NCG060020_2022 DMR_20221115

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 jDMR1 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. NCG06EI 0=❑] Person Collecting Samples: James Brown
Facility Name: Tyson Farms,lnc.Wilkesboro Complex Laboratory Name:Statesville Lab
Facility County:Wilkes 0 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 for any benchmark exceedances? ■❑Yes E No
If so,which Tier(I,II,or III)? II a
Part A:Analytical Monitoring Requirements for Outfalls with Industrial Activities—Benchmarks in(Red)
Parameter Parameter Outfall Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class Wilk-01 Wilk-02
N/A Date Sample Collected MM/DD/YYYY
46529 24-Hour Rainfall in inches
00556 1 Oil &Grease in mg/L(30)
C0530 TSS in mg/L(100 or 50*) _ _
00400 pH in standard units(6.0-9.0)
31616 Fecal Coliform per 100 ml of
freshwater(1000)
61211 Enterococci per 100 ml of saltwater
(500)
00340 Chemical Oxygen Demand in mg/L
(120)
Part B: Vehicle&Equipment Maintenance Areas—Benchmarks in (Red)
Parameter Parameter Outfall Outfall Outfall Outfall Outfall
Code
N/A Receiving Stream Class Wilk-01
N/A Date Sample Collected MM/DD/YYYY
00552 Non-Polar Oil &Grease in mg/L(15)
NCOIL New Motor/Hydraulic Oil Usage in
gal/month
* Outfalls to Outstanding Resource Waters(ORW), High Quality Waters(HOW),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): October 2022
"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,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."
,./32144 Z9Zist"--- 1` f� �l
Signature of ermittee or Delegated Authorized Individual Date
,