NCG060182 DMR SW (10)

a
Environrf ltal Plan'
for Norffi Calina Division of Water Quality General Permit No. NCG06000O
11A^ Date submitted 2 ,
CERTIFICATE Ot COVERAGE SAMPLE SAMPLE COLLECTION YEAR
FACILITY NAME v FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY,c+ / a use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES .., �4�h,�DISCHARGING TO SALTWATERS? []YES �O
LABORATORY6 111 6,r4{5nlCS— Lab Cert. # SS"9
Part A: Stormwater Benchmarks and Monitoring Results
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall 2 or ❑ No discharge this period'
Outfall No. Sample Collected; TSS,
mo/dd/yr mg/L
pH, COD, Oil and Grease,
Standard units mg/L mg/L
Fecal -Coliform , Enterococcil,
Colonies per 100 ml Colonies per 100 ml
Benchmark - 100 or 504
Within 6.0 — 9.0 120 30
1000 500
D / 'AO V
e ar
1 Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on-site rain gauge.
3 For sampling periods with no discharge at any outfalls. You must still submit this discharge monitoring report with a checkmark hereLl---"
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yesio (if ves, complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor oil/month.
Outfall No. Sample Collected, Oil and Grease, TSS, pH, New Motor Oil Usage,
mo/dd/yr mg/L mg/L Standard units Annual average gal/mo
Benchmark - 30 100 or 504 6.0-9.0 -
014
r'Eie rjAL r LCA
Only applies to facilities that use/process meats.
2The total precipitation must be recorded using data from an on-site rain gauge.
3 For sampling periods with no discharge at any outfalls, you must still submit this discharge monitoring report with a checkmark here.
4See General Permit text, Table 3, identifying the especially sensitive receiving water classifications where the more protective benchmark applies.
Z:\Environmental\Industrial\PP-Pilgrim'sPrtde\PPNC-North Carolina\PPNC01-Marshvdle\PPNCOS-02 SPILL PLANS\2013 Monitoring Form 2

Environmental Plan
*FOR PART A AND PART B MONITORING RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES INA ROW FOR THE SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL? YES ❑ NO
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DMR, including all "No Discharge" reports within 30 days of receipt of the lab results (or at end of monitoring
period in the case of "No Discharge" reports) to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CERTIFICATION FOR ANY INFORMATION REPORTED:
"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 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."
(Signature of Permittee)
17--119
1/�!
(Date)
Additional copies of this form may be downloaded at: http://r)ortal.ncdenr.org/web/­w-ci/ws/­su/npdessw#tab-4
SWU-249
Z:\Environmental\Industrial\PP-Pilgrim's Pride\PPNC-North Carolina\PPNC01-Marshvllle\PPNCOI-02 SPILL PLANS\2013
Last Revised: October, 18, 2012_
Monitoenlfg Form 2