NCG060360_MONITORING INFO_20170501

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
/V � �� '� �4 L
DOC TYPE
❑HISTORICAL FILE
'MONITORING REPORTS
DOC DATE
❑ QVI � 05 0 )
YYYYMMDD

Appendix F
•SEMI-A_NNUALSTO_RMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCGO60000
Date submitted 04125/2017
CERTIFICATE OF COVERAGE NO. NCG06jj-j_EQ SAMPLE COLLECTION YEAR- 2017
FACILITY NAME _ BU1iBCb3El, LLC _- FACILTTYACTNITIESINCLUDE {checkallthatapply}; L.rE1VP
COUNTY. 1-loke ® use/process meats '0 use animal fats/byproducts
PERSON COLLECTING SAMPLES Vanest�• SinO�tary DISCHARGING TO SALTWATERS? ❑YES ®NO MAY 0 2017 _
LABORATORY TBI Laboratories Lab Cert. # 37CENTRAL FILES _
PLEASE REMF_MBER TO SIGN ON THE REVERSE 4. DWR SEC
T10Jv:
Part A: Stormwater Benchmarks and Monitoring Results Tots! event rainfa!! z or [01 No discharge this perioa�
' Outfall No..
Sample.Collected, -
mold d/
TS51
mg/L:
PH,
Standard units
COD,
mg/L
Oil and Grease,
= = mg/L
Fecal Coliform ,
Colonies per 100'm]
En erococci ,
Coloniesper-100 ml
Benchmark
-
100 or So
Within 6.0-9.0
120
30 -
1000
500
OF 1
04/06/2017
43.2
7.22
42.5
8 •
120
1 Only applies to facilities -that use/process meats.
2-The total precipitation must be recorded using data from an on-Isite rain gauge. _
gFor sampling periods with no discharge at Uy outfalis. Youmuststitl submit this discharge monitoring report with a checkmark here =
45ee General Permit text; Table 3,1dentifying the espedaily sensitive receiving water ciassiflcations where the more.prot:ect]ve benchmark applies.
Did this facility ierform Vehicle Maintenance Activitles-using more than 55 gallons -of new motor oil per month? ] Yes ®no. _ f ifi v complete Part Bj
Part B: Vehicle Maintenance Area Monitoring Results: only for facllities averaging n 55 gal of new orator oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
011 and Grease,
mg/L
TSS,
mg/L
_• . - PH,
Standard units
New Motor Oil Usage,
Annual average gallmo
Benchmark
-
30
100 or SO
Only applies to facilities that uselprocess meats.
2The total precipitation must be recorded using data from an orrslte rain gauge.
a For sampling periods with no discharge at any.outfalls, you must still submit this discharge monitoring report with a checkmark here.
45ee General Permit text, Table 3, identifying the especially sensitive receiving water dassifications,where the more protective benchmark applies:'
SVIU-219 IAa Revised; Ootober'18, 201-7 - f
Page i of 2
- _ .

*FOR PART A -AND PART B MONrrORLNG RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER AT THE SAME OUTFALLTRIGGER TIER 2 REQUIREMENTS. SEE PERMIT PART II SECTION B_
TIER B: HAS YOUR FACILITY HAD 4.OR MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER ATANYONE OUTFALL? YES ❑ NO Q
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 Ic6 results (or at end of
monitoring period in the Case of "lVe Discharcrep reparts)to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN TN15 CER77FICATION 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."
X--V) - aS /
(Signature r
ermittee) ( te)
Additional copies of this form may be downloaded at; htta://aortal.ncdenr.ofrfwebtwv/wsLsufnpdessw�#tab-4
SWU-249 LastReeEsed: October 18, 2012
Page 2 of 2

Appendix F
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCGO60000
Date submitted 03/28/2017
CE:RTiFICATE.0F COVERAGE NO. NCG06a-1-E-a
SAMPLE COLLECTION YEAR 2017
FACILITY NAME Butterball LLC FACILITY ACTWITIES INCLUDE (check all that apply):
COUNTY _ Hoke ECUV D� use/prates meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES Vanest& Singletary �SCHARGING TO SALTWATERS? OYES EINO
LABORATORY TBI_ Laboratories _ Lab Cert. # 37 APP 0 2017
Part A: 5tormwater Benchmarks and Monitoring Results
CENTRAL FILES
DWR SECTION
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rainfall T or n No discharge this aerforla
Outfall No,
Sample Collected,
mojddJyr
TSS,
mg/L
PH,
Standard units
COD,
mg/L
Oil and Grease,
mdL
Fecal Colifurm1,
Colonies per 100 ml
Enteracocai ,
Colonies per 100 ml
Benchmark
-
inn or
Within 6.o-9dl
( 320
30
1000
500
OF 1
03/14/2017
20.7
7.33
1 <30.0
BDL
100
Only applies to facilities that usa/process meats.
`The total precipitation must be recorded using data from an on -site raln gauge.
3For sampl ng periods with no discharge at Aaouthlis. You must stil i sub mit this discharge monitoring report with a checkmark here.
'See General Permit text, Table 3, identifying the especially sensitive receiving water classic ications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? ❑ yes [Zno Cif es complete Part B)
Part S: Vehicle Maintenance Area Monitoring Results: oniv for facilities averaging> 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mojdd/yr
Oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor.D€1 Usage,
Annual average gal/mo
Benchmark
-
30
100 or 50'
6-0 — 9.0
-
"Only applies to 'facilities that use/process meats.
t—he 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.
{See General Permit text, Table 3, identifying the especially sensitive receiving water classifications -where the more protective benchmark applies.
SWU-249 Last Reyised: October.18, 2012
Page I of 2

*FOR PART AAND PART B MONITORING -RESULTS,
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
e 2 DCCEEDANCFS IN A ROW FORTH E SAME PARAMETER AT THE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS, SEE PERMIT PART 11 SECTION B.
• TIER 3: HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK DCCEEDENCES FOR THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑X
IF YES, HAVE YOU CONTACTED THE DWQ REGIONAL OFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an original and one copy of this DM►t includimgall "No Discharge"reeports, within 30 days of rereint of the lab results (or at end of
monitoring period in the case of "No Discharge reports) to;
Division of Water Quality
Attn: DWQCentral Ties
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST SIGN THIS CEIMFICAT ION FOR ANY INFORMATION REPORTED:
"i certify, under penalty of la�v, that this document and all attachments were prepared under my direction or supervision in accordance with a
system designed to assure that cual1ed personnel properly gather and evaluate the information submitted. Based on my inquiry of the
person or persons who manage the system, or _hose 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."
l
(Signat 7of iPermittee) ate)
Additional copies of this form may be downloaded at: http://Portal_ncdenr.org/web/wci/ws/su/npdessw#tab-4
5 W U-249 Last Revised: October 19, 2012
Page 2 of 2

Appendix F
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina Division of Water Quality General Permit No. NCGO60000
Date submitted
ClZ/ -'/ Z017
CERTIFiCATE.Of COVERAGE NO. NCG06Q a_,_ft SAMPLE COLLECTION YEAR 2017
FACILITY NAME Butterball, LLC FACILITY ACTIVITIES INCLUDE (checkall that apply):
COUNTY . i-Inke ® use/process meats use animal fats/byproducts
PERSON COLLECTING SAMPLES VanesterSina to[y DISCHARGING TO SALTWATERS? []YES ®NO
LABORATORY Cab Cert.#
PLEASE REMEMBER TO SIGN ON THE REVERSE 3
Part A: Stormwatar Benchmarks -and Monitoring; Results Total event rainrfalr2 or n No discharge this oerio?
Outfall No.
Sample Collected,
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Oil and Grease,
mg/L
Fecal Coigfnrm ,
Colonies per 100 mi
F_riterococc31,
Colonies per100 ml
Benchmark
-
MO or50`
Withln 6.0--9.0
120
30
low
Soo
No QualjfVincl i
ain Event
a,
i
IV
A 2
-MA
10nlyappliestofauiitiwthat use/process meats. CENTRAL FILES
aThe total precipitation must.be recorded using data from an on -site rain gauge R SECTION
For templing. periods with no discharge at awn rr outfalb, You must still submitthis discharge monitoring report with a checkmark h�r
45ee General Permit text, Table 3, identifying the especially sensitive recenhng•water classifications where the more protective benchmark applies.
Did this facility -perform Vehicle Maintenance Activities using more than 55 gallons of new motorail per month? [] yes ®no if es complete Part B)
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging > 55 gal of new motor-oil/month.
OutWI No.
Sample Collected,
mo/dd/yr
oil and Grease,
mg/L
TSS,
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Bendhmark-
30
100-or 04
1 Only applies to facilitiesthat.use/promss meats.
The total precipitation must be recorded using data from an on -site rain gauge.
a For sampling periods with no discharge at any outFalls, you must still submit this discharge monitoring report with a checkmark here.
45ee General Permit text, Table3, identifying the especially sensitive receiving water classifitatians where the more protective benchmark applies.
SWU-249
Last Revisrd: October 19, 2012-
Page 1 of 2

*FOR PART --A AND PART B MOMITORING•RESULTS:
• A BENCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
2 EXCEEDANCES IN A ROW FOR THE SAME PARAMETER ATTHE SAME OUTFALL TRIGGER TIER 2 REQUIREMENTS. SEE PERMrF PART II SECTION B.
• TIER B: HAS YOUR FAGUfY HAD 4 OR MORE BENCHMARK EXCEEDENCES FOR -THE SAME PARAMETER AT ANYONE OUTFALL? YES ❑ NO ❑X
IF YES, HAVE YOU -CONTACTED THE DWQ REGIONAL bFFICE? YES ❑ NO ❑
REGIONAL OFFICE CONTACT DAME:
Mail an original and Me copy of this DMR, induding all "No Discharge" reports, within 30 days of receipt of the lab results ror at end of
manitoring period in the case of ONo Discharger reports) to
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU,MUST SIGN 7MS CERTiFICATION FOR ANYINFORMATION 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."
r
(Signature rmittee) ( e)
Additional copies of this form may be downloaded at: http://portal.ncdenr.ore/web/wa/ws/Su/npdessw#tab-4
SWU-249 lastReeiscd: October 18, 2012
PW2of2

Appendix F
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING REPORT
for North Carolina D'nrision of Water Quality General Permit No. NCG060000
Date submitted �% / ���%
CERTIFICATE OF COVERAGE NO. NCCsDS� � Q SAISiIPLE CDLiE�CnON YEAR 2017
FACILITY NAME _Butterbali _LLC
COUNTY Hnke
PERSON COLLECTING SAMPLES Vanester Single_�l
LABORATORY TBL Laboratories Lab Cert. # 37
Part A: Storrnwaber Benchmarks and Monitoring Results
RECEIVED
MAR 0 6 2017
FACIM ACTIVITIES INCLUDE (checkall that apply): CENTRAL FILES
® use/process meats ❑ use animal fats/byproducts DWR SECTION
DISCHARGING TO SALTWATERs? DYES ®No
PLEASE REMEMBER TO SIGN ON THE REVERSE 4
Total event rain fay I or n No disrJht7rae this oeri
Outfal[ No..
5arnple.Col1ected,
ma/dd/yr
ns,
mg/L
PH,
Standard units
COB,
mg/L
Oil and Grease,
rr[g/l.
Fecal CoBform ,
Colonies per IDD m!
Enterococda
Colorises per 100 mi
Benchmark
-
1W or Se
Within sz— ax
1iD
30
1DOD
Sod
OF 1
21/15/2017
61.6
BAS
56.0
BQL
300
I
I
i
'Only app3iesto faci€sties that use/pracess meats
=Thetotal precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at air outfalls. You must still submit this discharge monitoring report with a checkmark here.
`See General Permit text; Table 3, identifying the especially sensitive receMngwater classifications where the mare prokecttive benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of view motor uil-per month? ❑ yes [] no if es 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,
nm/dd/yr
CC and Grease,
mg/L
TsS,
L
PH,
Standard units
New Motor Oil Usage,
Annual average gal/mo
Benchmark
-
30
SOD or So
G.0--.9.0
-
' 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 rim outfails, yot rmust still submit this discharge monitoring report with a checkmark here.
`See General Permit text, Tahle 3, identrfying the especially sensitive receiving water classifications where the more protective benchmark applies.
SWU-249
Last Revised: October 18,.2012
Page 1 cif 2

;FOR PART A AND PART B MONITORING RESULTS:
• A B=_NCHMARK EXCEEDANCE TRIGGERS TIER 1 REQUIREMENTS. SEE PERMIT PART II SECTION B.
• 2 EXCE£DANCES IN A ROW FOR THE SAME PARAMETER ATTHE-SAME OUTFALLTRIGGER TIER 2 REQUIREMENTS. 5EE PERM[T PART II SECT[ON B.
• TIER 3. HAS YOUR FACILITY HAD 4 OR MORE BENCHMARK EXCEED ENCES FOR THE SAME PARAMETER AT ANYONE O[Ti'FAU? YES ONO I-
iE YES, HAVE YOU CONMAC ED THE DWQ REGIONAL OFFICE? YES Q NO ❑
REGIONAL OFFICE CONTACT NAME:
Mail an art inal and one copy of this AMR, indudina all 'No Discharge-v reports, within .30 days of receiyt of the lub results (or at end of
monitoring a6ad in the case of '"No Dischar en re artsj to:
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1617
YOU MUST .SIGN THIS CERTIFICATION FOR ANY INFORMATIOM 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 designer] -to assure that qualified personne€ 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.-1 am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
(Signatur of rmittee) { e)
Additional copies of this form may be downloaded at: h=:aortal.ncdenr.oMLwebLwq/ws/suLnl)d es'
sw#tab4
S M-249 Last Revised_ Oember 19, 2012
Page 2 of 2

J
Appendix F
SEMI-ANNUAL STORMWATER DISCHARGE MONITORING FtEPORT
for North Carolina Division of Water Quality General Permit No. NCGO60000
Date submitted 01 /04/2017
CERTIFICATE OF COVERAGE NO. NCG06�,a _E_a .SAMPLE COLLECTION YEAR 20] 6
FACILITY NAME Butterball, LLC FACILITY ACTIVITIES INCLUDE (check all that apply):
COUNTY _ HnkP_ ® use/process meats ❑ use animal fats/byproducts
PERSON COLLECTING SAMPLES DISCHARGINGTOSALTWATERS? []YES ®NO
LABORATORY Mirrohar Labnratorbliab CerL.# 11
PLEASE REMEMBER TO SIGN ON THE REVERSE4
Part A: Stormwater Benchmarks and Monitoring Results
'ECSI y ED
`BANS:
CARP,AL Ff
CTlON
Tdial event rainfall Z or ❑ No discharge this period
OutfalI No.
Sample Collected,.
mo/dd/yr
TSS,
mg/L
pH,
Standard units
COD,
mg/L
Od and Grease,
nWL
Fecal Coliform ,
Colonies per 100 ml
Enterococ e,
Colonies per 100 ml
Benchmark
-
100 or 50°
Within 6.0 — 9X
120
30
I=
SD0
12/12/2016
115.0
9.00
1400
l Only'applies to facilities that'use/process meats.
2 TFie total precipitation must be recorded using data from an on -site rain gauge.
3 For sampling periods with no discharge at aU outfalls."You must still submit -this discharge monitoring report with a checkmark here.
`see General Permit text, Table 3, identifying the especially sensitive receiving water classrfications where the more protective benchmark applies.
Did this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month?. -El Yes ®no
Part B: Vehicle Maintenance Area Monitoring Results: only for facilities averaging> 55 gal of new motor oil/month.
Outfall No.
Sample Collected,
mo/dd/yr
Oil and Grease,
rrig/L
TSS, I
mg/L
pH,
Standard units
New Motor Oil Usage,
Annual average gal%mo
Benchmark
-
30
100 or SO
6.0 — 9.0
-
2 Only applies to facilities that 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.
!See General Permit text, Table 3, identrfyingthe especially sensitive receiving water classifications where the more protective benchmark applies.
if yes complete Part B)
SWU-249 Last Revised: October 18,2012
Page 1 of 2

`FOR PART A AND PART R MONITORING RESULTS:
A BENCHMARK EXCEEDANCE TRIGGERS TIER i REQUIREMENTS. SEE PERMrr PART II.SECnON B.
e 2 EXCEEDANCES IN.AROW FOR THE SAME PARAMETER' AT THE SAME OUTFALLTRIGGER TIER 2 REQUIREMENTs. SEE PERMIT PART 11 SECnON B.
* TIER 3: HAS YOUR FAdLrrY HAD 4 0R MORE BENCHMARK EXCEEDENCES FOR THE SAME PARAMETER AT ANY ONE OUTFALL7 YES ❑ NO
IF YES, HAVE YOU'CONTAcm THE aWQ REGIONAL OFFICE? YES [Q NO ❑
REGIONAL OFFICE CONTACT NAME:
Marl an oriclinal and one cosy of DMR inducting all oft D1=kcrree" reports. within 3D days of receipt of_the lab results (or art end 'QIF
manitorinn Ledad in the case of `No Discharve" Mp rts�,to: - -
Division of Water Quality
Attn: DWQ Central Files
1617 Mail Service Center
Raleigh, NC 27699-1517
YOU MUST SIGN THIS CERTIFICATION FOR AIVYINFORMATION 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 an my inquiry of the
person or persons who manage the system, orthose persons directly responsible for gathering the` information, the information submitted is,.
to the best of my knowledge and.belief, true, accurate, and complete. 1 am aware thatthere are significant penalties forsubmitting.false
information, including the possibility of fines and imprisonment for knowing violations."
(Signature Sf Permittee) (Dane) j
Additional copies ofthisform maybe downloaded at ortai.ncdenr.a web w ws su n dessw#Eab-4
SVM-249
LassRevised: Ocmber 19, 2012
Page 2 of 2

PERMITTEENAMEIAODRESS(indudeFacUityNamaL=OonifDifferent] NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPD1=S)
DISCHARGE MONITORING REPORT (DMR)
NAME Butterball, LLC NC 060360
ADDRESS 1000 E. Central Ave., PERMIT NUMBER DISCHARGE NUMBER
Raeford, NC, 28376
MONrrORING PERIOD
FACILITY Same As Above
LOCATION
FROM
YEAR I MO I DAY
TO
YEAR I MO I DAY
C 7 F5—
Form Appmved
OMB No. 2040-OOD4
NOTE: Read instructions before
PARAMETER
QUANTnY OR LOADING
QUALITY OR CONCENTRATION
NO.
EX
FREQUENCY
OF
ANALYSIS
SAMPLE
TYPE
AVERAGE
MAXIMUM
UNITS
MINIMUM
AVERAGE
MAXIMUM
UNITS
Chemical Oxygen
Demand (COD)
SAMPLE
38.4
MGIL
11180
Grab
PERMIT
.REQUIREMENT
11.120
_
11180
Grab
Total Suspended
Solids (TSS)
SAMPLE
2/n7..3
MGIL
11180
Grab
PERMIT =
REQUIREMENT
1 W-
_
_
-
111$0
Grab
Fecal Coliform -
Membrane Filter
SAMPLE
38,167
Coll
100m1
11180
Grab
PERMIT
_ REQUIREMENT
1,000
-
1 /180
Grab
Oil and Grease
SAMPLE
BDL
MGIL
1/180
Grab
—PERMIT
REQUIREMENT".
30 -
_
-
- _
,.1/180
Grab -
pH
SAMPLE
8.25
Su
11180
Grab
PERMIT
REQUIREMENT
-
11180
G ra b
BiochemicalOxygen
Demand (BOD)
SAMPLE
9.1
MGIL
11180
Grab
PERMIT
REQUIREMENT°
N R -
-
_
SAMPLE
PERM]
REQUIREMENT
_
NAME/TITLE PRINCIPAL EXECUTIVE OFFICER I certfy under penalty of taw that duI dowmem and al attachments were Prepared under my di—c n a TELEPHONE DATE
sup —Won in—rdance with a system desioned to assure matqualihed personnel properly gamer and avatuete
the War.- submit0ad. Based on my Y of the person or persons wtro manage me system, or #ruse
Lankford Ruffin , direcEyreapar�letargaherfgmeinformaton,menfam,abansubmftled1s,tame�tofmykn0=dge 919 255-7900 201 06 116
and be4ef, true. —rate, and complete. I am aware that there are significant penathe for submltdng false
informalim- md-dirng the Ixa: Rdty of r— and iesV ir—mem Ian tnawmg riohtens. SIGNATURE OF PRINCIPAL EXECUTIVE
TYPED OR PRINTED OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR MD DAY
COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference aA attachments here)
Fecal Coliform High from wild birds nesting on roof of facility. Will begin corrective action.
EPA Form 3320-1 (Rev. 03-99) Previous edition may be used. This is a 4-part form PAGE 1 OF 1

� w
PERMITTEE NAMEfADDRESS (h We Fara'tity NamaLOcafbn it Drferenf) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
DISCHARGE MONITORING REPORT (DMR)
NAME Butterbali, LLC NC 060360
ADDRESS 1000 E. Central Ave., PERMIT NUMBER DISCHARGE NUMBER
Raeford, NC, 28376
MONITORING PERIOD
FACILITY Same As Above YEAR MO DAY I YEAR MO DAY
LOCATION FROM ')nl rt n7 01 TO 901 r 12 Ill
Form Approved
OMB No. 2040-0004
NOTE: Read instructions before
PARAMETER
QUANTITY OR LOADING
QUALITY OR CONCENTRATION
NO
EX
FREQUENCY
OF
ANALYSIS
SAMPLE
TYPE
AVERAGE
MAXIMUM
UNITS
MINIMUM
AVERAGE
MAXIMUM
UNITS
Chemical Oxygen
Demand (COD)
SAMPLE
38.4
MGIL
1/180
Grab
PERMIT
REQUIREMENT
120
1/180
1 Grab
Total Suspended
Solids (TSS)
SAMPLE
27.3
MGIL
1/180
IGrab
PERMIT
REQUIREMENT
100
1/180
Grab
Fecal Conform -
Membrane Filter
SAMPLE
38,167
Coll
100m!
1/180
Grab
PERMIT
REQUIREMENT
1,000
1/180
Grab
Oil and Grease
SAMPLE
BDL
MGIL
11180
Grab
REQIE ERMIT
30
11180
Grab
pH
SAMPLE
W
8.25
-
SU
- -
-
-
1/180
Grab
PERMIT
REQUIREMENT
6-9
1/180
Grab
Biochemical Oxygen
Demand (BOD)
SAMPLE
9.1
MGIL
1/180
Grab
PIT
REQUIREMENT
N R
SAMPLE
PERMIT
REQUIREMENT
NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I ee+* under peraft of bw ew 0* dn==* and .tl att.dh h. r . prepared under my d.ec4un w TELEPHDNE DAZE
.upervldonln accordance wth. q.wmde 4Pw w s.a,aa thm cowl Pone.- prepe,htp.M—d evere.t.
�kford Ruffin �, le wn dK000-sp h r� e
Add � coo. accmd., and . . M� d -o II I- aea 919 255-7900 201 06 16
Officer�,. p. , a �..ndl�d..�,d wr l�.tip �e�er� SONATUM OF PfttNcztAL mCUTI rE
OFFICOV OR ENT
rMEDORPRWIM AUTNOR�.EG AG AREA NUMBER YEAR MO I DAY
COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
Fecal Coliform High from wild birds nesting on roof of facility. Will begin corrective action.
EPA Form 3320-1 (Rev. D3-99) Previous addons may be used This is a 4-part form PAGE 1 OF 1

PERMITTEE NAMEIADDRESS (lrfctude Fadlrry)Vamal Dcatlon ifDr ferent) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM fNPDES) Farm Approved
DISCHARGE MONITORING REPORT fDMR) OMB No. 2040-0004
NAME Butterball, LLC NC 060360
ADDRESS 1000 E. Central Ave., PERMITNUMBER I DISCHARGE NUMBER
Raeford, NC, 28376 MONITORING PERIOD
FACILITY Same As Above YEAR MO DAY YEAR MO DAY
LOCATION FROM 2516 01 01 TO 1 2016 1 06 30
NOTE: Read instructions before
PARAMETER><
QUANTITY OR LOADING
QUALITY OR CONCENTRATION
NO
EX
FREQUENCY
OF
ANALYSIS
SAMPLE
TYPE
AVERAGE
MAXIMUM
UNITS
MINIMUM
AVERAGE
MAXIMUM
UNITS
Chemical Oxygen
Demand (COD)
SAMPLE
147.0
MG/L
1/180
Grab
PERMIT
REQUIREMENT
120
11180
Grab
Total Suspended
Solids JSS)
SAMPLE
128.0
MGIL
1/180
Grab
PERMIT
'- REQUIREMENTS
,100
_
- _ _
J -
_ -
_-
1/180
Grab
Fecal Collform -
Membrane Filter
SAMPLE
1,000
Col/
100ml
1/180
Grab
PERMIT
...-. REQUIREMEN-t-
1.000
...r _ _
-
-
-
- ..
_1/180 -
Grab
Oil and Grease
SAMPLE
BDL
MG/L
11180
Grab
PERMIT
.REQUIREMENT -
30
11180 -
Grab
pH
SAMPLE
6.47
SU
1/1p8n0
Grabb,
PERMIT
REQUIREMENTBiochemical
6,1_ 9- -. -
-
-
1/180
.Grab,
Oxygen
Demand (BOD)
SAMPLE
14.3
MGIL
1/180
Grab
PERMIT,
REQUIREMENT'
N R
-
-
-
SAMPLE
PERMIT
REQUIREMENT
-
-
I --" Tarts- penalty of Iaw That Cris d—it and ar aH-hems were prepared under my direction or
NAMEtTITLE PRINCIPAL EXECUTIVE OFFICER - * TELEPHONE DATE
supervwlon m aaordanu with a system designed W assure Matqua6fied personnel property gather and evaluate
the information wbmt!led. Based on my i KWy at the Person or persons wtrp manage the system, or Mane
Lankford Ruffin pc+swrsdirecltyrespons"ehxgat=vngthenfomaYon,Cuintommriimsubmitted w.tothebestoimyknoWedge 919 255-7900 201 06 16
and belief, true, acmrate, anawm d complete. I am s that Mere are significant penebes for wbmiltng taws
information, inMdlrrg Me poscidity of One and'crgasonment for tnawkrg vldetiors, SIGNATURE OF PRINCIPAL EXECUTIVE
TYPED DR PRINTED OFFICER OR AurHORIZFD AGENT AREA NUMBER YEAR MO I DAY
COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachmenffi here)
COD and TSS high due to current construction. To be Completed by 07/15/16.
EPA Form 3320-1 (Rev. 03-99) Previous editions may be used. This is a 4-part form PAGE 1 OF 1

PERMITTEE NAMEIADDRESS FI. de Faa&NameRncar=italllerenr) NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM (NPDES)
DISCHARGE MONITORING REPORT fDMR)
NAME Butterball, LLC NC 060360
ADDRESS 1000 E. Central Ave., PERMIT NUMBER DISCHARGE NUMBER
Raeford, NC, 28376 MONITORING PERIOD
FACILITY Same As Above II YEAR MO DAY I YEAR MO I DAY
LOCATION FROM 12016 01 01 1 TO 1 2016 06 30
Form Approved
OMe No. 204&DOG4
NOTE: Read Instructions before
PARAMETER
QUANTITY OR LOADING
QUALITY ORCONCENTRATION
NO
EX
FREQUENCY
OF
ANALYSIS
SAMPLE
TYPE
AVERAGE
MAXIMUM
UNITS
MINIMUM
AVERAGE
MAXIMUM
UNITS
Chemical Oxygen
Demand (COD)
SAMPLE
147.0
MGIL
11180
Grab
REQUIREMENTPERMI
120
11180
Grab
Total Suspended
Solids (TSS)
SAMPLE
128.0
MGIL
1/180
Grab
PERMIT
REQUIREMENT
100
1/180
Grab
Fecal Coliform -
Membrane Filter
SAMPLE
1,000
Coll
100ml
1/180
Grab
PERMIT
REQUIREMENT
,000
1/180
Grab
Oil and Grease
SAMPLE
DL
[30
MGIL
1/180
Grab
REQUIREMENT
1/180
Grab
pH
-
SAMPLE
6.47
- - - -
Su
--
-- - ---
1/180
Grab
PERMIT
REQUIREMENT
-
6-9
1/180
Grab
Biochemical Oxygen
Demand (BOD)
SAMPLE
14.3
MGIL
1/180
Grab
PERMIT
REQUIREMENT
N R
SAMPLE
PERMIT
REQUIREMENT
NAMEMTLE PRINCIPAL EXECUTIVE OFFICER I Offt urA°r pftn&Y m Iw dw fth doomwl and al aMmh—bt w P<tp&W undo mV cbecibn a + TELEPHONE DATE
mr Fdwma0aue� whmabd Bad tummy b'Pd�Y W Pefwn ar AmgtP W" marm" E� siMet. p dl
Lankford Ruffin
.4 b w 6w..m&,,.,a - I ma M am& a wwi&.d Pam br W- 919 255-7900 2016 06 16
. &Kk ft penI ml of *A wW ImpriommeM br km vft vktdwj - SIGNATURE OF PRINOIpAL "ECUmrE
TYPED OR PFUNTED OFFICER OR AUTHORIZED AGENT AREA NUMBER YEAR No I DAY
COMMENT AND EXPLANATION OF ANY VIOLATIONS (Reference all attachments here)
COD and TSS high due to current construction. To be completed by 07/15/16.
EPA Form 3320-9 (Rev. 03 99) Previous edlrons may be used This Is a 4-part form PAGE 1 OF 1

NPDES Permit Tracking No.:
INICIO16101316101JJ
� E PA UNITES STATES ENVIRONMENTAL PROTECTION AGENCY
ti� WASHINGTON, DC 20460
Annual Reporting' Form
A. GENERAL INFORMATION
1. Facility Name: I"IOultltlelrlblalllil,I ILIL10I I III 1 1 1 11 l _l_I_IJJ
2. NPDES Permit Tracking No.: I NOO16101316101 I
3. Facility Physical Address:
a. Street: 11101010eInItIrIalilv e
b. City: IRIaIeI f IoI r1 d1 1 1 I 1 I I I I I 1 1 l I I I I G, State: INICI d. Zip Code: 1218131716 -1 I I I 1
4. Lead Inspectors Name: NaInldlal IRIiIcIhIalrldlslolnl 11 1 I Title: Isliltlel lE1nlvliIrlolnHelntlalI � I
Additional Inspectors Name(a): IBI i 1 i 1 i Ivl Idal n1 i Iel i Isl 1 1 1 1 1 11 PISPISIM jCjojojrjdjijnjajtjojr1
5.ContactPerson: ILIaInIklf Io1rld1 IRIuIfIf l ilnl I I I I I Title: ICIoIrIp1.I jr niv1 i1rlolJt�ejn t a t
Phone: [phone] at F--mail: l r u f f i n b u t t e r b a l I. c o
6. Inspection Date: 0 6 LiU6 f 2 0 1 6
B. GENERAL INSPECTION FINDINGS
1. As part of this comprehensive site Inspection, did you inspect all potential pollutant sourcea, including areas where Industrial activity may be exposed to stormwater?
® YES ❑ NO
It NO, describe why not:
NOTE: Complete Section C of this form for each Industrial activity area inspected and included in your SWPPP or as newly identified In B.2 or B.3 below where pollutants
maybe exposed tostormwater.
2. Did this Inspection Identify any stornwater or no"lormwater outfalls not previously Identified In your SWPPP? []YES ®NO
If YES, for each location, describe the sources of those stormwater and non-stormwater discharges and any associated control measures in place:

NPDES Permit Tracking No.:
NC06036101 I�
3. Did this inspection identify any sources of stormwater or non-stormwater discharges not previously identified in your SWPPP? ❑ YES ®NO
If YES, describe these sources of stormwater or non-stormwater pollutants expected to be present In these discharges, and any control measures In place:
4. Did you review stormwater monitoring data as part of this Inspection to identify potential pollutant hot spots? ® YES ❑ NO ❑ NA, no monitoring performed
If YES, summarize the findings of that review and describe any additional Inspection activities resulting from this review:
Found high Fecal Coliform analytical data from first sampling event, installingultrasonic bird repellers to roof area of facility.
Also found nigh COD and TSS counts during second sampling event. Believe to be coming from on -going construction.
5. Describe any evidence of pollutants entering the drainage system or discharging to surface waters, and the condition of and around outfalis, including flow
dissipation measures to prevent scouring:
Installed grass sod and grass seeding to help prevent soil run-off.
6. Have you taken or do you plan to take any corrective actions, as specified In Part 3 of the permit, Since your last annual report submission (or since you received
authorization to discharge under this permit if this is your first annual report), Including any corrective actions identified as a result of this annual comprehensive site
Inspection?
® YES ❑ N0
If YES, how many conditions requiring review for correction action as
specified in Parts 3.1 and 3.2 were addressed by these corrective actions? 0 2
NOTE. Complete the attached Corrective Action Form (Section D) for each condition identified, including any conditions Identified as a result of this comprehensive
stormwater inspection.

r I
NPDES Permit Tracking No.:
INICIO16101316101 I l
C. INDUSTRIAL ACTIVITY AREA SPECIFIC FINDINGS
Complete one block for each Industrial activity area where pollutants may be exposed to atormwater. Copy this page for additional Industrial activity areas.
In reviewing each area, you should consider:
• Industrial materials, residue, or trash that may have or could come Into contact with stormwater,
• Leaks or spills from Industrial equipment, drums, tanks, and other containers;
• Offaite tracking of industrial or waste materials from areas of no exposure to exposed areas; and
• Tracking or blowing of raw, final, or waste materials from areas of no exposure to exposed areas.
INDUSTRIAL ACTIVITY AREA 5WA1
1. Brief Description:
Rear of Main Facility, 256,275 sq. ft., 78,950 sq. ft, impervious surface.
2. Are any control measures In need of maintenance or repair? ❑ YES ®NO .
3. Have any control measures failed and require replacement? ❑ YES ® NO
4. Are any additional/revised control measures necessary in this area? ❑ YES ®NO
If YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form)
INDUSTRIAL ACTIVITY AREA SWA2;
1. Brief Description:
Shipping Area, 146,250 sq. ft., 146,250 impervious surface.
2. Are any control measures in need of maintenance or repair? ❑ YES ®NO
3. Have any control measures failed and require replacement? ❑ YES ® NO
4. Are any additional/revised c necessary in this area? ❑ YES ®NO
If YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form) '
I INDUSTRIAL ACTIVITY AREA SWA3:
Brief Description:
Raw Receiving, 26,250 sq. ft., 23,625 sq. ft. impervious surface.
2. Are any control measures in need of maintenance or repair? Cl YES ® NO
3. Have any control measures failed and require replacement? ❑ YES m NO
4. Are any additlonsUrevised BMPs necessary in this area? ❑ YES ® NO
If YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form)

NPD5$ Permit Tracking No.:
INICIO16101316101 .
NOTE: Copy this page and attach addiSonal pages as necessary
INDUSTRIAL ACTIVITY AREA SWA4:
1. Brief Description:
Front Half of Building, 70,000 sq. ft., 70,000 sq. ft. impervious surface.
2. Are any control measures In need of maintenance or repair? ❑ YES ® NO
3. Have any control measures failed and require replacement? ❑ YES ® NO
4. Are any additional/revised BMPs necessary in this area? ❑ YES m NO
If YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form)
INDUSTRIAL ACTIVITY AREA SWA5:
1. Brief Description:
Empty Trailer Parking, 274,500 sq. ft., 18,750 sq. ft. impervious surface.
2. Are any control measures in need of maintenance or repair? ❑ YES ® NO
3. Have any control measures failed and require replacement? ❑ YES ®NO
4.Are any additionallrevised BMPs necessary In this area? ❑ YES ® NO
If YES to any of these three questions, provide a description of the problem; (Any necessary corrective actions should be described on the attached
Corrective Action Form)
INDUSTRIAL ACTIVITY AREA SWAB:
1, Brief Description:
Grassy area at Front of Facility, 88,000 sq. ft., 6,875 sq. ft. impervious surface.
2. Are any control measures in need of maintenance or repair? ❑ YES ®NO
3. Have any control measures failed and require replacement? ® YES ❑ NO
4. Are any additional/revisad BMPs necessary In this area? ❑ YES ® NO
If YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form)
Possible soil run-off resulting from recent renovations. Installed grass sod and planted grass seed in disturbed area.

NPDES Permit Tracking No.:
INICIO16101316101. I lI
C. INDUSTRIAL ACTIVITY AREA SPECIFIC FINDINGS
Complete one block for each Industrial activity area where pollutants may be exposed to atormwater. Copy this page for additional Industrial activity areas.
in reviewing each area, you should consider:
• Industrial materials, residue, or trash that may have or could come into contact with stormwater;
• Leaks or spills from Industrial equipment, drums, tanks, and other containers;
• Offsite tracking of indusidat or waste materials from areas of no exposure to exposed areas; and
• Tracking or blowing of raw, final, or waste materials from areas of no exposure to exposed areas.
INDUSTRIAL ACTIVITY AREA SWAT;
1, Brief Description:
Employee Parking, 168,750 sq. ft., 141,250 sq. ft. impervious surface.
2. Are any control measures In need of maintenance or repair? ❑ YES m NO
3. Have any control measures failed and require replacement? ❑ YES ® NO
4. Are any additionat/revised control measures necessary in this area? ❑ YES ® NO
If YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form)
INDUSTRIAL ACTIVITY AREA
I` 1, Brief Description:
2. Are any control measures in need of maintenance or repair? ❑ YES ❑ NO
3. Have any control measures failed and require replacement? 0 YES ❑ NO
4. Are any additional/revised c necessary in this area? ❑ YES ❑ NO
If YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form)
INDUSTRIAL ACTIVITY AREA
Brief Description:
2. Are any control measures in need of maintenance or repair? ❑ YES ❑ NO
3. Have any control measures failed and require replacement? ❑ YES ❑ NO
4. Are any add itlonallrevised BMPs necessary In this area? ❑ YES ❑ NO
If YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form)

NPDES Permit Tracking No
1* 0/01316101 LJ
D. CORRECTIVE ACTIONS
Complete this page for each specific condition requiring a corrective action or a review determining that no corrective action Is needed. Copy this
page for additional corrective actions or reviews.
Include both corrective actions that have been Initiated or completed since the last annual report, and future corrective actions needed to address problems
Identified in this comprehensive stormwater Inspection. Include an update on any outstanding corrective actions that had not been completed at the time of your
previous annual report.
1. Corrective Action # 10111 of 0 � for this reporting period.
2. Is this corrective acttom
❑ An update on a corrective action from a previous annual report; or
® A new corrective action?
3. Identify the condition(s) triggering the need for this review;
❑ Unauthorized release or discharge
❑ Numeric effluent limitation exceedanoe
❑ Control measures inadequate to meet applicable water quality standards
❑ Control measures inadequate to meet non -numeric effluent limitations
❑ Control measures not properly operated or maintained
❑ Change In facility operations necessitated change in control measures
m Average benchmark value exceedance
❑ Other (describe):
4. Briefly describe the nature of the problem Identified:
High Fecal Coliform results, believed to be caused by wild birds nesting and roosting on roof area.
5. Date problem identified: 1 0 112101,12101115
B. Now problem was Identified:
❑ Comprehensive site inspection
© Quarterly visual assessment
❑ Routine facility inspection
m Benchmark monitoring
❑ Notification by EPA or State or local authorities
❑ Other (describe):
7. Description of corrective action(s) taken or to be taken to eliminate or further investigate the problem (e.g., describe modifications or repairs to control
measures, analyses to be conducted, etc.) or if no modifications are needed, basis for that determination:
Investigating means of installing bird deterrents on roof areas.
A. Didiwill this corrective action require modification of your SWPPP? []YES ® NO
9. Date corrective action Initiated: I 1 1011 3 0 12 0 1115
10, Date correction action completed: W! W! 1 I I I 1 or expected to be completed: 11101111151112101116
11.If corrective action not yet completed, provide the status of corrective action at the time of the comprehensive site inspection and describe any remaining steps
(fnc(uding fteframes associated with each step) necessary to complete corrective action:
Vetting different audible (audio) systems that are designed to keep fowl from landing and/or staying on roof.

NPDES Permit Tracking No.:
W016101.316101 J�
D. CORRECTIVE ACTIONS
Complete this page for each specific condition requiring a corrective action or a review determining that no corrective action is needed. Copy this
page for additional corrective actions or reviews.
Include both corrective actions that have been Initiated or completed since the last annual report, and future corrective actions needed to address problems
identifled In this comprehensive stonnwater inspection. Include an update on any outstanding corrective actions that had not been completed at the time of your
previous annual report.
1. Corrective Action # 10121 of 10121 for this reporting period.
2. Is this corrective action:
❑ An update on a corrective action from a previous annual report; or
® A new corrective action?
3. Identify the conditions) triggering the need for this review:
❑ Unauthorized release or discharge
❑ Numeric effluent limitation exceedance
❑ Control measures inadequate to meet applicabte water quality standards
❑ Control measures Inadequate to meet non -numeric effluent limitations
❑ Control measures not property operated or maintained
❑ Change In facility operations necessitated change In control measures
m Average benchmark value exceedance
© Other (describe):
14. Briefly describe the nature of the problem Identified:
High Chemical Oxygen Demand (COD) and Total Suspended Solids (TSS) results, believed to be caused by on -going facility
renovation.
15. Date problem identified: 0 4 Z 5 i 2 101110
6. How problem was identified:
❑ Comprehensive site Inspection
❑ Quarterly visual assessment
® Routine facility Inspection
❑ Benchmark monitoring
❑ Notification by EPA or State or local authorities
❑ Other (describe):
7. Description of corrective action(s) taken or to be taken to eliminate or further Investigate the problem (e.g., describe modifications or repairs to control
measures, analyses to be conducted, etc.) or if no modifications are needed, basis for that determination:
Installed grass sod and planted grass to aid In controlling run-off from renovation activities.
8. Did/will this corrective action require modification of your SWPPP? ❑ YES ONO
9. Date corrective action initiated: 0 4 i 1 1 i 2 0 1 6
I i I I { '
10. Date correction action completed: 0 or expected to be
i 15 i 2 0 16 completed: W f I ! f ! I�LILI
11. If corrective action not yet completed, provide the status of corrective action at the time of the comprehensive site Inspection and describe any remaining steps
(including timeframes associated with each step) necessary to complete corrective action:

NPDES Permit Tracking No.:
L d0I6101316101
E. ANNUAL REPORT CERTIFICATION
1, Compliance Certification
Do you certify that your annual inspection has met the requirements of Pan 4.2 of the permit, and that, based upon the results of this Inspection, to the best of
your knowledge, you are in compliance with the permit? ® YES ❑ NO
11 NO, summarize why you are not in compliance with the permit:
2. Annual Report Certification
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 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 fine and Imprisonment for knowing
violations.
Authorized
Printed Name: Representative ILIalnIklf lolddl l ujf Ifk+I�l l I Ill l l Tl�e: I�ojrjpI •I j�InIvIiIrlolrjelnItlal1j � 4
Signature:
Date Signed; June 16, 2016

NPDE5 Permit Tracking No.:
i
INICIO16101316101 I
UNITED STATES ENVIRONMENTAL 0460t;71t7N AG2NCY
� WA8tttN(iTON, DC 20460
EPA
Annual Reporting
Form
A. GENERAL INFORMATION
+
1. Facility Name. INuItI flelrIblal II II rI ILILICI I I I I I III 11 III I
2. NPDES Permit Tracking No.: I+ d OI6I OI 316I OI I
3. Facility Physical Address:
a.Street: 1010101 Id ICIeinitlrlal 11 IAIvIeI I I I I I I I I III I '
..I.
b.city: Ioalelflalrldl I I I I I I I I I I I I I I I I I I I State: INd d.Z€pCode: 28376 -1 1 1 1
4. Lead Inspectors Name; WalnLlal iRi i Icihlairldisioinl I _III I,t1e: S' i, t,e,_],nlvl i I r JoInHeInIt jal l
Additional InspectorsName(s): IBI II II IIyl Idalnl IIel IIsl I I I _I 1 H IPISjM ICIOIOIrldlllriialtlfllrl I I 111
s.Contact Pawn: jL1a1njk1f1o1rjd1 Idulf1f1dril'n' la: Idol rlpl .I IF-Inlvl i I rlolnl e n .t a l
Phone: gLg-265-7900EA798g E-mall:lrulffin butterhal I I.co
0. Inspection Date: 6/ L6 1 9L 6
B. GENERAL INSPECTION FINDINGS
1. As part of this comprehensive sits Inspection, did you Inspect all potential pollutant sources, including
® YES ❑ NO
i
areas where Industrial activity may be exposed to stormwate(1
If NO, describe why not:
NOTE: Complete Section C of this form for each Industrial scavlty area Inspected and Included In your
c
SWPPP or as newly ldentlfied in 8.2 or B.3 below where pollutants
may be exposed to stormwater.
2. Did this Inspection ident
ify tify any stomtwater Identified in
SWPPP?
or nonmtormweter ouffall9 not previously your
❑YES ®NO
If YES, for each location, describe the sources of those stormwater and norrstorrmvater discharges
and any associated control measures In place:

NPOES Permit Tracking No
INICIO16101316101 I I
3. Did this Inspection Identify discharges not
Identified In SWPPP? ❑ YES ONO
any sources of atormwater or non-stormwatar previously
your
If YES, describe these sources of stormwater or no"tormwater pollutants expected to be present
in these discharges, and any control measures In place.
4. Did you review stormwater monitoring data as part of this Inspection to Identify potential pollutant
hot spots? ® YES © NO ❑ NA, no monitoring performed
If YES, summarize the findings of that review and describe any additional Inspection activities resulting
from this review:
Found high Fecal Coliform analytical data from first sampling event, installing'
ultrasonic bird repellers to roof area of facility.
Also found high COD and TSS counts during second sampling event. Belleve!to
be coming from on -going construction.
G. Describe any evidence of pollutants entering the drainage system or discharging to surface waters,
and the condition of and around outfalls, including flow
dissipation measures to prevent scouring:
Installed grass sod and grass seeding to help prevent soil run-off.
8. Have you taken or do you plan to take any corrective actions, as specified in Part 3 of the permit,
since your last annual report submission (or since you received
authorization to discharge under this permit If this Is your first annual report), including any corrective
actions Identified as a result of this annual comprehensive site
inspection?
® YES ❑ NO
It YES, how many conditions requiring review for correction action as
specified In Parts 3.1 and 3.2 were addressed by these corrective actions? O 121
NOTE: Complete the attached Corrective Action Form (Section O) for each condition identified, Ircludlnp
any conditions Identified as a result of this comprehensive
stormwater inspection.

NPOES Permit Tracking No.:
INICIO16101316101 I 1
C. INDUSTRIAL ACTIVITY AREA SPECIFIC FINDINGS
Complete one block for each industrial activity area where pollutants may be exposed to stormwater. Copy this page for addiffonal Industrial activity areas.
In reviewing each area, you should consider.
Industrial materials, residue, or trash that may have or could come into contact with storiater,
• Leaks or spills from industrial equipment, drums, tanks, and other containers; Ii
• Offalte tracking of Industrial or waste materials from afar of no exposure to exposed areas; and
• Tracking or blowing of raw, final, or waste materials from areas of no exposure to exposed areas.
INDUSTRIAL ACTIVITY AREA SWA1:
1. Brief Description:
Rear of Main Facility, 256,275 sq. ft., 78,950 sq. ft. impervious surface.
2. Are any control measures In need of maintenance or repaid ❑ YES ® NO
3. Have any control measures failed and require replacement? ❑ YES ® NO
4. Are any addlGonallrevised control measures necessary in this area? ❑ YES ®NO
If YES to any of these three questions, provide a description of the problem; (Any necessary corrective actions should be described on the attached
Corrective Action Form)
INDUSTRIAL ACTIVITY AREA SWA2:
1. Brief Description:
Shipping Area, 146,250 sq. ft., 146,250 impervious surface.
2. Are any control measures in need of maintenance or repair? ❑ YES ®NO ,
3. Have any control measures failed and require replacement? ❑ YES ®NO '
4. Are any additionallrevised c necessary In this area? ❑ YES ® NO
If YES to any of these three questions, provide a description of the problem: (Any necessary correcilve actions should be described on the attached
Corrective Action Form) E'
INDUSTRIAL ACTIVITY AREA SWAB;
Brief Description:
Raw Receiving, 26,250 sq. ft., 23,625 sq. ft. impervious surface.
2. Are any control measures in need of maintenance or repair? ❑ YES ® NO
3. Have any control measures failed and require replacement? ❑ YES ® NO
4. Are any additional/revised BMPs necessary in this area? ❑ YES ®NO ,
It YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Aoilon Porn)

NPDES PermitTracking No.:
INIcU6L1316101 I I
j I NOTE: Copy this page and attach addillonal pages as necessary
INDUSTRIAL ACTIVITY AREASWA4.
1. Brief Description:
Front Half of Building, 70,000 sq. ft., 70,000 sq. ft. impervious surface.
2. Are any control measures In need of maintenance or repair ❑ YES ® NO
3. Have any control measures failed and require replacement? ❑ YES ® NO
4. Are any additionallrevised BMPs necessary In this areal ❑ YES ® NO
If YES to any of these three questions, provide a description of the problem: {Any necessary corrective actions should be described on the attached
Corrective Action Forth) i
INDUSTRIAL ACTIVITY AREA SWA5:
1. Brief Descriptlon:
Empty Trailer Parking, 274,500 sq. ft., 18,750 sq. ft. Impervious surface.
2. Are any control measures In need of maintenance or repair? ❑ YES ® NO
3. Have any control measures failed and require replacement? ❑ YES ® NO
4, Are any additionallrevised BMPs necessary in this area? ❑ YES ® NO
If YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form)
INDUSTRIAL_ ACTIVITY AREA
1. Brief Description:
Grassy area at Front of Facility, 88,000 sq. ft., 6,875 sq. ft. impervious
2. Are any control measures In need of maintenance or repair ❑ YES ® NO
3. Have any control measures failed and require replecement7 ® YES ❑ NO
4.Are any edditionaltrevised BMPs necessary In this area? ❑ YES ® NO
If YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form)
Possible soil run-off resulting from recent renovations. Installed grass sod and plented grass seed In disturbed area.

NPDES Permit Tracking No.:
INICI016i01316101 l I
C. INDUSTRIAL ACTIVITY AREA SPECIFIC FINDINGS
Complete one block for each Industrial activity area where pollutants may be exposed to stormwater. Copy this page for additional Industrial activity areas.
In reviewing each area, you should consider.
• Industrial materials, residue, or trash that may have or could come Into contact with stomtwater,
• Leaks or spills from Industrial equipment, drums, tanks, and other containers;
• Offsfte tracking of Industrial or waste materials from areas of no exposure to exposed areas; and
• Tracking or blowing of raw, final, or waste materials from areas of no exposure to exposed areas.
INDUSTRIAL ACTIVITY AREA SWA7
1. Brief Description:
Employee Parking, 168,750 sq. ft., 141,250 sq. ft. impervious surface.
2. Are any control measures In need of maintenance or repaiR ❑ YES ® NO
3. Have any control measures failed and require replacement? ❑ YES ® NO
4. Are any addltionallrevised control measures necessary In this area? ❑ YES ® NO
If YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form)
INDUSTRIAL ACTIVITY AREA
1. Brief Description:
2. Are any control measures In need of maintenance or repair? ❑ YES ❑ NO
3. Have any control measures failed and require replacement? ❑ YES ❑ NO
4. Are any additionallrevlsed c necessary In this area? ❑ YES [--]NO
If YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form)
INDUSTRIAL ACTIVITY AREA
Brief Description:
2. Are any control measures in need of maintenance or repair? ❑ YES ❑ NO
3. Have any control measures felled and require replacement? ❑ YES ❑ NO
4. Are any additlonaurevlsed BMPs necessary in this area? ❑ YES ❑ NO
if YES to any of these three questions, provide a description of the problem: (Any necessary corrective actions should be described on the attached
Corrective Action Form) I
i

D. CORRECTIVE ACTIONS
Complete this page for each speciRe condition requiring a corrective action or a review de
page for additional corrective actions or reviews.
Include both corrective actions that have been initiated or completed since the last annual report,
Identified in this comprehensive stormwater Inspection. Include an update on any outstanding co
previous annual report.
1. Corrective Action # 0 1 of 0 2 Ior thls reporting period.
2. Is this corrective action:
❑ An update on a corrective action from a previous annual report: or
® A new corrective action?
3. Identify the conditlon(s) triggering the need for this review:
❑ Unauthorized release or discharge
❑ Numeric effluent limitation excesdanoe
❑ Control measures Inadequate to meet applicable water quality standards
❑ Control measures Inadequate to meet non -numeric effluent limitations
❑ Control measures not properly operated or maintained
❑ Change in facility operations necessitated change in control measures
m Average benchmark value exceedance
0 Other (describe):
a. Briefly describe the nature of the problem identified:
NPDES Permit Tracking No.:
N060360
that no corrective action is needed. Copy this
future corrective actions needed to address problems
Ve actions that had not been completed at the time of your
High Fecal Coliform results, believed to be caused by wild birds nesting and, roosting on roof area.
5. Date problem Identified: 11101 i 2 0 i 2 1 0 1 15
S. How problem was identified:
❑ Comprehensive site inspection
❑ Quarterly visual assessment
❑ Routine facility inspection
® Benchmark monitoring
❑ Notification by EPA or State or local authorities
❑ Other (describe):
7. Description of corrective actions) taken or to be taken to eliminate or further Investigate the
measures, analyses to be conducted, etc.) or if no modifications are needed, basis for that c
Investigating means of installing bird deterrents on roof areas.
8. Did/will this corrective action require modification of your BwPPP? ❑ YES ® NO
8. Date corrective action Initiated: 11101 i 13101 i 12M 1 5
1I fi � f or expected to be
10. Date correction action completed: i LEi iI__Ll__I completed:
11.If corrective action not yet completed, provide the status of corrective action at the time of the r
(including timerrames associated with each stop) necessary to complete correct" action:
Vetting different audible (audio) systems that are designed to keep fowl
, describe modifications or repairs to control
10i15i2016
site Inspection and describe any remaining steps
landing and/or staying on roof.

NPDES Permit Tracking No.:
JNI 016101316101 I I .
D. CORRECTIVE ACTIONS
Complete this page for each specific condition requiring a corrective action ora review determining that no corrective action is needed. Copy this
page for additional corrective actions or reviews.
Include both corrective actions that have been initiated or completed since the last annual report, and future corrective actions needed to address problems
identif€ed In this comprehensive stormwater inspection. Include an update on any outstanding corrective actions that had not been completed at the Gme of your
previous annual report.
1. Corrective Action # O 121 of Q 2 for this reporting period.
2. is this corrective action:
❑ An update on a corrective action from a previous annual report; or
® A new corrective action?
3. identify the oondition(s) triggering the need for this reviews
❑ Unauthorized release or discharge
❑ Numeric effluent limitation exceedance
❑ Control measures inadequate to meet applicable water quality standards
❑ Control measures inadequate to meet non -numeric effluent limitations
❑ Control measures not properly operated or maintained
❑ Change In facility operations necessitated change in control measures
m Average benchmark value exceedance
❑ other (describe):
4. Briefly describe the nature of the problem Identified:
High Chemical Oxygen Demand (COD) and Total Suspended Solids (TSS)'n
renovation.
s. Date problem Identified: 0 4 i 2 5 i 2 10 1110
B. How problem was identified:
❑ Comprehensive site inspection
❑ Quarterly visual assessment
® Routine facility inspection
❑ Benchmark monitoring
❑ Notification by EPA or State or local authorities
❑ Other (describe):
7. Description of corrective action(s) taken or to be taken to eliminate or further Investigate the
measures, analyses to be conducted, etc.) or if no modifications are needed, basis for that i
Installed grass sod and planted grass to aid in controlling run-off from
S. Dldlwill this corrective action require modification of your SWPPP? ❑ YfiS ONO
8. Date corrective action initiated: 10141 i U1 J1 2 0 1 6
10. Date correction action completed: 10141 l 15 i 2 Q 1 6 or expected to be
completed:
11.If corrective action not yet completed, provide the status of corrective action at the time of the
(including timeframes associated with each step) necessary to complete corrective action:
believed to be caused by on -going facility
describe modifications or repairs to control
Mlon activities.
•ahenstve site Inspection and describe any remaining steps

NPDES Permit Tracking No.:
INCI01610316101 I 1
E. ANNUAL REPORT CERTIFICATION
1. Compliance Certification
Do you certify that your annual Inspection has met the requirements of Part 4.2 of the permit, and that, based upon the results of this inspection, to the best of
your knowledge, you are In compliance with the permit? OYES ❑ NO 1
If NO, summarize why you are not In compliance with the permit:
2. Annual Report Certification
I certify under penalty of law that this document and all attachments were prepared under my directlon or supervision In accordance with a system designed to
assure that qualified personnel properly 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 fine and Imprisonment for knowing
violations. 1
Authorized Representative ntie: �+' 1 I�1 1 -I� 1 I ,1 1 Y 1 1 1 �1 I
Printed Name: Lankford u f f i n 0 r n v l r o e n t s l
Signature: Data signed: June 16 2016