WQ0005681_Monitoring - 09-2022_20221005

Monitoring Report Submittal
Permit Number #* WQ0005681
Name of Facility:* Pilgrims
Month: * September Year: * 2022
Report Information
Type* Upload Document*
NDMR, NDAR-1, NDAR-2, NDMLR septsigned.pdf 240.35KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
Confirmation Email Address:* [e-mail]
Name of Submitter: * Tina Pedley
Signature:
9 "i
Date of submittal: 10/5/2022
This will be filled in automatically
Initial Review
Reviewer: Gerald, Wanda

Is the project number correct?* WQ0005681
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 10/25/2022

FORM- NDAR=1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page ,,, __ of
Permit No.: W00005681
Facility Name: Pilgrim's Corporation - Staley
County: Randolph Month: September
Year: 2022
Did irrigation occur
Sea
at this facility?
tY
YES No
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page
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? p Compliant ❑ ton -Compliant
Were all setbacks listed in your permit maintained for every application to each permitted site? Q Compliant ❑ Non -Compliant
Were all freeboards maintained in accordance with the specified freeboard heights in your permit? J Compliant -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 dates) of the non-compliance and describe the corrective
taKen. Hnacn aaaltional sneets IT necessary.
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Tina Pedley Permittee:
Plgrim'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? ® y f No Phone Number: 9198953455 Permit Exp.. 11 /30/26
t mLJ4 -
Signatur Date Signature Date
By the signature, I certify that this report r. accurrate and complete to the best of my kno e. I certify, under penalty of taw, 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 persors tflrectly responsitlle for gathering the irdormaliat, 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 submMing false information, including the possibility of fines and imprisonment for knowing violations -
Mail Original and Two Copies to:
Division of Water Quality
Information Processing Unit
1617 Mail Service Center

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page of
Permit No.: W00005681
Facility Name: Pilgrim's Pride - Staley WWTP
County: Randolph
Month: September
rear: 2022
PPI: 001
Flow Measuring Point: ❑� Influent ❑ Effluent ❑ No flow generated
parameter Monitoring Point: ❑ influent Effluent ❑ aandwater towering Surface water
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3 X Year;
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3 X Year
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page l of ?
Permit No.: WQ0005681
Facility Name: Pilgrim's Pride - Staley WWTP
County: Randolph 7Month:
September
Year: 2022
PPI: 001
Flow Measuring Point: ❑ Influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point: ❑ Influent ❑ Effluent ❑ Groundwater Lowering ❑ surface Water
Parameter Code
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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? 21 compliant 0 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
a�nwnto/ ranvn. nrra�.n awm�nai mrovra u
Operator in Responsible Charge (ORC) Certification Permittee Certification
ORC: Tina Pedley Permittee: Pilgrim's Corporation
Certification No.: 997617/994534 Signing Official: Dan Shaw
Grade: SUM W4 Phone Number: 919-895-3457 Signing Official's Title: Complex Manager
Has the ORC changed since the previous NDMR? Yes ` No Phone Number: 9198953455 Permit Expiration: 11 /30/2026
- zz
Signature IV Date Signature Date
By this signature_ I certify that this report is accurrate and complete 10 the hest 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 Me person or persons who manage the system, or those persons directly responsible for
gathering dre information, the information submitted is- to dre best of my knowledge and belief, true, accurate. and complete, I am
aware that there are significant penalties for subinfli fakm ollormabon, including the possibility of fines and imprisonment for
knowing violations
MailOriginal and Two Copies to:
Division of Water Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617