NC0006548_Renewal (Application)_20230508

ROY COOPER i;ice .111 ::-- 's
,� °� '-
Governor '':g 1 \1`1�i` r,
ELIZABETH S.BISER S ,•,%
Secretary
RICHARD E.ROGERS,JR. NORTH CARLI QualityA
Director Environmental
May 08, 2023
Wayne-Sanderson Farms, LLC
Attn: Kevin McDaniel
4110 Continental Dr
Oakwood, GA 30566
Subject: Permit Renewal
Application No. NC0006548
Dobson Plant
Surry County
Dear Applicant:
The Water Quality Permitting Section acknowledges the May 8, 2023, receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150E-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit.The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincere)
26AL: re. Cilip
Wren T -dfor•
Administrative Assistant
Water Quality Permitting Section
cc: Stephanie Shoemaker, Sr. Director of Environmental
ec: WQPS Laserfiche File w/application
pp* North Carolina Department of Environmental Quality I Division of Water Resources
Winston-Salem Regional Office 1450 West Hanes M MI Road,Suite300 I Winston-Salem,North Carolina 27105
r 336.776.9800

WAYNE )��
SANDER - 1 N
TOGETHER.WE MAKE CHICKEN AMAZING
Certified Mail #: 7021 2720 0000 4465 1506
Division of Water Resources
Water Quality Permitting Section—NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
May 2, 2023
To whom it may concern,
Enclosed are the original and two copies of Form 1 NPDES and Form 2C NPDES for the Wayne Farms LLC
Dobson Fresh Plant WWTP renewal. The permit number is NC0006548.
Please contact me at 601-426-1572 or [e-mail] with any questions.
Thank you,
j)2ige144114,4
Stephanie Shoemaker
Sr. Director of Environmental
Wayne-Sanderson Farms LLC
4110 Continental Drive, Oakwood, waynesandersonfarms.com is 30566 800.392.0844
g

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh OMB No.2040-0004
Form U.S.Environmental Protection Agency
a EPA Application for NPDES Permit to Discharge Wastewater
NPDES GENERAL INFORMATION
SECTION 1.ACTIVITIES REQUIRING AN NPDES PERMIT(40 CFR 122.21(f)and(f)(1))
1.1 Applicants Not Required to Submit Form 1
Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
1.1.1
treatment works? 11.2.
treating domestic sewage?
If yes,STOP. Do NOT complete ❑✓ No If yes,STOP.Do NOT E✓ No
Form 1.Complete Form 2A. complete Form 1.Complete
Form 2S.
1.2 Applicants Required to Submit Form 1
1.2.1 Is the facility a concentrated animal feeding 1.2.2 Is the facility an existing manufacturing.
operation or a concentrated aquatic animal commercial.mining.or silvicultural facility that is
a production facility? currently discharging process wastewater?
oYes 4 Complete Form 1 ❑✓ No El Yes 4 Complete Form ❑ No
a and Form 2B. 1 and Form 2C.
z
1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
mining,or silvicultural facility that has not yet commercial,mining,or silvicultural facility that
commenced to discharge? discharges only nonprocess wastewater?
cr d ❑ Yes 4 Complete Form 1 ❑✓ No Yes 3 Complete Form 2No
and Form 2D. 1 and Form 2E.
1.2.5 Is the facility a new or existing facility whose
'— discharge is composed entirely of stormwater
associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
❑ Yes 4 Complete Form 1 2 No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x)or
b 15.
SECTION 2.NAME,MAILING ADDRESS,AND LOCATION(40 CFR 122.21(f)(2))
2.1 Facility Name
Wayne Farms Dobson Fresh Plant WWTP
0 2.2 EPA Identification Number
0
0
J
2.3 Facility Contact
Name(first and last) Title Phone number
Jeremy Bowlin Complex Environmental Manager [phone]
Email address
[e-mail]
2.4 Facility Mailing Address
Street or P.O.box
P.O. Box 383
City or town State ZIP code
Dobson 'NC 27017
EPA Form 3510-1(revised 3-19) Page 1

r-
_
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh OMB No.2040-0004
d 2.5 Facility Location
. . Street,route number,or other specific identifier
a o 802 East Atkins st
c c County name County code(if known)
a 8 Surry
E City or town State ZIP code
z Dobson NC 27017
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
2015 Poultry Slaughtering and Processing
co
a)
'O
O
H
U
3.2 NAICS Code(s) Description(optional)
V 311615
c
SECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
4.1 Name of Operator
Wayne Farms LLC
0 4.2 Is the name you listed in Item 4.1 also the owner?
0 ❑ Yes ❑✓ No
4.3 Operator Status
w
❑ Public—federal ❑ Public—state ❑Other public(specify)
2 Private ❑ Other(specify)
4.4 Phone Number of Operator
[phone]
4.5 Operator Address
Street or P.O. Box
€ d 4110 Continental Drive
0
City or town State ZIP code
•c
o toi Oakwood GA 30566
is
o. Email address of operator
[e-mail]
SECTIN 5.INDIAN LAND(40 CFR 122.21(f)(5))
0 5.1 Is the facility located on Indian Land?
c ❑Yes 0 No
EPA Form 3510-1(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh OMB No.2040-0004
SECTION 6.EXISTING ENVIRONMENTAL PERMITS(40 CFR 122.21(f)(6))
6.1 Existing Environmental Permits(check all that apply and print or type the corresponding permit number for each)
171 NPDES(discharges to surface 0 RCRA(hazardous wastes) ❑ UIC(underground injection of
water) fluids)
o NC006548
> E
W ri ❑✓ PSD(air emissions) ElNonattainment program(CM) ❑ NESHAPs(CAA)
05124R11
w ❑ Ocean dumping(MPRSA) 0 Dredge or fill(CWA Section 404) 0 Other(specify)
SECTION 7.MAP(40 CFR 122.21(f)(7))
7.1 Have you attached a topographic map containing all required information to this application?(See instructions for
A specific requirements.)
❑/ Yes 0 No ❑ CAFO—Not Applicable(See requirements in Form 2B.)
SECTION 8.NATURE OF BUSINESS(40 CFR 122.21(f)(8))
8.1 Describe the nature of your business.
Poultry processing
w
m
c
en
m
0
SECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
L d ❑✓ Yes 0 No 4 SKIP to Item 10.1.
I is 7. 9.2 Identify the source of cooling water.(Note that facilities that use a cooling water intake structure as described at
40 CFR 125,Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
c NPDES permitting authority to determine what specific information needs to be submitted and when.)
o Y
0j Cooling towers(condensers)for ammonia refrigerations system -city water(less than 25%of total water used,and
less than 2 MGD)
SECTION 10.VARIANCE REQUESTS(40 CFR 122.21(f)(10))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)?(Check all that
apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
41)
Section 301(n)) 302(b)(2))
❑ Non-conventional pollutants(CWA ❑ Thermal discharges(CWA Section 316(a))
Section 301(c)and(g))
❑✓ Not applicable
EPA Form 3510-1(revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC000tc4$ Wayne Farms Dobson Fresh Pla + OMB No.2040-0004
SECTION 11.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
11.1 In Column 1 below, mark the sections of Form 1 that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note
that not all applicants are required to provide attachments.
Column 1 Column 2
CI Section 1:Activities Requiring an NPDES Permit ❑ w/attachments
❑✓ Section 2:Name,Mailing Address,and Location ❑ w/attachments
❑� Section 3:SIC Codes ❑ w/attachments
❑✓ Section 4:Operator Information ❑ w/attachments
❑✓ Section 5: Indian Land ❑ w/attachments
Cl Section 6: Existing Environmental Permits ❑ w/attachments
w/topographic
w ❑✓ Section 7: Map ❑✓ map ❑ w/additional attachments
oco
❑✓ Section 8:Nature of Business ❑ wl attachments
❑� Section 9:Cooling Water Intake Structures ❑ wl attachments
`' ❑✓ Section 10:Variance Requests ❑ w/attachments
v
❑✓ Section 11:Checklist and Certification Statement ❑ wl attachments
d 11.2 Certification Statement
U
1 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 fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Kevin McDaniel Senior VP and GM Fresh
Signature Date signed
7,61 5 N9-3
EPA Form 3510-1(revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0006548 OMB No.2040-0004
Wayne Farms Dobson Fresh Plant
Form U.S.Environmental Protection Agency
2C -/EPA Application for NPDES Permit to Discharge Wastewater
NPDES EXISTING MANUFACTURING,COMMERCIAL,MINING,AND SILVICULTURE OPERATIONS
SECTION 1.OUTFALL LOCATION(40 CFR 122.21(g)(1))
1.1 Provide information on each of the facility's outfalls in the table below.
g Numbelr Receiving Water Name Latitude Longitude
T'
O 001 Fisher River 36' 24' 36.3" N 80' 41' 26-5 W E
SECTION 2.LINE DRAWING(40 CFR 122.21(g)(2))
a, 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
c balance?(See instructions for drawing requirements.See Exhibit 2C-1 at end of instructions for example.)
J c` ❑✓ Yes ❑ No
SECTION 3.AVERAGE FLOWS AND TREATMENT(40 CFR 122.21(g)(3))
3.1 For each outfall identified under Item 1.1.provide average flow and treatment information.Add additional sheets if
necessary.
**Outfall Number** 001
Operations Contributing to Flow
Operation Average Flow
Processing Plant 0.527 mgd
Condenser o.oi mgd
m -2'. Stormwater 0.0005 mgd
mgd
O Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
Meat Screen 1-T Renderer
Feather Screen 1-T Renderer
Screen Effluent Tank 0.035 MG;0.753 MGD;0.05 days RT 2-B
Flow EQ Tank(FEB TANK)0.5 MG;0.753 MGD;0.66 days RT 2-B
EPA Form 3510-2C(Revised 3-19) Page 1

Section 3: Treatment Units(continued)
Description Code from Final Disposal of Solid or Liquid
Exhibit 2C-2 Waste other than By Discharge
Dissolved Air Flotation (DAF)—1200 gpm; 0.753 2-D
MGD
Covered FEB Lagoon; 2.5 MG; 0.538 MGD; 7 3-C
days
Anoxic Reactor 0.6 MG; 0.538 MGD; 1.1 days 3-D
Nitrification Reactor 1.5 MG; 0.538 MGD; 2.8 3-A
days
35-ft. Clarifier 0.058 MG; 0.2 MGD; 7.6 hours 1-U
60-ft. Clarifier 0.317 MG; 0.338 MGD; 18 hours 1-U
Chlorine Contact Chamber; 0.538 MGD; 30 min. 2-F
Dechlorination Chamber; 0.538 MGD; 10 min. 2-E

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant OMB No.2040 0004
3.1 **Outfall Number**
cont. Operations Contributing to Flow
Operation Average Flow
mgd
mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit. Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
d
0
U
a
**Outfall Number**
y Operations Contributing to Flow
Operation Average Flow
L
c mgd
d
> mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, ' Liquid Wastes Other Than
retention time,etc.) Table 2C-1 by Discharge
3.2 Are you applying for an NPDES permit to operate a privately owned treatment works?
m m El Yes ❑✓ No 4 SKIP to Section 4.
Nto
3.3 Have you attached a list that identifies each user of the treatment works?
❑ Yes ❑ No
EPA Form 3510-2C(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0006548 OMB No.2040-0004
Wayne Farms Dobson Fresh Plant
SECTION 4.INTERMITTENT FLOWS(40 CFR 122.21(g)(4))
4.1 Except for storm runoff,leaks,or spills,are any discharges described in Sections 1 and 3 intermittent or seasonal?
❑ Yes ✓❑ No 4 SKIP to Section 5.
4.2 Provide information on intermittent or seasonal flows for each applicable outfall.Attach additional pages,if necessary.
Outfall Operation Frequency Flow Rate
Number (list) Average Average Long-Term Maximum Duration
Days/Week Months/Year Average Daily
days/week months/year mgd mgd days
3o days/week months/year mgd mgd days
W
mdays/week months/year mgd mgd days
days/week months/year mgd mgd days
c
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
SECTION 5.PRODUCTION(40 CFR 122.21(g)(5))
5.1 Do any effluent limitation guidelines(ELGs)promulgated by EPA under Section 304 of the CWA apply to your facility?
❑� Yes ❑ No 4 SKIP to Section 6.
d, 5.2 Provide the following information on applicable ELGs.
w ELG Category ELG Subcategory Regulatory Citation
-00 40 CFR Part 432 K 432.112
c,
Z.
a
Q
5.3 Are any of the applicable ELGs expressed in terms of production(or other measure of operation)?
to IDYes ❑ No 4 SKIP to Section 6.
0
0▪ 5.4 Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
J Outfall Operation,Product,or Material Quantity per Day Unit of
-0 Number Measure
0
0
co 001 Birds processed 150,000 1,350,000 live lb
C
0
to
o
0
a
EPA Form 3510-2C(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0006548 OMB No.2040-0004
Wayne Farms Dobson Fresh Plant
SECTION 6.IMPROVEMENTS(40 CFR 122.21(g)(6))
6.1 Are you presently required by any federal,state,or local authority to meet an implementation schedule for constructing,
upgrading,or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
❑ Yes ❑✓ No. SKIP to Item 6.3.
6.2 Briefly identify each applicable project in the table below.
Affected Final Compliance Dates
Brief Identification and Description of Outfalls Source(s)of
c Project (list outfall Discharge Required Projected
number)
E
0)
d
v
Q.a
� I
6.3 Have you attached sheets describing any additional water pollution control programs(or other environmental projects
that may affect your discharges)that you now have underway or planned?(optional item)
❑ Yes ❑ No El Not applicable
SECTION 7.EFFLUENT AND INTAKE CHARACTERISTICS(40 CFR 122.21(g)(7))
See the instructions to determine the pollutants and parameters you are required to monitor and,in turn,the tables you must
complete.Not all applicants need to complete each table.
Table A.Conventional and Non-Conventional Pollutants
7.1 Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A pollutants for any of
your outfalls?
❑ Yes ❑✓ No 4 SKIP to Item 7.3.
7.2 If yes,indicate the applicable outfalls below.Attach waiver request and other required information to the application.
Outfall Number Outfall Number Outfall Number
7.3 Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
fn requested and attached the results to this application package?
No;a waiver has been requested from my NPDES
ElYes ❑ permitting authority for all pollutants at all outfalls.
iS Table B.Toxic Metals,Cyanide,Total Phenols,and Organic Toxic Pollutants
7.4 Do any of the facility's processes that contribute wastewater fall into one or more of the primary industry categories
co
listed in Exhibit 2C-3?(See end of instructions for exhibit.)
❑ Yes ✓❑ No 4 SKIP to Item 7.8.
3 7.5 Have you checked"Testing Required"for all toxic metals,cyanide,and total phenols in Section 1 of Table B?
❑ Yes ❑ No
7.6 List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s)identified
in Exhibit 2C-3.
Primary Industry Category Required GC/MS Fraction(s)
(Check applicable boxes.)
❑Volatile ❑Acid ❑ Base/Neutral ❑ Pesticide
❑Volatile ❑Acid ❑ Base/Neutral ❑Pesticide
❑Volatile ❑Acid 0 Base/Neutral ❑ Pesticide
EPA Form 3510-2C(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0006548 OMB No.2040-0004
Wayne Farms Dobson Fresh Plant
7.7 Have you checked"Testing Required"for all required pollutants in Sections 2 through 5 of Table B for each of the
GC/MS fractions checked in Item 7.6?
❑ Yes ❑ No
7.8 Have you checked"Believed Present"or"Believed Absent"for all pollutants listed in Sections 1 through 5 of Table B
where testing is not required?
❑✓ Yes ElNo
7.9 Have you provided(1)quantitative data for those Section 1,Table B,pollutants for which you have indicated testing is
required or(2)quantitative data or other required information for those Section 1,Table B,pollutants that you have
indicated are`Believed Present"in your discharge?
El Yes ❑ No
7.10 Does the applicant qualify for a small business exemption under the criteria specified in the instructions?
❑ Yes 4 Note that you qualify at the top of Table B, ❑ No
0 then SKIP to Item 7.12.
CD
'= 7.11 Have you provided(1)quantitative data for those Sections 2 through 5,Table B,pollutants for which you have
c determined testing is required or(2)quantitative data or an explanation for those Sections 2 through 5.Table B,
pollutants you have indicated are"Believed Present"in your discharge?
❑✓ Yes ❑ No
4) Table C.Certain Conventional and Non-Conventional Pollutants
7.12 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed on Table C
for all outfalls?
❑✓ Yes ❑ No
c 7.13 Have you completed Table C by providing(1)quantitative data for those pollutants that are limited either directly or
indirectly in an ELG and/or(2)quantitative data or an explanation for those pollutants for which you have indicated
"Believed Present"?
❑� Yes ❑ No
W Table D.Certain Hazardous Substances and Asbestos
7.14 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed in Table D for
all outfalls?
❑ Yes ❑ No
7.15 Have you completed Table D by(1)describing the reasons the applicable pollutants are expected to be discharged
and(2)by providing quantitative data,if available?
❑ Yes ❑✓ No
Table E.2,3,7,8-Tetrachlorodibenzo-p-Dioxin(2,3,7,8-TCDD)
7.16 Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the instructions,or do you
know or have reason to believe that TCDD is or may be present in the effluent?
❑ Yes 4 Complete Table E. ❑✓ No 4 SKIP to Section 8.
7.17 Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes ❑ No
SECTION 8.USED OR MANUFACTURED TOXICS(40 CFR 122.21(g)(9))
8.1 Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
m an intermediate or final product or byproduct?
❑ Yes ❑ No 4 SKIP to Section 9.
C 8.2 List the pollutants below.
a 1. 4. 7.
0
2. 5. 8.
3. 6. 9.
EPA Form 3510-2C(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0006548 OMB No.2040 0004
Wayne Farms Dobson Fresh Plant
SECTION 9.BIOLOGICAL TOXICITY TESTS(40 CFR 122.21(g)(11))
9.1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
within the last three years on(1)any of your discharges or(2)on a receiving water in relation to your discharge?
❑/ Yes ❑ No 4 SKIP to Section 10.
9.2 Identify the tests and their purposes below.
0 Test(s) Purpose of Test(s) Submitted to NPDES Date Submitted
Permitting Authority?
0
Ceriodaphnia Acute pass or fail
❑ Yes ❑ No 05/13/2022
a,
0
c Ceriodaphnia Acute pass or fail
m ✓❑ Yes ❑ No 08/03/2022
Ceriodaphnia Acute pass or fail
✓❑ Yes ❑ No 11/14/2022
SECTION 10.CONTRACT ANALYSES(40 CFR 122.21(g)(12))
10.1 Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
❑✓ Yes ❑ No 4 SKIP to Section 11.
10.2 Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1 Laboratory Number 2 Laboratory Number 3
Name of laboratory/firm Meritech Inc.Environmental
Laboratory
a
>, Laboratory address
642 Tamco Road,Reidsville,
North Carolina 27320
is
as
0 Phone number
c-)
[phone]
Pollutant(s)analyzed BOD,TSS,Nh3-N,TN,TP,
Fecal,Turbidity,Oil and
Grease.Toxiccity
SECTION 11.ADDITIONAL INFORMATION(40 CFR 122.21(g)(13))
11.1 Has the NPDES permitting authority requested additional information?
❑ Yes ❑✓ No 4 SKIP to Section 12.
0
11.2 List the information requested and attach it to this application.
0
1. 4.
c
0
-0 2. 5.
3. 6.
EPA Form 3510-2C(Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant OMB No.2040-0004
SECTION 12.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
12.1 In Column 1 below,mark the sections of Form 2C that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note
that not all applicants are required to complete all sections or provide attachments.
Column 1 Column 2
✓❑ Section 1:Outfall Location ✓❑ w/attachments
❑✓ Section 2:Line Drawing ✓❑ w/line drawing El w/additional attachments
rm Section 3:Average Flows and w/list of each user of
Treatment ✓❑ w/attachments El privately owned treatment
works
❑ Section 4:Intermittent Flows 0 w/attachments
❑✓ Section 5: Production El w/attachments
wl optional additional
ElSection 6: Improvements ❑ w/attachments ❑ sheets describing any
additional pollution control
plans
❑ wl request for a waiver and ❑ w/explanation for identical
supporting information outfalls
w/small business exemption
d 0 request ❑ w/other attachments
co ❑ Section 7: Effluent and Intake ❑ w/Table A ❑✓ w/Table B
Characteristics
0
✓❑ w/Table C ❑� w/Table D
d ✓❑ w/Table E ❑ w/analytical results as an
attachment
❑ Section 8: Used or Manufactured ❑ w/attachments
;� Toxics
❑ Section 9: Biological Toxicity ❑ w/attachments
Tests
v
❑ Section 10:Contract Analyses ❑ w/attachments
❑ Section 11:Additional Information 0 w/attachments
❑✓ Section 12:Checklist and El wl attachments
Certification Statement
12.2 Certification Statement
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 fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Kevin McDaniel Senior VP and GM Fresh
Signature Date signed
EPA Form 3510-2C(Revised 3-19) Page 7

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plane 001 OMB No.2040-0004
TABLE A.CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(iii))1
Effluent Intake
Waiver (Optional)
Pollutant Requested Units Maximum Maximum Long-Term
(if applicable
) (specify) Daily Monthly Average Daily Number of Long-Term Number of
Discharge Discharge Discharge Analyses Average Value Analyses
(required) (if available) (if available)
❑ Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
Biochemical oxygen demand Concentration mg/L 20.4 6.8 5.1 155
1. ❑
(BODs) Mass
Chemical oxygen demand Concentration mg/L 34 1
2. ❑
(COD) Mass
Concentration mg/L 6.40 1
3. Total organic carbon(TOC) ❑
Mass
Concentration mg/L 12 6.75 5.28 155
4. Total suspended solids(TSS) ❑ -
Mass
Concentration mg/L 1.2 0.18 0.13 155
5. Ammonia(as N) 0
Mass
6. Flow 0 Rate MGD 1.031 0.632 0.541 365
Temperature(winter) ❑ °C °C 26 22 125
7.
Temperature(summer) 0 °C °C 31 30 128
pH(minimum) El Standard units s.u. 6.7 253
8.
pH(maximum) El Standard units S.U. 8.3 253
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 9

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number;if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Dailyof Term of
Discharge Discharge Discharge Anal Average
g Analyses Analyses
(required) (if available) Value
(if available)Ei _
Check here if you qualify as a small business per the instructions to Form 2C and,therefore,do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table. Note,however,that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1.Toxic Metals,Cyanide,and Total Phenols
Antimony,total Concentration
1.1 (7440-36-0) Mass
Arsenic,total Concentration
1.2 (7440 38 2) 00 0
Mass
Beryllium,total Concentration
1.3 (7440-41-7) Mass
' Cadmium,total Concentration
1.4 (7440 43 9) ❑ 0 0
Mass
Chromium,total Concentration
1.5 (7440-47-3) Mass
Copper,total Concentration
1.6 (7440-50-8) Mass
Lead,total Concentration
1.7 El 0(7439-92-1) Mass
1 8 Mercury,total El 0El
(7439-97-6) Mass
Nickel,total Concentration
1'9 (7440-02-0) 0El CIMass
1.10 Selenium,total Concentration
(7782-49-2) Mass
1.11 Silver,total Concentration
(7440-22-4) Mass
EPA Form 3510-2C(Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
Discharge Discharge Average
(required) (if available) Discharge Analyses Value Analyses
(f available) _
Thallium,total Concentration
1.12 (7440 28 0) 0 0 ❑ Mass
Zinc,total Concentration
1.13 (7440 66 6) El 0 ✓❑ 1
Mass
1.14 Cyanide,total El ❑ ❑ Concentration
(57-12-5) Mass
Concentration
1.15 Phenols,total ❑ ❑ ❑✓
Mass
Section 2.Organic Toxic Pollutants(GCIMS Fraction—Volatile Compounds)
Acrolein Concentration
2.1 (107-02-8) ❑ 0 ❑
Mass
Acrylonitrile Concentration
2.2 (107-13-1) 0 0 0
Mass
2.3 Benzene El ❑ © Concentration
(71-43-2) Mass
2.4 Bromoform ❑ 0
❑ Concentration
(75-25-2) Mass
2.5 Carbon tetrachloride El 0
❑ Concentration
(56-23-5) Mass
Chlorobenzene Concentration
2.6 (108-90-7) ❑ ❑ © Mass
2.7 Chlorodibromomethane El ❑ ❑ Concentration
(124-48-1) Mass
2.8 Chloroethane ❑ ❑ a Concentration
(75-00-3) Mass
EPA Form 3510-2C(Revised 3-19) Page 12

r
EPA Identification Number NPDES Permit Number Facility Name Ouffall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
Long-
(and CAS Number,if available) Required Believed Believed Maximum Maximum q (specify) DailyMonthlyAverage Number Term Number
Present Absent
aily of of
Discharge Dischargef available) DisDcharge Analyses AverageValue Analyses
(if available)
2.9 2-chloroethylvinyl ether ❑ ❑ ❑ Concentration
(110-75-8) Mass
2.10 Chloroform(67-66-3) 0 0 0Concentration
Mass
Dichlorobromomethane El 0
❑ Concentration
2.11 (75-27-4) Mass
1,1-dichloroethane El ❑ ❑ Concentration
2.12 (75-34-3) Mass
1,2-dichloroethane 0 ❑ ❑ Concentration
2.13 (107-06-2) Mass
2.14 1,1-dichloroethylene ❑ ❑ © Concentration
(75-35-4) Mass
1,2-dichloropropane 0 El
Concentration
2.15 (78-87-5) Mass
1,3-dichloropropylene ❑ ❑ ❑ Concentration
2.16 (542-75-6)
Mass
Ethylbenzene ❑ ❑ ❑ Concentration
2.17 (100-41-4) Mass
2.18 Methyl bromide El ❑ 0 Concentration
(74-83-9) Mass
2 19 Methyl chloride El 0
❑ Concentration
(74-87-3) Mass
2.20 Methylene chloride El ❑ 0 Concentration
(75-09-2) _ Mass
2 21 1,1,2,2-tetrachloroethane ❑ ❑ ❑ Concentration
(79-34-5) Mass
EPA Form 3510-2C(Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
Long-
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number
g Number
Present Absent Daily Monthly Term
Discharge Discharge Daily of Average of
(required) (if available) Discharge Analyses Value Analyses
(if available)
2.22 Tetrachloroethylene 0 0 ❑✓ Concentration
(127-18-4) Mass
Toluene Concentration
2.23 (108-88-3) Mass
2.24 1,2-trans-dichloroethylene ❑ 0 Concentration
(156-60-5) Mass
1,1,1-trichloroethane El ❑ Concentration
2.25 (71-55-6) Mass
2.26 1,1,2-trichloroethane ❑ Concentration
(79-00-5) Mass
2.27 Trichloroethylene ❑✓ Concentration
(79-01-6) Mass
•
2.28 Vinyl chloride 0 0 Concentration
(75-01-4) Mass
Section 3.Organic Toxic Pollutants(GC/MS Fraction—Acid Compounds)
3.1 2-chlorophenol Concentration
(95-57-8) Mass
3.2 2 4-dichlorophenol 0 ❑ Concentration
(120-83-2) Mass
3.3 2,4-dimethylphenol El ❑ Concentration
(105-67-9) Mass
3.4 4,6-dinitro-o-cresol El ❑ Concentration
(534-52-1) Mass
3.5 2,4-dinitrophenol Concentration
(51-28-5) Mass
EPA Form 3510-2C(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number if available) Required Believed Believed Maximum Maximum Long
-
(and (specify) Average Number Number
Present Absent Daily Monthly g Term
Discharge Discharge Daily of Average of
(required) (if available) Discharge Analyses Analyses
Value
(if available)
3.6 2-nitrophenol Concentration
(88-75-5) Mass
3.7 4-nitrophenol 0Concentration
0 0(100-02-7) Mass
3.8 P chloro m cresol 0 ❑ ✓❑ Concentration
(59-50-7) Mass
3.9 Pentachlorophenol ❑ © Concentration
(87-86-5) Mass
Phenol Concentration
3.10 El(108-95-2) 0 El
Mass
3.11 2,4,6-trichlorophenol El ❑ Concentration
(88-05-2) Mass
Section 4.Organic Toxic Pollutants(GCIMS Fraction—Base/Neutral Compounds)
4,1 Acenaphthene Concentration
El 0 El
(83-32-9) Mass
4.2 Acenaphthylene Elf 0 Concentration
(208-96-8) Mass
4.3 Anthracene Concentration
(120-12-7) Mass
4.4 Benzidine Concentration
(92-87-5) Mass
4.5 Benzo(a)anthracene Concentration
(56-55-3) Mass
4,6 Benzo(a)pyrene 0 0 Concentration
(50-32-8) Mass
EPA Form 3510-2C(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
PollutantlParameter Testing Units Long-Term
(and CAS Number.if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
of of
Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) Value
(if available) _
4.7 3 4-benzofluoranthene El ❑ ✓❑ Concentration
(205-99-2) Mass
4.8 Benzo(ghi)perylene El ❑ 0Concentration
(191-24-2) Mass
4.9 Benzo(k)fluoranthene El ❑ 0Concentration
(207-08-9) Mass
Bis(2-chloroethoxy)methane � ❑ Concentration
4.10 (111-91-1) Mass
Bis(2-chloroethyl)ether � El Concentration
4.11 (111-44-4) Mass
4.12 Bis(2-chloroisopropyl)ether ❑ ❑ 0Concentration
(102-80-1) Mass
4.13 Bis(2-ethylhexyl)phthalate ❑ 0Concentration
(117-81-7) Mass
4.14 4-bromophenyl phenyl ether El 0 0Concentration
(101-55-3) Mass
Butyl benzyl phthalate El ❑ ❑ Concentration
4.15 (85-68-7) Mass
4.16 2-chloronaphthalene 0Concentration
El 0
(91-58-7) Mass
4 17 4-chlorophenyl phenyl ether ❑ El ✓❑ Concentration
(7005-72-3) Mass
Chrysene Concentration
4.18 (218-01-9) Mass
Dibenzo(a,h)anthracene El ❑ ❑ Concentration
4.19 (53-70-3) Mass
EPA Form 3510-2C(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
PollutantlParameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
Discharge Discharge Daily of Average of
(required) (if available) Discharge Analyses if available Value Analyses
4.20 12-dichlorobenzene 0 Concentration
El El
(95-50-1) Mass
4.21 1,3-dichlorobenzene El 0 Concentration
(541-73-1) Mass
4.22 1,4-dichlorobenzene Concentration
(106-46-7) Mass
4.23 3,3-dichlorobenzidine 0 0 Concentration
(91-94-1) Mass
4.24 Diethyl phthalate © Concentration
0 0(84-66-2) Mass
4.25 Dimethyl phthalate 0 0 Concentration
El
(131-11-3) Mass
4.26 Di-n-butyl phthalate El El Concentration
(84-74-2) Mass
4.27 2,4-dinitrotoluene El El Concentration
(121-14-2) Mass
2,6-dinitrotoluene � � Concentration
4.28 El
(606-20-2) Mass
4.29 Di-n-octyl phthalate 0 El Concentration
(117-84-0) Mass
4.30 1,2-Diphenylhydrazine a Concentration
(as azobenzene)(122-66-7) Mass
4.31 Fluoranthene Concentration
El 0 El
(206-44-0) Mass
4.32 Fluorene Concentration
(86-73-7) Mass
EPA Form 3510-2C(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0006548 Wayne Farms Dobson Fresh Plant 001
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))r
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
Discharge Discharge Datly of Average of
(required) (if available) Discharge Analyses Analyses
Value
(if available)
4.33 Hexachlorobenzene El Concentration
(118-74-1) Mass
4.34 Hexachlorobutadiene Concentration
(87-68-3) Mass
4.35 Hexachlorocyclopentadiene El ElConcentration
(77-47-4) Mass
4.36 Hexachloroethane Concentration
(67-72-1) Mass
4.37 Indeno(1,2,3-cd)pyrene ❑ 0 0Concentration
(193-39-5) Mass
4.38 Isophorone 0 0 CIConcentration
(78-59-1) Mass
4.39 Naphthalene CIConcentration
0 0(91-20-3) Mass
4.40 Nitrobenzene Concentration
(98-95-3) Mass
4.41 N-nitrosodimethylamine 0 ❑ Concentration
(62-75-9) Mass
4.42 N-nitrosodi-n-propylamine El ❑ Concentration
(621-64-7) Mass
4.43 N-nitrosodiphenylamine El ❑ Concentration
(86-30-6) Mass
4.44 Phenanthrene Concentration
(85-01-8) Mass
Pyrene Concentration
4.45 El ❑ 0(129-00-0)
Mass
EPA Form 3510-2C(Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number.if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
Daily of of
Discharge Discharge Average
(required) (if available) Discharge Analyses Analyses
Value
(if available)
4.46 1,2,4-trichlorobenzene El 0 0Concentration
(120-82-1) Mass
Section 5.Organic Toxic Pollutants(GCIMS Fraction—Pesticides)
Aldrin Concentration
5.1 (309-00-2) D El ❑ Mass
o-BHC 0 Concentration
5.2 (319-84-6) El El
R-BHC Concentration
5.3 El El ❑
(319-85-7) Mass
y-BHC Concentration
5.4 (58-89-9) ❑ El Mass
6-BHC Concentration
5.5 (319-86-8) El El Mass
5.6 Chlordane El ❑ 0Concentration
(57-74-9) Mass
5.7 4,4'-DDT El 0
0Concentration
(50-29-3) Mass
5.8 4,4'-DDE El ❑ ❑ Concentration
(72-55-9) Mass _
5.9 4,4'-DDD El ❑ ❑ Concentration
(72-54-8) Mass
Dieldrin Concentration
5.10 (60-57-1) ❑ El Mass
5.11 a-endosulfan ❑ ❑ ❑ Concentration
(115-29-7) Mass
EPA Form 3510-2C(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0006548 Wayne Farms Dobson Fresh Plant 001
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
PollutantlParameter Testing Units Long-Term
(and CAS Number.if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
Discharge Discharge Daily of Average of
(required) (if available) Dischar(ifavailablge)e Analyses Value Analyses
_
R-endosulfan ❑ 0 0 Concentration
5.12 (115-29-7) Mass
5.13 Endosulfan sulfate ❑ ❑ ❑ Concentration
(1031-07-8) Mass
5.14 Endrin ❑ 0
0
Concentration
(72-20-8) Mass
Endrin aldehyde El 0 0 Concentration
5.15 (7421-93-4) Mass
5.16 Heptachlor El ❑ 0
Concentration
(76-44-8) Mass
Heptachlor epoxide Concentration
5.17 (1024-57-3) ❑ 0 0
Mass
PCB-1242 Concentration
5.18 (53469-21-9) 0 0 Mass
PCB-1254 Concentration
5.19 (11097-69-1) 0 ❑ 0 Mass i
PCB-1221 Concentration
5.20 (11104-28-2) ❑ 0
Mass
PCB-1232 Concentration
5.21 (11141-16-5) ❑ 0 E Mass
PCB-1248 Concentration
5.22 (12672-29-6) 0 0 E Mass
PCB-1260 Concentration
5.23 (11096-82-5) 0 ❑ 0 Mass
PCB-1016 Concentration
5.24 (12674-11-2) ❑ 0 0 Mass
EPA Form 3510-2C(Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0006548 Wayne Farms Dobson Fresh Plant 001
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
Daily of of
Discharge Discharge Average
(required) (if available) Discharge Analyses Analyses
Value
(if available)
Toxaphene Concentration
5.25 (8001-35-2) 0 0 ✓❑ Mass
' Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter 1,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 21

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0006548 Wayne Farms Dobson Fresh Plant 001
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))l
Presence or Absence Intake
(check one) Effluent (Optional)
Units
Pollutant Maximum Long-Term
Believed Believed (specify) Maximum Daily Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
(required) Discharge Discharge Analyses Value Analyses
(if available) (if available)
❑
Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall.You need not complete the"Presence or Absence"column of Table C for
each pollutant.
❑ Check here if you believe all pollutants on Table C to be absent in your discharge from the noted outfall.You need not complete the"Presence or Absence"column of Table C for
each pollutant.
1 Bromide ❑ ❑✓ Concentration
(24959-67-9) Mass
Chlorine,total ❑ ❑ Concentration ug/L 45 22.2 17.2 251
2. residual Mass
3. Color CI ❑ Concentration ntu 6.9 3.9 2.7 52
Mass
4. Fecal coliform 0 ElConcentration CFU 110 ' 20 8.3 156
Mass
5 Fluoride ❑ ❑ Concentration
(16984-48-8) Mass
6 Nitrate nitrite 0 0 Concentration mg/L 30.3 24.78 20.1 52
Mass
Nitrogen,total Concentration mg/L 31.0 25.1 21.0 52
7' organic(as N) ❑ Mass
8. Oil and grease 0 ❑ Concentration mg/L <5 <5 <5 156
Mass
Phosphorus(as ❑ 0 Concentration _ mg/L 37.2 27.62 21.18 52
g' P),total(7723-14-0) Mass
10. Sulfate(as SO4) ❑ Concentration mg/L 106 1
(14808-79-8) Mass
Concentration mg/L <0.100 1
11. Sulfide(as S) ❑✓ 0
Mass
EPA Form 3510-2C(Revised 3-19) Page 23

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence Intake
(check one) Effluent (Optional)
Units
PollutantMaximum Long-Term
Believed Believed (specify) Maximum Daily Monthly Average Daily Number of Long-Term Number of
Present Absent D�equi ed)e Discharge Discharge Analyses AVa uee Analyses
(if available) (if available)
Sulfite(as SO3) Concentration
12. (14265-45-3)
Mass
13. Surfactants Concentration mg/L <0.100 1
Mass
14. Aluminum,total ✓❑ ❑ Concentration mg/L <0.050 1
(7429-90-5) Mass
15. Barium,total ❑ ❑✓ Concentration
(7440-39-3) Mass
16. Boron,total ❑ ❑✓ Concentration
(7440-42-8) Mass
17 Cobalt,total Concentration
(7440-48-4) Mass
18 Iron,total 0 ❑✓ Concentration
(7439-89-6) Mass
El
Magnesium,total Concentration
19. (7439-95-4)
Mass
Molybdenum, Concentration
20. total 0 0 Mass
(7439-98-7)
21. Manganese,total ❑ 0 Concentration
(7439-96-5) Mass
22 Tin,total 0 ❑✓ Concentration
(7440-31-5) Mass
Titanium,total Concentration
23. (7440-32-6)
Mass
EPA Form 3510-2C(Revised 3-19) Page 24
i

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0006548 Wayne Farms Dobson Fresh Plant 001
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence
(check one) Effluent Intake
(Optional)
Units
Pollutant Maximum Long-Term
Believed Believed (specify) Maximum Daily Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
Discharge Discharge Analyses Analyses
(required) Value
(if available) (if available)
24 Radioactivity
Concentration
Alpha.total ❑ ❑✓
Mass
Beta,total ❑ ❑✓
Concentration
Mass
Concentration
Radium,total ❑ ✓❑
Mass
Concentration
Radium 226,total ❑ ❑✓ -
Mass
' Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 25

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0006548 Wayne Farms Dobson Fresh Plant 001
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
1. Asbestos ❑ 121
2. Acetaldehyde ❑ 0
3. Allyl alcohol ❑ 0
4. Allyl chloride 0 El
5. Amyl acetate 0 0
6. Aniline 0 ❑✓
7. Benzonitrile 0 0
8. Benzyl chloride 0 0
9. Butyl acetate ❑ 0
10. Butylamine 0 0
11. Captan 0 0
12. Carbaryl ❑ 0
13. Carbofuran 0 0
14. Carbon disulfide ❑ 0
15. Chlorpyrifos ❑ 0
16. Coumaphos ❑ 0
17. Cresol ❑ 0
18. Crotonaldehyde 0 0
19. Cyclohexane ❑ 0
EPA Form 3510-2C(Revised 3-19) Page 27

EPA Identification Number NPDES Permit Number Facility Name Duffel!Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
20. 2,4-D(2,4-dichlorophenoxyacetic acid) El 0
21. Diazinon ❑ 0
22. Dicamba 0 0
23. Dichlobenil 0 0
24. Dichlone 0 0
25. 2,2-dichloropropionic acid 0 0
26. Dichlorvos 0 0
27. Diethyl amine 0 0
28. Dimethyl amine 0 0
29. Dintrobenzene ❑ 0
30. Diquat ❑ 0
31. Disulfoton 0 0
32. Diuron ❑ 0
33. Epichlorohydrin ❑ 0
34. Ethion ❑ 0
35. Ethylene diamine 0 0
36. Ethylene dibromide Cl 0
37. Formaldehyde Cl 0
38. Furfural 0 0
EPA Form 3510-2C(Revised 3-19) Page 28

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
39. Guthion ❑ ❑✓
40. Isoprene ❑ ❑✓
41. isopropanolamine ❑ ❑�
42. Kelthane ❑ ❑✓ — --—— —�— --- -43. Kepone ❑ ❑✓
44. Malathion 0 ❑✓
45. Mercaptodimethur ❑ ❑✓
46. Methoxychlor ❑ ❑✓
47. Methyl mercaptan 0 ❑✓
48. Methyl methacrylate ❑ ❑✓
49. Methyl parathion ❑ ❑✓
50. Mevinphos ❑ ❑✓
51. Mexacarbate ❑
52. Monoethyl amine 0 ❑✓
53. Monomethyl amine 0 ❑✓
54. Naled ❑ ❑✓
55. Naphthenic acid 0 ❑✓
56. Nitrotoluene ❑ ❑✓
57. Parathion 0 ❑✓
EPA Form 3510-2C(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent _
58. Phenolsulfonate ❑ ❑✓
59. Phosgene ❑ ❑✓
60. Propargite ❑ 121
61. Propylene oxide ❑ ✓❑
62. Pyrethrins ❑ ❑✓
63. Quinoline 0 ❑✓
64. Resorcinol ❑ ❑✓
65. Strontium 0 ✓❑
66. Strychnine ❑ ❑
67. Styrene 0 ❑✓
68. 2,4,5-T(2,4,5-trichlorophenoxyacetic ❑ ❑
acid)
69. TDE(tetrachlorodiphenyl ethane) ❑ ❑✓
70. 2,4,5-TP[2-(2,4,5-trichlorophenoxy) ❑ ❑
propanoic acid]
71. Trichlorofon 0 ❑✓
72. Triethanolamine 0 ✓❑
73. Triethylamine 0
74. Trimethylamine 0 ❑✓
75. Uranium ❑ ❑✓
76. Vanadium 0 ❑✓
EPA Form 3510-2C(Revised 3-19) Page 30

EPA Identification Number NPDES Permit Number Facility Name Ouffall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant 001 OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units/
Present Absent
77. Vinyl acetate ❑ ❑✓
78. Xylene ❑ ❑✓
79. Xylenol ❑ ❑✓
80. Zirconium ❑ ✓❑
Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 31

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0006548 Wayne Farms Dobson Fresh Plant OMB No.2040-0004
TABLE E.2,3,7,8 TETRACHLORODIBENZO P DIOXIN(2,3,7,8 TCDD)(40 CFR 122.21(g)(7)(viii))
TCDD Presence or
Congeners Absence
Pollutant Used or (check one) Results of Screening Procedure
Manufactured Believed Believed
Present Absent
2,3,7,8-TCDD ❑✓
EPA Form 3510-2C(Revised 3-19) Page 33

EPA Identification Number NPDES Permit Number Facility Name l Form Approved 03/05/19
NC0006548 Wayne Farms /e5V„ OMB No.2040-0004
SECTION 12.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
12.1 In Column 1 below, mark the sections of Form 2C that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to complete all sections or provide attachments.
Column 1 Column 2
✓❑ Section 1:Outfall Location ❑✓ w/attachments
❑✓ Section 2:Line Drawing ❑✓ w/line drawing ❑ w/additional attachments
Section 3:Average Flows and w/list of each user of
0 Treatment ❑✓ w/attachments Elprivately owned treatment
works
❑ Section 4: Intermittent Flows El w/attachments
❑✓ Section 5: Production ❑ w/attachments
w/optional additional
❑ Section 6: Improvements El w/attachments ❑ sheets describing any
additional pollution control
plans
1-1 supporting
request for a waiver and ❑ w/explanation for identical
supporting information outfalls
w/small business exemption wl other attachments
"I request
El
N ❑ Section 7: Effluent and Intake ❑✓ w/Table A ❑✓ w/Table B
Characteristics
0
✓❑ wl Table C ❑✓ w/Table D
m ✓ w/Table E w/analytical results as an
c� ❑ ❑ attachment
❑ Section 8:Used or Manufactured ❑ w/attachments
Toxics
❑ Section 9:Biological Toxicity ❑ w/attachments
Tests
U
❑ Section 10:Contract Analyses ❑ w/attachments
❑ Section 11:Additional Information ❑ w/attachments
❑ Section 12:Checklist and El w/attachments
Certification Statement
12.2 Certification Statement
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 fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Kevin McDaniel Senior VP and GM Fresh
Signature Date signed
"Ai
EPA Form 3510-2C(Revised 3-19) Page 7

Attachments
Attachment#1: Topographic Map of the Facility with property lines
Attachment#2: Process Flow Diagram
Attachment#3: Facility and Discharge Point Diagram

Attachment 1
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Attachment 2
Processing Plant ► Meat Screen Screen Effluent Tank FEB Tank
0.527 MGD average ► 0.035 MG ►
Feather Screen 0.5 MG
Condenser Water
0.010 MGD average
Stormwater(First Flush)
Nitrification Reactor Anoxic Reactor
V
1.5 MG 0.6 MG 4 - Covered FEB Lagoon 2.5 MG D.A.F
4
1200 gpm
35-ft. Clarifier
Splitter Box ►
0.05 MG Chlorine Contact
Chamber
► Dechlorination
60-ft. Clarifier Chamber
0.317 MG
O utfa I l 001
Fisher River

Attachment 3
Yev Hopi + ..e,.
_f
.
Outfall 001 •
F.', E- (flows S)
•
. e.t:.:sek - • r• !Shwa at.
' . Hwy 601 bypass :cam r •:
�/ f
, •
f ......... Discharge line(flows north); , i - _
r - ' in Hwy 601 right-of--way, i�' %
' (approximate location) / • .
1' -
• ` _ 1 , Rockford Street
`_ , . (US Hwy 601)
- I �-
:o k 1 ••
��� :. • •
.:./ J' '>1 11,E
• '- a Duks l : i 11
I Wayne Farms LLC t +
• A` `-
, //11
•
Fisher River
(flows SE) •
St..!,.. ewna •
\ Cam"n•r.ity C+41.• — -
•/
1
o- a • -
mc •
•S. Main Street ''�•"1i� • M \
micgoe ...- -- • • .-." i . , ., • •
Wayne Farms LLC Facility
*
Dobson Fresh Plant WWTP Location
State Grid: BI6NW LSGS Quad: Dobson,NC not to scale
Receiving Stream: Fisher River Stream Class: C
Draninage Basin: Yadkin-Pee Dee Stream Segment: 12-63-49)
Latitude: 36°24'37"N Sub-Basin: 03-07-02 NPDES Permit NC0006548
Longitude: 80°41'22"W Ill C: 03040101 North
Sum' County