NC0003344_Application_20230920 (2)

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EPA Identfication Number
NPDES Permit Number
Facility Name
C"&AMpQ
NC0003344
House of Raeford -Wallace
OMB No. 2040-0004
Form
U.S. Environmental Protection Agency 2023
1
\'/EPA
Application for NPDES Permit to Discharge Wastewater
NPDES
GENERAL INFORMATION
1.1
Applicants Not Required to Submit Form 1
1 1 1
Is the facility a new or existing publicly owned
1.1.2
Is the facility a new or existing treatment works
treatment works?
treating domestic sewage?
If yes, STOP. Do NOT complete 0 No
If yes, STOP. Do NOT 0 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,
aoperation
or a concentrated aquatic animal
commercial, mining, or silvicultural facility that is
CL
production facility?
currently discharging process wastewater?
w
0
Yes -+ Complete Form 1 No
Yes 4 Complete Form No
z
and Form 26.
1 and Form 2C.
R
1.2.3
Is the facility a new manufacturing, commercial,
1.2.4
Is the facility a new or existing manufacturing,
c
mining, or silvicultural facility that has not yet
commercial, mining, or silvicultural facility that
commenced to discharge?
discharges only nonprocess wastewater?
Cr
Yes -� Complete Form 1 No
Yes 4 Complete Form No
y
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
a
associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater'?
Yes 4 Complete Form 1 No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x) or
b 15 .
SECTIONADDRESS,•
• r
2.1
FacilityName
House of Raeford -Wallace Division
0
2.2
EPA Identification Number
v
0
J
2.3
Facility Contact
v�
i
Name (first and last)
Title
Phone number
Cowan Johnson
Plant Manager
[phone]
Email address
[e-mail]
m
2.4
Facility Mailing Address
zStreet
or P.O. box
PO Box 669
City or town
State
ZIP code
Wallace
NC
28466
'DES
EPA Form 3510-1 (revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NC0003344
House of Raeford -Wallace
OMB No.2040-0004
w
2.5
Facility Location
a 5
Street, route number, or other specific identifier
a 0
253 Butterball Rd
CD
C c
County name
County code (if known)
Duplin
E
City or town
State ZIP code
Z
Teachey
NC 28464
SECTION1
NAICS CODESI
3.1
SIC Codes)
Description (optional)
2015
y
m
'D
O
U
N
C�
z
3.2
NAICS Code(s)
Description (optional)
v
311615
V
4.1
Name of Operator
House of Raeford, Inc
0
4.2
Is the name you listed in Item 4.1 also the owner?
E
© Yes ❑ No
.0-
0
4.3
Operator Status
120
❑ Public —federal ❑ Public —state ❑ Other public (specify)
d
p
© Private ❑ Other
(specify)
4.4
Phone Number of Operator
[phone]
4.5
Operator Address
Street or P.O. Box
.g
E
PO Box 669
o �
City or town
State
ZIP code
r 0
R
L
Wallace
NC 28466
C,
Email address of operator
[e-mail] [e-mail] [e-mail]
SECTION.r
C
5.1
s the facility located on Indian Land?
-'
1
❑ 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
NC0003344 House of Raeford -Wallace OMB No. 2040-0004
SECTION. EXISTING ENVIRONMENTALI
6.1 Existing Environmental Permits (check all that apply and print or type the corresponding permit number for each)
d
❑✓ NPDES (discharges to surface
❑ RCRA (hazardous wastes)
❑ UIC (underground injection of
o
water)
fluids)
'E
w a
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
a�
x
❑ Ocean dumping (MPRSA) ❑ Dredge or fill (CWA Section 404) ❑ Other (specify)
w
SECTION1
7.1
Have you attached a topographic map containing all required information to this application? (See instructions for
C
specific requirements.)
ID Yes ❑ No ❑ CAFO—Not Applicable (See requirements in Form 213.)
SECTIONOF
i
8.1
Describe the nature of your business.
Live Chickens arrive by trucks in cages. They enter our plant where they are hung on trolleys. Next they are stalled,
de -feathered, eviscerated, inspected, chilled, deboned, weighed, packaged, and shipped.
N
d
Residual blood, fat, and grease is pumped along with wash water to an activated wastewater plant. Prior to flowing
c
N
into equalization basin and aeration system, blood, fats, oil and grease are removed by dissolved air floatation unit
m
for rendering.
0
is
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SECTION••
,0
9.1
Does your facility use cooling water?
cm
❑r Yes ❑ No 4 SKIP to Item 10.1.
L
F9.2
Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
2
40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r). Consult with your
c
CD
NPDES permitting authority to determine what specific information needs to be submitted and when.)
0 w
_
We have cooling towers for our refrigeration process and all the water goes to wastewater treatment.
SECTION
!
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
y
apply. Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
Cr d
❑ Fundamentally different factors (CWA ❑ Water quality related effluent limitations (CWA Section
Of
Section 301(n)) 302(b)(2))
CD
❑ Non -conventional pollutants (CWA ❑ Thermal discharges (CWA Section 316(a))
Section 301(c) and (g))
❑r Not applicable
EPA Form 3510-1 (revised 3-19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name Form Approved 03/05/19
NC0003344
House of Raeford -Wallace OMB No.2040-0004
^d
SECTION•
CERTIFICATION STATEMENT (40
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
0 Section 1: Activities Requiring an NPDES Permit
❑ w/ attachments
0 Section 2: Name, Mailing Address, and Location
❑ w/ attachments
Section 3: SIC Codes
❑ wl attachments
Section 4: Operator Information
❑ wl attachments
❑✓ Section 5: Indian Land
❑ w/ attachments
❑ Section 6: Existing Environmental Permits
❑ wl attachments
a�
mSection
7: Map
w/ topographic
Elw/ additional attachments
map
c
Section 8: Nature of Business
❑ w/ attachments
�a
❑� Section 9: Cooling Water Intake Structures
—
❑ wl attachments
m
❑ Section 10: Variance Requests
❑ w/ attachments
cc
0 Section 11: Checklist and Certification Statement
❑ w/ attachments
Y
s
11.2
Certification Statement
U
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 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
Robert C. Johnson If
Plant Manager
Signature
Date signed
EPA Form 3510-1 (revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0003344 House of Raeford -Wallace OMB No 2040-0004
n.
Form U.S. Environmental Protection Agency
2C \8.EPA Application for NPDES Permit to Discharge Wastewater
NPDES EXISTING MANUFACTURING, COMMERCIAL, MINING, AND SILVICULTURE OPERATIONS
SECTIONOUTFALL LOCATION
1.1 Provide information on each of the facility's outfalls in the table below.
Numbelr Receiving Water Name Latitude Longitude
v
O 001 Rockfish Creek via Duff Cra 34' 756' 672" -78' 052' 345
J ii
m
13 o o
O
SECTIONDRAWING
o, 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
_ 3 balance? (See instructions for drawing requirements. See Exhibit 2C-1 at end of instructions for example.)
J �
o ❑✓ Yes ❑ No
SECTION•.GE FLOWS AND
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
Operation Average Flow
Eviisceration and Debone of chickens 1.089 mgd
c
mgd
cc
F mgd
c
mgd
3
0 Treatment Units
m Description Final Disposal of Solid or
(include size, flow rate through each treatment unit, Code from Liquid Wastes Other Than
Qretention time, etc.) Table 2C•1 by Discharge
2DAFS 6000g each 10min retention time 1200gpm 1-G DARLING PROTEINS
EQ Basin 13.2hr retention time 1.2million 1-0
MBBR 750gpm 6.4hr retention time 290,000gallons 3-A
2 Aeration Basins 600,000 gallons each 13.3hrs retention 3-A LEWIS FARMS
EPA Form 3510-2C (Revised 3-19) Page 1

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
NC0003344
House of Raeford -Wallace
OMB No. 2040-0004
n,
3.1
"Outfall Number*" 001
Cont.
Operations
Operation Average Flow
mgd
mgd
mgd
mgd
Treatment
Description
Units
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
60ft diameter-12ft deep clarifier .545mgd
1-U
c
45ft diameter-12ft deep clarifier .270mgd
1-U
0
U
c
100ftx15ft- loft deep rectangular clarifier .270mgd
1-U
w
E
v
m
Retention Pond 1.5acres
1-0
a
**Outfall Number*"
c
Operations Contributing
Operation
to Flow
Average Flow
o
LL
m
mgd
L
Qi
a
mgd
mgd
mgd
Treatment
Description
Units
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 Dischar e
Final DAF 32ftx10ftx7.5ft 1.089mgd
1-H
LEWIS FARMS
3 Tertiary Filter Towers 4ftx4ftx22ft tall 1.089mgd
1-Q
UV Disinfection 64inch lamps 90 total 1.089mgd
2-H
3 sludge digesters 48,900gallons each
5-P
LEWIS FARMS
3.2
Are you applying for an NPDES permit to operate a privately owned treatment works?
✓❑ Yes ❑ No 4 SKIP to Section 4.
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 03105/19
110027397001 NC0003344 House of Raeford -Wallace OMB No.2040-0004
n,
SECTION • 1
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 in cessary.
Frequency
Flow
Rate
Outfall
Operation
Duration
Average
Average
Long -Term
Maximum
Number
(list)
Da sfWeek
Months[Year
Average
Dail
days/week
months/year
mgd
mgd
days
cdays/week
monthslyear
mgd
mgd
days
days/week
monthslyear
mgd
mgd
days
days/week
monthslyear
mgd
mgd
days
m
c
days/week
monthslyear
mgd
mgd
days
days/week
monthslyear
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
monthslyear
mgd
mgd
days
days/week monthslyear mgd mgd days
SECTION'-•1
• 1
Do any effluent limitation guidelines (ELGs) promulgated by EPA under Section 304 of the CWA apply to your facility?
5.1
❑� Yes ❑ No 4 SKIP to Section 6.
y
5.2
Provide the following information on applicable ELGs.
ELG Category
ELG Subcategory
Regulatory Citation
uJ
as
Industry
Poultry First Processor
40 CFR 432 Subpart K
U
_
a.
a.
Q
5.3
Are any of the applicable ELGs expressed in terms of production (or other measure of operation)?
❑ Yes ❑ No 4 SKIP to Section 6.
0
5.4
Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
J
Outfall
Operation, Product, or Material
Quantityper Day
Unit
Number
r
Measure
m
cc
m
001
Raw Chicken Plant
1.600,000
Ibs
c
0
c�
v
0
a
EPA Form 3510-21C (Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NCO003344 House of Raeford -Wallace OMB No.2040-0004
SECTION'• 1
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.
41 =
E
Brief Identification and Description of
Affected
Outfalls
Source(s) of
Final Compliance Dates
Required
Projected
40
c
Project
(list outfall
Discharge
Q-
E
number
cc
d
-a
aL
a
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 0 No ❑ Not applicable
-SECTION1
See the instructions to determine the pollutants and parameters you are required to monitor and, in turn, the tables you must
7
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
requested and attached the results to this application package?
0 Yes ❑ No; a waiver has been requested from my NPDES
permitting authority for all pollutants at all outfalls.
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
listed in Exhibit 2C-3? (See end of instructions for exhibit.)
❑ Yes ✓❑ No -* SKIP to Item 7.8.
7.5
Have you checked "Testing Required" for all toxic metals, cyanide, and total phenols in Section 1 of Table B?
LU
w
❑ 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 ❑ Base/Neutral ❑ Pesticide
EPA Form 3510-2C (Revised 3-19) Page 4

EPA Identification Number
NPDES Permit Number
Faciliy Name
Form Approved 03105/19
NC0003344
House of Raeford -Wallace
n.
OMB No. 2040-0004
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?
El Yes ❑ No
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
❑
then SKIP to Item 7.12.
7.11
Have you provided (1) quantitative data for those Sections 2 through 5, Table B, for which have
pollutants you
determined testing is required or (2) quantitative data or an explanation for those Sections 2 through 5, Table B,
y
pollutants you have indicated are "Believed Present' in your discharge?
y
0 Yes ❑ No
U
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
U
for all outfalls?
Y
A
❑ Yes ❑ No
c
7.13
Have you completed Table C by providing (1) quantitative data for those pollutants that are limited either directly or
c
indirectly in an ELG and/or (2) quantitative data or an explanation for those pollutants for which you have indicated
c
"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?
r❑ 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?
21 Yes ❑ No
Table E. 2,3,7,8-Tetrachlorodibenzo- -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. ❑r No 4 SKIP to Section 8.
7.17
Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes ❑ No
SECTIONOR
MANUFACTURED TOXICS
8.1
Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
an intermediate or final product or byproduct?
❑ Yes ❑ No 4 SKIP to Section 9.
8.2
List the pollutants below.
Fo
L
1. 4. 7.
O
d
2 5• 8.
w
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
NC0003344 THouse of Raeford -Wallace OMB No. 2040 0004
n.
SECTION • • • r
9.1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
7 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.
N
9.2
Identify the tests and their
ourposes below.
Tests
()
Purpose of Test(s)
Submitted to NPDES
Date Submitted
o
PermittingAuthority?
F"
Chronic Toxicity
Required by Permit
0 ❑
Yes No
12/31/2021
a�
0
o
m
Chronic Toxicity
Required by Permit
0 ❑
Yes NO
03/31/2022
Chronic Toxicity Required by Permit
0 ❑
Yes No 06/30/2002
SECTION•
r
10.1
Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
0 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.
Vann Laboratories
Environmental Chemist Inc.
N
N
Laboratory address
642 Tamco Rd
PO Box 668
6602 Windmill Way
aReidsville,
INC 27320
Wallace, NC 28466
Wilmington, NC 28405
iy
m
L
C
c�
Phone number
[phone]
[phone]
[phone]
Pollutant(s) analyzed Chronic Toxicity BOD, TSS, Ammonia, BOD, TSS, Ammonia,
Temperature, pH Temperature, pH
SECTION11
• •• • 1
11.1
Has tfie NPDES permitting authority requested additional information?
c
❑ Yes ❑ No 4 SKIP to Section 12.
11.2
List the information requested and attach it to this application.
_o
1 4.
c
0
a
2. 5.
a
3. 6.
EPA Form 3510-2C (Revised 3-19) Page 6

EPA Identification Number
NPDES Permit Number Facility Name Form Approved 03/05/19
NC0003344 House of Raeford -Wallace OMB No. 2040-0004
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 com lete all sections or provide attachments.
Column 1
Column 2
❑✓ Section 1: Outfall Location
❑ wl attachments
❑� Section 2: Line Drawing
w/ line drawing ❑ w/ additional attachments
❑Section 3: Average Flows and
w/ list of each user of
❑
Treatment
w/ attachments ❑ privately owned treatment
works
❑ Section 4: Intermittent Flows
❑ w/ attachments
❑ Section 5: Production
❑ w/ attachments
w/ optional additional
❑ Section 6: Improvements
❑ w/ attachments ❑ sheets describing any
additional pollution control
tans
❑ w/ request for a waiver and ❑ w/ explanation for identical
supporting information outfalls
2
❑ wl small business exemption ❑ w/ other attachments
request
z
Section 7: Effluent and Intake
Characteristics
❑� w/ Table A wl Table B
0
© w/ Table C 0 w/ Table D
0 w! E ❑ w/ analytical results as an
attachment
El Section 8: Used or Manufactured
❑
N
Toxics
w/ attachments
Section 9: Biological Toxicity
El❑
wl attachments
s
Tests
c.�
❑ Section 10: Contract Analyses
❑ wl attachments
❑ Section 11: Additional Information
❑ wl attachments
Section 12: Checklist and
❑
❑ 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
Robert C. Johnson II
Plant Manager
SigD,alie
Date signed
------------
EPA Form 3510-2C (Revised 3-
Page 7

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Our`all Number I Form Approved 03/05/19
110027397001 NC0003344 I House of Raeford -Wallace Division I OMB No. 2040-0004
Effluent
Intake
0 tional
Waiver Units Maximum Maximum Long -Term
Pollutant
Requested (specify) Daily Monthly Average Daily Number of
Long -Term
Number of
(if applicable) 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.
1'
Biochemical oxygen demand
Concentration
mg/I
5.3
1.55
.87
156
Mass
(BOD5)
2'
Chemical oxygen demand
❑
Concentration
Mass
(COD)
Concentration
3.
Total organic carbon (TOC)
❑
Mass
Concentration
mg/I
9.6
2.56
1.5
156
4.
Total suspended solids (TSS)
Mass
Concentration
mg/I
0.49
.11
.03
156
5.
Ammonia (as N)
✓❑
Mass
6.
Flow
©
Rate
mgd
1.445
1.105
1.000
365
Temperature (winter)
❑✓
°C
°C
23.6
20.7
18.74
72
7.
Temperature (summer)
❑✓
°C
°C
32.4
30.3
27.33
84
pH (minimum)
✓❑
Standard units
S.U.
6
156
8.
pH (maximum)
Q
Standard units
s.u.
8
7.4
7.02
156
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 GFR 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
NC0003344 House of Raeford -Wallace Division
001 OMB No, 2040-0004
Presence or Absence
Intake
check one
Effluent (optional)
Pollutant/Parameter Testing Units
(and CAS Number, if available) Required Believed Believed (specify)
Maximum
Maximum
Long -Term
Average
Number
Long -
Number
Present Absent
Daily
Discharge
Monthly
Discharge
Daily
of
Term
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
f available
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
1.1
Antimony, total
El
1:1
❑
Concentration
(7440-36-0)
Mass
1.2
Arsenic, total
El
✓
Concentration
(7440-38-2)
Mass
1.3
Beryllium, total
✓
Concentration
(7440-41-7)
Mass
1.4
Cadmium, total
❑
El
IZI
Concentration
ug/I
0
0
0
6
(7440-43-9)
Mass
1.5
Chromium, total
Concentration
(7440-47-3)
Mass
1.6
Copper, total
P/1
IZI
Concentration
ug/I
31
21.5
16
24
(7440-50-8)
Mass
1.7
Lead, total
El
El
IZI
Concentration
(7439-92-1)
Mass
1.8
Mercury, total
El
1:1
El
Concentration
(7439-97-6)
Mass
1.9
Nickel, total
El
El
✓
Concentration
(7440-02-0)
Mass
1.10
Selenium, total
El
El
El
Concentration
(7782-49-2)
Mass
1.11
Silver, totalEl
E3
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 03tOS19
NC0003344
House of Raeford -Wallace Division
OMB No.2040-0004
Presence or Absence
check one
Effluent
Intake
(oplionali
PolutantlParameter
Testing
Units
Long -Term
(and CAS Number, if awar1ade
Required
Believed
Believed
(sperm)
Maximum
Maximum
Average
Number
Long-
Number
Present
Absent
Daily
Monthly
aily
of
Term
DisDcharge
Analyses
Average
Analyses
(required)
it available)
5f available
Value
1112
Thallium, total
❑
❑
❑
Concentration
Mass
(7440-28-0)
1.13
Zinc, total
❑
Q
❑
Concentration
ug/I
11
11
2.75
4
Mass
(7440-66-6)
1.14
Cyanide, total
El
❑
Concentration
Mass
(57-12-5)
1.15
Phenols, total
❑
❑
❑r
Concentration
Mass
Section 2. Organic Toxic Pollutants (GC/MS Fraction —Volatile Compounds)
2.1
Acrolein
El
❑
✓
❑
Concentration
Mass
(107-02-5)
22
Acrylonitrile
❑
❑
❑
Concentration
Mass
(107-13-1)
2.3
Benzene
El
❑
❑
Concentration
Mass
(71-43-2)
2.4
Bromoform
El
El❑
Concentration
Mass
(75-25-2)
2 5
Carbon tetrachiorde
El
❑
❑
Concentration
Mass
(56-23-5)
2.6
Chiorobenzene
El
❑
El
Concentration
Mass
(108-90-7)
2.7
Chlorodibromomethane
El
El
❑
Concentration
Mass
(124-48-1)
2.8
Chloroethane
❑
❑
Concentration
Mass
(75-00-3)
EPA Form 3510-2C (Revised 3-19)
Page 12

)ES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0003344 House of Raeford -Wallace Division OMB No.2040-0004
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
o
kill fog
Presence or Absence
check one
Units
(specify)
(p �)
111112 1111
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthl y
fscharle
iavailable)Analyses
Long -Term
Average
aily
Discharge
if available
Number
of
Analyses
Long-
Term
Average
Number
of
2.9
2-chloroethylvinyl ether
(110-75-8)
✓
Concentration
Mass
2.10
Chloroform (67-66-3)
Concentration
Mass
2.11
Dichlorobromomethane
(75-27-4)
©
Concentration
Mass
2.12
11-dichloroethane
(75-34-3)
El
Concentration
Mass
2.13
12-dichloroethane
(107-06-2)
✓
Concentration
Mass
2.14
1,1-dichloroethylene
(75-35-4)
✓
Concentration
Mass
2.15
12-dichloropropane
(78-87-5)
El
E
Concentration
Mass
2.16
13-dichloropropylene
(542-75-6)
1:1
El
O
Concentration
Mass
2.17
Ethylbenzene
(100-41-4)
Q
Concentration
Mass
2.18
Methyl bromide
(74-83-9)
El
O
Concentration
Mass
219
Methyl chloride
(74-87-3)
El
El
Concentration
Mass
2.20
Methylene chloride
(75-09-2)
Concentration
Mass
2.21
1,1,2,2-tetrachloroethane
(79-34-5)
✓
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 13

Number NPUES Permit Number Facility Name Outfall Number
NC0003344 I House of Raeford -Wallace Division
Form Approved 03/05/19
OMB No. 2040.0004
PollutanUParameter
(and CAS Number, if available )
Testing
Required
q
Presence or Absence
check one
Units
(specify)
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Dail y
Discharge i
)
Maximum
Monthly
y
scharge
(if available)
( )
Long -Term
Average
Discharge
if available)Value
Number
Analyses
Long-
Term
Average
Number
of
Analyses
2.22
Tetrachloroethylene
(127-18-4)
El
✓
Concentration
Mass
2.23
Toluene
(108-88-3)
El
Z
Concentration
Mass
2.24
12-trans-dichloroethylene
(156-60-5)
El
✓
Concentration
Mass
2.25
11,1-trichloroethane
(71-55-6)
✓
Concentration
Mass
2.26
11,2-trichloroethane
(79-00-5)
El
✓
Concentration
Mass
2.27
Trichloroethylene
(79-01-6)
✓
Concentration
Mass
2.28
Vinyl chloride
(75-01-4)
El
✓
Concentration
Mass
Section 3.Organic Toxic Pollutants GCIMS
Fraction
—Acid Compounds
3.1
2-chlorophenol
(95-57-8)
1:1✓
Concentration
Mass
3.2
2,4-dichlorophenol
(120-83-2)
El
El
✓
Concentration
Mass
3.3
2,4-dimethylphenol
(105-67-9)
✓
Concentration
Mass
3.4
4,6-dinitro-o-cresol
(534-52-1)
El
✓
Concentration
Mass
3.5
2 4-dinitrophenol
(51-28-5)
✓
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 14

jtb rermu Numoer Facility Name Outfall Number Form Approved 03/05/19
NC0003344 I House of Raeford -Wallace Division I OMB No. 2040-0004
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
Presence or Absence
check one
Units
(specify)Maximum
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
if available
Number
of
Analyses
Long -
Term
Average
Value
Number
of
Analyses
3.6
2-nitrophenol
(88-75-5)
Concentration
Mass
3.7
4-nitrophenol
(100-02-7)
El
✓
Concentration
Mass
3.8
p-chloro-m-cresol
(59-50-7)
Concentration
Mass
3.9
Pentachlorophenol
(87-86-5)
Concentration
Mass
3.10
Phenol
(108-95-2)
✓
Concentration
Mass
3.11
2,4,6-trichlorophenol
(88-05-2)
El
1:1
✓
Concentration
Mass
Section 4.Organic Toxic Pollutants GC/MS
Fraction
—Base /Neutral
Compounds)
4.1
Acenaphthene
(83-32-9)
El
21
Concentration
Mass
4.2
Acenaphthylene
(208-96-8)
El
✓
Concentration
Mass
4.3
Anthracene
(120-12-7)
El
1:1
✓
Concentration
Mass
4.4
Benzidine
(92-87-5)
1:1
El
✓
Concentration
Mass
4.5
Benzo (a) anthracene
(56-55-3)
El
✓
Concentration
Mass
4.6
Benzo (a) pyrene
(50-32-8)
El
El
El
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 15

EPA Identification Number NPDES Permit Number r-acmry Name Outfall Number
NC0003344 I House of Raeford -Wallace Division
Form Approved 03/05/19
OMB No. 2040-0004
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
q
Presence or Absence
check one
Units
(specify)
Effluent
Intake
(optional)
Believed
Present
Believed
Absentof
Maximum
Daily
Discharge
a
Maximum
Monthly
harge
(if availablle)
Long -Term
Average
Discharge
if available
Number
Analyses
Long-
Term
Average
Number
Analyses
4.7
3 4-benzofluoranthene
(205-99-2)
Concentration
Mass
4.8
Benzo (ghi) per lene
(191-24-2)
Concentration
Mass
4.9
Benzo (k) fluoranthene
(207-08-9)
El
El
El
Concentration
Mass
4,10
Bis (2-chloroethoxy) methane
(111-91-1)
El
✓
Concentration
Mass
4.11
Bis (2-chloroethyl) ether
(111-44-4)
E
Concentration
Mass
4.12
Bis (2-chloroisopropyl) ether
(102-80-1)
Concentration
Mass
4.13
Bis (2-ethylhexyl) phthalate
(117-81-7)
11
ElConcentration
✓
Mass
4.14
4-bromophenyl phenyl ether
(101-55-3)
El
R
Concentration
Mass
4.15
Butyl benzyl phthalate
(85-68-7)
1:1
El
Q
Concentration
Mass
4.16
2-chloronaphthalene
(91-58-7)
1:1
El
✓
Concentration
Mass
4.17
4-chlorophenyl phenyl ether
(7005-72-3)
Concentration
Mass
4.18
Chrysene
(218-01-9)
1:1
El
21
Concentration
Mass
4.19
Dibenzo (a,h) anthracene
(53-70-3)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 16

Number NPutS Permit Number Facility Name Outfall Number
NCO003 I House of Raeford -Wallace Division
Form Approved 03/05/19
OMB No. 2040-0004
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
I a- i
Presence or Absence
(check one)
fflA2111111111,11r
Units
(Specify)
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Dail y
Discharge
(required)
Maximum
Monthly
y
Discharge
(if available)
Long -Term
Average
Daily
Discharge
if available
Number
of
Analyses
Long -
Term
Average
Value
Number
of
Analyses
4.20
12-dichlorobenzene
(95-50-1)
Concentration
Mass
4.21
13-dichlorobenzene
(541-73-1)
El
E
Concentration
Mass
4.22
1,4-dichlorobenzene
(106-46-7)
✓
Concentration
Mass
4.23
3 3-dichlorobenzidine
(91-94-1)
Concentration
Mass
4.24
Diethyl phthalate
(84-66-2)
Concentration
Mass
4.25
Dimethyl phthalate
(131-11-3)
✓
Concentration
Mass
4.26
Di-n-butyl phthalate
(84-74-2)
Concentration
Mass
4.27
2 4-dinitrotoluene
(121-14-2)
Concentration
Mass
4.28
2 6-dinitrotoluene
(606-20-2)
Concentration
Mass
4.29
Di-n-octyl phthalate
(117-84-0)
Concentration
Mass
4.30
1,2-Diphenylhydrazine
(as azobenzene)(122-66-7)
Concentration
Mass
4.31
Fluoranthene
(206-44-0)
✓
Concentration
Mass
4.32
Fluorene
(86-73-7)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 17

Number NHutS Hermit Number Facility Name
NC0003344 I House of Raeford -Wallace Division
Form Approved 03/05/19
OMB No. 2040.0004
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
q
Presence or Absence
check one
Units
(specify)
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Dail y
Discharge
(required)
Maximum
Monthly
y
Discharge
(if available)
Long -Term
Average
aily
Discharge
if available
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
4.33
Hexachlorobenzene
(118-74-1)
El
1:1
El
Concentration
Mass
4.34
Hexachlorobutadiene
(87-68-3)
❑
El
Concentration
Mass
4.35
Hexachlorocyclopentadiene
(77-47-4)
El
El
Concentration
Mass
4.36
Hexachioroethane
(67-72-1)
1:1✓
Concentration
Mass
4.37
Indeno (1,2,3-cd) pyrene
(193-39-5)
✓
Concentration
Mass
4.38
Isophorone
(78-59-1)
Concentration
Mass
4.39
Naphthalene
(91-20-3)
El
El
El
Concentration
Mass
4.40
Nitrobenzene
(98-95-3)
El
E
Concentration
Mass
4.41
N-nitrosodimethylamine
(62-75-9)
Concentration
Mass
4.42
N-nitrosodi-n-pro pylamine
(621-64-7)
1:1
El
✓
Concentration
Mass
4.43
N-nitrosodiphenylamine
(86-30-6)
13
El
ID
Concentration
Mass
4,44
Phenanthrene
(85-01-8)
✓
Concentration
Mass
4.45
Pyrene
(129-00-0)
El
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 18

)ES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0003344 I House of Raeford -Wallace Division I OMB No. 2040-0004
•
•
• ••
• ••
Presence or Absence
check one
Effluent
Intake
(optional)
Pollutant/Parameter
Testing
�
Units
Maximum
Maximum
Long -Term
Long-
and CAS Number, if available
( )
14.46
Required
q
Believed
Believed
(specify)
Daily
Monthly
Average
Number
Term
Number
Present
Absent
Discharge
Discharge
Daily
of
Average
of
(required)
(if available)
Discharge
Analyses
Value
Analyses
if available
1,2,4-trichlorobenzene
Concentration
Mass
(120-82-1)
Section 5.Organic Toxic Pollutants (GC/MS Fraction
—Pesticides)
5.1
Aldrin
El
H
Concentration
Mass
(309-00-2)
5.2
a-BHC
Concentration
Mass
(319-84-6)
5.3
(3-BHC
Concentration
Mass
(319-85-7)
5.4
y-BHC
Concentration
Mass
(58-89-9)
5.5
b-BHC
El
E
Concentration
Mass
(319-86-8)
5.6
Chlordane
El
❑
Concentration
Mass
(57-74-9)
5.7
4,4'-DDT
Concentration
Mass
(50-29-3)
5.8
4,4'-DDE
Concentration
Mass
(72-55-9)
5.9
4,4'-DDD
a
Concentration
Mass
(72-54-8)
5.10
Dieldrin
Concentration
Mass
(60-57-1)
511
a-endosulfan
Concentration
Mass
(115-29-7)
EPA Form 3510-2C (Revised 3-19) Page 19

Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0003344 House of Raeford -Wallace Division OMB No. 2040-0004
•
Pollutant/Parameter
(and CAS Number, if available )
•lk'[9111111ily.
MINIQzZicyW4101:191
Presence or Absence
check one
MRr
Units
(specify)
,
Effluent
Intake
(optional)
Testing
Required
q
Believed
Present
Believed
Absent
Maximum
Dail y
Discharge
)
Maximum
Monthly
y
Discharge
f available)
( )
Long -Term
Average
aily
Discharge
rfavailable
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
5.12
R-endosulfan
(115-29-7)
❑
❑
❑
Concentration
Mass
5.13
Endosulfan sulfate
(1031-07-8)
❑
✓
Concentration
Mass
5.14
Endrin
(72-20-8)
❑
❑
a
Concentration
Mass
5.15
Endrin aldehyde
(7421-93-4)
❑
❑
✓
❑
Concentration
Mass
5.16
Heptachlor
(76-44-8)
❑
El
El
Concentration
Mass
5.17
Heptachlor epoxide
(1024-57-3)
❑
❑
Concentration
Mass
5.18
PCB-1242
(53469-21-9)
Concentration
Mass
5.19
PCB-1254
(11097-69-1)
❑
❑
❑r
Concentration
Mass
5.20
PCB-1221
(11104-28-2)
Concentration
Mass
5.21
PCB-1232
(11141-16-5)
❑
❑
Concentration
Mass
5.22
PCB-1248
(12672-29-6)
❑
❑
Concentration
Mass
5.23
PCB-1260
(11096-82-5)
❑
❑
❑r
Concentration
Mass
5.24
PCB-1016
(12674-11-2)
❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 20

dts rermit Number Facility Name I Outfall Number
NC0003344 House of Raeford -Wallace Division
Form Approved 03/05119
OMB No. 2040-0004
Presence or Absence
check one
Effluent
Intake
(optional)
Pollutant/Parameter
(and CAS Number, If available
Testing
Required
q
Believed
Believed
Units
(specify)
Maximum
Maximum
Long -Term
Average
Number
Long.
Number
Present
Absent
Daily
Monthly
Daily
of
Term
of
Discharge
(required)
Discharge
(if available)
Discharge
Analyses
Average
Value
Analyses
if available
Toxaphene
Concentration
5.25 (8001-35-2)
El
El
Mass
♦7GIIIpill IV ai Ian nw Lie Cuummu aclun iy to suniuienuI➢ y SWISve lest proceaures (i.e., memoas) approved under 4u GhK 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 21

This page intentionally left blank.

EPA (dent fication Number NPDES Permit Number Facility Naas Outfal Number Form Approved 03105,19
NCO0O3344 House of Raeford -Wallace Division 001 OMB No.2040-M
Presence or Absence
check one Effluent Intake
(Optional)
Units
Pollutant Maximum Long -Term
Believed Believed (specify) Maximum Daily Long -Tenn
Present Absent Discharge Monthly Average Daily Number of Average Number of
(required) Discharge Discharge Analyses Value Analyses
if avalaWe 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 outfali. You need not complete the 'Presence or Absence' column of Table C for
each pollutant.
i
Bromide
El
ID
Concentration
Mass
(24959-67-91
2'
Chlorine, total
Concentration
Mass
residual
3.
Color
❑
ED
Concentration
Mass
4.
Fecal coliform
0
Concentration
n/looms
120
9.3
2.46
156
Mass
5
Fluoride
✓
Concentration
Mass
(1rx98"")
6
Nitrate -nitrite
rQ
Concentration
mg/I
143
86.5
55.39
156
Mass
T
Nitrogen, total
O
El
Corcentration
mg/I
.49
.11
.03
156
Mass
organic (as N)
8.
Oil and grease
0
Concentration
mg/l
6.5
1.5
.19
156
Mass
9
Phosphorus (as
❑
Concentration
mg/I
8.45
8.45
7.2
12
Mass
P), total (n23-14-0)
10
Sulfate (as SO4)
Concentration
Mass
(148a8-79-e)
11.
Sulfide (as S)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 23

EPA Identification Number NPDES Permit Number Facility Name Outfal Number Forth Approved =509
NCOW3344 House of Raeford -Wallace Division 001 OMB No.2tk40(Id4
• • • • • • • r
Presence or Absence
(chew one Effluent Intake
(Optional)
Pollutant Una 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
rfavailable if available
12
Sulfite (as S03)
(142fi5-45-3)
❑
✓
❑
Concentration
Mass
13.
Surfactants
❑
Concentration
Mass
14
Aluminum, total
(7429-90-5)
❑
✓
❑
Concentration
Mass
15
Barium, total
(7440.39.3)
❑
Concentration
Mass
16
Boron, total
(744042-8)
✓
❑
Concentration
Mass
17
Cobalt, total
(7440-48-4)
❑
❑
Concentration
Mass
18
Iron, total
(7439- M)
❑
❑
Concentration
Mass
19
Magnesium, total
(7439-95-4)
❑
❑
Concentration
Mass
20.
Molybdenum,
total
439-9&7
❑
Concentration
Mass
21
Manganese, total
(7439.96-5)
❑
❑
Concentration
Mass
22
Tin, total
(7440-31-5)
❑
✓
Concentration
Mass
23
Titanium, total
(7440-32-6)
❑
❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19) Page 24

This page intentionally left blank.

EPA identification Number NPDES Permit Number Fadlny Narne OutFal Number Form Approved 03l0519
NC0003344 House of Raeford -Wallace Division 003 OMB No. 2040-0004
•
410TAWN I • ei e 9401,•
•
t1011511
Presence or Absence
check one
Effluent
Intake
(Opfionaq
Pollutant
Believed
Believed
Units
(sped
Maximum Daily
Maximum
Long•Termfy)
Long -Term
Present
Absent
Discharge
Monthly
Average Daily
Number of
Average
Number of
(required)
Discharge
Discharge
Analyses
Value
Analyses
0available)
(ifavailable)
24.
Radioactivity
Alpha, total
❑
❑
Concentration
Mass
Beta, total
El
Concentration
Mass
Radium, total
❑
❑
Concentration
Mass
Radium 226, total
❑
Concentration
Mass
Sampling snag oe conducted according to sumcienuy sensitive test procedures (i.e., mettiods) 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 351(-X (Revised 3-19) Page 25

EPA Iden6ficabon Number NPDES Permit Number - Facility Name Outfal Number Form Approved 03105599
_7
N00003344 House of Raeford -Wallace Division 001 OMB No. 204DMU
a all gjltmffF)Juj��
Pollutant
Presence or Absence
check one
Reason Pollutant Believed Present in Discharge
Available Quantitative Data
(specify units)
Believed
Present
Believed
Absent
1.
Asbestos
❑
2.
Acetaldehyde
❑
❑r
3.
AIM alcohol
❑
4.
Alto chloride
❑
❑
5.
Amyl acetate
❑
El
6.
Aniline
❑
El
7.
Benzonihile
❑
0
8.
Benzyl chloride
❑
El
9.
Butyl acetate
❑
10.
Butylamine
❑
11.
Caplan
❑
Q
12.
Carbaryl
❑
0
13.
Carbofuran
❑
14.
Carbon disulfide
❑
0
15.
Chlorpyrifos
❑
0
16.
Coumaphos
❑
El
17.
Cresol
❑
❑r
18.
Crotonaldehyde
❑
❑r
19.
Cydohexane
❑
EPA Form 3510.2C (Revised 3.19) Page 27

EPA Identification Number NPOES Permit Number Fad ity Name Outfal Number Fam Approved 03A5,19
-7
NCO003344 House of Raeford -Wallace Division 001 OMB No. 204MD34
a �a a r
Pollutant
Presence or Absence
check one
Reason Pollutant Believed Present in Discharge
Available Quantitative Data
(specify its)
Believed
Present
Believed
Absent
20.
2,4-D (2,4-dichlorophenoxyacefic acid)
❑
❑Q
21.
Diazinon
❑
El
22.
Dicamba
❑
0
23.
Dichlobenil
❑
0
24.
Dichlone
❑
25.
2,2-dichloropropionic acid
❑
26.
Dichlorvos
❑
❑r
27.
Diethyl amine
❑
o
28.
Dimethyl amine
❑
29.
Dintrobenzene
❑
30.
Diquat
❑
❑r
31.
Disulfoton
❑
❑r
32.
Diuron
❑
E
33.
Epichlorohydrin,
❑
❑r
34.
Ethion
❑
0
35.
Ethylene diamine
❑
El
36.
Ethylene dibromide
❑
❑�
LM.
Formaldehyde
Furfural
❑
❑r
EPA Forth 3510.2C (Revised 3-19) Page 28

EPA Idenlification Number
�•
NPOES Permit Number Facky Name Outfal Number Form Approved ON&I9
NC0003344 House of Raeford -Wallace Division 001 OMB No.204D-OM
1 1
Pollutant
Presence or Absence
cnecc°ne
Reason Pollutant Believed Present in Discharge
Available Quantitative Data
(aN)
Believed
Present
Believed
Absent
39.
Guthion
❑
40.
Isoprene
❑
0
41.
Isopropanolamine
❑
El
42.
Kelthane
❑
❑r
43.
Kepone
❑
44.
Malathion
❑
r❑
45.
Mercaptodimethur
❑
❑r
46.
Methoxychlor
❑
47.
Methyl mercaptan
❑
0
48.
Methyl methacrylate
❑
49.
Methyl parathion
❑
50.
Mevinphos
❑
0
51.
Mexacarbate
❑
52.
Monoethyl amine
❑
53.
Monometho amine
❑
❑r
54.
Naled
❑
55.
Naphthenic add
❑
56.
Nitrotoluene
❑
57.
Parathion
❑
EPA Form 3510.2C (Revised 3.19) P*e 29

EPA Idenff"ton Number NPDES Permit Number Facility Name Outran Number Form Approved 03105i19
NC0003344 House of Raeford -Wallace Division 1 001 OMB No. 2040-OM
Pollutant
7Pher,.1,u'lfn.t.
Presence or Absence
(check one)
Reason Pollutant Believed Present in Discharge
Available Quantitative Data
(specify units)
Believed
Present
Believed
Absent
58.
❑
12
59.
Phosgene
❑
60.
Propargite
❑
0
61.
Propylene oxide
❑
El
62.
Pyrethrins
❑
0
63.
Quinoline
❑
Q
64.
Resorcinol
❑
E
65.
Strontium
❑
❑
66.
Strychnine
❑
67.
Styrene
❑
68.
2,4,5-T (2,4,5-trichlorophenoxyacetic
acid
❑
❑
69.
TDE (tetrachlorodiphenyl ethane)
❑
70.
2,4,5-TP j2- 2,4,54chlorophenoxy)
propanoic acid
❑
❑
71.
Trichlorofon
❑
72.
Triethanolamine
❑
73.
Triethylamine
❑
74.
Trimethylamine
❑
0
75.
Uranium
❑
76.
Vanadium
❑
EPA Forth 3510.2C (Revised 3-19) Page 30

EPA identification Number NPDES Permit Number
Facility Name QuUaY Number Form Approved 03Ni19
NC0003344
House of Raeford -Wallace Division 001 OMB No.2C40-0R74
Presence or Absence
Pollutant
check one
Reason Pollutant Believed Present in Discharge
Available Quantitative Data
Believed
Believed
Present
Absent
(meaty, urri�)
77.
Vinyl acetate
❑
❑v
78.
Xylene
❑
Q
79.
Xylenol
❑
❑r
80.
Zirconium
❑
❑r
a,,,M., y „ a„ wnuuo,cu a utuuiy w bwouenuy benbnrve rebr oroceaures (i.e., memoos) approver unrer 40 crtt tse for the analysis of pollutarts 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 31

This page intentionally left blank.

EPA IdenUficabon Number NPOES Permit Number Facility Name Outfal Number Forth Approved 03IW9
NC0003344 House of Raeford -Wallace Division 001 OMB No.2040-00%
•-011,rr All t �t
r
TCDD
Presence or
Congeners
Absence
Pollutant
Used or
check one
Results of Screening Procedure
Believed
Believed
Manufactured
Present
Absent
2,3,7,8-TCDD
11Cl
ID
EPA Form 35142C (Revised 3-19) Page 33

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ATTACHMENT 1: PERMIT APPLICATION SUPPLEMENT- PFAS SCREENING
OUESTIONS•
I, Dn x/nll me any material or prodil tC (dirt-vt1v or 1ndlrAr ly) in ynllr nrrwratinnC that
contain fluorinated chemicals? If so, please identify what materials or products contain
fluorinated chemicals. D
2. Will your facility formulate or create products (directly or indirectly) which contain
flnnrinafAA-hPm;r-*1c9 Tf en n a.aaa iilantif�r the enAr•ifir flnnrin�ta�l �hPmir�lc that macr
....w.aaa...a�r�a .r--•---•-•-•� .gay
be formulated or created. NO
3. Will your facility produce solid waste, liquid waste, wastewater effluent, or other waste
containing fluorinated chemicals? Please be as specific as possible to describe what MO
fluorinated chemicals may result in the facility's wastewater, solid waste, or sludge.
4. Are there processes or operations that use equipment, material, or components that
contain PFAS chemicals (e.g., surface coating, clean room applications, solvents,
lubricants, fittings, tubing, processing tools, packaging, facility infrastructure)? Could
these activities result in fluorinated chemicals being discharged as products, or by- f 1D
tlftNt�NrLJ �t.ti., tt!lV�l�t1: i�tfl��, merit:tt� YrCswaS, tri.i�. u+�tt:ri.tx, �n�.S�i'tit7.�ttns, wn..�;
S. List CAS numbers of all known or believed present fluorinated compounds from the
questions above. Please provide descriptions, quantities, and whether there are any
unknowns related to the above questions. AI V
6. Are there other facilities or operations in the U.S. or internationally that are identical to or
may use processes similar to the facility in North Carolina? If so, please provide facility
identification information and wastewater characterization including all PFAS
compounds? Nb
7. Additionally, have any PFAS analytical results been collected with any analytical test
method similar to the following EPA Test Methods. Are any of the fluorinated
compounds listed in one of the following methods and can you provide us with data
resulting from these test methods?
A d sly.. i CZZ D. GZ 7 1 /.7.:«l�:«
:wri.a:ttsu� rs✓ u, r.s .: t��a►:thy iwiawar
• SW-846: Method 8327 (water)
• Draft Method 1633 (water, solids, tissue)
• "Total PFAS" Draft Method 1621 (wastewater)
Ae Sc w�� �j�`� krz,-,finrf O'ce,;�r�l
D E Q�� North Carolina Department of Environmental Quality Division of Water Resources
512 North Salisbury Street 1611 Mail Service Center Raleigh, North Carolina 27699-1611
,.y^Rfi1dff. Pi<
wr� /✓ 919,707,9000

Environmental Chemists, Inc.
nvirochem 6602 Windmill Way, Wilmington, NC 28405 • 910.392.0223 Lab • 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 • 252.473.5702 Lab/Fax
255-A Wilmington Highway, Jacksonville, NC 28540 • 910.347.5843 Lab/Fax
ANALYTICAL & CONSULTING CHEMISTS [e-mail]
House of Raeford -Wallace Facility Date of Report: Jun 27, 2023
PO Box 669 Customer PO #:
Wallace NC 28466 Customer ID: 13030026
Attention. Report #: 2023-10774
Project ID: WWTP
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
23-27066 Site: Outfall 001 5/30/2023 9:25 AM Water Brad Vann
Test
Cadmium
Residue Suspended (TSS)
Ammonia Nitrogen
Total Kjeldahl Nitrogen (TKN)
BOD
Nitrate Nitrogen (Calc)
Nitrite Nitrogen
Nitrate+Nitrite-Nitrogen
Nitrate Nitrogen
Total Nitrogen (Calc)
Total Nitrogen
Lab ID Sample ID:
23-27067 Site: Outfall 001, grab
Test
Fecal Coliform
Temperature
pH
Dissolved Oxygen
Lab ID Sample ID:
23-27067A Site: Outfall 001. grab
Test
Method
Results
Date Analyzed
EPA 200 8, Rev 5 4, 1994
<0.5 pg/L
06/06/2023
SM 2540 0-2015
<2.5 mg/L
05/31 /2023
SM 4500 NH3 C-2011
0.57 mg/L
06/01 /2023
SM 4500 Norg B-2011
2.3 mg/L
05/31 /2023
SM 5210 B-2010
<2 mg/L
05/31/2023
EPA 353 2, Rev. 2 0, 1993
0.04 mg/L
05/30/2023
EPA 353 2, Rev 2 0, 1993
57.7 mg/L
05/31 /2023
Subtraction Method
57.7 mg/L
06/09/2023
Total Nitrogen
60.0 mg/L
06/09/2023
Collect Date/Time
Matrix Sampled by
5/30/2023 1:50 PM
Water JCB/envirochem
Method
Results
Date Analyzed
Idexx Colilert-18 19 MPN/100ml 05/30/2023
SM 2550 B-2010 27.9 C 05/30/2023
SM 4500 H B-2011 6.8 units 05/30/2023
SM 4500 O G 7.55 mg/L 05/30/2023
Collect Date/Time Matrix Sampled by
5/30/2023 1:50 PM Water JCB/envirochem
Method Results Date Analyzed
Oil & Grease (O&G) EPA IOU Rev 8 <5.0 mg/L 06/20/2023
Comment:
Reviewed by:
Report # 2023-10774 Page 1 of 1

Ism
ANALYTICAL & CONSULTING CHEMISTS
House of Raeford -Wallace Facility
PO Box 669
Wallace NC 28466
Attention:
Lab ID Sample ID:
23-28289 Site: Outfall 001
Environmental Chemists, Inc.
6602 Windmill Way, Wilmington, NC 28405 - 910.392.0223 Lab - 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 - 252.473.5702 Lab/Fax
255-A Wilmington Highway, Jacksonville, NC 28540 - 910.347.5843 Lab/Fax
Test Method
info+a environmentalchemists.com
Revised Report: Jul 06, 2023
Original Report Date: Jun 28, 2023
Report #: 2023-11293
Customer ID: 13030026
Project ID: WWTP
Collect Date/Time Matrix
6/6/2023 9:20 AM Water
Results
Sampled by
Brad Vann
Copper
EPA 200.7, Rev 4.4, 1994
0.014 mg/L
Cadmium
EPA 200.8. Rev. 5.4, 1994
<0.5 pg/L
Total Hardness
Sat 2340 C-2011
170 mg/L
Residue Suspended (TSS)
SM 2540 D-2015
5.5 mg/L
Total Kjeldahl Nitrogen (TKN)
SM 4500 Norg B-2011
2.3 mg/L
Total Phosphorus
SM 4500 P (F-H)-2011
9.24 mg/L
BOD
SM 621C B-2016
<2 mq/L
Sample estimated Did not meet quality control requirements. Blank= 0 32mg,,L, above acceptable limit of 0.2mg/L.
Nitrate Nitrogen (Calc)
Nitrite Nitrogen
EPA 353.2, Rev 2 0 1993
0.04 mg/L
Nitrate+Nitrite-Nitrogen
EPA 353.2,Rev 20 1993
50.6mg/L
Nitrate Nitrogen
Sy_btractior. Method
50.6 mg/L
Total Nitrogen (Calc)
Total Nitrogen
Total Ndrogen
52.9 mg/L
Lab ID Sample ID:
23-28289A Site: Outfall 001
Test
Ammonia Nitrogen
Collect DatetTime Matrix
6/6/2023 9.20 AM Water
Method
SM 450•0 NH3 C-2011
Results
Date Analyzed
06/15/2023
06/09/2023
06/20/2023
06/06/2023
06/09/2023
06/12/2023
06/06/2023
06/06/2023
06/07/2023
06/20/2023
06/20/2023
Sampled by
Brad Vann
Date Analyzed
0.57 mg/L 07/05/2023
Report A:: 2023-11293 Page 1 of 2

House of Fn ty
PO Boot 669
WON" NC 28466
Attention:
Environmental Chemists, Inc.
OWA wlnamut way, wnmingWM nL A"" • Y1V.JVA.ULLJ LAD * rax
710 Bowsertown Road, Manteo, NC 27954 • 252.473.5M Lab!Fax
255-A Wilmington Highway, Jacksonville, NC MAO • 910.3475843 Lab/Fax
infoOftavilonmentaichemists.com
Dab of Report: Jul 05, 2023
Customer PO S:
Customer ID: 13030026
Report S: 2023-11890
Lab M! Sample 0.
Collect DstelTime
Matrbc Sampled by
23 29997 Site: Oufall 001
6/13/2023
9:10 AM Water Brad Vann
Test
Method
Results Dab Atalyzed
Cadmium
EPA 2Ma• Rev. 0.4. 1N4
<1 NgIL
06/2&2023
Residue S (TSS)
eM 2M 0-2015
<2.5 mg/L
06/13/2023
Ammonia Nibogen
sM 4M NM c-2011
0.67 mglL
06/14/2023
Y-0-4 PrWkI\
A"'AAfk1A4tmN-'X11�
BOD
sM me "is
42 moll
0614/2023
Mtrab Nitrogen (Caic)
Nr*ft Nitrogen
EPA M 2, Rev.10. iM
< 0.02 mg/L
06/13/2023
N&M*+N***-K%knc t.An
EPA 3W 2 Rev 2 0. HM
S t1 rrtclll_
M— I V# 7f 123
Nye Nitrogen
sAeaaaion I m
54.0 mg/L
06/27/2023
TOW Nftnopen (Caic)
Total Nkow
TOM Ntropwl
55.2 mgl1.
OW27/2023
Lab ID Semple ID:
Collect DaielTinte
Matrix Sampled by
L./'4L47WWW %riff. vwwew wr, view
%N iJfLYLJ
14•Y4 f M VTMIM J OcM#V*UWIVOII
Test Method Results Dab Analyzad
t.e..,., r4p-4.10
Ternswatune sM 2550 e-2010 29.7 C 06/112023
PH sM 4500 H 620il 6.6 units 06/13=3
Dissohrad Oxygen sM 4b00 0 0 7.31 mglL 06/13/2023
1 *I% tits q0%. 11a!.A.- A.....{ww %-
23-29999 Site: UP$bwn 6/13/2023 1.00 PM Water JCB/envtrochem
Tat Method Result Dab Analyzed
Conckmbft EPA IM 1. Rev wart 146lxnhoslcm 06/14rM3
I t�rrt{xrt Ilgltt3 •,••• •."•,• �-<� •" L4.Y L tJtN l 3ILUL3
pH SM 4M H e-2011 6.0 units 06/13J2023
Reports-* 2tt33.11OW Pepe 1 of 2

Environmental Chemists, Inc.
tbU[ WlnCIM111 way, Wilmington, M- Z64U, - VIU-WZ.UYL.i Lao • NIU-M."m raX
VIEW-`
710 Bowsertown Road, Manteo, NC 27954 v 252.473.5702 Lab/Fax
`
255-A Wilmington Highway, Jacksonville, NC 28540 a 910.347.5843 Lab/Fax
ANALYTICAL. A CONNA71101 CHEMISTS
info ,e.environmentakhernists com
Howse of Raeford -Wallace Facility Date of Report: Jul 10, 2023
PO Box 669
Customer PO 0:
VhNaoe NC 28466
Customer ID: 13030026
Attention:
Report Il`: 2023-12735
Lab ID Sample ID:
Collect Daterrime Matrix Sampled by
23-31796 Site: Ot" 001
6/21/2023 9:10 AM Water Brad Vann
Test
Method Results Date Analyzed
--- _ _---
Cadmium
EPA 200 8 R1w 5 4 1984 < 1 IIg/L M28/2023
Residue Suspended (TSS)
SM 2W 0-2015 <2.5 mg/L 06/22/2023
Ammonia Nitrogen
SM 4500 NM C-2011 0. 57 mg/L 06/26/2023
T04 Xk 04 (Tkw,)
SM 45W UMq 13.2011 7 A --x Ene r�nrsn
BOD
SM $21011-2018 <2 mg/l. 06/21/2023
Nitrate Nitrogen (Cale)
Nitrite Nitrogen
N drate+Ndrite-N itroow
Nitrate Nitrogen
Total Nitrogen (Cale)
Total Nitrogen
Lab ID Sample ID:
r-%" r i of aftw: vu4601+ %v r , yp au
EPA 353 2, Rev 2 0. 19W
EPA 353.2, Rev 2.0, 1993
Subtrwbon Wiliod
TOW NAmW
Test Method
0.06 mg/L 06/21/2023
7n I mn/I 06/22/2023
70.2 mg/L 07t07/2023
73.7 mg/L 07/07/2023
Collect DatefTtreee Matrix Sampled by
WA9 114uza 1 1: 1U Am Yvatter jt;cuemnrocnem
Results Date Analyzed
Temperature SM 2500 8-2010 29.7 C W21/2023
pH SM 4500 H B-2011 6.9 units W21/2023
Dissolved Oxygw SM 4500 0 c 7.03 mg/L 06/21/2023
23-31798 Site: Upstream 6/21/2023 11:25 AM Water JC61w4irochem
Test Method Result Date Analyzed
CWXluCbvity EPA 120.1, Rev 1982 145 WnhoSlem 06r26M23
t envwawre :NMa-&V,U 22.5 C 06/21/2023
Dissolved Oxygen SM 4500 0 a 5.11 mg/L 06/21=3
Report! 2023-12735 , Pao Id2

,,,envirochem
4
ANALYTICAL & CONSULTING CHEMISTS
House of Raeford -Wallace Facility
PO Box 669
Wallace NC 28466
Attention:
Environmental Chemists, Inc.
6602 Windmill Way, Wilmington, NC 28405 • 910.392.0223 Lab • 910,392.4124 Fax
710 Bowsertown Road, Manteo, NC 27954 • 252.473.5702 Lab.`Fax
255-A Wilmington Highway, Jacksonville, NC 28540 • 910.347.5843 Lab, -'Fax
info -a environmentalchemists.com
Date of Report: Jul 14, 2023
Customer PO #:
Customer ID: 13030026
Report #: 2023-13370
Project ID: WWTP
Lab ID Sample ID:
23-33280 Site: Outfall 001
Test
Collect DaterTime
6/28/2023 9:10 AM
Method
Matrix Sampled by
Water Brad Vann
Results Date Analyzed
Cadmium
EPA200.8. Rev, 5.4, 1994
<1 ug/L
07/05/2023
Residue Suspended (TSS)
SM 2540 D-2015
<2.5 mg/L
06/29/2023
Ammonia Nitrogen
SM 4500 NF13 C-2011
1.72 mg/L
07/03/2023
Total Kjeldahl Nitrogen (TKN)
SM 4500 Norg B-2011
1 7 mg/L
07/06/2023
BOD
SM 5210 B-2016
<2 mg/L
06/28/2023
Nitrate Nitrogen (Cale)
Nitrite Nitrogen
EPA 353.2, Rev. 2.0, 1993
0.03 mg/L
06/28/2023
Nitrate;Nitrite-Nitrogen
EPA 353 2, Rev 2.0, 1993
55.2 mg/L
06/29/2023
Nitrate Nitrogen
sutxracbon MethM
55.2 mg/L
07/14/2023
Total Nitrogen (Cale)
Total Nitrogen
Total Nitrogen
56.9 mg/L
07/14/2023
Lab ID Sample ID:
Collect DaterTime
Matrix Sampled by
23-33281 Site: Outfall 001, grab
6/28/2023 11:15 AM
Water JCB/envirochem
Test
Method
Results
Date Analyzed
Oil & Grease (O&G)
EPA 1664 Rev 8
<5.0 mg/L
07/08/2023
Fecal Coliform
ttlexxColitert-18
<1 MPN/100ml
06/28/2023
Temperature
SM 2550 B-2010
31.2 C
06/28/2023
pH
SM 4500 H B-2011
7.2 units
06/28/2023
Dissolved Oxygen
SM 4500 o G
7.38 mg/L
06/28/2023
Lab ID Sample ID:
Collect DatelTime
Matrix Sampled by
23-33282 Site: Upstream
6/28/2023 11:30 AM
Water JCB/envirochem
Test
Method
Results
Date Analyzed
Conducbvity
EPA 120.1. Rev 1982
135 pmhos/cm
06/3012023
Temperature
SM 2550 B-2010
25.4 C
06/28/2023
Dissolved Oxygen
SM 4500 0 G
5.30 mg/L
06/28/2023
Report x . 2023-13370
Page 1 of 2

envirochem
ANALYTICAL & CONSMLTINO CHEMISTS
House of Raeford -Wallace Facility
PO Box 669
Wallace NC 28466
Attention
Lab ID Sample ID:
23-34543 Site: Outfall 001
Test
Cadmium
Residue Suspended (TSS)
Ammonia Nitrogen
Total Kjeldahl Nitrogen jKN)
BOD
Nitrate Nitrogen (Calc)
Nitrite Nitrogen
Nitrate+N itrite-Nitroge n
Nitrate Nitrogen
Total Nitrogen (Calc)
Total Nitrogen
Lab ID Sample ID:
23-34544 Site: Outfall 001, grab
Test
Oil & Grease (OBG)
Fecal Coliform
Environmental Chemists, Inc.
6602 Windmill Way, Wilmington, NC 28405 - 910.392.0223 Lab - 911' 392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 - 252.473.5702 Lab. Fax
255-A Wilmington Highway, Jacksonville, NC 28540 - 910.347.5843 Lab Fax
info;a envtronmentalchemists.com
ti
Date of Report:
Jul 21, 2023
Customer PO #:
Customer ID:
13030026
Report #:
2023-13864
Project ID: WWTP
Collect Date/Time Matrix
Sampled by
715/2023 9:00 AM Water
Brad Vann
Method
EPA 200 a Rev 5.4 1994
SM 2540 0-2015
SM 4500 NH3 C-2011
SM 4500 Nag B-2011
SM 5210 B-2016
EPA 313 2 Rev 2 0 1 +'
EPA 3532 Rev 20 1+9
Subbacton Method
Results
Date Analyzed
<1 pg/L
07/12/2023
<2 5 mg/L
07/07/2023
1.15mg/L
07/11/2023
1.7 mg/L
07/07/2023
<2 mg/L
07/06/2023
0.02 mg/L
07 06/2023
71.3 mg/L
0711012023
71.3 mg/L
07/21/2023
Tota Ndrogen 73 0mg/L 07/21/2023
Collect Daternme Matrix Sampled by
7/5/2023 2 10 PM Water JCB/enwrochem
Method
EPA 1604 Rev 6
10enc ca tart-18
Lab ID Sample ID:
23-34545 Site: Upstream
Test Method
Conductivity
Lab ID
23-34546
Test
Conductivity
sample lu:
Site: Downstream
Results Date Analyzed
<50mg/L 07/11/2023
<1 MPN/100ml 07/05/2023
Collect Date/Time Matrix Sampled by
7/5/2023 2 25 PM Water JCB/envirochem
Results Date Analyzed
EPA 120 1 Rev 1982
Coiled Date/Time Matrix
7/5/2023 2 35 PM Water
Method
EPA 120 1 Rev 1982
155 umhos/cm 07/07/2023
Sampled by
JCB/enwrochem
Results Date Analyzed
510 Nmhos/cm 07/07/2023
Report 2 2323 138U Pape 1 of 2

Adddl -
ANALYMAL d CONBLUM CHEMIM
Mouse of Raeford4ftilace Fat::ilky
PO Box NO
Wallace NC 28486
Attention:
Environmental Chemists, Inc.
%MVd. V VU"U & •ray, V VLUALu%any iv%. •.o=w • �LV..JYA.vA.0 a.av r Ya%O ✓PYA -Vmwz a aw
710 Bowsertown Road, Manteo, NC 27954 . 257.4733M Lab/Fax
255-A Wilmington Highway, Jacksonville, NC 28540 . 910-347—%0 Lab/Fax
info*xovironmentalchernism m
Date of Report: Aug 16, 2023
Cudomw PO #-
CV$tN riD: 13030026
Report ak 2023-14210
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
23..35334 Sib: OUftN 001 7/10/2023 8:53 AM Water Chris Murray
Test Method Results Date Anafyzml
CadrllHAn
EPA 200.6. Rev 5.4, 190
<1 Pg
Residue Suspended (TSS)
sM 2UO D-2015
2.9 mglL
Ammonia Nitrogen
sM 4500 twat c-2011
0.57 mg/L
Teftl KieldW Nilresaen (TKN)
sM 45M NM B-2011
7.4 mall
l300
lOtt 5410 8-2016
sample esrinalsd. OW not meet qualdy
contra requmnen:e: Blank= 0.2a3rnWL,
above acceptable Nrnit 010.
Nitrate Nitrogen (Cale)
Nitrite Nitrogen
EPA 30 2 Rev 2.0. IM
0.14 mg/L
Nitrate Nitrogen
Total Nkarogen (Cale)
Total Nitrogen
23-36335 Sib: OWN! 001, grab
Test
67.1 mg/L
07/12/2023
07/11/2023
07/12/2023
07/1612023
07/10/2023
07/11/2023
M16/2023
TOM Wftw 74.6 m91L 08116/2023
plc. .r a - Irv• nF_ - = a_.__ _A_33__.
7/10/2023 10:35 AM Water JCB/envirochem
Method Results Date Analyzed
00 S Gres" (O&G)
EPA 1e64 Rw a
<5.0 mg/L
07/19/2023
Fecal Coliform
klmCOtlen-le
1 MPW100m1
07/10=3
Temperature
sM 2NO e-2010
31.0 C
07/10=3
pi.l
sM 45M H e-2011
6.5 units
07/10=3
Owed Oxygen
sM 4500 o c
6.90 mg/L
07/10/2023
R*W t 2023-U210 Pape 1 d 2

_
envirochem
•.r
ANALYTICAL d CONSULTiNG CHEMISTS
House of Raeford -Wallace Facility
PO Box 669
►Ar ,t�-,,.,c, Air 7Q.A.PA
Attention
Lab ID Sample ID:
23-38019 Site: Outfall 001
Tom,
6602 Windmill Way, Wilmington, NC 28405 • 910.392.0223 Lab - 910.392.4424 Fax
710 Bowsertown Road, Manteo, NC 27954 • 252.473.5702 Lab/Fax
255-A Wilmington Highway, Jacksonville, NC 28540 • 910.347.5843 Lab Fax
info,,j env ironmentalchemists.com
Date of Report: Aug 03, 2023
Customer PO #:
M. IInInr1?R
Report #: 2023-15379
Project 10: WWTP
Collect Date/Time Matrix Sampled by
_�
7/18/2023 9.10 AM Water Brad Vann
Cadmium
EPA 2008 Rev 54 1994
<1 pg/L
07/21/2023
Residue Suspended (TSS)
SM 2540 D-2015
<2.5 mg/L
07/20/2023
Ammonia Nitrogen
SM 4500 NH3 c-2011
<0.1 ma/L.
07/26/2023
..... .,..,.,,........,,y..,, .....,
- ...y,
—I_V1 ...
BOD
Sample Did
SM 5210 B-2016
23
<2 mg/L
07/19/2023
est mated not meet quality control requirements blank= 0 mg/L above acceptable limit of 0 0 mg/L
Nitrate Nitrogen (Cale)
Ni►rvtp Nilrnnon
EPA 353 2 Rev 2 0 1993
n 09 mn/I
07/19/2023
Nitrate+Nitnte-Nitrogen
EPA 353 2 Rev 2 0 1993
51.1 mg/L
07r25/2023
Nitrate Nitrogen
Subtraction Method
51.1 mg/L
08,03/2023
Total Nitrogen (Cale)
Total Nitrogen
tal N tr San
52.5 mo/L
08/03/2023
Lab ID Sample ID:
Collect Date/Time
Matrix Sampled by
23-38020 Site: Outfati 001, grab
7/18/2023 2 25 PM
Water JCB/envirochem
Test
Medicid
Results
Date Analyzed
Reporting' lmR elevated due to insufficient sample volume
Fecal Coliform
Idexxco!bm-18
<1 MPN/100ml
0718/2023
Temperature
SM 2550 B-2:1%
31.3 C
0718/2023
PH
SM 4500 H 8-201
6.2 units
07/18/2023
vaaurotru UxyytNl
o.Od mgrt_
U111tuzuZ15
ROW! 2023 15379 Page 1 of 2

ANALYTICAL & CONSULTING CHEMISTS
Environmental Chemists, Inc.
bbUL Wtnamtll Way, Wilmington, Nil. 264U� O 4IV.3VZ.ULLJ Lab - 91U-392.44Z4 hax
710 Bowsertown Road, Manteo, NC 27954 Y 252.473.5702 Lab/Fax
255-A Wilmington Highway, Jacksonville, NC 28540 • 910.347.5843 Lab/Fax
info.a environmentalchemists com
House of Raeford -Wallace Facility Date of Report: Aug 11, 2023
PO Box 669 Customer PO #:
Wallace NC 28466 Customer ID: 13030026
Attention: Report #: 2023-15946
I-roject lu: ww I P
Lab ID Sample ID: Collect Date/Time Matrix Sampled by
23-39351 Site: Outfall 001 7/24/2023 9:30 AM Water Brad Vann
Test
Method
Resi,Its nx-to Analwed
Cadmium
EPA 200.8. Rev. 5.4, 1994
<0.5 pg/L
08/02/2023
Residue Suspended (TSS)
SM 2540 D-2015
<2.5 mg/L
07/24/2023
Ammonia Nitrogen
SM 4500 NH3 C-2011
1.44 mg/L
07/30/2023
BOD
SM 5210 8-2016
3 mg/L
07/24/2023
Sample estimated. Did not meet quality control requirements; Blank= 0.21nV1, above acceptable limit of 0.2mg/L.
Nitrate Nitrogen (Cale)
Nitrite Nitrogen
EPA 353.2. Rev 2 0. 1993
0.02 mo/L
07/24/2023
Nitrate+Nitrite-Nitrogen
Ct'A aos.2, Kev 2 u. i»vs
63.9 mg/L
08/01/2023
Nitrate Nitrogen
subtraction MetW
63.9 mg/L
08/11/2023
Total Nitrogen (Caic)
Total Nitrogen
TOW Nitrogen
67.5 mg/L
08/11/2023
►YN YY/ VYYIYI'YY>Y Y✓•
V�I{IOH✓{{{�r/ 1 {IIIO
IV{d�{{A Y'Vd11{#0MU yy
23-39352 Site: Outfall 001, grab
7/24/2023 2:15 PM
Water XWenvirochem
Test
Method
Results
Date Analyzed
I)iI
Fecal Coliform
IdexxCoilert-1e
<1 MPN/100ml
07/24/2023
Temperature
SM 2550 B-2010
31.6 C
07/23/2023
pH
SM 45M H B-2011
6.8 units
07/23/2023
r'4ggMKMd riY nan
SM4.5M0G
Q ?14 -rtr1
RAW 6 2023-1 SM Pape 1 012

. k
S,
f
A
i.PArt
. IN'

17jM Technologies Inc.
W Disinfection Systems
' 1997
AARV
ENVIROAMENT4
• is'r'w 30 r wa a
LUFORBUSINESS �OF°ON CO ME�"RC�E
RECEIVED
SEP 2 0 LU23
PERFORMANCE GUARANTEE NCDEQ/DWR/NPDES
TROJAN TECHNOLOGIES, INC. certifies to—13UiTEREAtt WALLACE,
NC - that the UV3000TM' DISINFECTION EQUIPMENT supplied will disinfect
to the limits of c 400 FECAL COLIFORM based upon a 1 Day MAXIMUM
provided the following criteria is upheld.
PEAK FLOW - 1.50 MGD
• SUSPENDED SOLIDS - c 5 MG/L 30 DAY AVERAGE
•
UV TRANSMISSION Q 253.7 nm - 65 % MINIMUM
This performance guarantee is also contingent upon proper care and
maintenance of the unit as detailed within the Operation and Maintenance
Manual.
3 March, 1998
Kevin Wylie
Senior Submittal Co-ordinator
3020 Gore Road, London, Ontario, Canada N5V 4T7 - Tel, [phone] - Fax: [phone] • Internet: htip://www.trojanuv.cam

9
TROJAN O" 3000 PLUS u
PROPOSAL FOR THE HOUSE OF RAEFORD - WALLACE, NC
QUOTE: MW-212718
04/13/2017
The TrojanUV3000P1us�'is operating in over 2000 municipal wastewater plants around the world.
Disinfecting over 17 billion gallons a day, the Trojan UV3000PIusI'll has become
the reference standard in the industry.
i
A
4P

TROJAN IUV3000PLUS'
April 13, 2017
In response to your request, we are pleased to provide the following Trojan LIV3000PIus Tm proposal for the
1 I/ . .r1 nr P w rr� r % . I w r I A nr
TYV.7v C r- MMC-%_"1kL/ - VVMLC L1A%,Project.
.
The TrojanUV3000P1usTm has been shown in over 2000 installations to provide dependable performance,
simplified maintenance, and superior electrical efficiency. As explained in this proposal, the system incorporates
innovative features to reduce O&M costs, including variable output electronic ballasts to provide dimming
capability and Trojan's revolutionary ActiClean-WW m system — the industry's only online chemical and
morhanirnl ni rart7 claava rlaaninn cvtm All Trninn inctaliatinnc aro ce innnrtori by a ninhal nafiernrk of r-artifiorl
.-._..;..._...__._-.__e_......,-js-e.... .._a_....._... .. .. r� .. �. __...�..._... �.�..
Service Representatives providing local service and support.
Please do not hesitate to call us if you have any questions regarding this proposal. Thank you for the opportunity
to quote the TrojanUV3000Plus-rm and we look forward to working with you on this project.
With best regards,
Michael Shortt
3020 Gore Road
London., Qntario N5V 4T7
Canada
(519) 457 — 3400 ext. 2112
mshortt(d)troianuv.com
DESIGN CRITERIA
HOUSE OF RAEFORD - WALLACE
Local Representative:
Shane Eckley
EW2 Environmental, Inc.
7245 Pineville -Matthews Road, Spite 109
Charlotte, NC
US
704-542-2444
n__i1
i-iPO^ LAZS, �f.4t f tk*W.
1 w r r.mi+n
i. # MNt7Y
UV Transmittance:
65 % (minimum)
Total Suspended Solids:
5 mg/I
200 Fecal Coliform per 100ml, based on a 30 day average of consecutive
Disinfection Limit:
samples.
400 Fecal Coliform per 100 mil, based on daily maximum
Validation Factors:
end of lamp life factor (Low -Pressure Amalgam Lamps)
fouling factor ActiClean-WWTM Chemical / Mechanical Cleaning System)
Redundancy:
100% at Peak Design Flow
House of Raeford - Wallace .2. MW-212718
04/13/2017

TROJAN 0ii3000PLUS
DESIGN SUMMARY
QUOTE: MW-212718
Based on the above design criteria_ the TroianUV3000P1usT"° nronosed consists of:
CHANNEL (Please reference Trojan layout drawings for details.)
Number at Channels:
1
Approximate Channel Length Required:
50 ft (existing channel length)
Channel Width Based on Number of UV Modules:
9 in (existing channel is 15 in wide)
Number of 6 in wide Stainless Steel Channel Reduction
RafflPc-
2
Channel Depth Recommended for UV Module Access:
42 in (existing channel depth)
UV MODULES
Total Number of Banks:
2 (1 duty, 1 redundant)
Number of Modules per Bank:
3
Number of Lamps per Module:
6
Total Number of UV Lamps:
18 (including redundancy)
Maximum Power Draw:
4.5 kW
[IV PANELS
Power Distribution Center Quantity:
2
System Control Center Quantity:
1
MISCELLANEOUS EQUIPMENT
Level Controller Quantitv:
1
Type of Level Controller:
Weighted Gate (ALC)
Automatic Chemical / Mechanical Cleaning:
Trojan ActiClean-WWTm
UV Module Lifting Device:
Davit Crane
otanaaro Spare Parts % Safeiy tquipmem:
tttClUi#eti
ELECTRICAL REQUIREMENTS
1. Each Power Distribution Center requires an electrical supply of one (1) 208V / 60Hz, 5 kVA
2. The Hydraulic System Center requires an electrical supply of one (1), 208V (60 Hz), 2.5 kVA.
3. The System Control Center requires an electrical supply of one (1) 110-240V 1 Ph, 2 Wire + Grid, 50/60
Hz, 15 Amps.
4. Electrical disconnects required per local code are not included in this proposal.
House of Raeford - Wallace -3. MW-212718
04/13/2017

TROJAN W3000PLUS
COMMERCIAL INFORMATION
Total Capital Cost: $166,000 (USD)
This nrir.P PxrludPs nnv taxes that may hp annlirahlP and is valid for 9n days from the date of this letter
EQUIPMENT WARRANTEES
1. Trojan Technologies warrants all components of the system (excluding UV lamps) against faulty
workmanship and materials for a period of 12 months from date of start-up or 18 months after shipment,
whichever comes first.
2. UV lamps purchased are warranted for 12,000 hours of operation or 3 years from shipment, whichever
comes first. The warranty is pro -rated after 9,000 hours of operation. This means that if a lamp fails prior
to 9,000 hours of use, a new lamp is provided at no charge.
3. Electronic ballasts are warranted for 5 years, pro -rated after 1 year.
House of Raeford - Wallace - 4 - MW-212718
04/13/2017

TROJA N W3000 PLUS"
EQUIPMENT INTERCONNECTIONS
DEscR an '
POWER DISTRIBUTION CENTER WDO) OSTMBUrpN P?NEC UDC
POWER SUPPLY Z) (BY OTHERS)
208T/12DV. 3 FUSE. 3 WIPE s GRLUND (NOT SHOWN)
4.6 YVA/PDC POWER DRAW
12.E AMPS -- CURRENT/RHAS/
'CCLOCAROM TO BE DETERMINED 2 SYSTEM CONTROL CENTER (BCC) II V:H SWRI' pSTRIBUnON PANEL `.00
(II'VERFACE SRE i0 BE POWER SUPPLY (DR) (BY OTHERS)
POSRIONED ]VAY FROM THE SUN) i10-2AUV, PHASE. 2 WIRE a cR%ND (NOT SHOWN)
1.3E-13— 1NPS, 0.1] WA
3 HYDRAULIC SYSTEMS CENTER (HSC) DISTRIBUTION PANEL ISO
L A POWER SUPPLY IDPI (BY OTHERS)
LOCI OVEM.f'MPENT PROTECTNWN 20EV. ] EASE, 3 WwE a CPOUNO. L.5 wA (NOT SHOWN)
DEVICE (Bt OTHERS) (1YPILAL) ROW METER FLOW LETER PANEL `CC
W-20 mA `CC ANALOG ABUT (NOT SHOWN)
.FETE PAO HSCOTHERS) (BY OTHERS)
HANDRAIL 50" MINU LB' RADIUS FOOTPRINT RE00WED -: 2 A' 5 GROUND LNN SOO TDC(.) THRV ISO
MO NO ALL: 112• MAxIMUI' RADVS FOUR (W) 1/2'0 t AWO TYPE TWN STFpN0E0 fDUSY CHAINED)
(BY OTHERS) KIOMAM LEVEL CONTROLLER (AC) (SEE CRMIE NOTE) ANCHORS REQURED 3 I 8 MOOBVS SCC IDC(s) THRU F5C
M'OW NJCHORS RE011NRED I SHIELDED TWTSTFD PAW (7ASY —.M)
(N)TE: SELL WATER-nCHT m 5 B
CFMNEL WITH GROUT (BY OTHERS)) �LSa50 �LEVEL' _ ITT n 5 6 .W HYDRAULIC LINE DLtrNG COHOTI [R V J DISCRETE LOW LEVEL SIMAL LOW LEVEL SENSOR •DCG) (DAISY CHAFED)
5 B (BY OTHERS) (TYPICAL) 12 NEC
O 2 CONDUCMRS
+EFANA.1B iBIAHK 1
A - - - ® ® NOTES:
V. DO NOT SLOPE CHANNEL FLOOR.
CHANNEL WIDTH k DEPTH- MUST RE KEPT WITHINA TOLERANCE CF a OR - X•.
: ANCHOR BOLTS ARE NOT "UPPLED BY TRO]AN TECHNOLOGIES.
—1I'-2• t3'-A'— SYSTEM CONDUIT. WIRING. )STFUBURON PANELS h INTERCONNECT ONS BY OTHERS.
REMOVABLE GRAIN: ELECTRICAL REOUIREAIENTS SHOWN ARE TO SUPIAN PLY TF W 0OPNENT ONLY.
(TYPICAL) 22•-M(• OVERW LENGTH OF 8' SIAIMESS STEEL CHY NEL REDUCTION BAFFLE ELECTRICAL INRUSH FAMR TO BE ADDED AS PER LOCAL CODE
'�
REMOVABLE CRATING SEC O-INS SHALL BE EASILY REMOVED BY OAE PERSON. MA%IMUM
2-0' TO EDGE OF WEIGHT OF THE SECTION(Y SHALL BE IN ACOOROMCE WITH REO,IIREIMENTS OF THE
LOW LEVEL SENSOR APPLICABLE JURISDICTION•
MODULE SUPPORT RACK : CONTRACTOR TO RENEW AL TROJAN 1-NOLOCIES NSTALUNOH IN5TRUCTIONS PRIOR
}ScpA�L�EyAN VIEW (501 TO EOUIPNFNT IKTAI-LATII'N.
CPANi S SHWH15E INSTALUTION IS THE CONN RACiOR•5 PESPONSIBIUTY. 7.,...mc.ANNE1
QiE2�EF LEYB! �I�E IEFIECf HTOPMAICS ASS06O® NTR TROMM EOINEMfRECOWEND5 CONSULTING A CML 9CFINEER OR OTHER QUALIFIED PROMSSONAL plY. FFFLARIR 1X AB 1E BE ALIENED O B ro 134 TYR DR P IP RAFEDETRY.ORLOW IIEED1117EO OLIX W HE U M m E OPEN 7WS (8. I'E]EDMIID) mAVOW IRUN IME EN HE OF T1E IN IIOOIW IBOTTOM OF LEVEL HBOCOMWR RUN EMIRM FE6AO POC(M) B TH NI V-0' IONE PROBE Ii TO BE CUT -SENSOR TO BE1 Vfll)FIlR1G aNm E MOTE 11WM 1'-0• ELQY POC MOlA/FN0
AT APPROl<RIATE LENOM INSTALLED AT EL=103, WO' ELEVATION TO PREVE7TT Nk PU1P FLOOD04.
BY TROJAN TEL aaIM ONLY "� TIXFNV/CE AT AIC IB CW*GL WIDTH ♦1•.(TOP •. F TOP LAMP) S m PRO" ASROVE (QIREIEEIED) NX'1NOR POFl19FORm U9E
AS PART OF T)EIR FALL IESTRVFR SYSTE]IAA= OPEN CIAAF VELA TIE ANCHOR
CENTERUJE OF BOLT POFOS MUST E POWMED 50 THAT THE REFEREED RETRACT OE VII1NE OF E
FTIT IS OF SIIFFImIR 6.71GTN m ACCESS THE 'WORT ATM IWNEL.
2 POINT FLOOR DEPTH MOUNTING BOLTS ME RECOMMEXt ED
�- TO E LOCATED ON THE CENTER 31
LIFTING FRAME 8' RECAMENDED
A THE SLOTS TO MUNTAIN ADJUSTA LITT.
SHOEMODLILE :
UPN'1G FRAME TO TO SCALE
(iVIICK)
DETAIL B
POC "f HYDRAULIC MANIFOLD SCALE: NOT TO SCALE
S14 (6) 1/2-. ANCHORS ROD
PEOURED (xRICK) FFFE NC CONDUIT ENTRANCE -\
8' STAWWi55 STEEL CFMNIEL _ REAWABLE OMRXC
PEOUCTKN BAFFLE I. 8-WA TROJMW3000PW5 I
'�' HME AIL MOUND ULE ] REWIRED / MODULE SUPPORT NALNit AlC :BrOTHERS) AUTOMATIC LEVEL BANK(TYC X) (121 1/2•. pNCIgRS WOUeiCONTROLLER (KOI E FOU' N (BY o FOR/ RF BAN% (IWIGL)WU(IMUM CABLE FOUTWG (BY OTHERS)/ EXLSTRAi ROW
DOWNSTPEW ITYPIGL) CONORIONER
N4-100.75REGUUTEO UPSTRF/VA
WL�t02.A2• WL�102.E5'
�t
EKS11NO
CONCRETE PAD
I ism 7C p
�T xISTNC NOTCH
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