NCG060309_2021 DMR_20220104

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. NCGO6 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 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 uploaded electronically via https:Hedocs.deg.nc.gov/Forms/SW-DMR ✓❑ Yes ❑ No
Date Uploaded:
Analytical Monitoring Requirements for Outfalls with Industrial Activities — Benchmarks in (Red)
Parameter
Parameter
OutfallI
Outfall2
Outfall
Outfall
Outfall
Code
N/A
Receiving Stream Class
Water Supply
Water Supply
N/A
Date Sample Collected MM/DD/YYYY
No Flow
No Flow
46529
24-Hour Rainfall in inches
C0530
T5S in mg L 200 or 50*
No Flow
No Flow
00400
pH in standard units (6.0 — 9.0)
No Flow
No Flow
00556
Oil & Grease in mg/L (30)
No Flow
No Flow
Fecal Coliform per 100 ml of
31616
freshwater (if required) (1000)
Enterococci per 100 ml of saltwater
61211
(if required) (500)
00340
i 20m ical Oxygen Demand in mg/L
No Flow
No Flow
Additional parameters for outfalis 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
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
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, orthose 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 thatthere are significant penaltiesfor submitting
false information, including the possibilityof fines and imprisonment for knowing violations."
Signature of Permittee or Delegated Authorized Individual
Email Address [e-mail]
12/31/2021
Date
Phone Number 402-250-3050