WQ0005681_Monitoring - 11-2023_20231226 (3)

Monitoring Report Submittal
Permit Number#*
Name of Facility:*
Month: * November
WQ0005681
Pilgrim's Staley
Report Information
Type *
NDMR, NDAR-1, NDAR-2, NDMLR
Confirmation Email Address:
Name of Submitter: *
Signature:
Date of submittal:
Initial Review
Year:* 2023
Upload Document*
W00005681.pdf 932.26KB
PDF Only
Please upload one PDF containing all applicable monitoring reports
(i.e., NDMR, NDAR-1, NDAR-2, NDMLR, GW-59).
[e-mail]
Daniel Shaw
Reviewer: Wanda.Gerald
12/26/2023
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: 1/16/2024

FORM: NDAR 1 OS 11 NON -DISCHARGE APPLICATION REPORT (NDAR-1) Page of j
Permit No.:
WQ0005681
Facility game:
Pilgrim's Corporation - Staley
County: Randolph
Month:
November
Year: 2023
Did irrigation
occur
Field Names
1
Field Name:
Field Name:
Field Name:
at this
facility?
Area {acres).
= 6 27
Area (acres):
Area (acres);
Area (acres):
{ )
Cover Crop:
Cover CroP
CoverCrrs�:
Cover Crop:
❑✓ YES
❑ No
Hourly Ha#C ( )
?
Hourly Rate {in}:
Hourly Rate fin).
Hourly Rate (in):
Annual Rate (in):
35.83
Annual Rate (in):
Annual Rate {ir,}:
Annual Rate {in}:
Weather
Freeboard
Field Irrigated?
ElE jP40_
Field Irrigated?
❑ YES [✓j No
Field Irrigated?
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Field Irrigated?
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FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Pane - of S'

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR) Page _�_ of 1

FORM: NDMR 03-12 NON -DISCHARGE MONITORING REPORT (NDMR)
Page 5' of .S
Sampling Person(s)
Name: Dennis Sumpter Name: Pilgrims Field Lab
Name: Don Kidney Tina Pedley Name: Cameron Testing
Certified Laboratories
Does all monitoring data and sampling frequencies meet the requirements in Attachment A of your permit?
E 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
action(s) taken. Attach additional sheets if necessary.
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 Official's Title: Complex Manager
Has the ORC changed since the previous NDMR? ❑ Yes 0 No Phone Number: 9198953455 Permit Expiration: 11/30/2026
r, /,-,G� I2 Z1'z3 11-2-1-5
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 property 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 Resources
Information Processing Unit
1617 Mail Service Center
Raleigh, North Carolina 27699-1617