NCG060168_COMPLETE FILE - HISTORICAL_20180924

STORMWATER DIVISION CODING SHEET
NCG PERMITS
PERMIT NO.
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DOC TYPE
HISTORICAL FILE
❑ MONITORING REPORTS
DOC DATE
❑ r-� Om 0 5 a
YYYYMMDD

RAMB &L
September 17, 2018
Via Federal Express
Laura Alexander
Stormwater Permitting Program
North Carolina Department of Environmental Quality
217 West )ones Street
Raleigh, NC 27603
RE: NOTIFICATION OF NAME CHANGE
KSLB HOLDINGS, LLC
110 SARA LEE ROAD
TARBORO, NORTH CAROLINA
STORMWATER PERMIT NO. NCG060168
Dear Ms. Alexander:
ENVIRONMENT
r & HEALTH
V
DECEIVED
SFP 2 n 2U
0ENR-LAND QUALITY
STORMWATEP, PERMITTING
Ramboll US Corporation has prepared this letter to notify the Department of Ramboll
Environmental Quality of a name change for the above -referenced facility. The new 101 Carnegie Center
Suite 200
name for the facility is Sara Lee Frozen Bakery, LLC. There is no change in ownership Princeton, NJ 08540
related to this name change. Attached please a signed and notarized State Stormwater: USA
Permit Information Update Application Form, as well as documentation of the name T [phone]
change. Ramboll understands that there is no fee associated with the name change. F [phone]
www.ramboll.com
If you have any questions or need further information, please feel free to call me at 609-
243-9816 or email me at [e-mail].
Sincerely,
Thomas V. Fusillo
Principal
Attachment

ATTACHMENT A
State Stormwater: Permit Information Update Application Form

STATE STORMWATER:
PERMIT INFORMATION UPDATE APPLICATION FORM
There is NO FEE for updating project name or permittee information.
RECEIVED
3FP 2 A 2J Ej
DENR-! AND QUALITY
This form is to only to be used by the current permittee to notify the Division of STQRI `'ATER PERA41TTING
1) changes to the Point of Contact (signing official) for the current permittee (LLC, Corporation, HOA or POA);
2) changes to the mailing address, phone number or email address of the current permittee;
3) changes to the name of the project, and
4) changes to the legal corporate name as documented by a Name Change or Merger filed with the NCSOS.
A. NEW PERMIT INFORMATION
State Stormwater Permit Number: NCG060168
Are you updating
(check all that apply):
If so, please provide the updated information:
❑ Project name
® Corporation Name'
Corporation name has been changed to Sara Lee Frozen Bakery, LLC from
KSLB Holdings, LLC. There is no ownership change associated with this name
change.
❑ Permit Contact Namez .3
❑ Permit Contact Title
❑ Mailing Address3
❑ Phone number
❑ Email address
Provide documentation such as a Name Change / Merger filed with the NCSOS.
Provide supporting documentation such as NCSOS filing. The permit contact's position must be in accordance
with 15A NCAC 02H .1040(1).
If more than one point of contact or mailing address is being changed, please attach a separate sheet.
B. CERTIFICATION OF PERMITTEE
I, Bartlett Harwood IV , the current permittee, hereby notify DEMLR that I am making the
changes as listed in Section A above. I further attest that this application for an update to the permit information currently
on file is accurate and complete to the best of my knowledge.
Signature: Date:
I, AN N stevt5�>-7 _ , a Notary Public for the State of M3(V YOgf:-� _
County of G510406T6`?- _,do hereby certify that
personally appeared before me this the 3 day of 20 16-, and acknowledge the due
execution of the forgoing instrument. Witness my hand and official seal,
(Notary Seal)
L
Notary Signatu J Lop,, v/ -
My commission expires
Stormwater Permit Information Update Form Page 1 of 1
MarrAnn Sievert
Notary Public, State of New York
No. 04 S16045090
Clualified in Putnam County
Certified in Westchester County
Commission Expires July 24, 20Q2
May 11, 2017

Delaware Page 1
The First State
I, JEFFREY W. BULLOCK, SECRETARY OF STATE OF THE STATE OF
DELAWARE, DO HEREBY CERTIFY THE ATTACHED IS A TRUE AND CORRECT
COPY OF THE CERTIFICATE OF AMENDMENT OF "KSLB HOLDINGS, LLC",
CHANGING ITS NAME FROM "KSL,H HOLDINGS, LLC" TO "SARA LEE FROZEN
BAKERY, LLC", FILED IN THIS OFFICE ON THE TWENTY—THIRD DAY OF
AUGUST, A.D. 2018, AT 12:38 O'CLOCK P.M.
1
6896468 8100
SR# 20186321016
You may verify this certificate online at corp.delaware.gov/authver.shtml
Authentication: 203300933
Date:08-23-18

STATE of DELAWARE
CERTIFICATE OF AMENDMENT
OF
CERTIFICATE OF FORMATION
OF
KSLB HOLDINGS, LLC
August 23, 2018
Stite of Ddiw&re,
Secretar4 of State
DtvWon "of Corporltlons
DeWemd 12:38 PA108J23J2018
FILED 11:38 PA1080 018
SR 20186321016 - ReSnmber 6896468
RECEA��
oSFP 2 4 2�; )j
DCNR-LAND QUALITY
STORM L� (ATER PE�M1i7'dt�.f^
The undersigned, desiring to amend the Certificate of Formation of KSLB Holdings, LLC
(the "Company') pursuant to the provisions of Section 18-202 of the Limited Liability Company
Act of the State of Delaware (6 Del,C. § 18-101, et s_g.), as amended from time to time, does
hereby certify as follows:
(1) The name of the limited liability company is KSLB Holdings, LLC.
(2) The Company was formed upon the filing of its Certificate of Formation with the
Delaware Secretary of State on May 22, 2018.
(3) The Certificate of Formation of the Company is hereby amended as follows:
"(1) The name of the limited liability company formed hereby is: Sara Lee
Frozen Bakery, LLC."
IN WITNESS WHEREOF, the undersigned has executed this Certificate of Amendment
of the Certificate of Formation as of the date first written above.
By: /s/ Bartlett Harwood IV
Name: Bartlett Harwood IV
Title: Vice President and Treasurer

•'
Hillshire_
aRAN0$
October 10, 2014
Re: Authorization to Sign
To Whom It May Concern:
Pursuant to my authority as a corporate officer of The Hillshire Brands Company ("Hillshire"), a wholly
owned subsidiary of Tyson Foods, Inc., I hereby authorize each Plant Manager, or person of equal
authority, of a Hillshire Supply Chain facility to sign as a "Responsible Corporate Official', or in a capacity
substantially similar thereto, on all reports and/or applications relating to the facility's Safety and
Environmental Programs for which the signature of a Responsible Corporate Official, or person in a
capacity substantially similar thereto, is required. This authorization will expire no later than October
10, 2016.
If you have any questions about the foregoing, please contact Perry Amoo-Mensah Director EH&S
Hillshlre Brands Company, 312-614-8115
Sincerely,
Thomas P. Hayes
Executive Vice President and Chief Supply Chain Officer
RECEIVED
DEC 0 9 2014
05NIR-LAND QUALIV
t m"TwIG

ApT-WIFAA
40
itva
NCDENR
r m Moir w ?4 v Rcaw m
Division of Energy, Mineral & Land Resources
Land Quality SectionlStormwater Permitting
National Pollutant Discharge Elimination System
PERMIT NAMEIOWNERSHIP CHANGE FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Day
1. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
A p a 1 6 0 1 6 8
If. Permit status prior to requested change.
a. Permit issued to (company name): The Hillshire Brands Company
b. Person legally responsible for permit: Philip Bain
First Ml Last
Plant Manager
Title
110 Sara Lee Road
Permit Holder Mailing Address
Tarboro NC 27886
City State Zip
[phone] ( )
~ Phone Fax
c. Facility name (discharge): Same As Above
d. Facility address: Same As Above
Address
City State Zip
e. Facility contact person: John H. Chapman Jr. [phone]
First / MI / Last Phone
I1I. Please provide the following for the requested change (revised permit).
a. Request for change is a result of. ❑ Change in ownership of the facility
® Name change of the facility or owner
If other please explain:
b. Permit issued to (company name):
c. Person legally responsible for permit:
RECEIVED
DEC 0 9 2014
DEI'R-LAND OUAL.ITY
STORMWATER 1'ERM11TNG
d. Facility name (discharge):
e. Facility address:
The Hillshire Brands Company Tarboro Plant, a wholly
owned subsidiary of Tyson Foods, Inc
Philip Bain
First Ml Last
Plant Manager
Title
110 Sara Lee Road
Permit Holder Mailing Address
Tarboro NC 27886
City State Zip
[phone] philip.bainphillshirebrands.com
Phone E-mail Address
Same As Above
Save As Above
Address
City State Zip
f. Facility contact person: John H Chapman -Jr.
First Ml Last
[phone]•[e-mail]
Phone E-mail Address
Revised Jan. 27, 2014

r�
NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact: John H Chapman Jr.
First _ MI Last
Ehs Supervisor
Title
110 Sara Lee Road
Mailing Address
Tarboro NC 27886
City State Zip
[phone] john.chapman ahillshirebrands.co_m��
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
❑ This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
.................... :................................................................................................
The certifications'below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature
Date
APPLICANT CERTIFICATION
1, . , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
1_P1 � ly
Signature Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Energy, Mineral and Land Resources
Stormwater Permitting Program
1612 Mail Service Center
Raleigh, North Carolina 27699-1612
Revised Jan. 27, 2014

NCDENR
North Carolina Department of Environment and Natura
Division of Water Quality
Pat McCrory Charles Wakild, P. E.
Governor Director
February 11, 2013
Ken Brandenburg
The Hillshire Brands Company
110 Sara Lee Rd
Tarboro, NC 27886
�..� E
I= EB 1 1 2013
,sources
NC DENR -
Secretary
Subject: NPDES General Permit NCG060000
Certificate of Coverage NCG060168
The Hillshire Brands Company
Edgecombe County
Dear Mr. Brandenburg:
Division personnel received your request to revise your stormwater permit Certificate of Coverage to
accurately reflect your new company and/or facility name.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained in the
General Permit remain unchanged and in full effect. This revised Certificate of Coverage is issued under
the requirements of North Carolina General Statutes 143-215.1 and the Memorandum of Agreement
between North Carolina and the U.S. Environmental Protection Agency.
If you have any questions, please contact the Stormwater Permitting Unit at 919-807-6300.
Sincerely,
ORIGINAL SIGNED 13)
KEN PICKLE
for Charles Wakild, P.E.
cc: Raleigh Regional Office
Central Files
Stormwater Permitting Unit
Wetlands and Stormwater Branch
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
location: 512 N. Salisbury St, Raleigh, North Carolina 27604
Phone: [phone] FAX: [phone] i Customer Service: 1-877-623-6748
Internet: www.ncwaterqua[4.org
NorthCarolina
Naturally
An Equal Opporlundy 1 Affirmative Action Employer

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERNUT NO. NCG060000
CERTIFICATE OF COVERAGE No. NCG060168
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission,
and the Federal Water Pollution Control Act, as amended,
The Hillshire Brands Company
is hereby authorized to discharge stormwater from a facility located at
The Hillshire Brands Company
110 Sara Lee Rd
Tarboro
Edgecombe County
to receiving waters designated as Tar River a class.C;NSW, waters in the Tar -Pamlico River Basin in
accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts
1, II, III, IV, V and VI of General Permit No. NCG060000 as attached.
This certificate of coverage shall become effective February 11, 2013.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day February 1 1, 2013.
ORIGINAL SIGNED Sl
KEN PICKLE
for Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

Hillshire
BRANDS
October 11, 2012
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Sara Lee Bakery Name Change
Certificate of Coverage NCG060168
To Whom It May Concern:
This letter is to inform you that our operating company name has changed from Sara Lee
Bakery to The Hillshire Brands Company. We will be updating permits, records, and
reports with our new name as needed going forward. Attached is a completed Permit
Name/Ownership Change Form.
In the interim, should you have any questions, please contact John Chapman,
Environmental Manager, at [phone].
Sincerely,
Ken Brandenburg
Plant Manager
The Hillshire Brands Company
Enc.

•w
NCDENR
ENVInR mvrt Y Pq I FKwU-[;"
Division of Water Quality / Surface Water Protection
National Pollutant Discharge Elimination System
PERMIT NAME/OWNERSHIP CHANGE FORM
FOR AGENCY USE ONLY
Date Received
Year
Month
Da
I. Please enter the permit number for which the change is requested.
NPDES Permit (or) Certificate of Coverage
6 1 0 1 0 0 0 q 0 6 0 1 1 1 6 8
1I. Permit status prior to requested change.
a. Permit issued to (company name): Sara Lee Bakery
b. Person legally responsible for permit: KenBrandenburg
First Nil Last
Plant Manager
Title
110 Sara Lee Road
Permit Holder Mailing Address
Tarboro NC 27886
City State Zip
[phone] { )
Phone Fax
c. Facility name (discharge): Sara Lee Bakery Tarboro
d. Facility address: l 10 Sara Lee Road
Address
Tarboro NC 27886
City State Zip
e. Facility contact person: John/H./Chapman [phone] _
First. / MI / Last Phone
HL' Please provide the fallowing for the requested change (revised permit).
a. Request for change is a result of ❑ Change in ownership of the facility
® Name change of the facility or owner
If other please explain:
b. Permit issued to (company name): The Hillshire Brands Company
c. Person lfor permit: Ken_ Brandenburg
D L19 n First Ml Last
iUl Plant Manager
Title
�3 110 Sara Lee Road
Permit Holder Mailing Address
UALITYwEmrich Tarboro NC 27886
- City State Zip
252) 641-230$- [e-mail]
Phone E-mail Address
d. Facility name (discharge): _ The Hillshire Brands Company_
e. Facility address: 110 Sara Lee Road
Address
Tarboro NC 27886
City State Zip
f. Facility contact person: John H. Chapman
First MI Last
[phone] [e-mail]
Phone E-mail Address
Revised 2012Apr23

NPDES PERMIT NAME/OWNERSHIP CHANGE FORM
Page 2 of 2
IV. Permit contact information (if different from the person legally responsible for the permit)
Permit contact: John H. Chapman
First MI Last
Enviromnental Manager
Title
110 Sara Lee Road
Mailing Address
Tarboro NC 27886
City State Zip
[phone] Johmchapman@hillshirebrands com
Phone E-mail Address
V. Will the permitted facility continue to conduct the same industrial activities conducted prior
to this ownership or name change?
® Yes
❑ No (please explain)
VI. Required Items: THIS APPLICATION WILL BE RETURNED UNPROCESSED IF ITEMS
ARE INCOMPLETE OR MISSING:
® This completed application is required for both name change and/or ownership change
requests.
❑ Legal documentation of the transfer of ownership (such as relevant pages of a contract deed,
or a bill of sale) is required for an ownership change request. Articles of incorporation are
not sufficient for an ownership change.
The certifications below must be completed and signed by both the permit holder prior to the change, and
the new applicant in the case of an ownership change request. For a name change request, the signed
Applicant's Certification is sufficient.
PERMITTEE CERTIFICATION (Permit holder prior to ownership change):
I, , attest that this application for a name/ownership change has been reviewed and is accurate and
complete to the best of my knowledge. I understand that if all required parts of this application are not
completed and that if all required supporting information is not included, this application package will be
returned as incomplete.
Signature
APPLICANT CERTIFICATION
Date
1, Ken Brandenbur>;, attest that this application for a name/ownership change has been reviewed and is
accurate and complete to the best of my knowledge. I understand that if all required parts of this
application are not completed and that if all required supporting information is not included, this application
package will be return d as com lete.
Si a Date
PLEASE SEND THE COMPLETE APPLICATION PACKAGE TO:
Division of Water Quality
Surface Water Protection Section
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Revised 71M

��x�
R7&
NCDENR
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Beverly Eaves Perdue Charles Wakild, P. E.
Governor Director
December 4, 2012
Fred Winner
Sara Lee Corporation
110 Sara Lee Rd
Tarboro, NC 27886-0220
Dee Freeman
Secretary
Subject: NPDES Stormwater Permit Coverage Renewal
Sara Lee Bakery
COC Number NCG060168
Edgecombe County
Dear Permittee:
In response to your renewal application for continued coverage under stormwater General Permit NCG060000
the Division of Water Quality (DWQ) is forwarding herewith the reissued General Permit. This permit is
reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of
Agreement between the state of North Carolina and the U.S. Environmental Protection Agency, dated October
15, 2007 (or as subsequently amended).
The following information is included with your permit package:
• A new Certificate of Coverage (COC)
• A copy of General Permit NCG060000
• A copy of the Technical Bulletin for the General Permit
• Two copies of the Discharge Monitoring Report (DMR) Form
• Two copies of the Qualitative Monitoring Report Form
The General Permit authorizes discharges of stormwater, and it specifies your obligations for discharge
controls, management, monitoring, and record keeping. Please review the new permit to familiarize yourself
with all the changes in the reissued permit. Your facility has six (6) months from the time of receipt of the
permit to update your current SPPP to reflect all new permit requirements.
The first sample period of your permit begins January 1, 2013. Your facility must sample a "measureable
storm event" beginning during the periods beginning January 1 and July 1 of every year (or, if applicable,
report "No Flow," as outlined in Part III, Section E). Also, please note that Tier 3 Actions in Part II of your
permit are triggered by benchmark exceedances on four occasions beginning on the effective date of this
permit and do not count prior exceedances_
The more significant changes in the General Permit since your last COC was issued are noted either in the
Draft Permit Fact Sheet that accompanied the public notice (http://Portal.ncdenr.org/web/wq/ws/su/current-
notices), or in the Response to Comments / Summary of Changes and Technical Bulletin documents that are
posted on the Stormwater Permitting Unit's website with the new General Permit. Please visit
http://Portal.ncdenr.orp/web/wq/ws/su/_npdessw (click on 'General Permits'tab) to review that information'
for your specific General Permit carefully.
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
Location: 512 N. Salisbury St. Raleigh, North Carolina 27604
Phone: 9; M07-6300 1 FAX: 919M-1,6492
Internet, rnvw-amaterguality.org
An Equal( Acton E nl;9 :yer
Nne
orthCai-o ina
.1vaturtAlf

Fred Winner
December 4, 2012
Page 2 of 2
Some of the changes include:
Part It:
• Section A: The Stormwater Pollution Prevention Plan (SPPP) section, if applicable, has been updated
to the most current language of our permits. Additional conditions for specific industry sectors have
been added to the SPPP requirements in some cases.
• Sections B, C: Failure to perform analytical stormwater monitoring may result in the Division requiring
that the permittee begin a monthly sampling scheme.
• Sections B, C: A lower TSS benchmark of 50 mg/I for HQW, ORW, PNA and Tr Waters applies to these
more sensitive waters.
• Sections B, C. The monitoring parameter Oil & Grease (O&G) has been replaced by the parameter
Total Petroleum Hydrocarbons (TPH) for vehicle maintenance areas, and in some cases, other
analytical monitoring requirements.
• Sections B, C, D: Inability to sample due to adverse weather must be recorded in the SPPP, or in
separate on -site records if your General Permit does not require an SPPP. Adverse weather is defined
in the "Definitions" section of the permit.
• Sections B, C: The term "Representative Storm Event" has been replaced by "Measurable Storm
Event." A measurable storm event is defined in the permit.
• Section D: If the permittee fails to respond effectively to problems identified by qualitative
monitoring, DWQ may require the permittee to perform corrective action.
Please review Parts III and IV to understand the Standard Conditions of your new NPDES General Permit,
including Compliance and Liability, Reporting, Monitoring and Records requirements; Operation and
Maintenance obligations; and Definitions. Please note that all samples analyzed in accordance with the terms
of this permit must be submitted to the Division on Discharge Monitoring Report (DMR) forms available on
the Stormwater Permitting Unit's website above. DMR forms must be delivered to the Division no later than
30 days from the date the facility receives the sampling results from the laboratory. Also note that existing
permittees do not need to submit a renewal request prior to expiration unless directed by the Division.
Your coverage under the General Permit is transferable only through the specific action of DWQ. This permit
does not affect the legal requirements to obtain other permits which may be required by DENR, nor does it
relieve the permittee from responsibility for compliance with any other applicable federal, state, or local law,
rule, standard, ordinance, order, judgment, or decree. If you have any questions regarding this permit
package, please contact the Division's Stormwater Permitting Unit at [phone].
Sincerely,
Ley r �
for Charles Wakild, P.E.
cc: DWQ Central Files
Stormwater Permitting Unit Files
Raleigh Regional Office

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCGO60000
CERTIFICATE OF COVERAGE No. NCG060168
STORMWATER
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In Compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission, and the Federal Water Pollution Control Act, as amended,
Sara Lee Corporation
is hereby authorized to discharge stormwater from a facility located at:
Sara Lee Bakery
110 Sara Lee Rd
Tarboro
Edgecombe County
to receiving waters designated as TAR RIVER, a class C;NSW waterbody in the Tar -Pamlico
River Basin in accordance with the effluent limitations, monitoring requirements, and other
conditions set forth in Parts 1, II, III, and IV of General Permit No. NCG060000 as attached.
This certificate of coverage shall become effective December 4, 2012.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this 41h day of December, 2012.
for Charles Wakild, P.E., Director
Division of Water Quality
By Authority of the Environmental Management Commission

o�OF W A rFq pG Michael F. Easley, Governor
William G. Ross, Jr.. Secretary
r North Carolina Deparrrnent of Environment and Natural Resources
10
Q ^� Alan W. Klimek, P.E., Director
Division of Water Quality
June 16, 2006
Mr. John Chapman
Environmental Manager
Sara Lee Bakery
110 Sara Lee Road
Tarboro, NC 27886
Subject: Compliance Evaluation Inspection on 05/23/2006
NPDES Stormwater General Permit NCG060000
Certificate of Coverage NCG060168
Sara Lee Bakery -Tarboro
Edgecombe County
Dear Mr. Chapman:
On May 23, 2006, I, Ronald Boone of the NC Division of Water Quality (DWQ), Raleigh Regional Office (RRO),
conducted a stormwater compliance evaluation inspection (CEI) of your plant located at 110 Sara Lee Road, Tarboro,
Edgecombe County, NC. Your assistance and cooperation was helpful and appreciated. During the inspection the
following items were noted. Please use the permit references cited throughout this report for further details as needed.
SITE SUMMARY
Sara Lee Bakery manufactures food products at this facility, grouping it under standard industrial classification code
(SIC) 20, Food and Kindred Products. Stormwater run-off generated at such facilities is regulated by general NPDES
stormwater permit NCG060000. As such, DWQ has issued Sara Lee certificate of coverage (COC) NCG060168, which
became effective on 1 September 2002 and expires on 31 August 2007.
Stormwater generated at the site is collected via a system of in -ground drains and stormwater ditches that surround a
majority of the property. The drains and ditches convey stormwater to four stormwater discharge outfalls. Discharged
stormwater flows to an unnamed tributary to the Tar River, a Class C, nutrient sensitive water (NSW) in the Tar -
Pamlico River Basin.
INSPECTION SUMMARY
1. You have done an excellent job of managing the stormwater program at this Sara Lee facility. Only minor
violations of your permit were identified during the inspection.
2. The stormwater system and stormwater discharge outfalls (SDO) were observed. There was no visible evidence of
spills, overflows or similar incidents in the system. No significant erosion was found.
3. The site was clean and well maintained.
4. All analytical and qualitative monitoring results were available on site and ready for inspection. Analytical
measurements were compliant and qualitative monitoring showed no signs of additional potential pollution sources.
5. The site plan was reviewed and found to be compliant.
10�°�l1tCarolina
dvuturrr!!r9
North Carolina Division of Water Quality Raleigh Regional Office Surface Water Protection
Internet: h2o.enr,state.na.us 1628 Mail Service Center Raleigh, NC 27699-1628
An Equal Opportunity/Affirmative Action Employer— 50% Recycled110% Post Consumer Paper
Phone [phone] Customer Service
FAX [phone]

Sara Lee Bakery, Compliance Evaluation Inspection, NCG060168
06/16/2006, Page 2 of 2
6. The stormwater pollution prevention plan (SP3) was reviewed and met all requirements with the following
exceptions:
a. The general location map (GLM) of the stormwater pollution prevention plan (SP3) needs minor updates as
follows:
1. The receiving stream needs to be better marked on the GLM. Only part of the Tar River is visible on the
existing GLM. You should be able to see the Tar River and the conveyance by which your discharged
stonnwater flows to the Tar River.
The conveyances by which your discharged stormwater flows to the Tar River need to be marked on the
GLM.
3. The latitude and longitude of each SDO must be clearly marked on the GLM. Currently you have only the
latitude/longitude of the plant itself.
b. The spill history for the plant should be updated annually. Your spill Iogs currently show that there have not
been any spills at your plant over the past few years. Please ensure that you make at least an annual entry on
the spill log stating that there haven't been any spills over the past year. Ideally, you would do this as part of
the annual SP3 update.
c. Part 11, Section A, Paragraph 7 of your permit requires that the SP3 be reviewed and appropriately updated
annually. Your SP3 was originally written in February 2003 and then updated in January 2006. Please ensure
that the SP3 is reviewed and updated at least once per year.
d. The SP3 is currently certified by the former Plant Director_ Please have the SP3 recertified by the new Plant
Director, Mr. Paul Clark.
In conclusion, I noted only minor discrepancies during my inspection of your facility. Please continue to be diligent in
your efforts to meet the requirements of your stormwater permit. If you have any questions regarding the inspection or
this letter, please contact me by phone at 919-7914200 or by email at [e-mail].
Sinc ,
�onal none
Environmental Technician IV
cc: Central Files
Non -Point Source Compliance Enforcement Unit
RRO Files
Attachments:
1. Inspection checklist for 23 May 2006 compliance evaluation inspection

United States Environmental Protection Agency
Form Approved.
EPA Washington, D.C. 20460
OMB No. 2040-0457
Water Compliance Inspection Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yrlmo/day Inspection Type Inspector Fac Type
1 12 U 31 NCGO60168 k11 12I 06/05/23 17 181C1 191SI 201
l I l
Remarks
211 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1.1 1 1 1 1 1 1 1 1 1 1 U_ 1 I I L I 1 1 I I I I I I _L_L 116
Inspection Work Days Facility Self -Monitoring Evaluation Rating 131 QA Reserved
671 169 701 1 711 1 721 N I 73 W 74 751 I1 I 180
l
Section $: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
02:00 PM 06/05/23
02/09/01
Sara Lee Bakery
Exit Time/Date
Permit Expiration Date
110 Sara Lee Rd
Tarboro NC 27886
04:00 PM 06/05/23
07/08/31
Name(s) of Onsite Representative(s)[ itles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible OfficiaVTitle/Phone and Fax Number
Paul Horan,Hwy 258 S Tarboro NC 27886//919-641-2315/ Contacted
No
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Storm Water
Section D: Summa of Finding/Comments Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Of{icelPhone and Fax Numbers Date
Ron Boone RRQ WQ//919-791-4200/
4G��6��aaG
Signature of agement wer AgencylOffice/Phone and Fax Numbers Date
// 61Ap
EPA Form 3564-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

{f
NPDES yr/molday Inspection Type
NCGO60168 lit 12i 06/05/23 117 18ICE
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Page # 2

111{A]f Michael F. Easley, Governor
�p William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
� Alan W. Klimek, P.E., Director
Q Division of Water Quality..'
August 23, 2002
JOHN H C14APMAN JR
SARA LEE BAKERY
110 SARA LEE ROAD
TARBORO, NC 27886
Subject: NPDES Stormwater Permit Renewal
Sara Lee Bakery
COC Number NCGO60168
Edgecombe County
Dear Permittee:
In response to your renewal application for continued coverage under general permit NCG060000, the Division of
Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This permit is reissued
pursuant to the requirements of North Carolina General Statute 143-215.1 and the Memorandum of Agreement
between the state of North Carolina and the U.S. Environmental Protection Agency, dated December 6, 1983.
The following information is included with your permit package:
A new Certificate of Coverage
A copy of General Stormwater Permit NCG060000
A copy of a Technical Bulletin for the general permit
Your coverage under this general permit is not transferable except after notice to DWQ. The Division may require
modification or revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal
requirements to obtain other permits which may be required by DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law, rule, standard, ordinance, order, judgment, or
decree.
If you have any questions regarding this permit package please contact Aisha Lau of the Central Office Stormwater
and General Permits Unit at [phone], ext. 578
Sincerely,
Bradley Bennett, Supervisor
Stonnwater and General Permits Unit
cc: Central Files
Stormwater & General Permits Unit Files
Raleigh Regional Office
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
TA
NCDENR
Customer Service
1-800-623-7748

Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
` Acting Director
Division of Water Quality
December 27. 2001
PAUL HORAN
SARA LEE BAKERY
HWY 258 SOUTH
TARBORO. NC 27886
Subject: NPDES Stormwater Permit Renewal
SARA LEE BAKERY
COC Number NCG060168
Edgecombe County
Dear Permittee:
Your facility is currently covered for Stormwater discharge under General Permit NCG060000. This permit expires
on August 31. 2002, The Division staff is currently in the process of rewriting this permit and is scheduled to have
the permit reissued by late summer of 2002. Once the permit is reissued, your facility would be eligible for
continued coverage under the reissued permit.
In order to assure your continued coverage under the general permit, you must apply to the Division of Water
Quality (DWQ) for renewal of your permit coverage. To make this renewal process easier, we are informing you in
advance that your permit will be expiring. Enclosed you will find a General Permit Coverage Renewal
Application Form. The application must be completed and returned by March 4, 2002 in order to assure continued
coverage under the general permit.
Failure to request renewal within this time period may result in a civil assessment of at least $250.00. Larger.
penalties may be assessed depending on the delinquency of the request. Discharge of stormwater from your facility
without coverage under a valid stormwater NPDES permit would constitute a violation of NCGS 143-215.1 and
could result in assessments of civil penalties of up to $10,0(X) per day.
Please note that recent federal legislation has extended the "no exposure exclusion" to all operators of industrial
facilities in any of the I l categories of "storm water discharges associated with industrial activity," (except
construction activities). If you feel your facility can certify a condition of "no exposure", i.e. the facilty industrial
materials and operations are not exposed to stormwater, you can apply for the no exposure exclusion. For additional
information contact the Central Office Stormwater Staff member listed below or check the Stormwater & General
Permits Unit Web Site at http://h2o.enr.state,nc,us/su/stormwater.html
If the subject stormwater discharge to waters of the state has been terminated. please complete the enclosed
Rescission Request Form. Mailing instructions are listed on the bottom of the term. You will be notified when the
rescission process has been completed.
If you have any questions regarding the permit renewal procedures please contact Joe Albiston of the Raleigh
Regional Office at 919-571-4700 or Aisha Lau of the Central Office Stormwater Unit at [phone] ext. 578
Sincerely,
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Raleigh Regional Office
ern
NCDENR
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone] Customer Service
1-800-623-7748

j
State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Managem
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Tom Forsythe
Sara Lee Corporation
Three First National Plaza
Chicago, IL 60602
Dear Tom Forsythe:
Ir�rnt
Ii)EHNR RALEIGH REGIONAL OFFICE
October 28, 1994
e��
�EHNF=?L
Subject: General Permit No. NCG060000
Sara Lee Corporation
COC NCG060168
Edgecombe County
In accordance with your application for discharge permit received on 05/31/94, we are forwarding
herewith the subject certificate of coverage to discharge under the subject state - NPDES general permit.
This permit is issued pursuant to the requirements of North Carolina General Statute 143-215 .1 and the
Memorandum of Agreement between North Carolina and the US- Environmental Protection agency dated
December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division
of Environmental Management. The Division of Environmental Management may require modification or
revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Environmental Management or permits required by the Division of Land Resources, Coastal
Area Management Act or any other Federal or Local governmental permit that may be required.
If you have any question concerning this permit, please contact Ms. Aisha Lau at telephone number
919/733-5083.
Sincerely0riginal Sighed By
David A. Goodrich
A. Preston Howard, Jr. P.E.
cc: Raleigh Regional Office
P.O. Box 29535, Raleigh, North Carolina 27626-0535 -telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL PERMIT NO. NCG06 000
CERTIFICATE OF CQVERAGE No. NCG06016
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATIQN SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Sara Lee Corporation
is hereby authorized to discharge stormwater from a facility located at
Sara Lee Bakery
Hwy. 258 South
Tarboro
Edgecombe County
to receiving waters designated as an unnamed. tributary to the Tar River in the Tar Pamlico River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I, II, III
and IV of General Permit No. NCGO60000 as attached.
This certificate of coverage shall become effective October 28, 1994.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 28, 1994.
Original Signets By
David A. Goodrich
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Commission

Michael E. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Gregory J. Thorpe, Ph.D.
Acting Director
Division of Water Quality
December 27, 2001
PAUL HORAN
SARA LEE BAKERY
HWY 258 SOUTH
TARBORO. NC 27886
Subject: NPDES Stormwater Permit Renewal
SARA LEE BAKERY
COC Number NCG060168
Edgecombe County
Dear Pcrmittce:
Your facility is currently covered for storrnwater discharge under General Permit NCG060000- This permit expires
on August 31. 2002. The Division staff is currently in the process of rewriting this permit and is scheduled to have
the permit reissued by late summer of 2002. Once the permit is reissued, your facility would be eligible for
continued covera*e under the reissued permit.
In order to assure your continued coverage under the general permit, you must apply to the Division of Water
Quality (DWQ) for renewal of your permit coverage. To make this renewal process easier, we are informing you in
advance that your permit will be expiring. Enclosed you will find a General Permit Coverage Renewal
Application Form. The application must be completed and returned by March 4, 2002 in order to assure continued
coverage under the general permit.
Failure to request renewal within this time period may result in a civil assessment of at least $250.00. Larger
penalties may be assessed depending on the delinquency of the request. Discharge of Stormwater from your facility
without coverage under a valid storrnwater NPDES permit would constitute a violation of NCGS 143-215.1 and
could result in assessments of civil penalties of up to $10,000 per day.
Please note that recent federal legislation has extended the "no exposure exclusion" to all operators of industrial
facilities in any of the I I categories of "storm water discharges associated with industrial activity." (except
construction activities). if you feel your facility can certify a condition of "no exposure", i.e. the lacilty industrial
materials and operations are not exposed to Stormwater, you can apply for the no exposure exclusion. For additional
information contact the Central Office Stormwater Staff member listed below or check the Stormwater & General
Permits Unit Web Site at http://h2o.cnr.state.nc.us/su/stormwater.html
If the subject stormwater discharge to waters of the state has been terminated, please complete the enclosed
Rescission Request Form. Mailing, instructions are listed on the bottom of the form. You will be notified when the
rescission process has been completed.
If you have any questions regarding the permit renewal procedures please contact Joe Albiston of the Raleigh
Regional Office at 919-571-4700 or Aisha Lau of the Central Office Stormwater Unit at [phone]. ext. 578
Sincerely.
Bradley Bennett, Supervisor
Stormwater and General Permits Unit
cc: Central Files
Raleigh Regional Office
N. C. Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 [phone]
=AA
RUH R
Customer Service
1- 800-623-7748

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E., Director
PAUL HORAN
SARA LEE BAKERY
HWY 258 SOUTH
TARBORO, NC 27886
,&4
C)EHNF�
September 11, 1997
Subject: Reissued Stormwater General Permit for Certificate of Coverage No. NCGO60168
Edgecombe County
Dear Permittee:
In response to your renewal application for continued coverage under the subject permit, the Division
of Water Quality (DWQ) is forwarding herewith the reissued stormwater general permit. This permit
is reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between North Carolina and the US Environmental Protection agency
dated December 6, 1983.
The following information is included with your permit package:
■ A copy of the stormwater general permit.
■ A Stormwater Pollution Prevention Plan Certification Form. This form certifies that you have
developed and implemented the Stormwater Pollution Prevention Plan (SPPP) required in your
permit. This form must be completed and returned to the Division within 30 days of receipt of
this letter. DO NOT send the SPPP with the signed form.
■ Five copies of Analytical Monitoring forms.
■ Five copies of Qualitative Monitoring forms.
■ A copy of a Technical Bulletin on the stormwater program with outlines program components
and addresses frequently asked questions.
■ A corrected Certificate of Coverage if you indicated a name or address change on the Renewal
Form returned to the Division.
Your certificate of coverage is not transferable except after notice to DWQ. The Division of Water
Quality may require modification or revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by
DWQ or permits required by the Division of Land Resources, Division of Air Quality, Coastal Area
Management Act or any other Federal or Local governmental permits that may be required.
If you have any questions concerning this permit or other attached documents, please contact the
Stormwater Group at telephone number [phone]
Sincerely,
for . Preston Howard, Jr., P. E.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Tom Forsythe
Sara Lee Corporation
Three First National Plaza
Chicago, IL 60602
October 28, 1994
fflI.I?FA
A&14�ja
EDEHNFi
Subject: General Permit No. NCGO60000
Sara Lee Corporation
COC NCG060168
Edgecombe County
Dear Tom Forsythe:
In accordance with your application for discharge permit received on 05/31/94, we are forwarding
-h&bwith the su ject ce xcate o coverage to distharge under the subject"state-= NPDES-general permit: This permit is issued pursuant to the requirements of North Carolina General Statute 143-215 .1"and the
Memorandum of Agreement between North Carolina and the US Environmental Protection agency dated
December 6, 1983.
If any parts, measurement frequencies or sampling requirements contained in this permit are
unacceptable to you, you have the right to request an individual permit by submitting an individual permit
application. Unless such demand is made, this certificate of coverage shall be final and binding.
Please take notice that this certificate of coverage is not transferable except after notice to the Division
of Environmental Management. The Division of Environmental Management may require modification or
revocation and reissuance of the certificate of coverage.
This permit does not affect the legal requirements to obtain other permits which may be required by the
Division of Environmental Management or permits required by the Division of Land Resources, Coastal
Area Management Act or any other Federal or Local governmental permit that may be required.
If you have any question concerning this permit, please contact Ms. Aisha Lau at telephone number
919/733-5083.
Sincerely,
Original 5�...J
David k Goodrich
A. Preston Howard, Jr. P.E.
cc: Raleigh Regional Office
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10'/o post -consumer paper

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT, HEALTH, AND NATURAL RESOURCES
DIVISION OF ENVIRONMENTAL MANAGEMENT
GENERAL PERMIT NO, NCG060000
CERTIFICATE OF COVERAGE No. NCG060168
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
Sara Lee Corporation
is hereby authorized to discharge stormwater from a facility located at
Sara Lee Bakery
Hwy. 258 South
Tarboro
Edgecombe County
to receiving waters designated as an unnamed tributary to the Tar River in the Tar Pamlico River Basin
in accordance with the effluent limitations, monitoring requirements, and other conditions set forth in Parts I,11,111
and IV of General Permit No. NCGO60000 as attached.
This certificate of coverage shall become effective October 28, 1994.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day October 28, 1994.
Original µi�r�erl BY
David A. Goodrich
A. Preston Howard, Jr., P.E., Director
Division of Environmental Management
By Authority of the Environmental Management Commission

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NPDES
MAP �`� � � � IV A5
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RECEi4d.!NG STREAM v 7—,
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