Outfall Outfall Outfall Code N/A Receiving Stream Class Wilk-01 Wilk-02 N/A Date Sample Collected MM/DD/YYYY 46529 24-Hour Rainfall In inches C0530 TSSin mg/L (100or50•) pH in standard units (6.0-9.0 FW, 00400 6.8 — 8.5 SW) 00556 Oil & Grease in mg/L(30) Fecal Coliform per 100 ml of 31616 freshwater (if required) (1000) Enterccocci per 100 ml of saltwater 61211 (if required) (500) Chemical Oxygen Demand in mg/L 00340 (120) Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average Estimated New Motor/Hydraulic Oil NCOIL Usa a in gal/month 00552 Non -Polar Oil & Grease in mg/L (15) • 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 FW (Freshwater) SW (saltwater) Notes (optional): "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 violations." Permittee or Delegated Authorized Individual james.s.brown@tyson.com Email Address 10/08/2021 Date 336-651-3836 Phone Number 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. NCG060021 Person Collecting Samples: James Brown Facility Name:Tyson Farms, Inc. Roaring River Feed Mill Laboratory Name: Statesville Analytical Facility County: Wilkes Laboratory Cert. No.: N.C. # 440 Discharge during this period: Yes No (if no, skip to signature and date) Has your facility implemented mandatory Tier 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-upfoaded-electronicaHyviatttpsa/edocs.deg.nc.gov/Forrm/SW=DMR — — ayes No Date Uploaded: Analytical Monitoring Requirements for Outfalls with Industrial Activities —Benchmarks in (Red) Parameter Parameter Outfall Outfall Outfall Outfall Outfall Code N/A Receiving Stream Class RRIV-01 RRIV-02 RRIV-04 N/A Date Sample Collected MM/OD/YYYY 46529 24-Hour Rainfall in inches C0530 TSS in mg/L (100 or 50*) PH in standard units (6.0-9.0 FW, 00400 6.8-8.5 SW) 00556 Oil & Grease in mg/L (30) Fecal Coliform per 100 ml of 31616 freshwater (if required) (1000) Enterococci per 100 ml of saltwater 61211 (if required) (500) Chemical Oxygen Demand in mg/L 00340 (120) Additional parameters for outfalls in drainage areas that use >55 gallons per month of new hydraulic oil on average Estimated New Motor/Hydraulic Oil NCOIL Usage in al/month 00552 1 Non -Polar Oil & Grease in mg/L (15) * Outfalls to Outstanding Resource Waters (ORW), High Quality Waters (HQW), Trout Waters (Tr) and Primary Nursery Areas (PNA) have a benchmark T55 limit of 50 mg/L. All other water classifications have a benchmark of 100 mg/L FW (Freshwater) SW (Saltwater) Notes (optional): "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 violations." &w2G//ip /crs— 10/08/2021 Permittee or Delegated Authorized Individual Date james.s.brown@tyson.com Email Address 336-651-3836 Phone Number