#5283_2017_0420_BS_FINAL

INSPECTION REPORT ROUTING SHEET
To be attached to all inspection reports in-house only.
Laboratory Cert. #:
5283
Laboratory Name:
Tyson Foods Fresh Retail Division, Inc.
Inspection Type:
Field Industrial Maintenance
Inspector Name(s):
Beth Swanson
Inspection Date:
April 20, 2017
Date Forwarded for Initial
Review:
April 21, 2017
Initial Review by:
Tonja Springer
Date Initial Review
Completed:
April 26, 2017
Cover Letter to use:
❑ Insp. Initial
❑insp. No Finding
®Corrected
❑ Insp. Reg
❑Insp. CP
❑Insp. Reg. Delay
Unit Supervisor/Chemist III:
Gary Francies
Date Received:
4/27/17
Date Forwarded to Admin.:
4/28/17
Date Mailed:
5/1/2017
Special Mailing Instructions:

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May 1, 2017
5283
Mr. James Brown
Tyson Foods Fresh Retail Division, Inc.
704 Factory Street
Wilkesboro, NC 28697
MICHEAL S. REGAN
S. JAY ZIMMERMAN
SUBJECT: North Carolina Wastewater/Groundwater Laboratory Certification (NC WW/GW LC)
Maintenance Inspection
Dear Mr. Brown:
Enclosed is a report for the inspection performed on April 20, 2016 by Beth Swanson. Since the
Finding(s) cited during the inspection were all corrected prior to the completion of the enclosed report, a
response is not required. The staff is commended for taking the initiative in correcting the Findings in
such a timely manner. For Certification maintenance, your laboratory must continue to carry out the
requirements set forth in 15A NCAC 2H .0800.
A copy of the laboratory's Certified Parameter List at the time of the audit is attached. This list will reflect
any changes made during the audit. Copies of the checklists completed during the inspection may be
requested from this office. Thank you for your cooperation during the inspection. If you wish to obtain an
electronic copy of this report by email, or if you have questions or need additional information, please
contact me at [phone].
Sincerely,
Gary Francies, Technical Assistance/Compliance Specialist
Division of Water Resources
Attachment
cc: Beth Swanson
Master file
Water Sciences Section
NC Wastewater/Groundwater Laboratory Certification Branch
1623 Mail Service Center, Raleigh, North Carolina 27699-1623
Location: 4405 Reedy Creek Road, Raleigh, North Carolina 27607
Phone: [phone] f FAX: [phone]
Internet: http:/fdeg.nc.gov/about/division slwater-resources/water-resources-data(water-sciences•home-pagetlaboratoryicertification-branch

LABORATORY NAME:
WATER QUALITY PERMIT #:
ADDRESS:
CERTIFICATE #:
DATE OF INSPECTION:
TYPE OF INSPECTION:
AUDITOR(S):
LOCAL PERSON(S) CONTACTED:
INTRODUCTION:
Tyson Foods Fresh Retail Division, Inc.
WQ0020793
704 Factory Street
Wilkesboro, NC 28697
5283
April 20, 2017
Field Industrial Maintenance
Beth Swanson
James Brown
This laboratory was inspected by a representative of the North Carolina Wastewater/Groundwater
Laboratory Certification (NC WW/GW LC) program to verify its compliance with the requirements
of 15A NCAC 2H .0800 for the analysis of environmental samples.
GENERAL COMMENTS:
The last inspection of this laboratory was in 2009 and the supervisor is to be commended on
remaining up to date on new Requirements and Policies.
All required Proficiency Testing (PT) samples have been analyzed for the 2017 PT calendar year
and the graded results were 100% acceptable.
Contracted analyses are performed by Statesville Analytical, Inc. (Certification # 440).
Current Quality Assurance Policies for Field Laboratories and Approved Procedure documents for
the analysis of the facility's currently certified Field Parameters were provided at the time of the
inspection.
III. FINDINGS, REQUIREMENTS, COMMENTS AND RECOMMENDATIONS:
Documentation
Comment: The laboratory needed to increase the documentation of purchased materials. The
laboratory's system of traceability was nearly complete. Only the vendor information for the pH
buffers was missing. The Quality Assurance Policies for Field Laboratories document states: All
chemicals, reagents, standards and consumables used by the laboratory must have the following
information documented: Date Received, Date Opened (in use), Vendor, Lot Number, and
Expiration Date. Consumable materials such as pH buffers and lots of pre -made standards are
included in this requirement. Acceptable corrective action (i.e., a note was added to the supply
receipt log book that all pH buffers are from Fisher) was performed by the laboratory and
approved by the auditor during the inspection. No further response is necessary for this
Finding.

#5283 Tyson Foods Fresh Retail Division, Inc.
IV. PAPER TRAIL INVESTIGATION:
The paper trail consisted of comparing original records (e.g., laboratory benchsheets, logbooks,
etc.) and contract lab reports to Non -Discharge Monitoring Reports (NDMR) and Ground Water
Monitoring Reports (GW-59) submitted to the North Carolina Division of Water Resources. Data
were reviewed for Hays Hatchery (Water Quality permit # WQ0020793) for November 2016 and
March 2017. No transcription errors were detected. The facility appears to be doing a good job
of accurately transcribing data.
V. CONCLUSIONS:
All Findings noted during the inspection were adequately addressed prior to the completion of
this report. The inspector would like to thank the staff for its assistance during the inspection and
data review process. No response is required.
Report prepared by: Beth Swanson Date: April 21, 2017
Report reviewed by: Tonja Springer Date: April 26, 2017

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