74241_Renewal (Application Form 2A)_May2021

tl'A kuraticalicn NuthGa
110012339987
NPDES Perot Number
NC0074241
Panay Name
Associated Asphalt Greensboro, 1
Form Approved 0315119
OMB No 2040-0004
FORM
2E
NPDES
aEFA
U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
MANUFACTURING, COMMERCIAL, MINING, AND SILVICULTURAL FACILITIES WHICH
DISCHARGE ONLY NONPROCESS WASTEWATER
SECTION 1. OUTFALL LOCATION (40 CFR 122.210)0})
1.1
Provide in omlation on each of the fad t-
Outfall
Number
001
Receiving Water Name
UT to East Fork Deep River
's outfalls in the table below.
Latitude
36' 4 28.6r
Longitude
79' 55 18.2- W EJ
SECTION 2. DISCHARGE DATE (4D CFR 122.210)(2))
L a
r."o
0
2.1
Are you a new or existing discharger? (Check only one response.)
❑ New discharger ❑� Existing discharger 4 SKIP to Section 3.
2.2
Specify your anticipated discharge date:
SECTION 3. WASTE TYPES (40 CFR 122.21010)1
a
3.1
What types of wastes are currently being discharged if you are an existing discharger or will be discharged if you are a
new discharger? (Check all that apply.)
❑ Sanitary wastes
❑ Restaurant or cafeteria waste
❑ Non -contact cooling water
0 Other nonprocess wastewater (destxibetexplain
directly below)
Boiler blow down
3.2
Does the facility use cooling water additives?
❑ Yes
❑✓ No 4 SKIP to Section 4.
3.3
List the cooling water additives used and describe their composition.
Coor'mg Water Additives
SECTION 4. EFFLUENT CHARACTERISTICS (40 CFR 122.21(h)(4))
Composition of Additives
(d mutable lo you)
4.1 Have you completed monitoring for all parameters in the table below at each of your outfalis and attached the results to
this application package?
❑ Yes ❑ No; a waiver has been requested from my NPDES permitting authority
(attach waiver request and additional information) 4 SKIP to Section 5.
4.2 Provide data as -s uested in the table below.' (See instructions for specifics.)
Parameter or Pollutant
Biochemical oxygen demand (BOD5)
Total suspended solids (TSS)
Oil and grease
Ammonia (as N)
Discharge flow
pH (report as range)
Temperature (winter)
Temperature (summer)
Number of
Analyses
(if actual data
reported)
Maximum Daily
Discharge
(specil7 uats)
Mass
Conn.
Average Daily
Discharge
(speelLurals}
Mass
Conc.
Spume
(use codes
Per
ins( ucbans)
N/A
7
7
2
7
7
N/A
mg
mg
mg
18 mg/I
5 mg/I
0 mg/I
0.396 MGD
6.68 - 7.6
mg
mg
11.7 mg,
0.7 mg/1
0 mg/I
O - Results
O - Results
O - Results
o - Results
0 - Results
N/A
ha r.n tirlorf amvAin 9r rffiePnthr CArr,itiw Icst nrnrnderes fie_ mefiod5l amro ed ender 40 CFR 136 lor the analysis of oollutsmts or pollutant
parameters or required tinder 40 CFR chapter I. subchapter N or 0 See msoveia►s and 40 CFR 122.2r(ek3),
EPA Form 3510-2E (revised 3.19)
Page 1

EPA Ida- iraion Number
110012339987
*FOES Perry Nmhrrer
NC0074241
Fairly Name
Associated Asphalt Greensboro, U.
Form Approved 03415/19
OMB No 2840-0004
a
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55
0
n
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VNumber
3
c.)
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0
w
4.3
is fed conform believed present, or is sanitary waste discharged
❑ yes p
(or will it be discharged)?
No 4 SKIP to Item 4.5.
4.4
Provide data as requested in the table below.' (See instructions for specifics.)
Parameter or Pollutant
Number of
AnalY5a5
fdadual dala
Maximum Daly
Discharge
(sped- )
Average Daly
Discharge
ispaily ma)
Source
(Use odes
Per
repaledt
Mass
on
Naas
Conc.
ilsingscosl
Fed conform
E cob
Enteraaocci
4.5
Is chlorine
•
used (or will it be used)?
Yes
151 No 4 SKIP to item
4.7.
4.6
Provide data as requested in the tattle below.'
(See instructions
for specifics.)
Parameter or Pollutant
of
AnalYsea
(if
Maximum Dairy
Discharge
(specify unit)
Average Daly
Discharge
(spesi airs)
Source
(use codes
Per
Mass Conc.
i )
maw)
Mass Conc.
Total Residual Chlorine
4.7
Is non -contact cooling water discharged (or will it be discharged)?
■ Yes ❑� No 4 SKIP to Section 5.
4.8
Provide data as requested in the table below.' (See instructions for specifics.)
Number of
Analyses
maximum Dairy
merge
Average Daily
Discharge
source
fuse coda
Parameter or Pollutant
(d acd,ai data
(sped*
ands)
(spay trills)
per
Wised)
Mass
Cone.
Mass Cone
s)
Chemical oxygen demand (COD)
Total organic carbon (TOC)
SECTION
5. FLOW
(40 CFR 122.21(h)(5)►
0
'L
5.1
Except for stormwater water runoff. leaks or spills, are any of the
application intermittent or seasonal?
Q Yes 3 Complete this section. ■
discharges you described
No 4 SKIP to Section
in Sections 1 and
6.
3 of this
5.2
Briefly describe the frequency and duration of flow.
Boiler blow down 1x/day; Est 2 gallon/day
SECTION
6. TREATMENT
SYSTEM (40 CFR 122.21(h)(6))
E
0
0
a.
1r
0
0
0
t--
6.1
Brietly describe any treatment system(s) used (or to be used).
None
' Sampling shall be cc ducled aowrdig m suMioentty s en b e Pr res (re. rthe9hods) appeared horde
parameters or required under 40 CFR chapter I. subchapter N or 0. See iisriicborts and 40 CFR 122.21(eX3).
EPA Form 3510.2E (revised 3-19)
Page 2

EPA tdenbbcabon Number NPOES Perrot Number
110012339987 NC0074241
Faaity Name
Associated Asphalt Greensboro, IL
Fart; Approved 0305/19
Ott Na 2O4O-O 4
SECTION
0
0
c
o
8
7.OTHER
7.1
INFORMATION (40 CFR 122.21(h)(7))
items. Use this space to provide any information you believe the
Attach additional sheets as needed.
Use the space below to expand upon any of the above
reviewer should consider in establishing permit limitations.
N/A
SECTION
8. CHECKLIST
AND CERTIFICATION STATEMENT (40
CFR 122.22(a) and Id))
that you have completed and are submitting with your application.
that you are enclosing to alert the permitting authority. Note that
2
S
co
c
Tu
•
u
c
a/
1
8.1
In Column 1 below, mark the sections of Form 2E
For each section, specify in Column 2 any attachments
not all applicants are required to provide attachments.
Column 1
Column 2
0 wl attachments (e.g., responses tor additional outfalls)
F. Section 1: Outfall Location
0 Section 2: Discharge Date
■ w/ attachments
0 Section 3: Waste Types
❑ w/ attachments
0 Section 4: Effluent Characteristics
■ w/ attachments
0 Section 5: Flow
0 wl attachments
Elw/ attachments
SI Section 6: Treatment System
0 vd attachments
51 Section 7: Other Information
❑ w/ attachments
51 Section 8: Checklist and Certification Statement
8.2
Certification Statement
1 certify under penally of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel property gather and evaluate the information
submitted Based on my inquiry of the person or persons who manage the system. or those persons directly
responsible for gathering the information. the information submitted is. to the best of my knowledge and belief, true.
accurate. and complete. ! am aware that there are significant penalties for submitting false information, including the
possibility of fine and imprisorunent for knowing violations.
Name (print or type first and last name)
Bruce weaver
Official title
Regional Manager
Signature
c------17-1-1/14
Date signed
ipo,z,
EPA Fain 3510-2E (revised 3-19)
Page 3