NCG060020_DMR_20220323

NC Dr) of
Enviromentalepartment Qualit
Rd y
MAR 2 2
WinstonSalemeceive022460
Tyson Regional Office
March 14, 2022
DEQ Winston-Salem Regional Office
Attn: DEMLR Stormwater Program
450 West Hanes Mill Road Suite 300
Winston-Salem,N.G. 27105 --
Subject: General Permit No. NCG060000
Tyson Foods, Inc. - Wilkesboro Complex
COC NCG060020
Wilkes County
Dear Madam or Sir:
Enclosed are two copies of the required storm water sampling results.
For the outfalls Covered under the above subject permit and certificate of coverage.
Tyson Foods, Inc. has made significant improvements to reduce the concentrations of the
parameter of concern.
Please contact me at 336.651.3836 should you have any questions.
Sinc rely, SM-14-#6-
James Brown
Complex Environmental Manager
Tyson Foods,Inc. Fresh Retail Division 704 Factory Wilkesboro,N.C.28697
336-651-3836 336.838.2171 Fax:[phone] www.tysonfoods.com

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(DMR) 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. NCGO6 0020 Person Collecting Samples: James Brown
Facility Name: Tyson Farms Inc.Wilkesboro Complex Laboratory Name: Statesville Analytical
Facility County: Wilkes 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 this sample period for any benchmark exceedances?®Yes ❑ No
If so,which Tier(I, II,or III)? I
A copy of this DMR has been uploaded electronically via https://edocs.deq.nc.gov/Forms/SW-DMR ®Yes ❑ No
Date Uploaded:
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 02/23/2022 02/23/2022
46529 24-Hour Rainfall in inches 0.87 0.87
C0530 'i TSS in mg/L(100 or 50*) 39.2 42.4
00400 pH in standard units(6.0—9.0 FW,
6.8-8.5SW) 6.87 6.85
31616 Fecal Coliform per 100 ml of
freshwater(if required)(1000) >6000 >6000
61211 Enterococci per 100 ml of saltwater
(if required)(500) NA NA
00340 Chemical Oxygen Demand in mg/L
(120) 78 62
Additional parameters for outfalls in drainage areas that use>55 gallons per month of new hydraulic oil on average
NCOIL Estimated New Motor/Hydraulic Oil
Usage in gal/month 630
00552 Non-Polar Oil&Grease in mg/L(15) <5.0 <5.0
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 me/L.All other water classifications have a benchmark of 100 mg/L
FW(Freshwater)SW(Saltwater)
Notes(optional): Qe,c; p�
"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."
Xj,u.,,
Signature of rmittee or Delegated Authorized Individual Date
line-S.5.brown -A-yst,N. Ct$uh 3340-/051 - 3834.
Email Address Phone Number

Wilkesboro Storm Water Calu. Sheet
Date 02/23/2022
Rain Begin: 8:30 AM light on and off
Run off started 8:55 AM
Grab Samples: 9:25 AM
Rain at end of
Storm Event: 0.87
Sampling Point WILK 01 Drainage Area= 140,800 Ft 2
Q= CIA
I = 0.87" (Total)
C = 1.0
Q = 1.0(0.87/12)(140,800*7.5)/1,000,000
0.077 MG
Sampling Point WILK 02 Drainage Area = 578,250 Ft 2
Q = CIA
I = 0.87" (Total)
C = 1.0
Q = 1.0(0.87/12)(578,250*7.5)/1,000,000
0.314 MG

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form,please visit https://deq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N/C/ G/0 /6 /0 /0 /0 /0 / or Certificate of Coverage No.: N/C/G/ 0/6 /0 /0 /2 /0 /
Facility Name: Tyson Farms Inc. Wilkesboro Complex
County: Wilkes Phone No. 336/651/3836
Inspector: James Brown
Date of Inspection: 02/23/20222/n
Time of Inspection: —1 3.5 kw\
Total Event Precipitation(inches): O•'"1
All permits require qualitative monitoring to be performed during a"measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period,and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature,I certify that this report is accurate and complete to the best of my knowledge:
(Signature ermittee or Designee)
1. Outfall Description:
Outfall No.W I L(( 0 I Structure(pipe,ditch,etc.): P..Q'c.
Receiving Stream: /i
�,IL11aI4ed "TT:bK4.ary4 b C 1 6rr✓�K
Describe the industrial activities that occur within the outfall drainage area: 1..;qG %Nan% atOA
Page 1 of 2
SWU-242,Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors(red, brown,blue,etc.)and tint
(light, medium, dark)as descriptors: L;51,.4
3. Odor: Describe any distinct odors that the discharge may have(i.e., smells strongly of oil,weak
chlorine odor, etc.): _ - ovn c.
4. Clarity: Choose the number which best describes the clarity of the discharge,where 1 is clear
and 5 is very cloudy:
1 �2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge,where I is no solids and 5 is the surface covered with floating solids:
1 �? 3 4 5
6. Suspended Solids: Choose the number which best describes.the amount of suspended solids in
the stormwater discharge,where I is no solids and 5 is extremely muddy:
1 3 4 5
7. Is there any foam in the stormwater discharge? Q Yes
8. Is there an oil sheen in the stormwater discharge? 0Yes 08eNo.
9. Is there evidence of erosion or deposition at the outfall? Co Yes O'1`lo.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity,high solids,and/or the presence of foam,oil sheen,or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242,Last modified 06/01/2018

Environmental
Quality
Stormwater Discharge Outfall (SDO)
Qualitative Monitoring Report
For guidance on filling out this form,please visit https://deq.nc.gov/about/divisions/energy-mineral-land-resources/
npdes-stormwater-gps
Permit No.: N/C/G/0 /6 /0 /0 /0 /0 / or Certificate of Coverage No.: N/C/G/ 0/6 /0 /0 /2 /0 /
Facility Name: Tyson Farms Inc. Wilkesboro Complex
County: Wilkes Phone No. 336/651/3836
Inspector: James Brown
Date of Inspection: 02/23/2022
Time of Inspection: a 35 A.rn
Total Event Precipitation(inches): 011
All permits require qualitative monitoring to be performed during a"measurable storm event."
A "measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period,and the permittee obtains approval from the local DEMLR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
12).4tru4,1.—
(Signature of rmittee or Designee)
1. Outfall Description: nn
Outfall No.\ILK, 01, Structure(pipe,ditch,etc.): 'Y: �t
Receiving Stream:
U►f%ftamec ` wkckry -4-d Cwb areel4
Describe the industrial activities that occur within the outfall drainage area: ()1 L Les ;net
<A.
Page 1 of 2
SWU-242,Last modified 06/01/2018

2. Color: Describe the color of the discharge using basic colors(red, brown, blue, etc.)and tint
(light,medium, dark)as descriptors: L :51.E
3. Odor: Describe any distinct odors that the discharge may have(i.e., smells strongly of oil, weak
chlorine odor,etc.): f1.onc
4. Clarity: Choose the number which best describes the clarity of the discharge,where 1 is clear
and 5 is very cloudy:
bl 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge,where 1 is no solids and 5 is the surface covered with floating solids:
1 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge,where 1 is no solids and 5 is extremely muddy:
1 l� 3 4 5
7. Is there any foam in the stormwater discharge? °Yes
8. Is there an oil sheen in the stormwater discharge? °Yes 'cfNo.
9. Is there evidence of erosion or deposition at the outfall? 0 Yes Go/No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity,high solids,and/or the presence of foam,oil sheen,or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 of 2
SWU-242,Last modified 06/01/2018

Analytical Results it STATESVILLE
ANALYTICAL
00
Tyson Foods-Wilkesboro
704 Factory Street
Wilkesboro, NC 28697
Receive Date: 02/23/2022
Reported: 03/07/2022
For: Stormwater
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
220223-29-01 Chemical Oxygen Wilk-01 78 mg/L HACH8000 02/25/2022 CL
Demand
220223-29-01 Fecal Coliforms Wilk-01 >6000 CFU100 ML SM9222D-2006 02/23/2022 MD
220223-29-01 Total Petroleum Wilk-01 <5.0 mg/L EPA1664RevB 02/28/2022 MT
Hydrocarbons
220223-29-01 TSS Wilk-01 39.2 mg/L SM2540D-2011 02/25/2022 LE
220223-29-02 Chemical Oxygen Wilk-02 62 mg/L HACH8000 02/25/2022 CL
Demand
220223-29-02 Fecal Coliforms Wilk-02 >6000 CFU100 ML SM9222D-2006 02/23/2022 MD
220223-29-02 Oil and Grease Wilk-02 <5 mg/L EPA1664RevB 03/04/2022 CE
220223-29-02 TSS Wilk-02 42.4 mg/L SM2540D-2011 02/25/2022 LE
Respectfully submitted,
Melissa Myers
NC Cert#440,
NCDW Cert#37755,
EPA#NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 5

Condition of Receipt
Sample Number 220223-29-01 Temp on Arrival: 3.1
pH on Arrival: <2 Parameter Schedule: Total Petroleum Hydrocarbons
Hydrochloric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TSS
Received on Ice
pH on Arrival: <2 Parameter Schedule: Chemical Oxygen Demand
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
Sample Number 220223-29-02 Temp on Arrival: 3.1
pH on Arrival: <2 Parameter Schedule: Oil and Grease
Hydrochloric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TSS
Received on Ice
pH on Arrival: <2 Parameter Schedule: Chemical Oxygen Demand
Sulfuric Acid Chemicals in containers, lab
Received on Ice
Parameter Schedule: Fecal Coliforms
Sodium Thiosulfate Received on Ice
Chemicals in containers, lab
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 2 of 5

r---
rn
CI' Lo
N O
M
co
cs
Client: 0 a
��5or1 4/�M<SI TIVG. — -- — 1 T �'J I I t c
Address: iANALt I It,AL
'tog Vperkast S4fc
--_--_ I��Cowl SIhCl • P.O.Um��x CO
W:l .esbota,NC a6ba'l fr Staliazille.N/' 'Kr.x7 W
Contact Person p Phone N --— FAXM I71FI)x7'-am N
Ame .Dr owtn slip.(est.38 3e Chain of z
Po N Requisitioned by: (Time Dale) Custody Record
a
Cuslomor Saar el Waive tab4D a -- Time Sampled Oak.Sampled MamaI'aranrkn nry.rc.lcJ Iv airbusSample IDS Zq (GM Only) _ (Drab OnlyI _ I owr• w we
CIJ
V 11gC- 0 1 nC11,3•24 C I Ct: a5 AM 2.23 22 (
./ NN./ t c.a. `�.0.0,IF,.....,,.._ OG 4/'f fli(ST-!tewl cB
NO o (72 q 35 P WIa�3•a2 ✓ Ni WD.1 I t?++i,VGG
•
CO
N
(V/ N
X
0
m
p
11
Relinquished by: ., r -- Time 1130 am.pm Date 2,73.l Sampled by: J
Received by: �•`/� Time I,I3o am,pm Date 2/_!rL Transported by: /vim+->
Relinquished by: _ Time am,pm Date / / Holding times met: IV
Received by: Time am,pm Date _ / /
-- — Compliance work:
Composite Sampling#1;
Time begin am.pm Data / /_ Non-compliance work:
Time end am,pm Dale / /
Lab Comments Samples Transported On Ine
ccrposlte_Sarnpling N2:
Time begin -_ am.pm Date / /
Time end am,pm Date / /
Initials

Meritech, Inc.
Environmental Laboratory
Laboratory Certification No.165
ilio
Contact: C.Little Report Date: 3/4/2022
Client: Statesville Analytical
122 Court St Project: Tyson Foods
Statesville,NC 28677 Date Sample Rcvd: 2/24/2022
Meritech Work Order# 02242244 Sample: 220223-29-01 Grab 2/23/22
Parameters Results Analysis Date Reporting Limit method
Oil&Grease-SGT HEM <5.0 mg/L 2/28/22 5.0 mg/L EPA 16648
I hereby certify that!have reviewed and approve these data. V4rnanda NOf 10(136-1)
Laboratory Representative
642 Tamco Road,Reidsville,North Carolina 27320
tel.[phone] fax.[phone]
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 4 of 5

r`
cn
tn
Lo
N O
N Lo
c
m
8ro/18 Chain of Custody Record(COC) NPDES#: o o_
MERITECH, INC. Phone:
Address: Fax co
t c to
ENVIRONMENTAL LABORATORIES �� V Email: N
Shy(642 Tamco Rd. Phone: [phone] N� yg0 3 1 Project: z
ReiOM i
dsville NC 27320 Fax: [phone] P.O.#: TSal-60dSCli
>Email:[e-mail] Attention: no( - p Turn Around Time
5
•RUSH work needs prior approval, 2
How would you like your report sent? harxesnoel ;s
www.meritechlabs.com StdllOda 3-5 n
ays 24 48Hrs -,
rn
Circle all that apply: Email(preferred), Fax, Mail I V I I I L
•
00
Sampling Dates&Times Person Taking Sample(Sign/Print): Lab Use Only N
IN
Sample Location and/or ID# Start End Comp? +r or On Ice? pH OK? o
Test(s) Required ClOK? 0
Date Time Date Time Grab? Cont. �4Ps/ No co
2 -0223-2q-o I 2/23 0 0925 G I 046 SCT-44-Di (-r*) liy — n_
Temperature Upon
Receipt: 1, er
Method of •••Dechlorination(<0.5 ppm)of Ammonia,Cyanide,Phenol and TKN samples must be done in the held prior to preservation.•••
Comments: Compositor It
Shipment:
❑ UPS ,� Jug#
❑ Fed Ex Are • for ri.ulat 4 purpose ? es No ❑ Report results in: mg/L ['/ g/kg ug/L ❑
❑ Relinquished b arpriemyea.,.,:9 D Time: Receivedeby: Timc:Hand Delivery 6,9.5.....,
>' ��✓ / ---._� " Tiz,- //,J
❑ Other rjennspyg�,•�, Imo _ t '�-7i_Time: S 2-) Received by: Date. Time:
Rc n ed b� y: Date: Time: lJ` Reggived by yob: 2-l f/•22 Date: Time:2 R�4
l�✓1, .1`IVt� C 1 rJ

71.9 .1;
1.yrsan
March 14, 2022
I)EQ Winston-Salem aegional Office
Attn: DEMLR. Storrnv,ater Program
450 West Hanes Mill i:;oad Suite 300
Winston-Salem,N.C. /105 •
Subject: General Permit No. NCG060000
Tyson l-oocls, :[ric. " Wilkesboro Complex
COC NC r i 060020
Wilkes County
Dear Madam or Sir:
Enclosed are two copi. s of the required storm water sampling results.
For the outfalls Covered under the above subject permit and certificate of coverage.
Tyson Foods, Inc. has made significant improvements to reduce the concentrations of the
parameter of concern.
Please contact me at 336.651.3336 should you have any questions.
Sincerely,
/
f y J ./
fames Brown
Complex Environmental Manages
Tyson i'eoods,:Inc. Fresh Retail Division 7o41 Factors' Niikesboro,N.C.28697
:mi-651•"38361 a36.t3:;8 21.71 Rix:33.651.3867 www.tysonfoods.eom

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(DMR)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.NCG060020 Person Collecting Samples: James Brown
Facility Name: Tyson Farms Inc.Wilkesboro Complex Laboratory Name: Statesville Analytical
Facility County: Wilkes 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 this sample period for any benchmark exceedances?®Yes D No
If so,which Tier(I,II,or III)? I
A copy of this DMR has been uploaded electronically via https://edocs.dea.nc.gov/Forms/SW-DMR ®Yes ❑No
Date Uploaded:
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 02/23/2022 02/23/2022
46529 24-Hour Rainfall in inches 0.87 0.87 •
C0530 TSS in mg/L(100 or 50*) 39.2 42.4
00400 pH in standard units(6.0—9.0 FW, 6.87 6.85
6.8-8.5SW)
31616 Fecal Coliform per 100 ml of >6000 >6000
freshwater(if required)(1000)
61211 Enterococci per 100 ml of saltwater
(if required)(500) NA NA
00340 Chemical Oxygen Demand in mg/L
(120) 78 62
Additional parameters for outfalls in drainage areas that use>55 gallons per month of new hydraulic oil on average
NCOIL Estimated New Motor/Hydraulic Oil
Usage in gal/month 630
00552 Non-Polar Oil&Grease in mg/L(15) <5.0 <5.0
*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
FW(Freshwater)SW(Saltwater)
Notes(optional): Pe,t
"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."
3-14- aa
Signature of rmittee or Delegated Authorized Individual Date
.3arA S S . rown ®-1-von. C'bw, 33(o-(051-3�3l0
Email Address Phone Number
•

Wilkesboro Storm Water Calu. Sheet
Date 02/23/2022
Rain Begin: 8:30 AM right on and off
Run off started 8:55 AM
Grab Samples: 9:25 AM
Rain at end of
Storm Event: 0.87
Sampling Point WILK 01 Drainage Area= 140,800 Ft 2
Q = CIA
I = 0.87" (Total)
C := 'I.0
Q = 1.0(0.87/12)(140,800*7.5)/1,000,000
0.077 MG
Sampling Point WI Lk 02 Drainage Area = 578,250 Ft 2
Q = CIA
0.87" (Total)
C '1.0
Q 1.0(0.87/12)(578,250*7.5)/1,000,000
0.3'14 MG

..],1;1! ,:.:1fi An
c,,virtxrnl,2,,to
(.:!!.:di?y
StorItrrewate r Discharge Outran (S}DO)
Qu llliita°th'e :M[o nitornx>tg Report
For guidance on filling a•ut this form,please visit https://deq.nc.gov/about/clivisions/energy-mineral-land-resources/
n pdes-stormwater-gps
Permit No.: N/C/ G/0 /( /0 /0 /0 /0 / or Certificate of Coverage No.: N/C:/G/ 0/6 /O /0 /2 /0 /
Facility Name: Tyson Eanus Inc. Wilkesboro Complex --- __--------
County:- Wilkes _.-_._..-'---------_-- Phone No. _336/651/33 3h --•---- ____
Inspector: James Brown_.....
Date of Inspection: — 02/?3/2022
I"irnls of Ins cction: W ,C,h.. . '.- • — — ---
Total Event Precipitation (inches):_ lL)), "tS—n —
All permits require qualitative monitoring to be performed during a"measurable storm event."
A"measurable storm event" is a storm event that results in an actual discharge from the permitted site
outfall. "I'he previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply if the perinittee is able to document that a shorter interval is representative for
local storm events during the sampling period,and the perrnittee obtains approval from the local DEIVILR
Regional Office.
By this signature, I certify that this report is accurate and complete to the best of my knowledge:
4. ) t'.'1 -
(Signature of ermitice 1.•1. Designee)
:1. outran Description:
Out fail No\;A)1 ,,;., 01 Structure(pipe,ditch,etc.): , _:___� --
Receiving Stream:
i 11]\1r':CI. ,,i,.:J ,.1. . ?, (,' ti 5. 0
x.
Describe the industrial activities that occur within the outfall drainage area: I:r_,,,I _Ka;,,,A? .I,,,,:Isle—�-
--------------------
Page I oft
S\V LJ"•::d2,Last modified 06/0 r/:!0 I S

2. Color: Describe the color of the discharge using basic colors(red, brown, blue,etc.)and tint
(fight, medium, dark)as descriptors:
3. Odor: Describe any distinct odors that the discharge may have(i.e., smells strongly of oil, weak
chlorine odor, etc.): 0.6
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
1 2) 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge. where l is no solids and 5 is the surface covered with floating solids:
/7! 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge, where I is no solids and 5 is extremely muddy:
1 2' 3 4 5
7. Is there any foam in the stormwater discharge? 0 Yes
8. Is there an oil sheen in the stormwater discharge? 0Yes 0-No.
9. Is there evidence of erosion or deposition at the outfall? 0 Yes 0-No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity,high solids,and/or the presence of foam,oil sheen,or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Page 2 o f 2
SWU-242.Last modified U O 1:.'"ii18

??J '4c€�G
roan ion cii
Stor:mwatci,!:r Discharge (Dlllltfalli (SD )
Qtilalliiltagtivss Monitoring Report
For guidance on filling or't this form,please visit https://deq.nc.gov/about/divisions/energy-mineral-land-resources/
n piles-stormwater-gps
Permit No.: N/C/G/0 /6 /0 /0 /0 rl) / or Certificate of Coverage No.: N/C/G/ 0/6 /0 /0 /2 /0 /
Facility Name: _T'ysort Farms Inc. Wilkesboro Complex
County: _Wilkes _._.._—__Phone No. 336/GS l/3836
Inspector: James Brown
I:)ate of inspection: 0:1/23/2022
Time of Inspection: C4,i- (S'�
I'ota.l Event Precipitation (inches):
All permits require qualirative monitoring to be performed during a "measurable storm event."
A G6'measurable storm event" is a storm event that results in an actual discharge fi'oin the permitted site
outfall. The previous measurable storm event must have been at least 72 hours prior. The 72-hour storm
interval does not apply igf the permittee is able to document that a shorter interval is representative for
local storm events during the sampling period,and the permittee obtains approval from the local DCNI R
Regional Office.
By this signature, I cei:if-/ that this report is accurate and complete to the best of my knowledge:
(Signature ofel,rmittee or Designee)
1. t)utran:Descripitioiii:
Cltil.fall I`lo.°1s���7.";t, it«'� Structure(pipe, ditch,etc.): 't'; 0 V.. _Receiving Stream:
'
Describe the industrial activities that occur within the outfall drainage area:
Page i of 2
SWU-:d2,Last modified Q6/01/2e:IF

2. Color: Describe the color of the discharge using basic colors(red, brown, blue, etc.)and tint
(light, medium,dark) as descriptors:
3. Odor: Describe any distinct odors that the discharge may have(i.e., smells strongly of oil, weak
chlorine odor, etc.):
4. Clarity: Choose the number which best describes the clarity of the discharge, where 1 is clear
and 5 is very cloudy:
til) 2 3 4 5
5. Floating Solids: Choose the number which best describes the amount of floating solids in the
stormwater discharge, where l is no solids and 5 is the surface covered with floating solids:
I 3 3 4 5
6. Suspended Solids: Choose the number which best describes the amount of suspended solids in
the stormwater discharge.where I is no solids and 5 is extremely muddy:
3 4 5
7. Is there any foam in the stormwater discharge? 0 Yes
8. Is there an oil sheen in the stormwater discharge? 0Yes O'No.
9. Is there evidence of erosion or deposition at the outfall? 0 Yes O No.
10. Other Obvious Indicators of Stormwater Pollution:
List and describe
Note: Low clarity, high solids,and/or the presence of foam,oil sheen,or erosion/deposition may be
indicative of pollutant exposure. These conditions warrant further investigation.
Pape 2 of 2
S tJ-2d2.Last modified orof s

AnaiiII j'ticall !Results
:at.in tar_ntaaata uman vanruaunnunuci an ri.nrauv w n.nr.nn n rwn mina arzanaaurram m ntn tan=suaatusarar,cnuntatumu'u r ..':` `- i `11t
m mu
'Tyson) Foods-WiIki9:a,1.»:,i'r
704 Factory Street
Wilkesboro, NC 28697
Receive Date: 02/23124:122
Reported: 03/0 712022
Foe: Stormw iter
Comments:
•
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
p.rv[raiNa:twfal{iW b1NYNMa{�ivt{YraNwNWYa»,{�aN nan[N':oai»r{».n,air,[.{nNn w[uin,w,Y»s»Yo,m{feria{m{aaYUNNYn[inNamt»Nautrm,MYm[�,nNNNYINwwwt�tltavw00ftVW[i[a:ani[n M1YM
220223-29-01 Chemical Oxygen Wilk-01 78 rng/L. HACH8000 02J25/2022 CI_
Demand
220223-29-01 Fecal Coliforms Wilk 01 >6000 CF11100 ivML SM922213.!OD6 02J23/2022 MD
220223-29-01 Total Petroleum Wilk-01 <5.0 mg/l_ EP.nwrnrr.va 02/28/2022 MT
Hydrocarbons
220223-29-01 TSS Wilk-01 39.2 mg/L sr:1251°1)zmrr 02/25/2022 LE
220223-29-02 Chemical Oxygen Wilk-02 62 rng/L H'1CF16006 02/25/2022 JCL
Demand
220223-29-02 Fecal Coliforms Wilk-02 >6000 CFU100 ML srr92221).2F10c 02/23/2022 MD
220223-2.9•-02 Oil and Grease Willc-02 <5 rng/L EF'A1OrrrfbivB 03/04/2022 CE
2202223-29•.02 TSS Wiik-02 42.4 rng/L 5M25400 2u11 02/25/2022 LE
Respectfully submitted,
O Melissa Myers
NC Cert#<440,
NCDW Cert r 37755,
EPA#NC00909
PO Box 228 0 Statesville, I''IC 28637 ° 704•/872/4c)7
Page 1 of 5

CoIrtto9iiaon of Receipt
'InL,lta317211 mwel:n11n111ia7tGOf1lit M1a11n11tAinL11131t2111l1a:'11OR'.1u 121 21111:21111113112111111,1a13151111112 C1.,1S1a.Y:mminx:132unu nrtt::rfrSffitnanlotmt 32L2132tn:aC711GLann ILT.tuC mraxt Ly:1:o
Sample Number 220223-29-01 Temp on Arrival: 3.1
11:1122:211rYIICn.2113111 1viiO2.1121 121111liaRn 31211 rtl111211211211221131111212111211 Utm IIGIm.R 2HcasiL=mm1GSG31133127turs 21133211311111 isammainscicRnI c¢omillnmRRenRl7:112121132123 aO12211
pH on Arrival: <2 Parameter Schedule: Total Petroleum Hydrocarbon;
Hydrochloric Acid • Received on lc()
Chemicals in containers, lab
Parameter Schedule: TSS
Received on Ice
pH on Arrival: <2 Parameter Schedule: Chemical Oxytjen IJernand
Sulfuric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: Fecal Coliform:;
Sodium'rhiosulfate Received on Ice
Chemicals in containers, lab
:11::nf12122a11n1•at:U111B61 011ID7.23.11 m an Otttltfllnas an:ll.11l:1.t1 Eta alal{/1eunnt:ttttrm111 wens:amenu ttti:a-+.p'raalalmlIIiLaliWa19Y11124 3Un:Q93ata tmluLuinlllarl DMZtO1131ar TO raf27:3tt
Sample Number 220223-29-02 Temp on Arrival: 3.'1
uattmtlnottn mmwr41RY1v71617JOQrIInnnIIIIIMtlAUrtl moor:1n7acusuaroccou utinessmRSWnat stm Lxlusur.taut.trsinssmtmernzamanmlWlnnnarnituzm{mntuarammccanrrovera rm
;at-I on Arrival: <:2 Parameter Schedule: Oil and Grease
Hydrochloric Acid Received on Ice
Chemicals in containers, lab
Parameter Schedule: TSS
Received on Ice
pH on Arrival: <2 Parameter Schedule: Chemical Oxyl;lten Demand
Sulfuric Acid Chemicals in containers, lab
Received on Ice
Parameter Schedule: Fecal Colii'orrn:>
Socliurrr Thiosulfate Received on Ice
Chemicals in containers. lab
PO Box 228 0 Statesville,P4C 28687 O 704/872/4i)7
Pay.2 of 5

| | --- --- -- - -
ij
ID
to CJ
VS
LA
21
CD Q
tit
ti
Hr
ZT
ZI
73
Fy to
PO Box 2]8 "Statesvi|ke, MC'28687 "7D4/&72/4.697
Page oo/o

I14Ieritech, Inc,,
Environmental Laboratory
Laboratory Certification No.165
Contact: C.Little Report Date: 3/4/2022
Clien:: Statesville Analytical
122 Court St Project: Tyson roods
Statesville,NC 20677 Date Sample Revd: 2/24/2022.
Meritech Work Order if 02"t.42244 Sample: 220223-29-01 Grab 2/23/22
Pa. lrtrrt:er" Itetiirll,s Analv.�i.5, :rte itcs2rtiVW Limit Lj_ii;kimj.
Oil&:Crease-SGP HEM c5.0 ni/L 2/28/22 5.0 mg/1. EPA 166413
I hereby certify that I have reviewed and approve:these data. (ii `nr• nCU't t j).gfk1
Laborator_, Representative
Ii42 Tamco Road,Reidsville,North Carolina 27320
tel.(336):'.42-<b748 fax.[phone]
•
PO Box 228 U Statesville,NC 28687 G 704/872/4697
Page 4 of 5

I
h.
01
CD
r11 -
N-
:.,.,, Chair of Custody o . rd(COC) tNPDEStt: •o it
aS r9"^P, asp-r. h It s as@ c..k F Client: ` I-• fify di f Phone:
P�:I E .l. am 4._e a g 1% ! ...,p ss:_f 0 a)4 .H-8 ro
_ ncldre r V Fax: M
t�.., ez
ENVIRONMENTAL i-HBUt�Ni�RiES —i!7.L. “i74- C34 ! !
! r., i i! 1 �r�.r c
.,.:. `i 642 Tanico Rd, Phone: 336-342"474S i U"1 i't• i',li.._.- —r(04J b �I Inn^,=et_ _ I
z.
i =-. Reidsville NC 27320 Eax: 336-3A�-].S7.2 f ;±• ! /( i () ni
• r?c..., T_� . .Ite <r,<,,.�.t�nT !,„tenlin, ! t:71, _•I 0 i, Turn.c.ouusiTime• v
�.. - ----- ,i• ...-------- -------------- - •MICil work ne,:tla p,ior ap1•rova1. U
How would you like your report sent? +-'
CZ
:,wtiA,,,,r.l-gei-iiechfabs.cc.;� __ 4-.
1 circle all that apply: t:rnAit l.,.orr•n.••i1• Fa., r.;,�i! +!r!I ifi rflaly�i? 5 DTI,. 11,� da_bj, Lr;
Sample•
Location,and/or I€3- Start _ End
- __. DIr.:?? a pr err f t i v tt�i i- ° I On!C^? �pl l� p
Gate I_ lilrr:^ njte TNne Grab? rrn, t CS-LI 1;i~L.�a=,}]! N IPr, J ^1r, n
C!Oii
2.�oZ2J�-7i' ! i �7-6 Z2 a !/r i 1 I �Z# • SGT- - v` `-rl—r � i;:� ! s
�- H-H I I - I --
_ E--__ iT -'�._. ► _�__ - _ L
i ! i ! I ! 1
i i
i
i-
---r-
—
----i I I 1.--- I -- ---
{ i I I 1"
I I I I i I
I I ! i i-.- .- - i
rsra :.Ya-:cc•.Yi^.c,^..,I ar...c:i•:;.. - :r:-:' - as.l r . ..� _ e=
111}G`.t'tCiCr 0 - -�= - ram^ .<:,.! �t
COninlcn Ls: ---• Campo:Ito;g
Shipment:
if_'i Fed Ex Arc us ,eat !t:tnr r�• ufal�r}lltfrpos{.? -Yes f h10 '_i Report results ill: rim!! !'I of f ,r 4-
II Prfinr akhcrl 1, 1 -' +-' Kc RJ
I- Hand Delivery, 1 ( , J_1 ;} '-' )7:- D•�7,/?"•--Itme:/ /, ncceh•ed br_r- /�'— %`7_c /7l) Time://_"i
IL= Other Iar7:nn„Ijs rtr <- ~--- - :i �%1.:;:c,f?J_. .,.. ,-.?6-7:� inneceivedby:/ DF:c Time:, 1
In :i<yu,:mu vY:� Wm: Time: '•:'(;t:y•-7.:,; 1 1
!� l;i, .Jt,'1i!f1 . _': -,.. Date. Time:_` :i(' }