NC0023876_Industrial User_20210520

CIty o Burlin ton
�,�� ' ;, Xristy Xing
� p. r IndustrialPretreatment Specialist
I AA
May 19, 2021 RECEIVED
• Mr. Michael Montebello mAY 2 0 2021
Municipal Permitting Unit NCDEQ/pWR/NPDES
Division of Water Resources
1617 Mail Service Center
Raleigh,N.C. 27699-1617
Subject: New Industrial User Permit
Dear Mr. Montebello,
Please find enclosed a copy of the Permit for Kayser-Roth Corporation. With the permit,
there is a copy of the last approved allocation table, Inspection Report, and permit
application.
There were no new permit modifications.
If you have any questions,please feel free to email me at klking@burlingtonnc,gov or
call me at 336-222-5133
Sincerely,
Kristy King
Industrial Pretreatment Specialist
City of Burlington
Connecting the Triad and the Triangle
1302 Belmont Street-PO Box 1358-Burlington,NC 27216
Phone [phone]-www.BurlingtonNC.gov

City of Burlington
Control Authority and/or Municipality
PERMIT
RECEIVED
Industrial User Pretreatment Permit(IUP)
To Discharge Wastewater Under the MAY 2 0 2021
Industrial Pretreatment Program
NCDEQ/DWR/NPDES
0052 N/A
IUP Number 40 CFR Category(if Applicable)
In compliance with the provisions of North Carolina General Statute 143-215.1, any
applicable federal categorical pretreatment regulations, all other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Control Authority and/or Municipality Sewer Use Ordinance. The
following Industry, hereafter referred to by name or as the permittee:
Industry name,permittee:
Kayser—Roth Corporation
Facility Located at Street Address
714 Interstate Service Road
City
Graham
State,Zip
North Carolina 27253
is hereby authorized to discharge wastewater from the facility located at the above listed
address into the sanitary sewer collection system and the wastewater treatment facility of
the Control Authority and/or Municipality listed below:
IUP Control Authority and/or Municipality WWTP name:
South Burlington Wastewater Treatment Plant
NPDES Number:
NC0023876
WWiP Address:
Boy Wood Road
City,State,Zip
Burlington,North Carolina 27215
in accordance with effluent limitations, monitoring requirements, and all other conditions
set forth in Parts I, II, and III of this Industrial User Pretreatment Permit(IUP).
Effective date, this permit and the authorization to discharge shall become
effective at midnight on this date:.
July 1, 2021
Expiration date,this permit and the authorization to discharge shall expire at
midnight on this date:
June 30, 2026
2 - c Pczt>
Water Resources Director Date

Industrial User Pretreatment Permit (IUP)
PARTI
Specific Conditions
Continued: IUP History
IUP, PART I, OUTLINE:
A.) IUP Basic Information
B.) IUP Modification History
C.) Authorization Statement
D.) Description of Discharges
E.) Schematic and Monitoring Locations
F.) Effluent Limits& Monitoring Requirements
G.) Definitions and Limit Page(s) notes
A. IUP Basic Information:
Receiving Control Authority&WWTP name: POTW NPDES#:
South Burlington Wastewater Treatment Plant NC0023876
IUP Name: IUP Number:
Kayser-Roth Corporation 0052
IUP Effective date: Pipe Numbers,list all regulated pipes:
July 1, 2021 01
IUP Expiration date: IUP 40 CFR#(if applicable),or N/A:
June 30, 2026 N/A
B. IUP History.
Effective New/Renewal or Description of changes over previous IUP.
Date Modification
7/01/1996 Renewal New Permit issued, former permit expired June
30, 1996.
9/30/1997 Modification Ph limit changed to 5 to 10 units.
7/01/2001 Renewal New Permit issued, former permit expired June
30, 2001 and Industry will sample semi-
annually and POTW will sample semi-
annually.
2/01/2002 Modification Abbreviated Bioassay for toxicity monitoring
no longer a permit requirement.
4/16/2002 Modification BOD and TSS analyses required quarterly.
11/01/2002 Modification Ph limit changed to 5 to 11 units..
2

Industrial User Pretreatment Permit (IUP)
PART I
Specific Conditions
Continued: IUP History
7/01/2003 Modification Monitoring for Aqueous CTAS and Surfactants
as MBAS no longer a permit requirement.
7/01/2006 Renewal New Industrial User Permit issued, former
permit expired June 30, 2006.
7/01/2011 Renewal New Industrial User Permit issued, former
permit expired June 30, 2011. Limit for
Chromium decreased to 1.00 lbs. /day from
2.50 lbs. /day. Limit for Copper decreased to
1.50 lbs. /day from 5.00 lbs. /day. Limit for
Nickel decreased to 0.80 lbs. /day from 0.88
lbs. /day. Limit for Zinc decreased to 2.60 lbs.
/day from 5.00 lbs. /day.
12/01/2012 Modification Chromium limit increased to 3.0 lbs. from 1.0
lbs.
6/01/2014 Modification Chromium limit increased to 8.0 lbs./day from
3.0 lbs. /day.
7/01/2016 Renewal New Industrial User Permit issued, former
permit expired June 30, 2016.
1/1/2017 Modification Quarterly sampling schedule will change to
POTW sampling 1st and 3rd quarters of the
calendar year, and industry will sample 2nd
and 4th quarters of the calendar year.
7/1/2021 Renewal New Industrial User Permit issued, former
permit expired June 30, 2021.
3

Industrial User Pretreatment Permit (IUP)
PART I
Specific Conditions
Continued: IUP History
C.) Authorization Statement:
1.) The Permittee is hereby authorized to discharge wastewater in accordance with
the effluent limitations, monitoring requirements, and all other conditions set
forth in this Industrial User Pretreatment Permit(IUP)into the sewer collection
system and wastewater treatment facility of the Control Authority and/or
Municipality.
2.) The Permittee is hereby authorized to continue operation of and discharge
wastewater from the following treatment or pretreatment facilities. These
facilities must correspond to the treatment units listed on both the application
and inspection forms.
IU Treatment Units
List all Treatment Units Descriptions:
Holding Tank 0.5 million gallon aerated equalization basin.
3.) The Permittee is hereby authorized to, if required by the Control Authority
and/or Municipality and after receiving Authorization to Construct (A to C)
from the Control Authority and/or Municipality, construct and operate
additional pretreatment units as needed to meet final effluent limitations.
D.) Description of IUP Discharge(s):
1. Describe the discharge(s) from all regulated pipes.
Pipe# 001 , Description of Discharge:
Wastewater generated from bleaching, dyeing and packaging of
men's, boys, and women's socks and domestic usage.
E.) Schematic and Monitoring Locations:
The facility schematic and description of monitoring location(s) given below must
show enough detail such that someone unfamiliar with the facility could readily find
and identify the monitoring location(s) and connection to the sewer. Include and
identify all regulated pipes.
4

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IUP, Part 1 Section F: Receiving POTW name=> South Burlington WWTP IU name=> Kayser-Roth
Corporation
Effluent Limits and Monitoring Requirements Receiving POTW NPDES#_> NC0023876 IUP#=> 0052
Effective date for these Limits=> July 01,2021 Pipe#=> 01
The Permittee may discharge from this specific Expiration date for these Limits=> June 30,2026 40 CFR#=> N/A
Pipe number according to these specific dates, if not applicable put N/A
effluent limits, and monitoring requirements THE LIMITS ON THIS PAGE ARE,(Check one below):
LIMITS for ENTIRE permit period => X
INTERIM Limits for period# 1 =>
INTERIM Limits for period#2 =>
FINAL Limits Page =>
Concentration Limits Mass Limits Monitoring Frequency
Sample Required
Collection Laboratory
Monthly Monthly Method Detection
Daily Max Average Units Daily Max Average Units By Industry By POTW (C or G) Level
1 Flow MGD Semi-annually Semi-annually Meter
2 BOD mg/1 See Note Semi-annually Semi-annually C 2
3 TSS mg/1 See Note Semi-annually Semi-annually C 2
4 Temperature _ 50 Degree C Semi-annually Semi-annually G
5 PH 5-11 Standard Semi-annually Semi-annually G
Units
OTHER PARAMETERS;Please List Alphabetically
6 Chromium 8.00 Lbs/day Semi-annually Semi-annually C 0.005 mg/1
7 Copper 1.50 Lbs/day Semi-annually Semi-annually C 0.002 mg/1
8 Nickel _ _ 0.80 Lbs/day _ Semi-annually Semi-annually C 0.01 mg/1
9 Zinc 2.60 Lbs/day Semi-annually Semi-annually C 0.01 mg/1
10 _
11
12
13
•
NOTE: The BOD and the TSS are to be surcharged if levels exceed 300 mg/1 and 150 mg/1 respectively. This permit may be reopened to include BOD limits
when the POTW influent exceeds 75 percent of its design capacity. This will be determined by an updated POTW headwork's analysis. Monitoring frequency by
industry should be completed within the second Quarter and fourth Quarter of the calendar year. The POTW will monitor within the first Quarter and third Quarter
of the calendar year. Other parameters and limits are also subject to change as a result of updated headwork's information.
5

All effluent entering the City of Burlington sewers at each discharge point shall meet the following restrictions:
1. Quarters run as follows: 1 St—January 1-March 31: 2nd-April 1-June 30: 3rd-July 1-September 30: 4th—October 1-December 31.
2. Effluent limitations and monitoring requirements may be changed at any time during the permit period as deemed necessary by the City of
Burlington.
3. The Industrial User shall monitor all results from an approved commercial lab.
4. Test procedures shall be in accordance with the EPA guidelines for specified parameters.
5. The City of Burlington may require approved sampling devices be installed at permittee's expense.
6

Industrial User Pretreatment Permit (IUP)
PART I
Specific Conditions
G.) Definitions and Limit Page(s) notes:
In addition to the definitions in the City of Burlington Sewer Use Ordinance the
following definitions and requirements apply:
1. Composite Sample, alternative definition:
A composite sample for the monitoring requirements of this IUP is the same
as described above unless specifically defined below as the automatic or
manual collection of constant volume and constant time grab samples
collected and composited according to the following criteria:
Specific volume of each grab sample= 300 Milliliters
Specific time interval between samples = 1 Hours
Total duration of sample collection period= 24 Hours
Total number of grab samples to be composited= 24 Samples
2. Daily Monitoring Frequency
Daily Monitoring Frequency as specified in this IUP shall mean each day
of discharge.
3. Grab Sample
Grab sample for the monitoring requirements of this IUP, is defined as a
single "dip and take" sample collected at a representative point in the
discharge stream.
4. Instantaneous measurement
An Instantaneous measurement for the monitoring requirements of this IUP
is defined as a single reading, observation, or measurement.
7

Industrial User Pretreatment Permit (IUP)
PART II
General Conditions
Outline of PART II,
1. Representative Sampling 16. Federal and/or State Laws
2. Reporting 17. Penalties
3. Test Procedures 18. Need to Halt or Reduce
4. Additional Monitoring by 19. Transferability
Permittee
5. Duty to comply 20. Property Rights
6. Duty to Mitigate 21. Severability
7. Facilities Operation, Bypass 22. Modification, Revocation,
Termination
8. Removed substances 23. Reapplication
9. Upset Conditions 24. Dilution Prohibition
10. Right of Entry 25. Reports of Changed Conditions
11. Availability of Records 26. Construction of pretreatment
facilities
12. Duty to provide information 27. Reopener
13. Signatory Requirements 28. Categorical Reopener
14. Toxic Pollutants 29. General Prohibitive Standards
15. Civil and Criminal Liability 30. Reports of Potential Problems
I. Representative Sampling
Samples and measurements taken as required herein shall be representative of the volume and nature
of the monitored discharge. All samples shall be taken at the monitoring points specified in this
permit and, unless otherwise specified, before the effluent joins or is diluted by any other
wastestream, body of water, or substance. Monitoring points shall not be changed without
notification to,and approval by,the permit issuing authority.
2. Reporting
a.) Monitoring results obtained by the permittee shall be reported on forms specified by the
Control Authority and/or Municipality, postmarked no later than the twentieth day of the
month following the month in which the samples were taken. If no discharge occurs during
a reporting period(herein defined as each calendar month)in which a sampling event was
to have occurred,a form with the phrase"no discharge"shall be submitted. Copies of these
and all other reports required herein shall be submitted to the Control Authority and/or
Municipality and shall be sent to the following address:
Robert C.Patterson,Jr., P.E.
Water Resources director
City of Burlington
PO Box 1358
Burlington,NC 27216-1358
b.) If the sampling performed by the permittee indicates a violation,the permittee shall notify the
Control Authority and/or Municipality within 24 hours of becoming aware of the violation. The
permittee shall also repeat the sampling and analysis and submit the results of the repeat
8

Industrial User Pretreatment Permit (IUP)
PART II
General Conditions
analysis to the Control Authority and/or Municipality within 30 days after becoming aware of
the violation.
3. Test Procedures
Test procedures for the analysis of pollutants shall be performed in accordance with the techniques
prescribed in 40 CFR part 136 and amendments thereto unless specified otherwise in the monitoring
conditions of this permit.
4. Additional Monitoring by Permittee
If the permittee monitors any pollutant at the location(s) designated herein more frequently than
required by this permit, using approved analytical methods as specified above,the results of such
monitoring shall be submitted to the Control Authority and/or Municipality. The Control Authority
and/or Municipality may require more frequent monitoring or the monitoring of other pollutants not
required in this permit by written notification.
5. Duty to Comply
The permittee must comply with all conditions of this permit.Any permit noncompliance constitutes
a violation of the Control Authority and/or Municipality Sewer Use Ordinance and is grounds for
possible enforcement action.
6. Duty to Mitigate - Prevention of Adverse Impact
The permittee shall take all reasonable steps to minimize or prevent any discharge in violation of
this permit,which has a reasonable likelihood of adversely affecting human health,the POTW,the
waters receiving the POTW s discharge,or the environment.
7. Facilities Operation, Bypass
The permittee shall at all times maintain in good working order and operate as efficiently as possible,
all control facilities or systems installed or used by the permittee to achieve compliance with the
terms and conditions of this permit. Bypass of treatment facilities is prohibited except when
approved in advance by the Control Authority and/or Municipality. Bypass approval shall be given
only when such bypass is in compliance with 40 CFR 403.17.
8. Removed Substances
Solids,sludges,filter backwash,or other pollutants removed in the course of treatment or control of
wastewaters shall be disposed of in a manner such as to prevent any pollutants from such materials
from entering the sewer system. The permittee is responsible for assuring its compliance with any
requirements regarding the generation,treatment,storage,and/or disposal of"Hazardous waste"as
defined under the Federal Resource Conservation and Recovery Act.
9. Upset Conditions
An "upset" means an exceptional incident in which there is an unintentional and temporary
noncompliance with the effluent limitations of this permit because of factors beyond the reasonable
control of the permittee. An upset does not include noncompliance to the extent caused by
operational error, improperly designed or inadequate treatment facilities, lack of preventative
maintenance,or careless or improper operations.
An upset may constitute an affirmative defense for action brought for the noncompliance. The
permittee has the burden of proof to provide evidence and demonstrate that none of the factors
specifically listed above were responsible for the noncompliance.
9

Industrial User Pretreatment Permit (IUP)
PART II
General Conditions
10. Right of Entry
The permittee shall allow the staff of the State of North Carolina Department of Environmental
Quality and Division of Water Resources, the Regional Administrator of the Environmental
Protection Agency, the Control Authority and/or Municipality, and/or their authorized
representatives,upon the presentation of credentials:
1. To enter upon the permittee's premises where a real or potential discharge is located or
in which records are required to be kept under the terms and conditions of this permit;
and
2. At reasonable times to have access to and copy records required to be kept under the
terms and conditions of this permit;to inspect any monitoring equipment or monitoring
method required in this permit;and to sample any discharge of pollutants.
11. Availability of Records and Reports
The permittee shall retain records of all monitoring information, including all calibration and
maintenance records as well as copies of reports and information used to complete the application
for this permit for at least three years. All records that pertain to matters that are subject to any type
of enforcement action shall be retained and preserved by the permittee until all enforcement
activities have concluded and all periods of limitation with respect to any and all appeals have
expired.
Except for data determined to be confidential under the Sewer Use Ordinance,all reports prepared
in accordance with terms of this permit shall be available for public inspection at the Control
Authority and/or Municipality. As required by the Sewer Use Ordinance,effluent data shall not be
considered confidential.
12. Duty to Provide Information
The permittee shall furnish to the Water Resources Director or his/her designees,within a reasonable
time, any information which the Director, his/her designee, or the State of North Carolina
Department of Environmental Quality and the Division of Water Resources may request to
determine whether cause exists for modifying,revoking and reissuing,or terminating this permit or
to determine compliance with this permit. The permittee shall also furnish,upon request,copies of
records required to be kept by this permit.
13. Signatory Requirements
All reports or information submitted pursuant to the requirements of this permit must be signed and
certified by the Authorized Representative as defined under the Sewer Use Ordinance. If the
designation of an Authorized Representative is no longer accurate because a different individual or
position has responsibility for the overall operation of the facility, or overall responsibility for
environmental matters for the company, a new authorization satisfying the requirements of this
section must be submitted to the Water Resources Director prior to or together with any reports to
be signed by an authorized representative.
14. Toxic Pollutants
If a toxic effluent standard or prohibition(including any schedule of compliance specified in such
effluent standard or prohibition)is established under Section 307(a)of the Federal Clean Water Act
for a toxic pollutant which is present in the discharge and such standard or prohibition is more
stringent than any limitation for such pollutant in this permit,this permit may be revised or modified
in accordance with the toxic effluent standard or prohibition and the permittee so notified.
10

Industrial User Pretreatment Permit (IUP)
PART II
General Conditions
15. Civil and Criminal Liability
Nothing in this permit shall be construed to relieve the permittee from civil or criminal penalties for
noncompliance.
16. Federal and/or State Laws
Nothing in this permit shall be construed to preclude the institution of any legal action or relieve the
permittee from any responsibilities, liabilities, or penalties established pursuant to any applicable
Federal and/or State law or regulation.
17. Penalties
The Sewer Use Ordinance of the Control Authority and/or Municipality provides that any person
who violates a permit condition is subject to a civil penalty not to exceed$25,000 dollars per day of
such violation.
Under state law, (NCGS 143-215.6B), under certain circumstances it is a crime to violate terms,
conditions, or requirements of pretreatment permits. It is a crime to knowingly make any false
statement,representation, or certification in any record or other document submitted or required to
be maintained under this permit, including monitoring reports or reports of compliance or
noncompliance. These crimes are enforced at the prosecutorial discretion of the local District
Attorney.
18. Need to Halt or Reduce not a Defense
It shall not be a defense for a permittee in an enforcement action that it would have been necessary
to halt or reduce the permitted activity to maintain compliance with the conditions of the permit.
19. Transferability
This permit shall not be reassigned or transferred or sold to a new owner, new user, different
premises,or a new or changed operation without approval of the Town.
20. Property Rights
This permit does not convey any property rights in either real or personal property,or any exclusive
privileges, nor does it authorize any injury to private property or any invasion of personal rights,
nor any infringement of Federal,State or local laws or regulations.
21. Severability
The provisions of this permit are severable and, if any provision of this permit or the application of
any provision of this permit to any circumstance is held invalid,the application of such provision to
other circumstances and the remainder of this permit shall not be affected thereby.
22. Permit Modification, Revocation, Termination
This permit may be modified, revoked and reissued or terminated with cause in accordance to the
requirements of the Control Authority and/or Municipality Sewer Use Ordinance and North
Carolina General Statute or implementing regulations.
23. Re-Application for Permit Renewal
11

Industrial User Pretreatment Permit (IUP)
PART II
General Conditions
The permittee is responsible for filing an application for reissuance of this permit at least 180 days
prior to its expiration date.
24. Dilution Prohibition
The permittee shall not increase the use of potable or process water or in any other way attempt to
dilute the discharge as a partial or complete substitute for adequate treatment to achieve compliance
with the limitations contained in this permit.
25. Reports of Changed Conditions
The permittee shall give notice to the Control Authority and/or Municipality of any planned
significant changes to the permittee s operations or system which might alter the nature,quality,or
volume of its wastewater at least 180 days before the change. The permittee shall not begin the
changes until receiving written approval from the Control Authority and/or Municipality. Also see
Part II,30 below for additional reporting requirements for spill/slug issues.
Significant changes may include but are not limited to
(a) Increases or decreases to production;
(b) Increases in discharge of previously reported pollutants;
(c) Discharge of pollutants not previously reported to the Control Authority and/or
Municipality;
(d) New or changed product lines;
(e) New or changed manufacturing processes and/or chemicals;or
(f) New or changed customers.
26. Construction
No construction of pretreatment facilities or additions thereto shall be begun until Final Plans and
Specifications have been submitted to the Control Authority and/or Municipality and written
approval and an Authorization to Construct(A to C)have been issued.
27. Reopener
The permit shall be modified or,alternatively,revoked and reissued to comply with any applicable
effluent standard or limitation for the control of any pollutant shown to contribute to toxicity of the
WWTP effluent or any pollutant that is otherwise limited by the POTW discharge permit. The
permit as modified or reissued under this paragraph may also contain any other requirements of
State or Federal pretreatment regulations then applicable.
28. Categorical Reopener
This permit shall be modified,or alternatively,revoked and reissued,to comply with any applicable
effluent standard or limitation issued or approved under Sections 302(b)(2XC)and(D),304(b)(2),
and 307(ax2)of the Clean Water Act, if the effluent standard or limitation so issued or approved:
1.) Contains different conditions or is otherwise more stringent than any effluent
limitation in this permit;or
2.) Controls any pollutant not limited in this permit.
The permit as modified or reissued under this paragraph shall also contain any other requirements
of the Act then applicable.
29. General Prohibitive Standards
The permittee shall comply with the general prohibitive discharge standards in 40 CFR 403.5 (a)
and(b)of the Federal pretreatment regulations.
12

Industrial User Pretreatment Permit (IUP)
PART II
General Conditions
30. Potential Problems
The permittee shall provide protection from accidental and slug discharges of prohibited materials
and other substances regulated by this permit. The permittee shall also notify the POTW
immediately of any changes at its facility affecting the potential for spills and other accidental
discharge,discharge of a non-routine,episodic nature,a non-customary batch discharge, or a slug
load as defined in the Sewer Use Ordinance.
Additionally, the permittee shall notify by telephone the Control Authority and/or Municipality
immediately of all discharges that could cause problems to the POTW including any slug loadings
as defined in the Sewer Use Ordinance. If the permittee experiences such a discharge,they shall
inform the Control Authority and/or Municipality immediately upon the first awareness of the
commencement of the discharge. Notification shall include location of the discharge,type of waste,
concentration and volume if known and corrective actions taken by the permittee. A written follow-
up report thereof shall be filed by the permittee within five(5)days,unless waived by the Control
Authority and/or Municipality.
13

Industrial User Pretreatment Permit (IUP)
PART III
Special Conditions
1. Slug/Spill Control Measures
The permittee shall provide protection from accidental and slug discharges of
prohibited materials and other substances regulated by this permit. The permittee
shall develop a written slug/spill control plan and submit it to the Control Authority
on or before January 17,2022 for the approval by the Control Authority. The plan
shall include, but is not limited to:
¥ Description of discharge practices, including non-routine batch discharges;
¥ Description of stored chemicals;
¥ Procedures for immediately notifying the POTW of slug discharges that
would cause a violation of 40 CFR 403.5(b),with procedures for follow-up
notification within 5 days;
¥ And if necessary, procedures to prevent adverse impact from accidental
spills, including inspection and maintenance of storage areas, handling and
transfer of materials, loading and unloading operations,control of plant site
run-off, worker training, building of containment structures or equipment,
measures for containing toxic organic pollutants (including solvents),
and/or measures and equipment for emergency response.
2. Sludge Management Plan
Ninety days prior to the initial disposal of sludge generated by any pretreatment
facility, the permittee shall submit a sludge management plan to the Control
Authority.
3. Flow Measurement Requirements
The permittee shall record the water meter reading providing water to the
facility at the beginning and end of each composite sample collection time
period, convert this to an estimate of the daily discharge flow for each pipe,
and report this value on the discharge monitoring report form. If the water
meter is unreadable, the control authority may use water consumption
reports for estimation of the daily discharge flow for each pipe, and report
this value on the discharge monitoring report form.
4. Certified Laboratory Analysis
Pollutant analysis shall be performed by a State of North Carolina Department of
Environmental Quality and the Division of Water Resources Certified Laboratory
that is certified in the analysis of the pollutant in wastewater.
14

IUP Synopsis
A. IUP Basic Information
Receiving POTW name: POTW NPDES#:
South Burlington Wastewater Treatment NC0023876
Plant
IUP name: IUP Number:
Kayser-Roth Corporation 0052
IUP Effective date: Pipe Numbers,list all regulated pipes:
July 1,2021 01
IUP expiration date: IUP 40 CFR#,if applicable:
June 30, 2026
B. IUP Survey & Application form
Attach a completed copy of the Industrial User Wastewater Survey &
Application Form (see appendix 6-A)
C. IU Inspection form
Attach a copy of an Industrial User Inspection Form(see chapter 7) completed
by the Control Authority within the past 12 months.
D. RATIONALE FOR LIMITATIONS:
As listed on the IUP Limits Page(s), PART I, Section F of the IUP.
RATIONALE#1:
Review of IU Monitoring Data, with no Over Allocation situation:
The following pollutants were assigned numerical limits in this IUP based on
a review of monitoring data for the permittee to determine what ranges of
concentrations are currently being discharged. To account for sample
variability a factor was applied to the monitoring data to determine the permit
limit. Permit limits assigned by the Local IUP Control Authority can not
results in an Over Allocation situation for any pollutants.
Chromium 8.00 lbs/day
Copper 1.50 lbs/day
Nickel 0.80 lbs/day
Zinc i 2.60 lbs/day
1

Workbook Name : 2020_Update_South_allocation.xlsx, Worksheet Name: AT Printed:4/12/2021, 1:54 PM
Page 1 of 4
Allocation Table Spreadsheet Instructions:
Headworks last approved: 02/02/16 1)Applicable Values should be entered in the Heavy Bordered cells. Rest of worksheet is protected,password is
Allocation Table updated: 06/08/20 2)Formulas are discussed in the Comprehensive Guidance,Chapter 6,Section C.
Permits last modified: 03/23/18 3)HWA and AT worksheets in this workbook are linked. Pollutant Names,MAHLs,Basis,and Uncontrollable load
in this AT worksheet are automatically entered from the HWA spreadsheet. This includes pollutant names in
columns AT through BK.
Po-rw=> South Burlington
NPDES#K> NC0023786
FLOW BOD TSS
Industry Type Renewal Modification Date Permit Limits Permit Limits Permit Limits
IUP INDUSTRY NAMES Permit Pipe of Effective Effective Permit Conc. Load Conc. Load
Count (please hst aiphabencly) number number Industry Date Date Expires MGD gal/day mg/I lbs/da m I Ibs/da
1 Alamance Foods 67 0001 Dairy 01/01/17 12/31/21
2 McComb Industries 71 ' 0001 Textile 01/01/17 12/31/21 _
3 Carolina Biological Supply 65 0001 .aborator: 01/01/17 12/31/21
4 Carolina Hosiery 55 0001 Textile 01/01/17 12/31/21 _
5 Kayser Roth 52 0001 Textile 07/01/16 01/01/17 06/30/21
6 Labcorp 66 0001 J,aborato` 01/01/17 12/31/21 i
Labcorp 66 0002 Laborator 01/01/17 12/31/21
7 Pickett Hosiery 76 0001 Textile 01/01/17 12/31/21
Column Totals=> i 1 0 0
Basis=> NPDES Design Design
MAHL from HWA(lbs/day)_> NPDES Permitted Flow=> 12.0000 45036 22518
Uncontrollable Loading(lbs/day)_> 4.9900 12110 9031
Total Allowable for Industry(MAIL)(Ibs/day)_> 7.0100 32926 13487
Total Permitted to Industry(lbs/day)_> 0 0
MAIL left(lbs/day)_> #VALUE! 32926 13487
Percent Allow.Ind.(MAIL)still available(%)_> 100.0% 100.0%
Percent MAHL still available(%)_> 73.1 % 59.9%
5 Percent MAHL(lbs/day)_> 0.6000 2252 1126
HWA.AT
Revised:November 2005

Workbook Name : 2020_Update_South_allocation.xlsx, Worksheet Name: AT Printed:4/12/2021, 1:54 PM
Page 2 of 4
Allocation Table
Headworks last approved: 02/02/16
Allocation Table updated: 06/08/20
Permits last modified: 03/23/18
Porw=> South Burlington
NPDES#=> NC0023786
Ammonia Arsenic Cadmium Chromium Copper Cyanide
Industry Permit Limits Permit Limits Permit Limits Permit Limits Permit Limits Permit Limits
IUP INDUSTRY NAMES Permit Pipe Conc. Load Conc. Load Conc. Load Conc. Load Conc. Load Conc. Load
Count (please list alphabelicly) number I number mg/1 lbs/day mg/1 lbs/day mg/I lbs/day mg/1 lbs/day i mg/I lbs/day mg/1 lbs/day
1 Alamance Foods 67 0001 0.2000 0.4000
e
2 McComb Industries 71 0001 1.8300 0.4000
3 Carolina Biological Supply 65 0001 0.1000 0.0400
4 Carolina Hosiery 55 0001 0.6000 0.3000^•••=m
5 Kayser Roth 52 0001 8.0000 1.5000
6 Labcorp 66 0001 0.1000, 0.1000
I ofLabcorp 66 0002 40............. 0.1000�� 0.1000
7 Pickett Hosiery 76 0001 1.0000 0.8200
Column Totals=> 1 0_1 1 0.00001 I 0.00001 11.93001 1 3.66001 0.0000
Stream Stream AS/Nit/TF AS/Nit/TF Stream
Basis=> Design Std Std inhibition inhibition Std
MARL from HWA(lbs/day)_> 3002.40 1.2207 0.4069 24.7867 34.9422 1.0829
Uncontrollable Loading(lbs/day)=> 1082.03 0.1248 0.1248 0.4495 1.9477 0.2081
Total Allowable for Industry(MAIL)(lbs/day)_> 1920.37 1.0958 0.2820 24.3372 32.9946 0.8748
Total Permitted to Industry(lbs/day)_> 0.00 0.0000 0.0000 11.9300 3.6600 0.0000
MAIL left(lbs/day)_> 1920.37 1.0958 0.2820 12.4072 29.3346 0.8748
Percent Allow.lnd.(MAIL)still available(%)_> 100.0% 100.0% 100.0% 51.0% 88.9% 100.0%
Percent MARL still available(%)=> 64.0% 89.8% 69.3% 50.1 % 84.0% 80.8%
5 Percent MAHL(lbs/day)_> 150.12 0.0610 0.0203 1.2393 1.7471 0.0541
HWA.AT
Revised:November 2005

Workbook Name : 2020_Update_South_allocation.xlsx, Worksheet Name: AT
Printed:4/12/2021, 1:54 PM
Page 3 of 4
Allocation Table
Headworks last approved: 02/02/16
Allocation Table updated: 06/08/20
Permits last modified: 03/23/18
POTw=> South Burlington
NPDESiK> NC0023786
Lead Mercury Molybdenum Nickel Selenium
Industry Permit Limits Permit Limits Permit Limits Permit Limits Permit Limits
IUP INDUSTRY NAMES Permit Pipe Conc. Load Conc. Load Conc. Load Conc. Load Conc. Load
Count (please list alphabelicly) number number mg/I lbs/day mg/I lbs/day mg/1 lbs/day mg/1 lbs/day mg/1 lbs/day
1 Alamance Foods 67 0001 0.0500
2 McComb Industries 71 0001 0.1400
3 Carolina Biological Supply 65 , 0001 0.0100
4 Carolina Hosiery 55 0001 0.1000
5 Kayser Roth 52 0001 _ 0.8000
6 Labcorp 66 0001 0.00110 0.0150
Labcorp 66 0002 0.000401 - 0.0150
7 Pickett Hosiery 76 0001 0.0800
Column Totals=> 0.00001 0.0015001 0.0000 1.21001 0.0000
Stream Sludge Stream Stream
Basis=> Std Stream Std Ceiling Std Std
MAHL from HWA(Ibs/day)_> 4.3037 0.063437 1.6953 4.7480 0.6714
Uncontrollable Loading(lbs/day)_> 0.1540 0.012485 0.0541 0.5036 0.0541
Total Allowable for Industry(MAIL)(Ibs/day)_> 4.1497 0.050952 1.6412 4.2445 0.6173
Total Permitted to Industry(lbs/day)_> 0.0000 0.001500 0.0000 1.2100 0.0000
MAIL left(lbs/day)_> 4.1497 0.049452 1.6412 3.0345 0.6173
Percent Allow.Ind.(MAIL)still available(%)_> 100.0% 97.1 % 100.0% 71.5% 100.0%
Percent MAHL still available(%)_> 96.4% 78.0% 96.8% 63.9% 91.9%
5 Percent MAHL(lbs/daX)_> 0.2152 0.003172 0.0848 0.2374 0.0336
HWA.AT
Revised:November 2005

Workbook Name : 2020_Update_South_allocation.xlsx, Worksheet Name: AT Printed:4/12/2021, 1:54 PM
Page 4 of 4
Allocation Table 1
Headworks last approved: 02/02/16
Allocation Table updated: 06/08/20
Permits last modified: 03/23/18
POTW=> South Burlington
NPDES#=> NC0023786
Silver - Zinc Total Nitrogen Total Phos. Aluminum
Industry Permit Limits Permit Limits Permit Limits Permit Limits Permit Limits
IUP INDUSTRY NAMES Permit Pipe Conc. Load Conc. Load Conc. Load Conc. Load Conc. Load
Count (please hstalphabeticly) number l number mg/1 lbs/day mg/1 lbs/day mg/I lbs/day mg/1 lbs/day mg/1 lbs/day
1 Alamance Foods 67 0001 1.5000
2 McComb Industries 71 0001 0.8000'
3 Carolina Biological Supply 65 0001 1.0000
4 Carolina Hosiery 55 0001 0.6600
5 Kayser Roth 52 , 0001 2.6000
6 Labcorp 66 0001 0.2500
Labcorp 66 0002 0.2500 ^ .
7 Pickett Hosiery 76 0001 0.4000
Column Totals=> 0.0000/ 7.46001 0.001 1 0.00 0.0000
AS/Nit/TF AS/Nit/TF
Basis=> inhibition inhibition NPDES
MAHL from HWA(lbs/day)_> 15.9242 74.9374 546.56
Uncontrollable Loading(lbs/day)=> 0.2081 7.9404 188.78 36.5893
Total Allowable for Industry(MAIL)(lbs/day)_> 15.7161 66.9969 357.78
Total Permitted to Industry(lbs/day)_> 0.0000 7.4600 0.00 0.00 0.0000
MAIL left(lbs/day)_> 15.7161 59.5369 357.78
Percent Allow.Ind.(MAIL)still available(%)_> 100.0% 88.9% ####### 100.0% #######
Percent MAHL still available(%)_> 98.7% 79.4% ####### 65.5% #######
5 Percent MAHL(lbs/day)_> 0.7962 3.7469 27.3280
HWA.AT
Revised:November 2005

SIU INSPECTION FORM 2020
Name Of Industry: Kayser Roth IUP# 0052
Address Of Industry: 714 Interstate Service Road IUP Expiration Date: I
Graham, NC 27253 06/30/202 I �b'~t;;1� 1 1 (Z t
Industry Representatives: Title i1t"
Laval Choiniere civ f?I. 1.CL
POTW Representatives: Title
Kristy King Industrial Pretreatment Specialist
Date Of Inspection: 11/18/2020 Time Of Inspection: 1:00 am,8ii
Purpose of Inspection: Annual X Other(Describe)
POTW to which IU discharges SBWWTP NPDES # NC0023876
Is SW currently in SNC? No If yes,for what?
PART I- INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product (YE_S'/NO !�;�-� 110. ::
Raw materials used YES
Manufacturing processes YES op-
Categorical, if applicable YES/N0-
Production rate YES.VNO- -4 ' :• ;,,y t2f'
Number of employees ( ESNO
Number of shifts YES/,O' 3 `-� C�r�ti I k4k1(, `7 r:;Iktial� L� . �y3i51�'t-)
Comments:
PART II - PLANT TOUR- Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A- PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? CYO/NO Where do theygo? f! 7_ C"? '�r j , -�
2. Are production areas diked,contained,or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? (YES/ENO Comments:
3. Are there floor drains in the storage area? YES(1,NO} Where do they go?
4. Are storage tanks and areas diked,contained or otherwise constructed in such a way as to prevent harm to the
WWTP,especially from spills or slugs? ES!NO Comments:
5. Are process and storage tanks and pipes labeled? 'il'ES/NO i
6. How are off-spec raw materials,and products disposed of? t_'. fit y i) iC%t l or
7. When is the production area cleaned? s;a (g%�re,t,-v t")
8. Is the wastewater from cleaningthe production a� is p o area discharged the POTW? �YESf NO 9
9. What non-process wastewaters are discharged to POTW? Cl..) lr?1e 1 t= t5oi 1€i i C: i
Comments:
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1,1994 Page I

SIU INSPECTION FORM 2020
•
1. Does operator seem knowledgeable about the system? YES/NO Comments: LILL.?
2. Are all units operational? YES/NO
3. How often does operator/maintenance person check system?
4. Is there an operator for each shift? YES/NO
5. How and when is sludge disposed of?
6. Is there a schedule for preventative maintenance? YES/NO
Comments:
PART II - Plant Tour Section C - SAMPLING POINT(S)AND FLOW MEASUREMENT
(Collect a sample if desired.) ,r
1. Does an outside lab complete sampling? AYES Y NO If yes,name of lab. L k°" e. I(
2. If industry completes sampling,ask the industry representative to describe sampling procedures. Co ments:
3. Is flow measurement equipment operational? (YES)/NO Comments:
4. Is there a calibration log for the flow meter? YES)NO Comments:
Comments:
PART III -EXIT INTERVIEW
Review monitoring records and.other SIU records required by IUP.
1. Are files well organized?(YE„S,7 NO Comments:
2. Are sample collection/chain-of-custody forms filled out properly? O Comments:
3. Do results in files agree with reports sent to POTW?, ES)NO Comments:
4. Who has aut(hhQrity to shut down prodj,i,ction ssho]u♦ld�a spill or slug discharge occur?
O._/ �,�J}iA iik��'� ..1�, .4,✓�1�1%'ffi Lu
5. How doers SIU �' 'o employees'of whom •
to call at POTW in case of spill/slug?
CAN-1 Vt.WO rti7
If slug/spill plan is already required by PPQJ W review procedures.
6. Is SIU implementing slug/spill plant_YES./NO Comments:
Comments:
INSPECTION RESULTS ri t, -cice_ke.
Slug/Spill Control Plan Needed? YES7/NO
Comments, Required Or Recommended Actions:
Signature Of Ins actors Date: I'- - ` ?)2.0
Signature of SUI Representative 4 t Date: Zv
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1,1994 Page 2

Industrial User Wastewater Survey
& Permit Application
COVER PAGE
Company Name: Kayser-Roth Corporation
Name of responsible person on site at the facility authorized to represent the Name of alternative on site person familiar with the day to day operations,
company in official dealings with the Sewer Authority and/or the City. environmental permitting requirements, monitoring, record keeping, and
Laval Choiniere data management.Mike Matthews 1
Title: Director Operations Engineering Years with firm:30 Title:Tech 6(Electronics) Years with firm:17
Phone# [phone] Fax# Phone#:[phone] Fax#
Physical street address of facility Official mailing address,if different. Note if same.
714 West Interstate Service Rd. 714 West Interstate Service Rd.
City:Burlington State:NC Zip:27253 City:Graham State:NC Zip:27253
The information provided by you on this questionnaire serves two functions:
1. The information is used to determine if your facility needs an Industrial
User Pretreatment Permit(IUP) for the discharge of wastewater to the local
sewer.
2. If an Industrial User Pretreatment Permit (IUP) is required, this survey
serves as the application for an Industrial User Pretreatment Permit(IUP).
Requests for confidential treatment of information provided on this form shall be governed by procedures
specified in 40 CFR Part 2. In accordance with Title 40 of the Code of Federal Regulations Part 403,
Section 403.14 and the Local Sewer Use Ordinance (SUO), information and data provided in this
questionnaire which identifies the content, volume and frequency of discharge shall be available to the
public without restriction.
This is to be signed by an authorized official of your firm,as defined in the Local Sewer Use Ordinance or the NC Model
Sewer Use Ordinance, Section 1.2,after completion of this form.
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
proper, gather and evaluate the information submitted. Based upon my inquiry of the person
or pe s4ns7ho manage the system, or those persons directly responsible for gathering the
info ation, the 'information submitted is, to the best of my knowledge and belief, true,
ac99 ate"and complete. I am aware that there are significant penalties for submitting false
information, i eluding the possibility of fine and/or imprisonment for knowing violations.
-- i z/-2-8/-1,Z,
ignature of Authorized Representative Date
listed above (seal if applicable)
Title: IU Wastewater Survey & Permit Application
File name: https://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/LocationsBurlington/Facility
General/Environmental/Wastewater/2021 IUP/Industrial Wastewater Survey IUP Permit Application r201228 lc.docx
Revision date:
12/30/97
Page l of 18
1

Industrial User Wastewater Survey
& Permit Application
1. Provide a brief narrative description of the type of business, manufacturing
processes, or service activities your firm conducts at this site.
This facility has manufacturing and distribution processes:
Manufacturing: knit, sew, dye, and finish men's and women's socks.
Distribution:receive finished goods,pick to order and ship.
2. List the primary products produced at this facility:
Men's and women's socks
3. List raw materials and process additives used:
Yarn (cotton, nylon, spandex, acrylic, wool, etc.)
Dyes (colorants)
Chemicals (for special properties:softeners, anti-microbials, etc.)
4. Are biocides added to any water discharged to the POTW,
if yes describe:
Yes X
No
We use antimicrobials in some products, so we believe it exits in the wastewater stream. We do
not know precisely how much is released in the effluent.
See attached SDS.
5. Describe weekly production schedule, including shifts worked per day,
employees per shift, and primary operation during shift.
Burlington Production Schedule
for IUP renewal(201209)
Shift Firs Employees Sun Mon Tue I Wed Thu Fri Sat 1°Operation
1 7-3 216 X X X X X X Dyehouse
2 3-11 21 X X X X X X Dyehouse
3 11-7 17 X X X X X X Dyehouse
254
Primary operation is the operation that most significantly impacts wastewater generation.
6. Production process is: Check, if all continuous
Check, if all batch X
If both please enter, % continuous= % %Batch=
Title: IU Wastewater Survey & Permit Application
File name: hops://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/Locations/Burlington/Facility
General/Environmental/Wastewater/2021 IUP/Industrial Wastewater Survey IUP Permit Application r201228 Ic.docx
Revision date:
12/30/97
Page 2 of 18

Industrial User Wastewater Survey
& Permit Application
7. Does production vary significantly (+- 20 %) by season. Describe.
Yes
No X
8. Are any significant (+- 20 %) changes in production that will affect wastewater
discharge expected in the next 5 years. If yes,please describe.
Yes
No X
We have completed the dyehouse construction project that was described in the previous IUP
application.However,the dye liquor recovery/reuse project was never completed.At this time,
we are evaluating further improvements we can make to reduce water and chemical
consumption and hope to have more information by year end 2021.
9. List all current waste haulers. Give name, address, phone numbers, volume and
materials hauled off.
Waste Industries(GFL) —Landfill waste- 703 Gilbreath Rd., Graham, NC 27253, (910) 303-
2396
Synergy Waste — Electrical electronics waste recycle- 320 S Gibson Drive, Madison, NC
27025, [phone]
Pallet Express—Recycle waste pallets/wood—6306 Old 421 Rd., P.O. Box 1998, Liberty, NC
27298 [phone]
CRC (Carolina Recycling and Consulting)—Recycle corrugate, corrugate cores, office paper,
mixed plastics, and fiber waste. 515 Saluda Rd, Chester, SC 29706. [phone]
CMC—metal recycle-Park Road, Burlington, NC 27215-336-584-0334
10. Attach a copy of laboratory analyses performed in the last year on the wastewater
discharge(s) from your facilities. Summarize data on the attached Data Summary
Form.
See attached
11. Attach sketch or schematic showing sampling points and all connections to the sewer.
See attached
12. Complete the Wastewater Pollutants Checklist attached to this Survey.
See below
Title: IU Wastewater Survey & Permit Application
File name: https://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/LocationsBurlington/Facility
General/Environmental/Wastewater/2021 IUP/Industrial Wastewater Survey IUP Permit Application r201228 Ic.docx
Revision date:
12/30/97
Page 3 of 18

Industrial User Wastewater Survey
& Permit Application
13. Do you have, or have you ever applied for,been issued,or been denied an
NPDES permit to discharge to the surface waters or storm sewers of North
Carolina? If yes,list all other NPDES permits,permit numbers,dates,and
names used to apply for them, or reason denied.
If yes: Permit,#,date,applicant name: NCG170228 X
Yes
If yes: Permit,#,date,applicant name
No
14. Do you have, or haveyou applied for or been issued an Industrial
ever pp
User Pretreatment Permit (IUP) to discharge wastewater to the sewer
collection system. If yes,list all other IUP permits,permit numbers,dates,
and names used to apply for them.
If yes: Permit,#,date,applicant name: City of Burlington IUP#0052 July 1,2016 through June 30,2021 X
Yes
If yes: Permit,#,date,applicant name
No
15. Do you have, or have you ever applied for or been issued any other
Environmental Permits (for example; air, RCRA, groundwater,
stormwater,general,Non-Discharge,septic tank,etc.). If yes, list all other
permits,permit numbers, dates, and names used to apply for them.
If yes: Permit type,#,date,applicant name:Air Permit#04059R11 Yes X
If yes: Permit type,#,date,applicant name:Hazardous Waste Small Generator#NCD98213131
No
If yes: Permit type,#,date,applicant name
16. Is a Spill Prevention Control and Countermeasure (SPCC) Plan prepared
for this facility?
Yes X
No
17. Is a Spill /Slug Control Plan required by the POTW, prepared for this
facility?
Yes X
No
Title: IU Wastewater Survey & Permit Application
File name: https://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/LocationsBurlington/Facility
General/Environmental/Wastewater/2021 IUP/Industrial Wastewater Survey IUP Permit Application r201228 Ic.docx
Revision date:
12/30/97
Page 4 of 18

Industrial User Wastewater Survey
& Permit Application
18. Do you have any underground storage tanks at your facility? If yes, list
contents and volume of each tank.
Yes
No X
19. Do you have any above ground storage tanks at your facility? If yes, for
each tank, list the contents, volume, whether the tank has any spill
prevention or containment devices, such as dikes, and procedures for
draining any containment devices.
Yes X #of Tanks 1
We have a#2 fuel oil storage tank with a 15,000 gallon capacity. There is no No
secondary containment but the tank is a dual wall structure and we have spill
materials within 20 ft of the tank..
Title: IU Wastewater Survey & Permit Application
File name: https://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/Locations/Burlington/Facility
General/Environmental/Wastewater/2021 IUP/Industrial Wastewater Survey IUP Permit Application r201228 Ic.docx
Revision date:
12/30/97
Page 5 of 18

Industrial User Wastewater Survey & Permit Application
PART II, Water Supply, Use, & Disposal Worksheet: -
Avg. Max. M E Avg. Max. M E
Water Used for: Water ea s Disposal ea s
Source(s) gal/day gal/day s
Method(s) gal/day gal/dayu i
r ma r ma
ed t ed t
e e
d _ d
(see Source List below) (see Disposal List below)
1. Process water 1 270,000 330,000 x 1 270,000 330,000 x
2. Washdown water 1 150 200 x 1 150 200 x
3. Water into product 1
4. Air Quality Permitted units
5. Domestic-toilets, drinking,cafe 1 1,750 2,500 x 1 1750 2500 x
6. Cooling water,Process NON-Contact 1 100 150 x 1 100 150 x
7. Boiler/Cooling tower blowdown 1 300 500 x 1 300 500 x
8. Cooling water,HVAC 1 1,750 2,000 x 5 1750 2000 x
9. Other:
Totals=> 274,050 335,350 Totals=> 274,050 335,350
Typical Water Sources: Possible Water Disposal Methods
1. City/Public supply 1. Sanitary sewer, with pretreatment
2. Private wells, drinking 2. Sanitary sewer, without pretreatment
3. Groundwater remediation wells 3. Storm sewer
4. Private ponds 4. Surface waters of NC
5. Surface waters of NC, please identify 5. Evaporation
6. Include others if applicable 6. Land applied
7. To groundwater
8. Septic Tank
• 9. Waste Haulers(identify)
10. Water into Product
11. Include others, if applicable
Title: IU Wastewater Survey & Permit Application
File name: https://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/LocationsBurlington/Facility General/Environmental/Wastewater/2021 IUP/Industrial
Wastewater Survey IUP Permit Application r2012281c.docx
Revision date: 12/30/97 Page 6 of 18

PART III, PRETREATMENT FACILITIES:
Are there any pretreatment devices or processes used for treating wastewater
before being discharged ed to the sewer? Check all that are present, and describe.
No pretreatment facilities =>
1 Flow equalization Aerated equalization=> X
NON-Aerated equalization=>
Total volume of equalization (million gal.)_>
2. Activated Carbon Yes No X Describe any, if present.
3. Activated Sludge Yes No X
4. Air Stripping Yes No X
5. Centrifugation Yes No X
6. Chemical Precipitation Yes No X
7. Chlorination Yes No X
8. Cyanide Destruction Yes No X
9. Cyclone Yes No X
10. Dissolved Air Floatation Yes No X
11. Filtration Yes No X
12. Flocculation Yes No X
13. Grease Trap Yes No X
14. Grit Removal Yes No X
15. Ion Exchange Yes No X
16. Neutralize,pH adjust Yes No X
17. Other Biological Treatment Yes No X
18. Ozonation Yes No X
19. Reverse Osmosis Yes No X
20. Screening Yes No X
21. Sedimentation Yes No X
22. Septic Tank Yes No X
23. Silver Recovery Yes No X
24. Solvent Separation Yes No X
25. Spill protection Yes X No Overflows into main SS line
List any others.
Title: IU Wastewater Survey & Permit Application
File name: https://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/LocationsBurlington/Facility
General/Environmental/Wastewater/2021 IUP/Industrial Wastewater Survey IUP Permit Application r201228 Ic.docx
Revision date:
12/30/97
Page 7 of 18

PART IV, CATEGORICAL INFORMATION:
1. When were operations started at this facility Facility start up date 1962
2. List all Standard Industrial Classification(SIC) codes for your facility.
These may be found on State Unemployment forms, tax forms,
accounting records, or from the Chamber of Commerce.
2252
3. Has this facility ever been considered a Categorical Industrial User
(CIU) as described by the Code of Federal Regulations (40 CFR)?
If yes, give complete 40 CFR number=>
No X
4. Are any other facilities owned and/or operated by your company
permitted as Categorical Industrial Users (CIUs) as described by the
Code of Federal Regulations (40 CFR)?
If yes please give name(s), location, and 40 CFR number. Yes
No X
Title: IU Wastewater Survey & Permit Application
File name: https://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/Locations/Burlington/Facility
General/Environmental/Wastewater/2021 IUP/Industrial Wastewater Survey IUP Permit Application r201228 lc.docx
Revision date:
12/30/97
Page 8 of 18

PART IV, CATEGORICAL INFORMATION:
(continued)
5. Check any activities listed below that are performed at your facility:
Check 40 Industrial Activity Check 40 Industrial Activity
below CFR# below CFR#
467 Aluminum Forming 432 Meat products
427 Asbestos Manufacturing 433 Metal finishing
461 Battery Manufacturing 464 Metal molding and casting
431 Builders paper&board mills 436 Mineral mining and processing
407 Canned&preserved fruits&veg. 471 Nonferrous Metal,Form&Powders
408 Canned&preserved seafood 421 Nonferrous Metals Manufacturing
458 Carbon black Manufacturing 414 OCPSF,Organic Chemicals,Plastics,
411 Cement Manufacturing &Synthetic Fiber Manufacturing
437 Centralized Waste Treatment 435 Oil&gas extraction
434 Coal Mining 440 Ore mining and dressing
465 Coil Coating 446 Paint formulating
468 Copper Forming 443 Paving and roofing materials Mfg.
405 Dairy products processing 455 Pesticide Manufacturing
469 Electrical,electronic components 419 Petroleum Refining
413 Electroplating 439 Pharmaceutical Manufacturing
457 Explosives Manufacturing 422 Phosphate Manufacturing
412 Feedlots 459 Photographic supplies
424 Ferro allay Manufacturing 463 Plastics molding and forming
418 Fertilizer Manufacturing 466 Porcelain enameling
464 Foundries,Metal Mold&Casting 430 Pulp,paper,and paperboard
426 Glass Manufacturing 428 Rubber Manufacturing
406 Grain mills 417 Soap&Detergent Manufacturing
454 Gum&Wood Chemicals Mfg. 423 Steam Electric power Generation
460 Hospitals 409 Sugar processing
447 Ink formulating X 410 Textile Mills
415 Inorganic chemical Manufacturing 429 Timber products processing
420 Iron& Steel Manufacturing 442 Transportation Equipment Cleaning
425 Leather Tanning&Finishing Others
Title: IU Wastewater Survey & Permit Application
File name: https://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/LocationsBurlington/Facility
General/Environmental/Wastewater/2021 IUP/industrial Wastewater Survey IUP Permit Application r201228 Ic.docx
Revision date:
12/30/97
Page 9 of 18

Wastewater Pollutant Checklist
Chemical Name EPA Check if Check if Check if Check if Concentration
Storet Present at Absent at Present in Absent in in Discharge,
e g ,
Code Facility Facility Discharge Discharge if Known
(mg/1)
Acid Extractable Organics
2-Chlorophenol 34586 X X
2,4-Dichlorophenol 34601 X X
X
2,4-Dimethylphenol 34606 X
2,4-Dinitrophenol 34616 X _ X
2-Methyl-4,6-dinitrophenol 34657 X X
4-Chloro-3-methylphenol 34452 X X
2-Nitrophenol 34591 X X
4-Nitrophenol 34646 X X
Pentachlorophenol 39032 x X
X Phenol
34694 X
2,4,6-Trichlorophenol 34621 X X
Base Neutral Organics
1,2,4-Trichlorobenzene 34551 x X
1,2-Dichlorobenzene 34536 X X
1,2-Diphenylhydrazine 34346 X X
1,3-Dichlorobenzene 34566 X X
1,4-Dichlorobenzene 34571 X X
2,4-Dinitrotoluene 34611 X X
2,6-Dinitrotoluene 34626 X X
2-Chloronaphthalene 34581 X X
3,3-Dichlorobenzidine 34631 X X
4-Bromophenyl phenyl ether 34636 X X
4-Chlorophenyl phenyl ether 34641 X X
Acenaphthene 03405 X X
Acenaphthylene 34200 X X
Anthracene 34220 X X
Benzidine 39120 X X
Benzo(a)anthracene 34526 X X
Benzo(a)pyrene 34247 X X
Benzo(b)fluoranthene 34230 X X
Benzo(ghi)perylene 34521 X X
Benzo(k)fluoranthene 34242 X X
Bis(2-chloroethoxy)methane 34278 X X
Bis(2-chloroethyl)ether 34273 X X
Bis(2-chloroisopropyl) ether 34283 X X
Bis(2-ethylhexyl)phthalate 39100 X X
Butyl benzyl phthalate 34292 X X
Chrysene 34320 X X
Di-n-butyl phthalate 39110 X X
Title: IU Wastewater Survey & Permit Application
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General/Environmental/Wastewater/2021 IUP/Industrial Wastewater Survey IUP Permit Application r201228 lc.docx
Revision date:
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Page 10 of 18

Wastewater Pollutant Checklist
Chemical Name EPA Check if Check if Check if Check if 'Concentration
Storet Present at Absent at Present in Absent in in Discharge,
Code Facility Facility Discharge Discharge if Known
(mg/1)
Base Neutral Organics (continued)
Di-n-octyl phthalate 34596 X X
Dibenzo (a,h) anthracene 34556 X X
Diethyl phthalate 34336 X X
Dimethyl phthalate 34341 X X
Fluoranthene 34376 X X
Fluorene 34381 X X
Hexachlorobenzene 39700 X X
Hexachlorobutadiene 34391 X X
Hexachlorocyclopentadiene 34386 X X
Hexachloroethane 34396 X X
Indeno(1,2,3-cd) pyrene 34403 X X
Isophorone 34408 X X
N-nitroso-di-n-propylamine 34428 X X
N-nitrosodimethylamine 34438 X X
N-nitrosodiphenylamine 34433 X X
Naphthalene 34696 X X
Nitrobenzene 34447 X X
Phenanthrene 34461 X X
Pyrene 34469 X X
Metals
Aluminum 01104 X X
Antimony 01097 X X
Arsenic 01002 X X
Beryllium 01012 X X
Cadmium 01027 X X
Chromium 01034 X X 0.4633
Copper 01042 X X 0.1782
Lead 01051 X X
Mercury 71900 X X
Molybdenum 01062 X X
Nickel 01067 X X 0.0680
Selenium 01147 X X .
Silver 01077 X X
Thalium 00982 X X
Zinc 01092 X X 0.1759
Title: IU Wastewater Survey & Permit Application
File name: https://kayserroth-my.sharepoint.com/personal/Iavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/Locations/Burlington/Facility
General/Environmental/Wastewater/2021 IUP/Industrial Wastewater Survey IUP Permit Application r201228 lc.docx
Revision date:
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Page 11 of 18

Wastewater Pollutant Checklist
Chemical Name EPA Check if Check if Check if Check if Concentration
Storet Present at Absent at Present in Absent in in Discharge,
Code Facility Facility Discharge Discharge if Known
(mg/1)
Other Inorganics
Barium 01007 X X
Chloride 00940 X X
Cyanide 00720 X X
Fluoride 00951 X X
Purgeable Volatile Organics
1,1,1-Trichloroethane 34506 X X
1,1,2,2-Tetrachloroethane 34516 X X
1,1,2-Trichloroethane 34511 X X
1,1-D ichloroethane 34496 X X
1,1-Dichloroethylene 34501 X X
1,2-Dichloroethane 34531 X X
1,2-Dichloropropane 34541 X X
2-Chloroethyl vinyl ether 34576 X X
Acrolein 34210 X X
Acrylonitrile 34215 X X
Benzene 34030 X X
Bromodichloromethane 32101 X X
Bromoform 32104 X X
Bromomethane 34413 X X
Carbon tetrachloride 32102 X X
Chlorobenzene 34301 X X
Chloroethane 34311 X X
Chloroform 32106 X X
Chloromethane 34418 X X
cis 1,3-Dichloropropene 34704 X X
Dibromochloromethane 32105 X X
Ethvlbenzene 34371 X X
Methylene chloride 34423 X X
Tetrachloroethylene 34475 X X
Toluene 34010 X X
trans 1,3-Dichloropropene 34699 X X
trans-1,2-D ich loroethylene 34546 X X
Trichloroethvlene 39180 X X
Trichlorofluoromethane 34488 X X
Vinyl chloride 39175 X X
Others
Xylene X X
Title: IU Wastewater Survey & Permit Application
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Revision date:
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Page 12 of 18

Data Summary Form
SBWWTP <= Receiving POTW
NC0023 876 <= Receiving NPDES #
KR Effluent Line <= Specific Sample Location!
i.e., Give IU Name, IUP#, and/or pipe#
BOD TSS Ammonia
Lab => Laboratory performing analysis =>
MDL => Laboratory Method Detection Limits=>
Notes => Notes=>
Q = Flow
Sample Date Notes about Sample M =Metered Conc. Results Conc. Results Conc. Results
ID, or Sample E=Estimated from Lab from Lab from Lab
Count Collected
mgd gal/day <? mg/1 <? mg/1 <? mg/1
1 4/21/2020 No flow recorded.Used month avg E 0.065381 65,381 109 674
2 10/21/2020 M 0.252740 252,740 54.3 338
3 2/27/2020 Sampled by Burlington E 0.0473793 47,379 99 140
4 7/30/2020 Sampled by Burlington E 0.0359032 35,903 48.4 115
5
6
7
8
9
10
11
12
etc
TNS => Total number of samples => 4 4
Max. value => Maximum data value (mg/1)=> 275 674
Avg. (use 1/2 BDL) =>Avg. data value, Include BDL values as 1/2 detection limit=> 77.675 316.75
Title: IU Wastewater Survey & Permit Application
File name: https://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/LocationsBurlington/Facility General/Environmental/Wastewater/2021 IUP/Industrial
Wastewater Survey IUP Permit Application r201228 lc.docx
Revision date: 12/30/97 Page 13 of 18

Data Summary Form
SBWWTP <= Receiving POTW
NC0023 876 <= Receiving NPDES #
KR Effluent Line <= Specific Sample Location!
i.e., Give IU Name, IUP#, and/or pipe #
Arsenic Copper Chromium Cadmium COD Copper
Lab =>
MDL =>
Notes =>
Sample Date Sample Conc. Results Conc. Results Conc. Results Conc. Results Conc. Results Conc. Results
ID or Collected from Lab from Lab from Lab from Lab from Lab from Lab
Count
<? mg/1 <? mg/1 <? mg/1 <? mg/1 <? mg/1 <? mg/1
1 4/21/2020 0.22 0.71
2 10/21/2020 0.29 0.4
3 2/27/2020 0.128 0.484
4 7/30/2020 0.0746 0.259
5
6
7
8
9
10
11
12
etc
TNS => 4 4
Max. Value => 0.29 0.71
Avg. (usel/2 BDL) _> 0.1782 0.4633
Title: IU Wastewater Survey & Permit Application
File name: https://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/Locations/Burlington/Facility General/Environmental/Wastewater/2021 IUP/Industrial
Wastewater Survey IUP Permit Application r201228 lc.docx
Revision date: 12/30/97 Page 14 of 18

Data Summary Form
SBWWTP <= Receiving POTW
NC0023 876 <= Receiving NPDES #
KR Effluent Line <= Specific Sample Location!
i.e., Give IU Name, IUP#, and/or pipe#
Cyanide Lead Mercury Nickel Silver Zinc
Lab =>
MDL =>
Notes =>
Sample Date Sample Conc. Results Conc. Results Conc. Results Conc. Results Conc. Results Conc. Results
ID or Collected from Lab from Lab from Lab from Lab from Lab from Lab
Count
<? mg/1 <? mg/1 <? mg/1 <? mg/1 <? mg/1 <? mg/1
1 4/21/2020 0.0064 0.25
2 10/21/2020 0.0064 0.25
3 2/27/2020 0.126 0.147
4 7/30/2020 0.133 0.0566
5
6
7
8
9 _ .
10
11
12
etc
TNS => 4 4
Max. Value => 0.133 0.25
Avg. (usel/2 BDL) _> 0.0680 0.1759
Title: IU Wastewater Survey & Permit Application
File name: https://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/Locations/Burlington/Facility General/Environmental/Wastewater/2021 IUP/Industrial
Wastewater Survey IUP Permit Application r201228 lc.docx
Revision date: 12/30/97 Page 15 of 18

Data Summary Form
<= Receiving POTW
<= Receiving NPDES #
<= Specific Sample Location!
i.e., Give IU Name, IUP#, and/or pipe #
Other Other Other Other Other Other
Lab =>
MDL =>
Notes =>
Sample Date Sample Conc. Results Conc. Results Conc. Results Conc. Results Conc. Results Conc. Results
ID or Collected from Lab from Lab from Lab from Lab from Lab from Lab
Count
<? mg/1 <? mg/1 <? mg/1 <? mg/1 <? mg/1 <? mg/1
1
2
3
4
5
6
7
8
9
10
11
12
etc
TNS =>
Max. Value =>
Avg. (use1/2 BDL) _>
Title: IU Wastewater Survey & Permit Application
File name: hops://kayserroth-my.sharepoint.com/personal/lavalchoiniere_kayser-roth_com/Documents/Documents/Site Info/LocationsBurlington/Facility General/Environmental/Wastewater/2021 IUP/industrial
Wastewater Survey IUP Permit Application r201228 lc.docx
Revision date: 12/30/97 Page 16 of 18

Industrial User Wastewater Survey
& Permit Application
Part V, Waste Reduction Information :
State Pretreatment Rule 15A NCAC 2H.0916 (c)(1)(M) requires Significant Industrial
Users to include a description of current and projected waste reduction (pollution
prevention) activities. The codes listed are standard EPA codes found on Toxic Release
Inventory and other environmental forms. Please check all applicable codes for your
facility related to wastewater discharge.
Current Projected Code Description
X W13 Improved maintenance scheduling recordkeeping, or procedures
X W14 Changed production schedule to minimize equipment and feedstock
changeovers
W19 Other changes in operating practices (explain briefly in comments)
X W21 Instituted procedures to ensure that materials do not stay in inventory
beyond shelf-life
W22 Began to test outdated material-continue to use if still effective
X W23 Eliminated shelf-life requirements for stable materials
X W24 Instituted better labeling procedures
W25 Instituted clearinghouse to exchange materials that would otherwise
be discarded
W29 Other changes in Inventory control (explain briefly in comments)
W31 Improved storage or stacking procedures
W32 Improved procedures for loading,unloading and transfer operations
X W33 Installed overflow alarms or automatic shutoff valves
X W34 Installed secondary containment
X W35 Installed vapor recovery systems
X W36 Implemented inspection or monitoring program of potential spill or
leak sources
W39 Other spill and leak prevention(explain briefly in comments)
W41 Increased purity of raw materials
X W42 Substituted raw materials
W49 Other raw material modifications (explain briefly in comments)
X W51 Instituted recirculation within a process
Title: IU Wastewater Survey&Permit Application
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Industrial User Wastewater Survey
& Permit Application
Current Projected Code Description
X W52 Modified equipment, layout, or piping
W53 Use of a different process catalyst
X W54 Instituted better controls on operating bulk containers to minimize
discarding of empty containers
X W55 Changed from small volume containers to bulk containers to
minimize discarding of empty containers
W58 Other process modifications (explain briefly in comments)
W59 Modified stripping/cleaning equipment
W60 Changed to mechanical stripping/cleaning devices (from solvents or
other materials)
W61 Changed to aqueous cleaners (from solvents or other materials)
W62 Reduced the number of solvents used to make waste more amenable
to recycling
W63 Modified containment procedures for cleaning units
X W64 Improved draining procedures
X W65 Redesigned parts racks to reduce dragout
W66 Modified or installed rinse systems
W67 Improved rinse equipment design
W68 Improved rinse equipment operation
W71 Other cleaning and degreasing operation(explain briefly in comments)
W72 Modified spray systems or equipment
W73 Substituted coating materials used
X W74 Improved application techniques
W75 Changed from spray to other system
W78 Other surface preparation and finishing (explain briefly in comments)
X W81 Changed product specifications
X W82 Modified design or composition of product
X W83 Modified packaging
W89 Other product modifications (explain briefly in comments)
W99 Other (specify in comments)
Comments (Please list corresponding code)
We are continuously reviewing processes and equipment to reduce material requirements, energy
requirements, waste, and improve quality.
Title: IU Wastewater Survey & Permit Application
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Revision date: 12/30/97
Page 18 of 18

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Data Tracking Sheet
Industry: Kayser-Roth Quarter: 1&3
Permit#: 0052 Year: 2020
pH Temp Flow BOD BOD TSS TSS Cu Cu Cr Cr Ni Ni Zn Zn sampled
S.U. deg C mgd mg/L lbs mg/L lbs mg/L lbs mg/L lbs mg/L lbs mg/L lbs by IND or
Limit»»> 5-11 50 300 150 1.50 8.00 0.80 2.60 POTW
Date
2/27/2020 7.5 33 0.047379 99 39.12 140 55.32 0.128 0.05 0.484 0.19 0.126 0.05 0.147 0.06 POTW
7/30/2020 5.8 37 0.035903 48.4 14.49 115 34.43 0.0746 0.02 0.259 0.08 0.133 0.04 0.0566 0.02 POTW
Maximum 7.5 37 0.047379 99 39.1192 140 55.32 0.128 0.05058 0.484 0.19125 0.133 0.04979 0.147 0.0580861
Average 6.65 35 0.041641 73.7 26.8046 127.5 44.875 0.1013 0.03529 0.3715 0.13562 0.1295 0.04489 0.1018 0.039043
%violation
City of
URLINGTON
`A,,,,r Water ResAurces

Pace Analytical Services,LLC
aceAnalytical® 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacelabs.com [phone]
May 04, 2020
Angie Tinervia
Kayser-Roth Corporation
714 Interstate Service Rd
Graham, NC 27253
RE: Project: Semi Annual testing
Pace Project No.: 92474533
Dear Angie Tinervia:
Enclosed are the analytical results for sample(s)received by the laboratory on April 21,2020. The results relate only to the
samples included in this report. Results reported herein conform to the applicable TNI/NELAC Standards and the
laboratory's Quality Manual,where applicable, unless otherwise noted in the body of the report.
The test results provided in this final report were generated by each of the following laboratories within the Pace Network:
• Pace Analytical Services-Asheville
•Pace Analytical Services-Charlotte
• Pace Analytical Services-Eden
If you have any questions concerning this report, please feel free to contact me.
Sincerely,���
z��7 Pr-C
Clayton McCrickard
[e-mail]
[phone]
Project Manager
Enclosures
cc: Kristi King,Kayser-Roth Corporation
fA«RE,
4, .0 REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,LLC. Page 1 of 10

Pace Analytical Services,LLC
® 205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacelabs.com [phone]
CERTIFICATIONS
Project: Semi Annual testing
Pace Project No.: 92474533
Pace Analytical Services Charlotte
9800 Kincey Ave.Ste 100,Huntersville,NC 28078 South Carolina Certification#:99006001
Louisiana/NELAP Certification#LA170028 Florida/NELAP Certification#:E87627
North Carolina Drinking Water Certification#:37706 Kentucky UST Certification#:84
North Carolina Field Services Certification#:5342 VirginiaNELAP Certification#:460221
North Carolina Wastewater Certification#: 12
Pace Analytical Services Asheville
2225 Riverside Drive,Asheville,NC 28804 North Carolina Wastewater Certification#:40
Florida/NELAP Certification#:E87648 . South Carolina Certification#:99030001
Massachusetts Certification#:M-NC030 VirginiaNELAP Certification#:460222
North Carolina Drinking Water Certification#:37712
Pace Analytical Services Eden
205 East Meadow Road Suite A,Eden,NC 27288 North Carolina Wastewater Certification#:633
North Carolina Drinking Water Certification#:37738 VirginiaNELAP Certification#:460025
•
REPORT
OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,LLC. Page 2 of 10

Pace Analytical Services,LLC
aceAnalytical® 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacelabs.com [phone]
SAMPLE ANALYTE COUNT
Project: Semi Annual testing
Pace Project No.: 92474533
Analytes
Lab ID Sample ID Method Analysts Reported Laboratory
92474533001 Effluent SM 2540D-2011 MWF 1 PASI-E
SM 5210B-2011 SOB 1 PASI-E
EPA 200.7 Rev 4.4 1994 SH1 4 PASI-A
92474533002 Effluent CHM 5 PASI-E
PASI-A=Pace Analytical Services-Asheville
PASI-C=Pace Analytical Services-Charlotte
PASI-E=Pace Analytical Services-Eden
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,LLC. Page 3 of 10

Pace Analytical Services,LLC
® 205 East Meadow Road-Suite A
7 , ceAiiaIyticaI Eden,NC 27288
www.pacelabs.com [phone]
ANALYTICAL RESULTS
Project: Semi Annual testing
Pace Project No.: 92474533
Sample: Effluent Lab ID: 92474533001 Collected: 04/21/20 12:50 Received: 04/21/20 15:20 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2011
Pace Analytical Services-Eden
Total Suspended Solids 674 mg/L 92.6 1 04/22/20 09:26
5210B BOD,5 day EDN Analytical Method:SM 5210B-2011 Preparation Method:SM 5210B-2011
Pace Analytical Services-Eden
BOD,5 day 109 mg/L 2.0 1 04/22/20 14:28 04/27/20 09:19
200.7 MET ICP Analytical Method:EPA 200.7 Rev 4.4 1994 Preparation Method:EPA 200.7 Rev 4.4 1994
Pace Analytical Services-Asheville
Chromium 0.71 mg/L 0.0050 1 04/30/20 01:01 04/30/20 22:20 7440-47-3
Copper 0.22 mg/L 0.0050 1 04/30/20 01:01 04/30/20 22:20 7440-50-8
Nickel 0.0064 mg/L 0.0050 1 04/30/20 01:01 04/30/20 22:20 7440-02-0
Zinc 0.25 mg/L 0.010 1 04/30/20 01:01 04/30/20 22:20 7440-66-6
Sample: Effluent Lab ID: 92474533002 Collected: 04/21/20 12:50 Received: 04/21/20 15:20 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
Field Data Eden Analytical Method:
Pace Analytical Services-Eden
Collected By Charles mg/L 1 04/21/20 12:50
Hornback
Collected Date 04/21/20 mg/L 1 04/21/20 12:50
Collected Time 12:50 mg/L 1 04/21/20 12:50
pH 6.91 mg/L 1 04/21/20 12:50
Temperature 21.8 deg C 1 04/21/20 12:50
Flow Monitoring Data Analytical Method:
Pace Analytical Services-Charlotte
Date(s) 04/21/20 1 04/21/20 12:50
Time(s) 12:50 1 04/21/20 12:50
Flow 0 1 04/21/20 12:50
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full, 1
Date:05/04/2020 09:05 AM without the written consent of Pace Analytical Services,LLC. Page 4 of 10

Pace Analytical Services,LLC
® 205 East Meadow Road-Suite A
:, /zaceAnalytical Eden,NC 27288
www.pacelabs.com [phone]
QUALITY CONTROL DATA
Project: Semi Annual testing
Pace Project No.: 92474533
QC Batch: 537533 Analysis Method: SM 2540D-2011
QC Batch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services-Eden
Associated Lab Samples: 92474533001
METHOD BLANK: 2866477 Matrix: Water
Associated Lab Samples: 92474533001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 04/22/20 09:20
LABORATORY CONTROL SAMPLE: 2866478
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 250 248 99 90-110
SAMPLE DUPLICATE: 2866479
92474533001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 674 863 25
SAMPLE DUPLICATE: 2866480
92474540001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 133 130 3
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:05/04/2020 09:05 AM without the written consent of Pace Analytical Services,LLC. Page 5 of 10

Pace Analytical Services,LLC
® 205 East Meadow Road-Suite A
aceAnalytical Eden,NC 27288
www.pacelabs.com [phone]
QUALITY CONTROL DATA
Project: Semi Annual testing
Pace Project No.: 92474533
QC Batch: 537595 Analysis Method: SM 5210B-2011
QC Batch Method: SM 5210B-2011 Analysis Description: 5210E BOD,5 day Final EDN
Laboratory: Pace Analytical Services-Eden
Associated Lab Samples: 92474533001
METHOD BLANK: 2866780 Matrix: Water
Associated Lab Samples: 92474533001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
BOD,5 day mg/L ND 2.0 04/27/20 08:51
LABORATORY CONTROL SAMPLE: 2866781
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
BOD,5 day mg/L 198 221 111 84.6-115.4
SAMPLE DUPLICATE: 2866783
92474577002 Dup
Parameter Units Result Result RPD Qualifiers
BOD,5 day mg/L 116 116 1
Results presented on this page are In the units Indicated by the"Units"column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date:05/04/2020 09:05 AM without the written consent of Pace Analytical Services,LLC. Page 6 of 10

1
Pace Analytical Services,LLC
4eAnalytical®® 205 East Meadow Road-SuiteEden,NC 27288
www.pacelabs.com [phone]
QUALITY CONTROL DATA
Project: Semi Annual testing
Pace Project No.: 92474533
QC Batch: 538936 Analysis Method: EPA 200.7 Rev 4.4 1994
QC Batch Method: EPA 200.7 Rev 4.4 1994 Analysis Description: 200.7 MET
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92474533001
METHOD BLANK: 2873197 Matrix: Water
Associated Lab Samples: 92474533001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chromium mg/L ND 0.0050 04/30/20 21:28
Copper mg/L ND 0.0050 04/30/20 21:28
Nickel mg/L ND 0.0050 04/30/20 21:28
Zinc mg/L ND 0.010 04/30/20 21:28
1 LABORATORY CONTROL SAMPLE: 2873198
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Chromium mg/L 0.5 0.50 100 85-115
Copper mg/L 0.5 0.49 98 85-115
Nickel mg/L 0.5 0.49 98 85-115
Zinc mg/L 0.5 0.49 98 85-115
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 2873199 2873200 1
MS MSD
92474413001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chromium mg/L ND 0.5 0.5 0.51 0.50 102 101 70-130 1
Copper mg/L ND 0.5 0.5 0.50 0.50 100 99 70-130 1
Nickel mg/L ND 0.5 0.5 0.50 0.49 100 99 70-130 1
Zinc mg/L ND 0.5 0.5 0.50 0.50 100 98 70-130 1
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 2873201 2873202
MS MSD
92474914001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chromium mg/L 0.51 0.51 0
Copper mg/L 0.52 0.52 1
Nickel mg/L 0.51 0.51 0
Zinc mg/L 0.57 0.57 0
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit Is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
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Date:05/04/2020 09:05 AM without the written consent of Pace Analytical Services,LLC. Page 7 of 10

Pace Analytical Servi@es,LLC
® 205 East Meadow Road-Suite A
_ 13
aceAnalytical Eden,NC 27288
www.pacelabs.com [phone]
QUALIFIERS
Project: Semi Annual testing
Pace Project No.: 92474533
DEFINITIONS
DF-Dilution Factor,if reported,represents the factor applied to the reported data due to dilution of the sample aliquot.
ND-Not Detected at or above adjusted reporting limit.
TNTC-Too Numerous To Count
J-Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL-Adjusted Method Detection Limit.
PQL-Practical Quantitation Limit.
RL-Reporting Limit-The lowest concentration value that meets project requirements for quantitative data with known precision and
bias for a specific analyte in a specific matrix.
S-Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270.The result for each analyte is
a combined concentration.
Consistent with EPA guidelines,unrounded data are displayed and have been used to calculate%recovery and RPD values.
LCS(D)-Laboratory Control Sample(Duplicate)
MS(D)-Matrix Spike(Duplicate)
DUP-Sample Duplicate
RPD-Relative Percent Difference
NC-Not Calculable.
SG-Silica Gel-Clean-Up
U-Indicates the compound was analyzed for,but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited.Contact your Pace PM for the current list of accredited analytes.
TNI-The NELAC Institute.
REPORT OF LABORATORY ANALYSIS
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Pace Analytical Services,LLC
4eAnalytical6 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacelabs.com [phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: Semi Annual testing
Pace Project No.: 92474533
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92474533001 Effluent SM 2540D-2011 537533
92474533001 Effluent SM 5210B-2011 537595 SM 5210B-2011 537660
92474533002 Effluent
92474533002 Effluent
92474533001 Effluent EPA 200.7 Rev 4.4 1994 538936 EPA 200.7 Rev 4.4 1994 538952
REPORT OF LABORATORY ANALYSIS
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Date:05/04/2020 09:05 AM without the written consent of Pace Analytical Services,LLC. Page 9 of 10

ace Analytical
CHAIN-OF-CUSTODY Analytical Request Document LABU WV$P • �LI�F f q�;j
o
' 111111111111111111111145
0
Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevant fields 92474�33
Company:Keyser-Roth Corporation
Billing Information: — cy,
co
Container Preservative Type-- ,_i f 11 1 t,9.53 5 n-
Address:Burlington,NC 1 (/ 7
U I U � 1 1 il
Report To: Email To: Types: 1 nitric acid,(2)sulfuric acid,(3)hydrochloric acid,(4)sodium hydroxide,(5)zinc acetate,
"Preservative ( )
(6)methanol,(7)sodium bisulfate,(8)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(B)ammonium sulfate,
Copy To: Site Collection Info/Address: (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other
Analyses Lab,Profile/Line:
Lab Sample Receipt Checklist: /
Customer Project Name/Number:Semi Annual Testing State: County/Ci Time Zone Collected: Custody Seals Present/Intact Y N �i
/ [ ]PT [ ]MT [ jCT [ ]ET Custody. Signatures Present Y N.NA
Phone:[phone] Site/Facility ID#: Compliance Monitoring? collector Signature Present �N NA
Bottles Intact �N NA
l
Email: [ ] Yes [ ]No Correct Bottles Y N NA
Collected By(print): ) Purchase Order#: DW PWS ID#: Sufficient volume �Si NA
( (..v9-y/�5 L iCleynkx..Quote#: DW Location Code: Samples Received on Ice Y N
ImmediatelyPacked on Ice: VOA - Headspace Acceptable Y N
Collect d By(signal re): Turnaround Date Required: USDA Regulated Soils „std.:
/] / �i n J� I ]Yes [ ]No Samples in Holding Time N NA
Il / Y.✓liJ // ��r• Y NA
Sample Disposal: Rush: Field Filtered(if applicable): � Residual Chlori>�t�rres_ent�l
Return Same DayNext Day [ ]Yes [ ]No al Cl Strips: t? !- 1
I ( pose as appropriate [ j [ ] ( ] ifs Sample pH Acceptab �7 �.�N NA
[ )Archive: ( ]2 Day [ ]3 Day [ ]4 Day [ ]5 Day Cl Strips:
\LL
I (Hold: (Expedite Charges Apply) Analysis: N N Sulfide Present ��, Y N N j
Lead Acetate Strips:
"Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WW), 0 LN to
Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) N eL c
LAB USE ONLY:
Comp/ Collected(or Res #of N CD E Composite End Lab Sample it / Comments:
ClCtns p
Customer Sample ID Matrix' Grab Composite Start) C O N
Date Time Date Time 0 Ems-- E. W LT- uL.
is ;�crMt c• 5
—41
Effluent WW Comp 11(-/zc )23s L//zl/z. (3-�7i 3 XXX X X Ph: •c 1 Temp: /• o
Effluent WW Grab X X {
LAB Sample Temperature Info:'
336-229-2269 Ext 3222 Call ahead of time Type of Ice Used: 1 /
Blue Dry None SHORT HOLDS PRESENT(<72 hours): ( N N/A Temp Blank Rece ve A
.��l0 3��' Lab Tracking#: Therm ID4:
Packing Material Used: Cooler 1 Temp U on Receip
Gay•i 5- Cooler 1 Therm Corr- Factory CC
• Samples received via: Cooler 1 Corrected Temp; ��
�� 5 C� U>el 3 FEDEX UPS Client Courier Pace tier Comments
Radchem samples)screened(<500 cpm): Y NA
•e eiv•. Co a Si nature Date he:
MTJL LAB USE ONLY
ReP�i�u 'Vied by/ ,•mpany:(Si; a ure) Daje/Ti e: ?� / bY/ / P f ( g , //,/ (-�?( I o Table#: -9r
ALg, `y 's ' L / Acble#: Trip Blank Received: Y N N
• Date ime:
Re quished by/Company:(Signature) Date/Time: B•ceve•by Company: �ignatuy HCL McOH TSP Other
Template:
Prelogin:
q•z',Z Non Conformance(s): Page:
Date/Time: Received by/Company:(Signature) Date/Time: PM: U
Relinquished by/Company:(Signature) PB: i 1 YES / NO of:

• Pace Analytical Services,LLC
aceAnalytical w 205 East Meadow Road-Suite A
Eden,NC 27288
www.paeslabs.com [phone]
November 02, 2020
Angie Tinervia
Kayser-Roth Corporation
714 Interstate Service Rd
Graham, NC 27253
RE: Project: SEMI ANNUAL TESTING(10/20)
Pace Project No.: 92501372
Dear Angie Tinervia:
Enclosed are the analytical results for sample(s)received by the laboratory on October 21,2020. The results relate only to
the samples included in this report. Results reported herein conform to the applicable TNI/NELAC Standards and the
laboratory's Quality Manual,where applicable, unless otherwise noted in the body of the report.
The test results provided in this final report were generated by each of the following laboratories within the Pace Network:
•Pace Analytical Services-Asheville
•Pace Analytical Services-Charlotte
•Pace Analytical Services-Eden
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Clayton McCrickard
[e-mail]
[phone]
Project Manager
Enclosures
cc: Kristi King,Kayser-Roth Corporation
pC
Z• REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services,LLC. Page 1 of 10

Pace Analytical Services,LLC
aceAnalytical 205 East Meadow Road-Suite
Eden,NC 27288
www.pacalabs.com [phone]
CERTIFICATIONS
Project: SEMI ANNUAL TESTING(10/20)
Pace Project No.: 92501372
Pace Analytical Services Charlotte
9800 Kincey Ave.Ste 100,Huntersville,NC 28078 South Carolina Certification#:99006001
Louisiana/NELAP Certification#LA170028 Florida/NELAP Certification#:E87627
North Carolina Drinking Water Certification#:37706 Kentucky UST Certification#:84
North Carolina Field Services Certification#:5342 VirginiaNELAP Certification#:460221
North Carolina Wastewater Certification#: 12
Pace Analytical Services Asheville
2225 Riverside Drive,Asheville,NC 28804 North Carolina Wastewater Certification#:40
Florida/NELAP Certification#:E87648 South Carolina Certification#:99030001
Massachusetts Certification#:M-NC030 VirginiaNELAP Certification#:460222
North Carolina Drinking Water Certification#:37712
Pace Analytical Services Eden
205 East Meadow Road Suite A,Eden, NC 27288 North Carolina Wastewater Certification#:633
North Carolina Drinking Water Certification#:37738 VirginiaNELAP Certification#:460025
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services,LLC. Page 2 of 10

Pace Analytical Services,LLC
aceAnalytical op 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacalabs.com [phone]
SAMPLE ANALYTE COUNT
Project: SEMI ANNUAL TESTING(10/20)
Pace Project No.: 92501372
Ana lytes
Lab ID Sample ID Method Analysts Reported Laboratory
92501372001 EFF 001 COMP SM 2540D-2011 SOB 1 PASI-E
SM 5210B-2011 MLS1 1 PASI-E
EPA 200.7 Rev 4.4 1994 DS 4 PASI-A
92501372002 EFF 001 GRAB KPD 6 PASI-E
PASI-A=Pace Analytical Services-Asheville
PASI-C=Pace Analytical Services-Charlotte
PASI-E=Pace Analytical Services-Eden
REPORT OF LABORATORY ANALYSIS
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without the written consent of Pace Analytical Services,LLC. Page 3 of 10

Pace Analytical Services,LLC
aceAnalytical W 205 East Meadow Road-Suite
Eden,NC 27288
www.pacalabs.com [phone]
ANALYTICAL RESULTS
Project: SEMI ANNUAL TESTING(10/20)
Pace Project No.: 92501372
Sample: EFF 001 COMP Lab ID: 92501372001 Collected: 10/20/20 16:05 Received: 10/21/20 08:00 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
2540D Total Suspended Solids Analytical Method:SM 2540D-2011
Pace Analytical Services-Eden
Total Suspended Solids 338 mg/L 38.5 1 10/21/20 11:14
5210B BOD,5 day EDN Analytical Method:SM 5210B-2011 Preparation Method:SM 5210B-2011
Pace Analytical Services-Eden
BOD,5 day 54.3 mg/L 2.0 1 10/21/20 15:18 10/26/20 11:30
200.7 MET ICP Analytical Method:EPA 200.7 Rev 4.4 1994 Preparation Method: EPA 200.7 Rev 4.4 1994
Pace Analytical Services-Asheville
Chromium 0.40 mg/L 0.0050 1 10/29/20 20:58 11/01/20 04:23 7440-47-3
Copper 0.29 mg/L 0.0050 1 10/29/20 20:58 11/01/20 04:23 7440-50-8
Nickel 0.0064 mg/L 0.0050 1 10/29/20 20:58 11/01/20 04:23 7440-02-0
Zinc 0.25 mg/L 0.010 1 10/29/20 20:58 11/01/20 04:23 7440-66-6
Sample: EFF 001 GRAB Lab ID: 92501372002 Collected: 10/20/20 16:15 Received: 10/21/20 08:00 Matrix: Water
Parameters Results Units Report Limit DF Prepared Analyzed CAS No. Qual
Field Data Eden Analytical Method:
Pace Analytical Services-Eden
Performed by CHARLES mg/L 1 10/20/20 16:15
HORNBAC
K
Collected By CHARLES mg/L 1 10/20/20 16:15
HORNBAC
K
Collected Date 10/20/20 mg/L 1 10/20/20 16:15
Collected Time 16:15 mg/L 1 10/20/20 16:15
pH 7.54 mg/L 1 10/20/20 16:15
Temperature 25.5 deg C 1 10/20/20 16:15
Flow Monitoring Data Analytical Method:
Pace Analytical Services-Charlotte
Performed by CHARLES 1 10/20/20 16:15
HORNBAC
K
Date(s) 10/21/20 1 10/20/20 16:15
Time(s) 16:15 1 10/20/20 16:15
Flow 252740 1 10/20/20 16:15
REPORT OF LABORATORY ANALYSIS
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Date: 11/02/2020 01:06 PM without the written consent of Pace Analytical Services,LLC. Page 4 of 10

Pace Analytical Services,LLC
aceAnalytical a 205 East Meadow Road-Suite
Eden,NC 27288
www.pacelabs.com [phone]
QUALITY CONTROL DATA
Project: SEMI ANNUAL TESTING(10/20)
Pace Project No.: 92501372
QC Batch: 574691 Analysis Method: SM 2540D-2011
QC Batch Method: SM 2540D-2011 Analysis Description: 2540D Total Suspended Solids
Laboratory: Pace Analytical Services-Eden
Associated Lab Samples: 92501372001
METHOD BLANK: 3042184 Matrix: Water
Associated Lab Samples: 92501372001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Total Suspended Solids mg/L ND 2.5 10/21/20 11:04
LABORATORY CONTROL SAMPLE: 3042185
Spike LCS LCS %Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Total Suspended Solids mg/L 250 250 100 90-110
SAMPLE DUPLICATE: 3042186
92501372001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 338 335 1
SAMPLE DUPLICATE: 3042187
92501381001 Dup
Parameter Units Result Result RPD Qualifiers
Total Suspended Solids mg/L 533 553 4
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result
REPORT OF LABORATORY ANALYSIS
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Pace Analytical Services,LLC
aceAnalytical 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacslabs.com [phone]
QUALITY CONTROL DATA
Project: SEMI ANNUAL TESTING(10/20)
Pace Project No.: 92501372
QC Batch: 574754 Analysis Method: SM 5210B-2011
QC Batch Method: SM 5210B-2011 Analysis Description: 5210E BOD,5 day Final EDN
Laboratory: Pace Analytical Services-Eden
Associated Lab Samples: 92501372001
METHOD BLANK: 3042587 Matrix: Water
Associated Lab Samples: 92501372001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
BOD,5 day mg/L ND 2.0 10/26/20 10:55
LABORATORY CONTROL SAMPLE: 3042588
Spike LCS LCS %Rec
Parameter Units Conc. Result % Rec Limits Qualifiers
BOD,5 day mg/L 198 226 114 84.6-115.4
SAMPLE DUPLICATE: 3042590
92501380002 Dup
Parameter Units Result Result RPD Qualifiers
BOD,5 day mg/L 122 124 1
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
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' Pace Analytical Services,LLC
ace Analytical g 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacs1abs.coiu [phone]
QUALITY CONTROL DATA
Project: SEMI ANNUAL TESTING(10/20)
Pace Project No.: 92501372
QC Batch: 576721 Analysis Method: EPA 200.7 Rev 4.4 1994
QC Batch Method: EPA 200.7 Rev 4.4 1994 Analysis Description: 200.7 MET
Laboratory: Pace Analytical Services-Asheville
Associated Lab Samples: 92501372001
METHOD BLANK: 3051970 Matrix: Water
Associated Lab Samples: 92501372001
Blank Reporting
Parameter Units Result Limit Analyzed Qualifiers
Chromium mg/L ND 0.0050 11/01/20 03:32
Copper mg/L ND 0.0050 11/01/20 03:32
Nickel mg/L ND 0.0050 11/01/20 03:32
Zinc mg/L ND 0.010 11/01/20 03:32
LABORATORY CONTROL SAMPLE: 3051971
Spike LCS LCS % Rec
Parameter Units Conc. Result %Rec Limits Qualifiers
Chromium mg/L 0.5 0.49 98 85-115
Copper mg/L 0.5 0.49 98 85-115
Nickel mg/L 0.5 0.50 101 85-115
Zinc mg/L 0.5 0.48 95 85-115
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 3051972 3051973
MS MSD
92501240002 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chromium mg/L ND 0.5 0.5 0.51 0.51 101 102 70-130 0
Copper mg/L 0.030 0.5 0.5 0.56 0.56 106 107 70-130 1
Nickel mg/L 0.0057 0.5 0.5 0.52 0.51 102 102 70-130 0
Zinc mg/L 0.073 0.5 0.5 0.56 0.56 97 97 70-130 0
MATRIX SPIKE&MATRIX SPIKE DUPLICATE: 3051974 3051975
MS MSD
92501660001 Spike Spike MS MSD MS MSD %Rec
Parameter Units Result Conc. Conc. Result Result %Rec %Rec Limits RPD Qual
Chromium mg/L 206 0.5 0.5 0.71 0.72 101 102 70-130 1
ug/L
Copper mg/L 208 0.5 0.5 0.76 0.73 111 104 70-130 4
ug/L
Nickel mg/L 75.8 0.5 0.5 0.56 0.57 97 98 70-130 2
ug/L
Zinc mg/L 44.2 0.5 0.5 0.51 0.52 93 95 70-130 2
ug/L
Results presented on this page are in the units indicated by the"Units"column except where an alternate unit is presented to the right of the result.
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
Date: 11/02/2020 01:06 PM without the written consent of Pace Analytical Services,LLC. Page 7 of 10

Pace Analytical Services,LLC
aceAnalytical 205 East Meadow Road-Suite
Eden,NC 27288
www.pacdabs.com [phone]
QUALIFIERS
Project: SEMI ANNUAL TESTING(10/20)
Pace Project No.: 92501372
DEFINITIONS
DF-Dilution Factor,if reported,represents the factor applied to the reported data due to dilution of the sample aliquot.
ND-Not Detected at or above adjusted reporting limit.
TNTC-Too Numerous To Count
J-Estimated concentration above the adjusted method detection limit and below the adjusted reporting limit.
MDL-Adjusted Method Detection Limit.
PQL-Practical Quantitation Limit.
RL-Reporting Limit-The lowest concentration value that meets project requirements for quantitative data with known precision and
bias for a specific analyte in a specific matrix.
S-Surrogate
1,2-Diphenylhydrazine decomposes to and cannot be separated from Azobenzene using Method 8270.The result for each analyte is
a combined concentration.
Consistent with EPA guidelines,unrounded data are displayed and have been used to calculate%recovery and RPD values.
LCS(D)-Laboratory Control Sample(Duplicate)
MS(D)-Matrix Spike(Duplicate)
DUP-Sample Duplicate
RPD-Relative Percent Difference
NC-Not Calculable.
SG-Silica Gel-Clean-Up
U-Indicates the compound was analyzed for,but not detected.
Acid preservation may not be appropriate for 2 Chloroethylvinyl ether.
A separate vial preserved to a pH of 4-5 is recommended in SW846 Chapter 4 for the analysis of Acrolein and Acrylonitrile by EPA
Method 8260.
N-Nitrosodiphenylamine decomposes and cannot be separated from Diphenylamine using Method 8270. The result reported for
each analyte is a combined concentration.
Pace Analytical is TNI accredited.Contact your Pace PM for the current list of accredited analytes.
TNI-The NELAC Institute.
REPORT OF LABORATORY ANALYSIS
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Date: 11/02/2020 01:06 PM without the written consent of Pace Analytical Services,LLC. Page 8 of 10

Pace Analytical Services,LLC
aceAnalytical 205 East Meadow Road-Suite A
Eden,NC 27288
www.pacalabs.com [phone]
QUALITY CONTROL DATA CROSS REFERENCE TABLE
Project: SEMIANNUAL TESTING(10/20)
Pace Project No.: 92501372
Analytical
Lab ID Sample ID QC Batch Method QC Batch Analytical Method Batch
92501372001 EFF 001 COMP SM 2540D-2011 574691
92501372001 EFF 001 COMP SM 5210B-2011 574754 SM 5210B-2011 575302
92501372002 EFF 001 GRAB
92501372002 EFF 001 GRAB
92501372001 EFF 001 COMP EPA 200.7 Rev 4.4 1994 576721 EPA 200.7 Rev 4.4 1994 576826
REPORT OF LABORATORY ANALYSIS
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Date: 11/02/2020 01:06 PM without the written consent of Pace Analytical Services,LLC. Page 9 of 10

CHAIN-OF-CUSTODY Analytical Request Document
LAB USEONLY-AffixWorkorder/Lo 14O# : 92501372
- - --- -- relevent
----- MTJL 111111
• aceAnalytical• 1 1111 I III
' Chain-of-Custody is a LEGAL DOCUMENT-Complete all relevent fields
Company:Kayser Roth 'Billing Information: ALL SHADED AR 92501372
Address:714 Interstate Service Road Burlington ! __ Container Preservative Typ ___—_ t b�`�a 1
Nf____ ______ UN no_neinone; UN HNO3VONEVONE , �� �� , _ _ -_ __-
•Report To:Johnathan Bray I Email To:[e-mail] ••Preservative Types:(1)nitric acid,(2)sulfuric acid,(3)hydrochloric acid,(4)sodium hydroxide,(5)zinc acetate,
I - (6)methanol,(7)sodium bisulfate,(g)sodium thiosulfate,(9)hexane,(A)ascorbic acid,(B)ammonium sulfate,
Co To: Site Collection Info/Address: (C)ammonium hydroxide,(D)TSP,(U)Unpreserved,(0)Other
—_- __ -Name/Number: IState: County/City: Time Zone Collected: `--T Lab Sample Receipt Checkiist:
/ I IPTI ]MT[ ]CT I (ET i
l Custody Seals Present/Intact Y N,ilt
I Phone:[phone] ext 3222 Site/Facility ID It: !Compliance Monitoring? I i Custody Signatures Present Y N le
jEmail: [ ] Yes [ ]No Collector Signature Present Jr N NA
y Bottles Intact X N NA
Collected By(print): Purchase Order if: !DW PWS ID e: : Correct Bottles Y. N NA
7 {_L tCN�ote tt: — DW Location Code: Sufficient Volume s+t"N NA
L� r Y'S itJ Y t�t�f' i' I Samples Received '.n Ice Jr N NA
C e ted By(si nature): I :around Date Required: ,Immediately Packed on Ice: I I I VOA - Headspace Acceptable Y N NA
USDA Regulated Soils Y N
i , ��•r. ., -� _[ ]Yes [ ]No Samples in Holding Time ,yN NA
S ple Disposal: ' ush: Field Filtered(if applicable): ; o I Residual chlorier P_e nc, L Y X NA
I )Dispose as appropriate [ I Return [ I Same Day [ ]Next Day i[ ]Yes I [No ' E Cl Strips: `1O K
[ (Archive [ ]2 Day [ [3 Day [ ]4 Day ( ]S Day Sample pH Acce to zs '
to
� /Y N NA
j P =t
pH Scrips:
•[ ]Hold: (Expedite Charges Apply) i Analysis: i [ d! Sul fi le Present Y N al/
I Lead Acetate Strips:
•Matrix Codes(Insert in Matrix box below):Drinking Water(DW),Ground Water(GW),Wastewater(WW), I 0-
—
' Product(P),Soil/Solid(SL),Oil(OL),Wipe(WP),Air(AR),Tissue(TS),Bioassay(B),Vapor(V),Other(OT) 5 I in I LAB USE ONLY
Comp/ Collected(or Res not 1- , H p i Lab Sample h / Commenra:
Composite End I
Customer Sample ID Matrix• ' Grab Composite Start) CI Ctns ❑ —
Date 1 Time Date ' Time 1 m w
!Effluent 001 Comp IC J a J a , Is. '4
Effluent 001 Grab ) In I�7 1 iii .Z: 5 J ;S^ 5-u
I
i Will 1 IIIIIIIIIIIIIIIIIIIIIIIIMIIIIII
1
I i I i
+— _ --- I MEIN _ �— — — --
! ..� I i
11111111111111 MINI
Customer Remarks/Special Conditions/Possible Hazards: Type of Ice Used: W Blue Dry None SHORT HOLDS PRESENT(<72 hours): N N/A Lab Sample Temperature Info:
_ --�—_ _.---------.------------ TempBlank Received: Y N NAB
_} /C Packing Material Used: Lab Tracking B:
�` C' C/ 5 i H1 7 !/l�l� Therm lD#: q5' 5�
1 'I�` 3 3 C j f G.ci Cooler 1 Temp Upon Receipt: r ] oC
/ Sam les received via: Cooler 1 Therm Corr.Factor: ^ oC
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.4 Comments:
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Relinquished by/Company:(Signature) Date/Time: Received by/Co mpany:(Signature) Date/Time: PM: i 1 ----._-..--
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