WQ0005681_Monitoring - 10-2022_20221110

Monitoring Report Submittal
Permit Number #* WQ0005681
Name of Facility:* Pilgrims
Month: * October
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:*
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2022
Upload Document*
oct signed.pdf 308.07KB
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: Gerald, Wanda
11 /10/2022
This will be filled in automatically

Is the project number correct?* WQ0005681
Is the monitoring report accepted?* Yes No
Regional Office* Winston-Salem
Reviewer: _anonymous
Review Date: 11/17/2022

FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) raga of
Permit No.: WQ0005681 Facility Name: Pilgrim's Corporation - Staley County: Randolph
Month: October
Year: 2022
Field Name:
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FORM: NDAR-1 08-11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page ra of 5
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?
0 Compliant
❑ Non -Compliant
❑✓ Compliant
❑ Non -Compliant
0 Compliant
❑ Non -Compliant
❑� Compliant
❑ Non -Compliant
❑� 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 dates) of the non-compliance and describe the corrective
Men. Anacn aoonionai sneers if
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 21 No
Phone Number: 9198953455 Permit Exp.: 11/30/26
Signature Date
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 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.
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-3— of
Permit No.: WQ0005681
Facility Name:
Pilgrim's Pride - Staley WWTP
County:
Randolph
Month-
October
Year:
2022
PPI: 001 Flow Measuring Point:
❑ influent ❑ Effluent ❑ No flow generated
Parameter Monitoring Point:
❑ Influent
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❑ surface water
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page l of
Permit No.: W00005681
Facility Name: Pilgrim's Pride - Staley WWTP
county: Randolph
Month: October
Year: 2022
PPI: 001
Flow Measuring Point: Influent Effluent E] 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 __C, of S
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? 0 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
acuunts) wKen. Allacn auumunap uriuuw rl
Operator in Responsible Charge (ORC) Certification
Permittee Certification
ORC: Tina Pedley
Permittee: Pilgrim's Corporation
Certification No.: 997617/994534
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 ' No
Phone Number: 9198953455 Permit Expiration: 11 /30/2026
i !- - a
1\ -q •2z
Signature Date
Signature Date
By this signature, I certify thal 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 property gathered and evaluated the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly respon6ible for
gathering the information, the _Tfonnat€:rr 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 ttre 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