wq0005681_Monitoring - 12-2021_20220104

Monitoring Report Submittal
Permit Number #*
Name of Facility:*
Month: * December
Report Information
wg0005681
Pilgrims
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2021
Upload Document*
Dec signed.pdf 267.51 KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Tina Pedley
9 "i
Reviewer: Saunders, Erickson G
1 /4/2022
This will be filled in automatically

Is the project number correct?* wg0005681
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Accepted Date:
1 /20/2022

PC;AM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page . ...... j
Permit No.: W00005681 Facility Name: Pilgrim's Corporation - Staley
County: Randolph Month: December
I Year: 2021
m", Field Name:
WN
Did irrigation occur
vZome, Area (acres):
Area (acres):
at this facility?
LEE! Cover Crop:
A A w Cover Crop:
YES 0 NO
% IN Hourly Rate (in):
Hourly Rate (in):
Annual Rate (in) 2 IN -j-, Rate (in):
00, MIL, Annual
Annual Rate (in):
Weather
Freeboard
61MBOA _J&
E[ Field Irrigated?
❑YES NO
3Field Irrigated?
❑YES NO
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FORM: NDAR t 08-1 t
NON -DISCHARGE APPLICATION REPORT(NDAR-1) Page of�,
Did the application rates exceed the limits in Attachment B of your permit?
Were adequate measures taken to prevent effluent ponding in or runoff from the sites?
Was a suitable vegetative cover maintained on all sites as specified in your permit?
Were all setbacks listed in your permit maintained for every application to each permitted site?
Were all freeboards maintained in accordance with the specified freeboard heights in your permit?
I] Compliant ❑ Non -Compliant
Q Gompliant ❑ Non -Compliant
2] Compliant ❑ Non -Compliant
E] Compliant ❑ Non -Compliant
2] Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action(s) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Tina Pedley Permittee: Pilgrim's Corporation
Certification No.: 997617/994534 Signing Official: Daniel Shaw
Grade: SI/WW4 Phone Number: 919-895-3457 Signing Official's Title: Complex Manager
Has the ORC changed since the previous NDAR-1? ® Yes ® No Phone Number: 9198953455 Permit Exp.: 11/30/26
Signature Dale Signature Date
By this signature. I certify that this report is accurrate and complete to the best of my knowledge. 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 all qualified personnel properly gathered and evaluated the information submitted. Based on my
inquiry of the person or persons who manage the system, or those persons directly responsible for galhefing the informalion, the
information submitted is. to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are signiticam
penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations.
Mail Original and Two Copies to:
Division of Water Ouality
Information Processing Unit
1617 Mail Service Center

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: W00005681
Facility Name: Pllgrim's Pride - Staley WWTP
County: Randolph
Month: December
Year: 2021
PPI: 001
Flow Measuring Point: ElInfluent ❑ Effluent ❑ No Flow generated
Parameter Monitoring Point: Ej influent ❑ Ca Effluent uundwater Lowering ❑ sumacs water
Parameter Code
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00310
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Corrbntfouo �
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Annually
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3 X Year
> 3 X Year,
3 X Year
3 X\Ysar : Weekly
�3X Year,
3 X Year
`3 X Year;;
Annually

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page q f
Permit No.: WQ0005681
Facility Name: Pilgrim's Pride - Staley WWTP
County: Randolph
Month: December
Year: 2021
PPI: 001
Flow Measuring Point: ❑ Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring
Point: ❑ Influent ❑ €ffluent ❑ Groundwater Lowering El Surface water
Parameter Code
\
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\
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m
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Daily Limrt.
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Sample Frequency
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101 "\ '
\\1001

FORM: NDMR 03-12
NON -DISCHARGE MONITORING REPORT (NDMR) Page � of
Sampling Person(s) Certified Laboratories
Name: Dennis Sumpter Name: Pilgrims Field Lab
Name: Don Kidney Tina Pedley Name: Cameron Testing
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit? G] Compliant ❑ Non -Compliant
If the facility is non -compliant, please explain in the space below the reason(s) the facility was not in compliance. Provide in your explanation the date(s) of the non-compliance and describe the corrective
action($) taken. Attach additional sheets if necessary.
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Tina Pedley
Permittee: Pilgrim's Corporation
Certification No.: 9976171994534
Signing Official: Dan Shaw
Grade: SI/WW4 Phone Number: 919-895-3457
Signing Officials Title: Complex Manager
Has the ORC changed since the previous NDMR? ❑ Yes 0 No
Phone Number: 9198953455 Permit Expiration: 11 /30/2026
Signature Date
Signature Date
By this signature, I certify that this report is aecurrale and complete to the Best of my knowledge.
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 all qualified personnel property gathered and evaluated 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, tnoluding the possibility of fines and imprisonment for
knowing violations.
Mail Original and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617