NCS000166 DMR SW (3)

Perm(t Number: NCS 000166
'Facility Name Perdue Farms Lewiston
Person Collecting Samples rim Mizelle
Certified Laboratories Perdue Farts Inc
Environment 1
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Stormwater Discharge Outfall (SDO)
Monitoring Report
_ Samples Collected During Calendar Year
(This monitoring report shall be received by the Division
no later than 30 days from receipt of sampling results)
_ County • Bertie
# 245 Phone Number 252-348-4326
Lab# 10 _
SIG ATURE OF PERMIPfE OR DESIGNEE
2015 ,
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month '?
X YES NO
If yes, complete Part B
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Ir it
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month '?
X YES NO
If yes, complete Part B
Par/ n Vnh,nln Mainfenanr•n Dr/nnh, M-4—inn Ronrdrom to
Storm Event Characteristics.
Date : 5/21/2015
Total Event Precipitation ( inches) . 05
Event Duration (hours) 14
( if more than one storm event was sampled)
Date
Total Event Precipitation ( inches)
Event Duration (hours)
Mail Onginal and one copy to,
Division of Water Quality
Attn Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 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 imprisionment for knowing violations "
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( Signature of Pernittee) ( Date )
I��L-JL11_
C_L-JC - - -- -1
Storm Event Characteristics.
Date : 5/21/2015
Total Event Precipitation ( inches) . 05
Event Duration (hours) 14
( if more than one storm event was sampled)
Date
Total Event Precipitation ( inches)
Event Duration (hours)
Mail Onginal and one copy to,
Division of Water Quality
Attn Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"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 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 imprisionment for knowing violations "
,1? �/" ice`
( Signature of Pernittee) ( Date )

V
Perdue Farms Incorporated
P.O.Box 460
Lewiston Woodville, NC 27849
www.perdue.com®
Office [phone]
Certified Mail # 7015 0640 0000 4319 7302
June 5, 2015
Division of Water Quality
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Re: Stormwater Analytical Monitoring
Permit # NCS000166
Perdue Farms Incorporated, Lewiston
To Whom it May Concern:
R-TIVED
J iN t l 1 2015
Please find enclosed duplicate copies of our stormwater analytical monitoring for the above-
mentioned permit. This sampling is for the second period of the second year of our permit, consisting of
December 1, 2014 thru May 31, 2015.
We hope this meets with your approval and should you have any questions or concerns please
contact me at 252-348-4326.
Sincerely,
Wayne Black, REM
Environmental Manager
Perdue Farms Incorporated
'IT ,
,�—
A Family Commitment to Quality Since 1920—