NC0055786_Pretreatment_Annual_Report_20230302

City of Lexington
Pretreatment Program Annual Report
January 1, 2022 to December 31, 2022

LEXINGTON
N ORTH C AROLI NA
WATER RESOURCES
Q U A L I T Y F I R S T
2/28/23
Mr. Michael Montebello
NC DENR
DWQ/PERCS Unit
1617 Mail Service Center
Raleigh, N.C. 27699-1617
Re: City of Lexington's Pretreatment Program Annual Report 2022
Dear Sir,
Attached is a copy of the City of Lexington's Pretreatment Program Annual Report
for the period of January 1, 2022, to December 31, 2022.
t
Sincerely,
r
Eglantina Minerali
Lab Supervisor/ Pretreatment Program Coordinator
cc: WSRO
500 Glendale Road - Lexington, NC 27292 - 336.357.7889
w,%,\&'.LEYINGT0NN C.G Off'

Annual Pretreatment Program Report
POTW Name: City of Lexington
Report Date: February 28, 2023
Report Covered by This Report: From 01/01/2022 to 12/31/2022
Period Covered by Previous Report: From 01/01/2021 to 12/31/2021
Name of Wastewater Treatment Plant(s): Lexington Regional WWTP
NPDES Permit Number: NC0055786
Person to Contact Concerning Information Contained In This Report: Eglantina Minerali
Title: Lab Supervisor/Pretreatment Program Coordinator
Mailing Address: 28 West Center Street, Lexington, NC 27292
Telephone: [phone]
I have personally examined and am familiar with the information submitted in this document and
attachments. Based upon my inquiry of those individuals immediately responsible for obtaining the
information reported herein, I believe that the submitted information is true, accurate, and complete.
I am aware that there are significant penalties for submitting false information.
.92 `
Date: 02/28/2023
Signature of Official
Title: Lab Supervisor/Pretreatment Program Coordinator

Narrative Summary
January 1, 2022 — December 31, 2022
City of Lexington
General Program Information:
A. AT, LTMP, HWA, SUO, ERP, IWS and IUP are up to date.
B. All dates on the Divisions Database Program Info Sheet are correct. A copy of our Program Info
Sheet is enclosed.
C. IUP for Egger Wood Products LLC, was sent for modification along with the updated Allocation
Table and was approved on 9/8/2022.
II. Toxicity Bioassay Analyses:
During the year of 2022, Lexington Regional WWTP has successfully passed February (Ceriodaphnia
Dubia), May (Ceriodaphnia Dubia), August (Ceriodaphnia Dubia) and November (Ceriodaphnia
Dubia) bioassay.
III. Letter of Delegation of Pretreatment Signatory Authority: Enclosed
IV. Asco Power Technologies — IUP #0038
A. SIU was not on SNC this PAR year.
B. Half of the BDL was used for the IDSF.
C. There was an issue with the pretreatment system on 10/12-13/2022, resulting low pH levels.
Overnight, the system was calling for sulfuric acid to adjust the pH when it wasn't needed. That
was due to a faulty pH probe cord which it was then replaced. There was no discharge from the
plant during the noncompliance (the system was locked out). They were able to stabilize the pH
at around 8.6 SU after lunchtime and sustained that pH throughout the day on 10/13/2022. The
City of Lexington's industrial sampling team verified their pH that day, around 2:30pm. Prior to
the team's second visit, they had not discharge.
D. Annual inspection was performed on 12/8/2022. Inspection form is enclosed.
E. Certification letters for TTO were submitted on 6/6/2022 and 12/5/2022. Copies are enclosed.

V. Schultz Container Service — IUP #0010
A. SIU was not on SNC this PAR year.
B. The IDSF for Schultz Container Services reflects monthly averages and half of BDL.
C. Annual inspection was performed during the Pretreatment Audit Inspection on 9/27/22.
Inspection form is enclosed.
VI. Hollywood Bed & Sgrinx Mfrs. Co., LLC — IUP #0028
A. SIU was not on SNC this PAR year.
B. Half of the BDL was used for the IDSF.
C. Annual inspection was performed on 12/6/2022. Inspection form is enclosed.
D. Certification letters for TTO were submitted on 6/7/2022 and 12/6/2022. Copies are enclosed.
VII. Matcor Metal Fabrication — IUP #0012
A. Half of the BDL was used for the IDSF.
B. NOV was issued on 2/23/2022 for permit limit exceedance for Cu and Zn during routine
monitoring form the City of Lexington 1/24-28/2021. The situation was assessed, and corrected
measurements were taken to resolve and prevent the problem.
C. SIU was not on SNC this PAR year.
D. Annual inspection was performed on 11/29/2022. Inspection form is enclosed.
E. Certification letters for TTO were submitted on 6/15/2022 and 11/30/2022. Copies are
enclosed.
Vill. Tier Rack— IUP #0045
A. The IDSF for Tier Rack is not enclosed. No discharge has occurred in 2022. Tier Rack is
continuing to pump and haul to HAZMAT. The manifest is enclosed.
B. Annual inspection was performed on 12/16/2021. Inspection form is enclosed.
C. Certification letters for TTO were submitted on 6/3/2022 and 12/1/2022. Copies are enclosed.
VIV. Egger Wood Products- IU #1114
A. Half of the BDL was used for the IDSF.
B. SIU was not on SNC this PAR year.
C. The IUP was modified and approved on 9/8/2022. Decision was made based on the nature
of the industry's operation and most of the pollutants coming from the natural wood used
as row material, their cooperation, and the effort of its staff to meet the original Permit
Limits. Since there are not specific Effluent Guidelines from the EPA, their limits for BOD,
TSS, NH3, CN have been removed. Metals limits have increased and changed to Ibs/day.
D. New plant inspection was performed on 12/13/2022. Inspection form is enclosed.

LEXINGTON
N O RTH C A R O L I N A
WATER RESOURCES
QUALITY F I RST
January 28, 2019
NC Division of Water Resources - PERCS Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Delegation of Pretreatment Program Signatory Authority
City of Lexington (NPDES Permit NC0055786)
Davidson County
Dear PERCS:
As the Mayor of City of Lexington, I hereby delegate responsibility for overall operation of the
City of Lexington's Pretreatment Program to Eglantina Minerali, Laboratory Supervisor
Pretreatment Coordinator.
This designation will provide Ms. Minerali with the authority to sign all required documents
under the Pretreatment Program, including the authority to sign the Pretreatment Annual Report
(PAR) and submit it to NC DWR PERCS.
If you have any questions, please contact me at [phone] or Eglantina Minerali at
[phone].
Sincerely,
Newell Clark,
Mayor
cc: Tom Johnson, Water Resources Utility Director, Public Services Admin
500 Glendale Road - Lexington, NC 27292 - 336.357.7889
VV\vw.D X1NGr0NNC.Gov

Pretreatment Annual Report (PAR)
Significant Non -Compliance Report (SNCR
PAR covers this calendar year => 2022
Control Authority=Program=Town Name =>
WWTP = Wastewater Treatment Plant, use separate form for each WWTP.
SIU = Significant Industrial User
SNC = Significant Non -Compliance
WWTP Name =>
NPDES # _>
City of Lexington
Lexington Regional WWTP
NCO055786
A SNCR Form must be submitted with every PAR, please write "None " if you had No SIUs in SNC during calendar year
IUP
#
Pipe
#
Industry Name
Parameter
or "Reporting"
SNC? (Yes/ No)
for each 6-month period.
Jan. - June
July - Dec.
NONE
Attach a copy of the Division's "SIUs in SNC Historical Report" for your POTW's SIUs behind this page.
Is the database correct ? Notify the Division of any errors ! Database indicates SNC history for previous years.
EVERY SNC MUST be explained in the Narrative, How was, is, or will it be resolved?
REPEAT SNCs are serious matters that MUST be explained in the Narrative.
Form name: PAR,SNCR,2001
Date Revised: 1/4/2001

Chapter 9, PAR Guidance
Pretreatment Performance Summary (PPS)
1. Pretreatment Town Name: City of Lexington
2. 'Primary" NPDES Number NC00 55786
or Non -Discharge Permit # if applicable =>
3.
PAR Begin Date, please enter 01/01/yyyy
3. =>
1/1/2022
4.
PAR End Date, please enter 12/31/yyyy
4. =>
12/31/2022
5.
Total number of SIUs, includes CIUs
5. =>
6
6.
Number of CIUs
6. =>
5
7.
Number of SIUs with no IUP, or with an expired IUP
7. =>
0
8.
Number of SIUs not inspected by POTW
8. =>
0
9.
Number of SIUs not sampled by POTW
9. =>
0
lo.
Number of SIUs in SNC due to IUP Limit violations
10. =>
0
11.
Number of SIUs in SNC due to Reporting violations
11. =>
0
12.
Number of SIUs in SNC due to violation of a Compliance Schedule, CO, AO or similar
12. =>
0
13.
Number of CIUs in SNC
13. =>
0
14.
Number of SIUs included in Public Notice
14. =>
0
15
Total number of SIUs on a compliance schedule, CO, AO or similar
15. =>
0
16.
Number of NOVs, NNCs or similar assesed to SIUs
16. =>
1
17.
Number of Civil Penalties assessed to SIUs
17. =>
0
18.
Number of Criminal Penalties assessed to SIUs
18. =>
0
19.
Total Amount of Civil Penalties Collected 19. =>
$
0
20.
Number of IUs from which penalties collected
20. =>
0
Votes:
AO Administrative Order IUP Industrial User Pretreatment Permit POTW
CIU Categorical Industrial User NNC Notice of Non -Compliance SIU
Publicly Owned Treatment Works
Significant Industrial User
CO Consent Order NOV Notice of Violation SNC
Significant
Non -Compliance
IU Industrial User PAR Pretreatment Annual Report
revised 1/2018: PAR PPS 2018

Pretreatment Program Info Database
for Program Name Lexington
WWTP Name City of Lexington
Program Approval Date 06/10/1983
Pretreatment Status Full
Region WSRO
County Davidson
printed on: 1 /19/2023
Stream Information IWC % at 7Q10 60.03
7Q 10 Fo—cfs / mgd 6.7 / 4.33
1 Q10 Flow cis / mgd 5.57 / 3.60
Stream Classification WS-V & B
Basin Number YAD07
Receiving Stream Name ABBOTTS CREEK
NPDES Number NCO055786
Last PAR Rec 02/28/2022
PAR Due Date03/01/2023
mercury
NPDES Effective Date O2/01/2021
1631
NPDES Expire Date 04/30/2025
Current Fiscal
04/14/2021
Year PCI Do ne
required
es
POTW is Primary WWTP TRUE
Last Audit on 09/21/2017
Audit Year Next21/22
Design Flow mgd 6.5000 % Design mgd is SIU permitted
2.52
Permitted SIU flow (mgd) [PtL SIU) 1
WWTP SIU's
�
program SIUs
WWTP CIU's
Program ClUs
HWA LTMP
IWS SUO
ERP
date Inactive Date Next Due
07/01/2024
11/23/2025
Date Received by DWR
01/30/2020 09/24/2020
11/28/2020 01/08/2013
02/03/2020
Date Approved
07/16/2020 03/11/2021
12/02/2020 01/09/2013
02/13/2020
Adopt Date Required
Date Adopted
Info in this Box from Pt Contacts Date Date Date
PT Pro Attended Attended Attended
Formal Name a_Prime Phonell ext Fax HWA Wksq [UP Wkso PAR WksD
Ms. Eglantina Minerali
jPrim
[phone]
1/30/2019 5/17/2016 1/29/201"V72-9-2—
[e-mail] Pretreatment Program
28 W. Center Street
Related NOVs from DWQ I
DWR Central Office Contact JPretreatment Staff
DWR Regional Contact Pim Gonsiewski
N,c 5NC—

ASCO POWER TECHNOLOGIES
I U P #0038

BOD
Used in Calculated
Calculation lbs/day
TSS
TSS
Column Averages => 0.00522 60.83 1 60.83 2.62 302.00 1 302.00 13.01
Maximum 0.00615 154.00 1 154.00 7.66 788.00 1 788.00 34.40

AMMONIA
Used in Calculated
Calculation lbs/day
1 •
1 •
1 1
1 •,
1 ��
11
0.84
0.84
0.04
2.73
2.73
0.12
CADMIUM
Used in Calculated
< mgJL Calculation Ibs/day
1 11
1 111
1 1111
a
1 11
1 1 1
1 1111
a
1 11
i
1 1111
1 11
I l e
1 1111
a
I ll
1 11
1!1
�
1 1111
1 Ill1
a
1 11
1 111
1 1111
a
1 11
�
1 1111
IEN1 111 1 1111
1 111 1 1111

CHROMIUM
_
Used in Calculated
d.
list
11 �
11 �
111
COPPER
Used in Calculated
Calculation d.
11.
�
111
11 '
11 '
111 1
CYANIDE
Used in Calculated
Calculation lbs/day
1 11
1 11
1 111
1 11
1 11
1 111
��
tt]�I:I:U■
0.170 0.159 0.159 0.0070 0.0025 0.0001
0.3470 0.3470 0.0151 0.0025 0.0001
0.1695
0.0075
0.502
0.502
0.0219

LEAD MERCURY MOLYBDENUM

NICKEL
11'
11
111
11:
11:
111 .
11'
1 •
111
11
�
111
®rim,
m.
0.149
0.149
0.007
0.365
0.365
1 0.016
luain lsdy
ILVER
Calculation lbs/day
11 11 1111.
111� 11 � 111
1 11. 1 11. 1 111
1 11 1 i 1 111
1 11 1 1 1 111
1 11 1 11 1 111
1 11 1 11 1 111
1 11 1 11 1 111
S
0.005
S
0.005
0.0048
0.0002
0.0130
0.013
0.0006

ZINC OIL & GREASE
--
1
---- ---- --
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
Chlorides

Total Phosphorus Conductivity Sodium

TN
Used in Calculated
Calculation d,
21.01 1
21.01
0.91
34.80
34.80
1.52

Column Averages => 0.00410
Maximum 0.00801
M..
BOD
Used in Calculated
mi"Calculation lbs/day
M=Used
TSS
in Calculated
Calculation lbs/day
41.791 41.791 1 186.631 186.631 5.30
123.001 123.001 468.001 468.001 10.49

AMMONIA ARSENIC CADMIUM
a

MmCalculation
CHROMIUM
FUse1 in Calculated
lbs/d.
1 ,.•
1 ,.•
1 11
-�
1,•
111
11
11
111
11
11
111 ,
1 1•
1 ,•
, 11,•
0.060
0.0604
0.0019
0.110
0.110
0.0042
COPPER
iUsed
in Calculated
Calculation lbs/day
1 1.
1 11
11
II
,11
1 1•
1 ,•
1 11
0.133
0.1326
1 0.0034
0.3390
1 0.3390
0.0092
CYANIDE
Used in Calculated
Calculation d.
a
1 11
, 1
, 1111
1 11 111
all 1 11 1 111

LEAD MERCURY MOLYBDENUM

NICKEL
Used in Calculated
Calculation lbs/day
Nor, :
1 11 1��'�
1 1� •
1 11
11 .
11 .
111
11
1 i
111
11.
11.
1111
0.079
0.079
0.003
0.138
0.138
0.008
SILVER
1 11
1 11
1 111
111
111
11 1
111
1 I
11 1
1 11 �
�1ii
1 111
1 11
�
1 111
1 11�
1 �
1 1111
0.005
0.0049
0.0001
0.0120
0.012
1 0.0005

ZINC OIL & GREASE
- - -- - - -- - -
---- ---- --
- - -- - - -- - -
- - -- - - -- - -
---- ---- --
Chlorides

Total Phosphorus Conductivity Sodium

MM:,
IN
19.250
19.250
0.387
26.180
26.180
0.470

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations,(chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/l) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Control Authority,
Town Name =>
WWTP Name =>
NPDES # _>
1st 6 months, dates =>
2nd 6 months, dates =>
City of Lexington
Lexington Regional WWTP
NC0055786
l/1/2022 to 06/30/2022
7/ 1 /2022 to 12/31 /2022
Industry
Name Asco Power Tech.
IUP # 0038
Pipe # 101
ow, mga
Wili
INN
Ammonia
Is( 6 months
2nd 6 months
st mon s
_2nd b months
st mon s
2nd 6 months
st 77mmomnMs
2nd6months
8
8
8
8
8
8
8
8
154
123
788
468
2.73
2.15
60.83
41.79
302
186.6
0.84
1.12
0%
0%
0%
0%
0%
0%
0%
0%
1 0%
0% 1
0%
0%
Arsenic
Cadmium
Chromium
st mont s2nd 6 mon- s
2nd 6 months
I st 6 months
2nd 6 months
8
8
8
8
0.0005
0.0005
0.502
0.110
0.0005
0.0005
0.170
0.06
0%
0%
0%
0%
0%
0%
0%
0%
Copper Cyanide :Lead
Mercury
st 6 months
2nd 6 months I st 6 months
2nd 6 months st r mon s
2nd 6 months
st mont s
2nd 6 months
8
8 2
2 8
8
0.347
0.339 0.0025
0.0025 0.0025
0.0200
0.159
0.133 0.0025
0.002 0.0025
0.0065
0%
0% 0%
0% 0%
0%
0%
0% 0%
0% 1 0%
0%
BDL => Below Detection Limit mg/I => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month. Qtr, or 6-month & if BDL , 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP => wastewater treatment plant
*Reflect monthly and daily limits half of BDL
Chapter: PAR Guidance File name: PARDOfiftate&9ivs1'doideteCAxppnt91 sMg6n B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or 6 mth Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Industry Name ASCO POWER TECHNOLOGIES
IUP # 0038
Pipe # 1
Nickel e
Selenium
Silver
IM
st months
n mon sn
monr s
st Monts n mon s
st 0 months
n months
8
8
8 8
8
8
0.365
0.138
0.013 0.012
1.185
0.706
0.149
0.0790
0.005 0.005
0.606
0.377
0%
0%
0% 0%
0%
0%
0%
0% 1
0% 0%
0%
0%
st 6 months
n months
mon s
n mon s
st months
n months
st months
n months
2
2
2
2
17.88
58.42
26.18
31.59
011.90
21.1
19.25
0%
0%
0%
0%
0%
0%
0%
0%
st 6 months
2nd 6 months
r7r7omnT 7s2nd
6 months
I st 6 months
2nd 6 months
I st 6 months
2nd 6 months
BDL => Below Detection Limit mg/l => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Av_ •riod could be month, Qtr, or 6-month & if BDL, 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP => wastewater treatment plant
Chapter: PAR Guidance File name: PARQhi ftdki aysibWdeteCdwgen%,s n B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

ASCOPower
Technologies
December 5, 2022
Ms. Eglantina Minerali
Lab Supervisor
Water Resources Department
500 Glendale Road
Lexington, NC 27292
RE: Permit (I UP #0038) TTO Statement
Dear Ms. Minerali,
Per the requirements of our TTO program I am submitting the following statement:
ASCO Power Technologies
PO Box 689
325 Welcome Center Blvd
Welcome, NC 27374
USA
T [phone]
"Based on my inquiry of the person or persons directly responsible for managing compliance with the
standards for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no
dumping of concentrated organics into the waste -streams has occurred since filing the last discharge
monitoring report. I further certify that this facility is implementing the toxic organic management plans
submitted to the Control Authority."
Best regards,
Rogelio Garcia Suarez
Welcome, NC Plant Manager
Life Is On Schneider
Electric
Internal

ASCO Power
Technologies
June 6, 2022
Ms. Eglantina Minerali
Lab Supervisor
Water Resources Department
500 Glendale Road
Lexington, NC 27292
RE: Permit (IUP #0038) TTO Statement
Dear Ms. Minerali,
Per the requirements of our TTO program I am submitting the following statement:
ASCO Power Technologies
PO Box 689
325 Welcome Center Blvd
Welcome, NC 27374
USA
T [phone]
"Based on my inquiry of the person or persons directly responsible for managing compliance with the
standards for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no
dumping of concentrated organics into the waste -streams has occurred since filing the last discharge
monitoring report. I further certify that this facility is implementing the toxic organic management plans
submitted to the Control Authority."
Best regards,
Rogelio Garcia Suarez
Welcome, NC Plant Manager
Life is On Schneider
Electric

SIU INSPECTION FORM
Name Of Industry:
Address Of Industry:
El Q
Indus Re resentatives• Title
IUP#
IUP Expiration Date:
POTW Repre entatives, � e Title
().. J. _
Date Of Inspection: Z 20 ? Z- Time Of Inspection:' �[g ' '3Q 0/pm
Purpose of Inspection: Annual Other (De 'be)
POTW to which IU discharges NPDES # A -1r - � 5-S2 8A
Is SIU currently in SNC? Ala— If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product
YES /
Raw materials used
YES /
Manufacturing processes
YES QSW
Categorical if applicable
NO
Production rate N
b .15 -n-
Number of employees S /
Number of shifts YES DdO `
Comments: 7 —
3 —it
ll..-7-
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? ES NO Where do they go? l�
2. Are production areas diked, cqptampd, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? i'ES / NO Comments:
3. Are there floor drains in the storage area? kYX�V NO Where do they go?
4. Are storage tanks and areas diked, conC"',or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? / NO Comments:
5. Are process and storage tanks and pipes labeled? Y NO
6. How are off -spec raw materials, and products disposed of?
7. When is the production area cleaned? RL_
8. Is the wastewater from cleaning the produ &ion area dischkiied to the P TW? YES To
9. What non -process wastewaters are discharged to POTW?
r
Comments:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-13
Revision data: August 1, 1994 Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? 'a/ NO Comments:
Are all units operational? ES NO
How often does operator/maintenance person c ck system?
Is there an operator for each shift?
How and when is sludge disposed of? _
Is there a schedule for preventative maintenance? ES-7 NO
Comments:
aS KR-Izf
PART II - Plant Tour Section C - SAMPLING POINTS) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? / NO If yes, name of lab. _ 10& CAL_ —_
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3. Is flow measurement equipment operational?
/ NO Comments:
4. Is there a calibration log for the flow meter? Y5°/ NO Comments:
Comments: v" ?I t ,L " Y /3 / 2,0 7-
PART III - EXIT INTERVIEW
Review monitoring records andpthK SIU records required by IUP.
1. Are files well organized?TO Comments:
2. Are sample collection / chain -of -custody forms filled out2roperly? ES O Comments: _
3. Do results in files agree with reports sent to POTWI( YJU / NO Comments:
4. Who has authority to s ut down pro uction should a spill or slug discharge occur?
o e 1,'� �,� '.. �, -,-C-L � sh-� r��c .ra.,-j s rKW--'1
5. How does SIU inform employees of whom to cal at OTW in case of spill/slug?
If slug/spill plan is already required by POT*,leview dures.
6. Is SIU implementing slug/spill plan? / NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? / NO
Comments, Required Or Recommen Actions:
Signature Of Inspector(s)
sue, nh "5
Ju�.sT�
Date: / a— 2 2--
Date: i > / q l
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 2

SHUTZ CONTAINER SERVICE
I U P #0010

Used in Calculated
7<7 mg/L Calculation lbs/day
566
.506
28.23
509
509
41.40
989
989
147.98
638
638
114.53
1098
1098
45.00
2635
2635
367.17
2470
2470
306.90
1300
1300
167.06
675.5
83.0
1875.8
221.5
1275.63
i52.28
Column Averages => 0.0134 1275.63 152.3
Maximum 0.0215 367.2
<
Used in Calculated
mg/L C';[lculation lbs/day
297
297
14.81
180
2050
180
2050
14.64
306.74
620
620
111.30
844
844
34.59
812
812
113.15
688
688
85.48
384
384
49.35
734.375
111.87
W
70.(A
734.3750
91.2578
V734.38
91.26
306.7

AMMONIA
Used in Calculated
< mg/L Calculation lbs/day
3.46 0.381
0.90
CADMIUM
Used in Calculated
< mg/L I Calculation lbs/day
, 1,1,•
, 111
1 111 1 1 1111•
1 1111•

CHROMIUM
Used in Calculated
< mg/I Calculation Ibs/day
11
11
1111
11
--1
111
11
�
111
11
11
111
0.02088 0.0024
0.0080
COPPER
l'sod in Calculated
< mg/L Calculation lbs/day
11
111
11
111
11
�
111�
11
�
111�
1 •�
11
0.0669 0.0073
0.0243

Used in Calculated
Calculation lbs/day
r
Used in Calculated
7, mg/L I Calculation lbs/day
0 1 1,
�m
,,,,
ow I=
WITImAm
MERCURY
lbs/dayUsed in Calculated
Calculation
1 111 �1 1 11111
1 111
�
1 1111
a
, 111
11
1 1111
a
1 111
111
Nor, ,J
a
, 111
111
, 1111
a
1 111
�
, 1111
®
0.0025 0.0003 k-1.0001 0.00001
0. 1 0.0004 0.00002

MOLYBDENUM NICKEL
SELENIUM

Used in Calculated
< mg/L I Calculation lbs/day
1 ,1• : 1 111•
1 11
Used in Calculated
1'< mg/L I Calculation lbs/day
1
1
1 1
�9-1675 70142]
1
OIL & GREASE

<
Total
mg/L
Phosphorus I
Used in Calculated
Calculation lbs/day
6.5
6.5
0.3242
52.7
52.7
2.1598
2.16

Used in Calculated
Calculation lbs/day
TN
Used in Calculated
Calculation •.
2.32

Column Averages => 0.0119
Maximum 0.0189
777 1 sed in Calculated
C;dculation lbs/day
2190
2190
84.80
2780
2780
386.50
1670
11670
206.37
1590
1590
197.74
1120
1 120
36.70
1175
1175
77.97
1955
1955
213.85
1975
1975
311.92
2057.5
218.9
1556.3
160,
1806.88
189.48
1806.88 189.5
386.5
Used in Calculated
< 707
g/L Calculation lbs/day
558.88 62.13
271.1

AMMONIA
Used in Calculated
Calculation lbs/day
12.15 Llo
2.81
CADMIUM
Used in Calculated
< mg/L Calculation lbs/day
a
1 11
�
1 1111
a
1 11
1 111
1 1
a
1 11
1. 1
1 111
a
1 11
�
1 111
1 11
�i
1 1111
1 11
it
1 111
1 11
1 ;
1 111
1 111 1 1 1111
1 1111:

CHROMIUM
Used in Calculated
< mgJL Calculation lbs/day
11
11 .
111 1
11
11
111
11
�
1111
11
1 '
111'
0.06950 0.0074
0.0263
COPPER
( Ised in Calculated
Calculation lbs/day
1 me
1 1�
�
1 11� •
11�
�
111 1
11
11
1111:
11 :�
111
11
�
111
1 1' 1 11•
1 1'

Used in Calculated
Calculation lbs/day
Used in Calculated
< mg/L Calculation lbs/day
1 1
I I
1 111�
11
11
111
-�
1 11•
1 1
1 I1
�
1 111
a
1 11
�
1 111
1 11
�
1 111�
�1
MERCURY j
itsLd in Calculated
< my
JL Calculation lbs/day
1 11111
a
1 111
�
1 1111
a
a
1 111
1 111
�
�
1 1111
1 1111
a
1 111
�
1 11111
a
1 111
1 111
1 1111
1 1111
a
1 111
1 1111
0.0093 0.0007 0.0001 0.00001
0.00 11 0.00002

MOLYBDENUM NICKEL
SELENIUM
1 11 --
1 11 --
1 11 --
1--
1 111
1 11 --
1 1 . --
1 1 . --

Used in Calculated
< mg/L Calculation lbs/day
111
111
11 1
-�
11
111
a
1 11
1 11
1 111
111
111
111
a
1,,
i
1,111
a
, 11
1 ,
1 1111
a
, 1
1 1 1
1 111
1 11
, 111
1 111
111�
1 1 1 111,
1 11
Used in Calculated
<rmg7/LCalculation lbs/day
0.983
0.983
0.0381
2.496
2.496
0.3470
1.986
1.986
0.2454
0.927
0.927
0.1153
1.4
1.1
0.0459
1.428
1.428
0.0948
0.824
0.824
0.0901
1.495
1.495
0.2361
1.598
0.1864
1.28675
0.1167
0.1516
1.4424 0.152
0.347
OIL & GREASE

Total
Phosphorus
Used in Calculated
Calculation d.
® 0.56
1.

Used in Calculated
Calculation lbs/day
TN
Used in Calculated
Calculation d.

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations,(chronic SNC is >= 66%) => ,
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) => 2'
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66%) => -5
% TRC violations, (SNC is >= 33 %) => M
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) => ,
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66%) =>
TRC violations, (SNC is >= 33 %) => M
Control Authority,
Town Name =>
City of Lexington
WWTP Name =>
LRW v-M
NPDES # =>
NCO055786
1st 6 months, dates =>
1/1/2022 to 6/30/2022
2nd 6 months, dates =>
7/1/2022 to 12/31/2022
Industry
Namel Shfitz Container Services
lUP # 10
Pipe # 1
OMMUM
—
L!1 i� i�il
. •
f►�iTI3 �T.Tiiii�
► .
f►�iTG� 'r��
1�[.�� �
6•TiTi[��
11:�'. i��
f�T[.TST�TiS1��'
--0000-
--
1 1111'
1 1111:
1 11:
1 1
--
1 1111.
1 1111
1 11
1 11
-
�-0000—
--0000—
--0000—
■R3[.TT.Tifii�ll►[.?ibTitli�
■�[.T'iT.Tifti�
Mb?TTiii�T,�
■R�i.?TTifi�7
V•T�Ti[�TTiti�T,�
■R�i[.TT•T1fP>�
1�[.T�1:Ti[lix�
00--000
1 1
1 1•
--
1 111
1 11
1 1111
1 1111
00--000
1
00--000
1
00--000
1
BDL => Below Detection Limit mg/1 => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four ws Ple caSa how vera. c e S C => > on-C m lian e m d => .11io allo s da
Av �lc�rCoi 1f1S' fr��t't$fsn����n B, Pages 12L14>�,��o� use in your PAR Nurc tt of

Pretreatment Annual Report (PAR) -
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66%) => z
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum =>
* or Minimum =>
% violations, (chronic SNC is >= 66%) => Z
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Industry Name Sbijtz Container Services
luP # to
Pipe # 1
1 • iTiTiTiTi
1�+ST[•='iT•iiii
IC%i'iTiTitl•�KUM=
UZ i*TT•Ti=
=X=
�•
KUM=
00--0000
00--0000
0�--0000
00--0000
Iff[•TiT•Ti 1W
WTI OW'tT[I
•
KT[IMMO IN
IF%TTC•M4 1TO
"trtr3 T•nITI
IFEC1T6"WE
KIt:[•TT•Til•�'1
BDL => Below Detection Limit mg/l => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
�fo rows, P g j di ate h avers es1 e { Si ant o__m_�ppli ce d —> illi gallQ�t� {fir day
�dtl Sit$°�11 �md��i�i�'tn B, pages 12, `PRI�relYt`Ct'rit use in your PAR Nu►��Se1e��il fY��fli€rit i"fst of

SIU INSPECTION FORM
Name Of Industry: 1�9A U + Z IUP # 00 110
Address Of Industry: IUP Expiration Date:
S-�
Industry Rer P`nsentat}ves: �j Title
LAX
POT Repr gentatives: 'k Ti le ,
Date Of Inspection: 27— Time Of Inspection: tol 30 pm
Purpose of Inspection: Annual Other(D cribe)
POTW to which IU discharges W P 'I t' _NPDES #
Is SIU currently in SNC? If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES
Raw materials used YES
Manufacturing processes YES (90
Categorical, if applicable YES
Production rate YES / NO
Number of employees -YES / NO -- to
Number of shifts YES / .
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? YES NO Where do they go? (
el.c% .,t rn 1 D 0 U! %,✓ Sr-t S4
2. AA production areas diked, co eta, or otherwise constructed in sb6 a way as to prevent harm to the WWTP,
especially from spills or slugs?cy / NO Comments:
3. Are there floor drains in the storage area? YE / NO Where do they go?
4. Are storage tanks and areas diked, contaoFech or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? (F. YE / NO Comments:
5. Are process and storage tanks and pipes labeled? C YES!
6. How are off -spec raw materials, and products dispose of?
When is the production area cleaned?
Is the wastewater from cleaning the production arAidischarged to the POTW? Y S NO
What non -process wastewaters are discharged to POTW?
8
Comments:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-1)
Revision data: August 1, 1994 Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system?'G NO Comments:
2. Are all units operational? YE / NO
3. How often does operator/maintenance person_owfk system? t O �.
4. Is there an operator for each shift? YES / �ti S
5. How and when is sludge disposed oP
6. Is there a schedule for preventative maintenance? YE / NO
Comments: - w
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES 40 If yes, name of lab.
2. If industry completes sampling, ask the industry representative to describersampling procedures. Comments:
3. Is flow measurement equipment operational? (-Yt§)/ NO Comments:
4. Is there a calibration log for the flow meter? ES NO
Comments:
Comments:
PART III - EXIT INTERVIEW
Review monitoring records and er IU records required by IUP.
1. Are files well organized? S O Comments:
2. Are sample collection / chain -of -custody forms filled out properly? YES / NO Comments:
3. Do results in files agree with reports sent to POTW? YES / NO Comments:
4. Who has
V[41111-
to shut down production should a spill or slug discharge occur?
1— . _ AI-.-.- /_ _ I— r..-s aW — — I ..--j
5. How does SIU inform employees Awhom to call dt POTW in case of
If slug/spill plan is already required by POTWhreview procedures.
6. Is SIU implementing slug/spill plan? / NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? O/ NO
Comments, Required Or Recommen Actions:
Signature Of Inspector(s)
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
Date: 2 Z--
Page 2

Hollywood Bed & Spring Mfg. Co.
I U P #0028

Column Averages => #DIV/0!
Maximum 0.00000
BOD
Used in Calculated
Calculation lbs/day
391.125 391.125 0.00
749.00 749.00 0.00
used in Calculated
<rmg7/LCalculation lbs/day
1 1
®
1 11
®®
1 1
111 111 1 11
1 1 11 1 1 11 1 11

AMMONIA
ARSENIC
CADMIUM
� :: � , „
� � ��
■ter , „ �
lag

CHROMIUM COPPER
CYANIDE

LEAD MERCURY MOLYBDENUM

NICKEL SELENIUM SILVER

ZINC OIL & GREASE
--
1--
1--
1--
1
--
-��--
1
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
Chlorides

Column Averages => #DIV/O!
Maximum I 0.00000
BOD
TSS
Used in Calculated
Calculation lbs/day
TSS
Used in Calculated
Calculation lbs/day
11
11
1 1
310.688 310.688 0.00 336.750 336.750 0.00
494.00 1 494.00 0.00 636.00 636.00 0.00

AMMONIA
ARSENIC
CADMIUM

CHROMIUM COPPER
11
11 11111
11
1 11
1 11. 1 1111
1 1�
1 11.
1 11. 1 1111
1 1'
111
111 I Ills
11
Wo milm11
11111
11
11 �
11 � 11111
11
111
111' 111 1
11
CYANIDE

LEAD MERCURY MOLYBDENUM

NICKEL SELENIUM SILVER

ZINC OIL & GREASE
--
1
--
1--
1--
11
- - -- - - -- - -
---- ---- --
---- ---- --
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
Chlorides

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or 6 mth Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations,(chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or 6 mth Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or 6 mth Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Control Authority,
Town Name =>
City of Lexington
WWTP Name =>
Lexington Regional WWTP
NPDES # =>
NCO055786
1st 6 months, dates =>
01/01/22 to 06/30/22
2nd 6 months, dates =>
07/01/22 to 12/31/22
Industry
Namel Hollywooda pring Mtg.Co.
IUP # 0028
Pipe # 01
ow, mg
mmonia
st mont. s
2nd6months
Istbinonths
ZnclOmonlhs
lstt)monLhs
2nd 6 months
s mont s
2nd 6 months
8
8
8
8
8
8
749
494
1020
636
71.8
58.9
391
310
511
336.8
56.5 1
47.4
Arsenic
Uadmium
Uhromium
st mont s
I st 6 months
I I st 6 months
12nd 6 months
8
8
12ndmonths
8
8
0.003
0.0005
0.014
0.024
0.0008
0.0005
0.008
0.011
0%
1 0%
0%
0%
0%
0%
0%
1 0%
opper
Uyanide
Lead
Mercury
st 6 months
2nd 6 months
I st 6 months
2nd 6 months
I st 6 months
2nd 6 months
Ist6months
2nd6months
8
8
2
2
8
8
69.0
0.058
0.006
0.03
0.006
0.008
8.670
0.035
0.005
0.035
0.004
0.0040
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
BDL => Below Detection Limit mg/1 => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Ave eEriod could be month tr, or 6-month & if BDL, 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP => wastewater treatment dant
*Reflects monthly and daily limits and half BDL
Chapter: PAR Guidance File name: Wklbgj1Dfi x vReaik1op t ftap"2psbdOd199A pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Industry Name Hollywood Bed & Spring Mfg.Co.
IUP # 0028
Pipe # 01
a enium
i ver
me
_mont
stmons :c
n
st mon s
2n months
8
8 8
8
8
0.023
0.002 0.001
0.256
0.186
0.0110
0.0110
0.0007 0.0006
0.1720
0.125
0%
0%
0% 0%
0%
0%
0%
0%
0% 0%
0%
0%
st 6 months
2nd 6 months
I st 6 months
2nd 6 months
I st 6 months
2nd 6 months
I st 6 months 1
2ndmonths
st mont s
2nd6monirs
I st 6 mont is
_nd 6 months
I st 6 months
_n mont s I st 6 months
2nd 6 months
BDL => Below Detection Limit mg/l => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr. or 6-month & if BDL. 1/2BDL, or zero values used. TRC => Technical Review Criteria W WTP => wastewater treatment plant
*Reflects monthly and daily limits and half BDL
Chapter: PAR Guidance File name: W1d?nj1EHiFmWREkik1cn dhaplhngtised6d@�% pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

HOLLYV' OOC !�E[� gip: SPRI G ��IM CO. INC.
LR-1,
THE BEST BEDDING SUPPORT PRODUCTS SINCE 1925
Total Toxic Organics Certification Statement
Based on my inquiry of the person or persons directly responsible for managing
compliance with the permit limitation for total toxic organics (70),1 certify
that, to the best of my knowledge, no dumping of concentrated toxic organics
into the wastewaters has occurred since filing of the last monitoring report. I
further certify that this facility is implementing the toxic organic management
plan submitted to the Control Authority.
Certifying Official:
Signature
Dan Harpole
Printed Name and Title
VP of Operations
6.7.2Z
Date
5959 Corvette Street • Commerce, CA 90040 • [phone] • Fax [phone]
161 Proctor Lane, Lexington, NC 27292 - [phone] Fax[phone]
www.hollywoodbed.com

HOLLYWOOD BED & SPRING MFG. CO., INC.
THE BEST BEDDING SUPPORT PRODUCTS SINCE 1925
Total Toxic Organics Certification Statement
Based on my inquiry of the person or persons directly responsible for managing
compliance with the permit limitation for total toxic organics (TTO), I certify
that, to the best of my knowledge, no dumping of concentrated toxic organics
into the wastewaters has occurred since filing of the last monitoring report. I
further certify that this facility is implementing the toxic organic management
plan submitted to the Control Authority.
Certifying Official;
DIJ2-a-1 r
Signature
Dan Harpole
7Anl J4a2P0 L
Printed Name and Title
12.4.-22
Date
VP of Operations
VP of 0J_e1-q 4-"0-11s
5959 Corvette Street • Commerce, CA 90040 • [phone] • Fax [phone]
11 PoLNOTi369566rocta,, )-5506
www.holluwoodbed.com

SIU INSPECTION FORM
Name Of Industry: 01 k 1jaod IUP #
Address Of Industry: �� IUP Expirati n Date:
1_1Z�J2�ji
C.
Industry Representatives: Title
POTW epresejltati es: ` Title
,o V't F ET.PoudA —
IID.
Date Of Inspection: IZ 6 Time Of Inspection: `r_ ' G _ (D/pm
Purpose of Inspection: Annual Other escribe)
POTW to which IU discharges _ � / %A / NPDES # A/ C +OO S '- Z
Is SIU currently in SNC? IV If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
Product
Raw materials used
COMMENTS
/ N
YES
Manufacturing processes
Y /
Categorical, if applicable
NO
Production rate
NO
Number of employees
/ NO
Number of shifts YES /
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? / NO Where do they go?
e Are production areas diked, c d, or otherwise constructed in such a wa s to prevent harm to the WWTP,
especially from spills or slugs? Q NO Comments:
3. Are there floor drains in the storage area? / NO Where do they go?
r
4. Are storage tanks and areas diked, contai or otherwise cons cted in such a way as to prevent harm to the
WWTP, especially from spills or slugs?/ NO Comments:
5. Are process and storage tanks and pipes labeled? YES / NO
6. How are off -spec raw materials, and products disposed of?
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production are ischarged to the POTW? YES O
9. What non -process wastewaters are discharged to POTW?
1
Comments:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-1)
Revision data: August 1, 1994
Page I

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? (ONO Comments:
2.
3.
4.
5.
Are all units operational? Y / NO
How often does operator/maintenance on check system?
Is there an operator for each shift? / NO
How and when is sludge disposed of? _
6. Is there a schedule for preventative maintenance? YES
Comments:
1, s n en-j -e-1
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES )W If yes, name of lab. _
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3. Is flow measurement equipment operational? YE '/ NO Comments:
4. Is there a calibration log for the flow meter? ES NO Comments:
Comments: �s� G�� S1 `-( l �LO Z(
PART III - EXIT INTERVIEW
Review monitoring records and o
JLP4 SIU records required by IUP.
1. Are files well organized? . E / NO Comments:
2. Are sample collection / chain -of -custody forms filled out properly? YES / NO Comments:
3. Do results in files agree with reports sent to POTW? YES / Nd Comments:
4. o has autho to shut down production should a 9pill or slug discharge occur?
Sc>Q n'A
5. How does SIU inform employees of whom to cah at POTW in case of spill/slug?
If slug/spill plan is already required by POT review procedures.
6. Is SIU implementing slug/spill plan? ES % NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? / NO
Comments, Required Or Recommen ed Actions:
n
Signature Of Inspector(s) �- _ Date: Z z
Date: 12.— &- Z2,
Title: S1U Inpsection Form
Filename: COMP.INSP App 7-D
Revision data: August 1. 1994
Page 2

MATCOR METAL FABRICATIONS
I U P #0012

Column Averages => 0.00655
Maximum 0.01376
7w �
Used in Calculated
< mg/L I Calculation lbs/day
>
362
362
13.88
>
375
375
15.10
>
365
365
22.68
>
374
374
14.75
55
70
10.7
55
70
10.7
6.31
6.87
0.66
9.4
9.4
0.74
52.5
52.5
1.72
11.1
11.1
0.35
31.5
31.5
1.01
33.6
33.6
0.85
145.8167
145.8167
7.0782
145.82 145.82 7.08
375.00 1 375.00 22.68
<
Used iii Calculated
mg/L Calculation lbs/day
20802080 79.76
870
870
35.02
210
211)
13.05
116
116
4.58
204
204
23.41
93
93
9.13
23.6
23.6
1.46
4.8
-4.8
0.38
168
168
5.51
23
23
0.71
173
165
344.20
173
165
344.20
5.56
4.19
15.23
344.20 344.20 15.23
2080.00 2080.00 79.76

AMMONIA
Used in Calculated
< mg L Calculation lbs/day
8.19 8.19 1
0.37
24.80 24.80 1.00
sdy
aed m Calculated
< mg/L Calculation lbs/day
U
0.007 O.W71
1 11 .1 i
1 11 11
111
1 1111:
1 1111
1 11
�
1 1111
1 11
11
1 1111
1 11
1 1
1 1111
1 11
— 11
1 1111
1 11
®
1 1111
0.0019 0.0015 0.00006
0.0070 1 0.00027

CHROMIUM
Calculation bd.
11
11
rm
1 1
11
11
111
11
©
111
won, .
11
11
1111
Used in Calculated
< mg/L Calculation lbs/day
7.44
3.524
1.249
7.44
3.524
1.249
0.2853
0.1419
0.0776
0.782
0.782
0.0308
1.617
1.617
0.1856
0.547
0.547
0.0537
0.204
0.104
0.0126
0.102
�.1 102
0.0081
1.141
1.141
0.0374
0.171
0.171
0.0053
0.733
0.733
0.0236
0.65
0.65
0.0165
1.513
1.513
0.073
CYANIDE
a
1 11
�,
1 111
1 1.51 1.51 1 1 0.005 0.0025 0.0001
1
0.221 1 0.221 1 0.0085 1 7.4400 1 7.4400 1 1 0.0025 0.0001
0.06
1 0.06 1
0.0023

LEAD MERCURY
MOLYBDENUM
111 111

NICKEL
Used in Calculated
Calculation lbs/day
0.142
0.142
0.006
0,491
0.491
1 0.019
SELENIUM
SILVER
1 11
1 11
11
�
1 111
1 1111
1 11
11
1 111
1 11
®
1 1111
1 11 •
�
1 111
1 11
®
1 111
11 �
�
1111
11
�
11 1
0.01
0.0054
0.0002
0.0140
0.014
1 0.0005

OIL & GREASE
Used in Calculated
< mg/L Calculation lbs/day
8.953
8.953
0.3433
4.468 1
4.468
0.1799
1.637
1.637
0.1017
1.1980
1.198
0.0472
1.27 I
1.27
0.1458
0.553
0.553
0.0543
0.169
0.169
0.0105
0.077
0.077
0.0061
0.669
0.669
0.0219
0.14
0.14
0.0044
0.726
0.726
0.0234
0.589
0.589
0.0149
1.704
1.704
0.0931
1.70 1.704 0.079
8.953 8.953 0.343

Column Averages => 0.00232
Maximum 1 0.00371
BOD
Used in Calculated
Calculation lbs/day
38.30 38.30 0.81
214.00 214.00 4.86
Used in Calculated
< mg/L Calculaticm lbs/day
30.96 30.96 0.5::]
46.50 46.50 1.02

AMMONIA
Used in Calculated
Calculation lbs/day
1
1
1 1
..
=111 FWW1„
1 �
1 •
, 1
0.86 0.86 ;02
3.65 3.65 0.08 ;]
ARSENIC
CADMIUM
Used m Calculated
< mg/L Calculation lbs/day
1 11
1 1
1 1111
a
1 11
1 11
1 1111
a
1 11
1 1
11111
a
1 11
�
1 1111
1 11
1 111
1 1111
1 11
11
1 1111
11
�
1 1111
1 11 1 1 111 1 1111
1 ,11 1 1111

CHROMIUM
Used in Calculated
< ma Calculation lbs/day
1 11:
1 11:
1 111
1 11.
1 11.
1 111
1 11
1 1!
1 1111
1 11
1 11
1 111
1 1
1 1
Nor, 11
1 11
11
1 111
a
1 11
11
1 111
11 1
11 1
1111
COPPER
t iseil in Calculated
< mg/L Calculation lbs/day
1 11
11.
�
111
0.162 0.162 1 0.003
0.272 1 0.272 10.005
CYANIDE
1 11
11 1�1
1 11
1 11
1 .
1 111
7z111 11,1 1a
1 11 ,11

LEAD MERCURY MOLYBDENUM
0 ,„ ,,, ,,,, --�- --
0 Nor,
Nor, --

NICKEL SELENIUM SILVER
1 1 1 1 1 111
11 11 1111
---_
11 11
1 , 1 1 , 111
- - -_
1 11 • ii�ifi
- 11 • �i 1111�
---_
111. ,�

ZINC OIL & GREASE
--
1
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
---- ---- --
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
Chlorides

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations,(chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/l) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Control Authority,
Town Name => Lexington
WWTP Name => LRWWTP
NPDES # => NCO05578
1st 6 months, dates => 1/l/2022 to 6/30/2022
2nd 6 months, dates => 7 l —022 to 12/31/2022
Industry
Name Matcor Metal Fabrication
IUP # 12
Pipe # 1
I
ow, mgAmmonia
st 6 months
2nd 6 mon s
Jst6months
2nd6months
lst9months
M16months
T'stT'mon'1rs72ndO
months
12
8
12
8
12
8
8
8
375
214.0
2080
47
24.8
3.65
0.86
145.8
38.3
344.2
30.96
8.19
0
0
0
0
0
0
0
0
0
0
0
0
rsenic
jUadmium.
Uhromium.
st mont s
n mon s
st mon s
2nd6months
2nd 6 months
months
8
8
8
8
7onn
0.0015
0.0005
0.221
0.010
0.0015
0.0005
0.058
0.0046
0
0
0
0
0
0
0
0
opper
Uyamde
Lead
Mercury
st mon s
n mon s
st mon s
n mon s
st mon s
n mon s
st mon s
n months
12
8
2
2
8
8
7.44
0.272
0.0025
0.0025
0.030
0.006
1.51
0.162
0.0025
0.0025
0.0076
0.0032
0
0
0
0
0
0
0
0
0
0
0
0
BDL => Below Detection Limit mg/1 => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Av,-,�,-riod could be month, Qtr, or 6-month & if BDL , 1/2BDL, or zero values used. _ TRC => Technical Review Criteria WWTP => wastewater treatment plant
Chapter: PAR Guidance File name: PAR-QEM SdeiaivsMaidaWCAapzsA,sl n B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each ]UP pipe - Page of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum =>
* or Minimum =>
violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Industry Name Matcor Metal Fabrication
IUP #
Pipe #
12
IC3i,TiTii'iTii'717►�C.
iTTiTifii�l�[.�TiS'iti�1�'iTi[.TiT.TiTi�lRC+TiTii'iiiit�l►3T[.TiTiTiTiit,71�.
iTiTiTiPi7i�iT[
i.TiTiSifi�T,�■
00
-
-000
1
t'
LEEE� iJTx lT, - iTiiM
MMIZEM
M1i6OT,TM
EffJBM=
Kiiil[.i'iTiYM
LELI iTiTiM
MZIGi'°iT=
MTE-1liiT.Tium
kronL3 I Orl m
IFF 710 TiOM
M'iTt[i3iTTiliT,■
fR�+'iitTiRi�
f►�iCi ..[7iGTitiiiR7
!�.?iRiiiT.�
. . �
BDL => Below Detection Limit mg/l => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit Ib/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avy period could be month, Qtr. or 6-month & if BDL . 1/2BDL or zero values used. TRC => Technical Review Criteria W WTP => wastewater treatment plant
Chapter: PAR Guidance File name: PAR-008ftdei iiives(WdeleC est91 sl n B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

A-INIOM
METAL FABRICATION
835 Salem Road
Post Office Box 729
Welcome, NC 27374
Phone: [phone]
June 15, 2022
City of Lexington
Ms. Eglantina Minerali
Pretreatment Program Coordinator
28 W. Center Street
Lexington, NC 27292
"I certify under penalty of law that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate the information submitted. Based on my inquiry of the person or
persons who manage the system or those persons directly responsible for gathering the
information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fine and imprisonment for knowing violations."
"Based upon my inquiry of the person or persons directly responsible for managing compliance
with the permit limitation for Total Toxic Organics (TTO), I certify that, to the best of my
knowledge, no dumping of concentrated toxic organics into the wastewater has occurred since
filing of the last monitoring report. I further certify that this facility is implementing the Toxic
Organic Management plan submitted to the Control Authority".
Signed: 0C.-c- aL.
1�/ L-
Print Name: Joe Edwards
Title: EH&S/Maintenance Supervisor
Date Signed: June 15, 2022

6*#MWX=
METAL FABRICATION
November 30, 2022
City of Lexington
Ms. Eglantina Minerali
Pretreatment Program Coordinator
28 W. Center Street
Lexington, NC 27292
835 Salem Road
Post Office Box 729
Welcome, NC 27374
Phone: [phone]
"I certify under penalty of law that this document and all attachments were prepared under my
direction or supervision in accordance with a system designed to assure that qualified personnel
properly gather and evaluate the information submitted. Based on my inquiry of the person or
persons who manage the system or those persons directly responsible for gathering the
information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false
information, including the possibility of fine and imprisonment for knowing violations."
"Based upon my inquiry of the person or persons directly responsible for managing compliance
with the permit limitation for Total Toxic Organics (TTO), I certify that, to the best of my
knowledge, no dumping of concentrated toxic organics into the wastewater has occurred since
filing of the last monitoring report. I further certify that this facility is implementing the Toxic
Organic Management plan submitted to the Control Authority".
Signed: �2
Print Name: Joe Edwards
Title: EHS/Maintenance Supervisor
Date Signed: November 30, 2022

SIU INSPECTION FORM
Name Of Industry: CAh, 004'IUP # 2—
Address Of Industry: IUP E Er 'on Date:
CAA- r _S 3 I ?A 2
Industry Representatives: Title
.:4�S�4Q -I, 'f'%k r4 S' . S Ho1m is
POTW eprese�tatives: Title
Date Of Inspection: '� 2'2-- � � � O�
p Time Of Inspection: I n ` 3Q (q/pM
Purpose of Inspection: Annual Other Describe) _ _
POTW to which IU discharges 1 iAJ NPDES # tj(C co
Is SIU currently in SNC? nl"_,. If yes, for what? _
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product
YES /
Raw materials used
YES /
Manufacturing processes
YES
Categorical, if applicable
YES / NO
Production rate
YE )�
Number of employees
O I - ( - Z 1 31
Number of shifts YES
TO
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? YES /0 Where do they go?
2. Are production areas diked, co ed, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs. ES
/ NO Comments:
3. Are there floor drains in the storage area? YES O Where do they go?
4. Are storage tanks and areas diked, cont ' 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? V!�E / NO
6. How are off -spec raw materials, and products dispo?
7. When is the production area cleaned?
8. is the wastewater from cleaning the production area disc arged to the POTW? YES
9. What non -process wastewaters are discharged to POTW? 1
Comments: P-e CDC
&.3 #,z- e!�t p
Title: SIU Inpsection Form
File name: COMRINSP App 7-D
Revision data: August 1, 1994
MV
r-
Page I

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? 4(9 NO Comments:
2.
3.
4.
5.
Are all units operational? AYE NO
How often does operator/mam enance check system?
Is there an operator for each shift? ES NO 0,,
How apd whFn is sludge.disposed of? _ ■ ,
z
�i= S _-Q S
6. Is there alschedule for preventative maintenance? O(ES)l NO
Comments: W eIz�
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES ,l0 If yes, name of lab.
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3. Is flow measurement equipment operational? E / NO Comments:
4. Is there a calibration log for the flow meter? E / NO Comments:
Comments: t t 2�—
PART III - EXIT INTERVIEW
Review monitoring records and other SIU records required by IUP.
1. Are files well organized? YES / NO Comments:
2. Are sample collection / chain -of -custody forms filled out properly?
YES / NO Comments:
3. Do results in files agree with reports sent to POTW? -YES/NO Comments:
4. Who has authority to shut down production should a spill or slug discharge occur?
5. How does $IU it fbT employee§ of whom to call at PQTW in case of spill/slug?
- 1.... r . L_s1 V1LA
If slug/spill plan is alreadvirequired by l reQew prode_sres
6. Is SIU implementing slug/spill plan? s) NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? Ped
NO
Comments, Required Or Recommenctions:
Signature Of Inspectors)
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
Date: lit lr( �12L
Date:
Page 2

TIER RACK
I U P #0045

NAME OF FACILITY: TIER -.RACK
Business Address: 200 Prospect Drive, Lexington, NC 27292
Discharge Address (if different from above):
TOTAL TOXIC ORGANICS CERTIFICATION STATEMENT
Based on my inquiry of the person or person directly responsible for managing compliance with
pretreatment standard for TTOs, I certify that to the best of my knowledge and belief, this
facility does not store, use, or discharge to the sanitary sewer system any toxic organic
chemicals.
CERTIFYING OFFICAL:
90' Signature' Date
Printed Name & Title
EXECUTIVE OFFICER:
Signature
c
Printed Name & Title
Date t/p 0.3 a?Do?a2

NAME OF FACILITY: TIER -RACK
Business Address: 200 Prospect Drive, Lexington, NC 27292
Discharge Address (if different from above):
TOTAL TOXIC ORGANICS CERTIFICATION STATEMENT
Based on my inquiry of the person or person directly responsible for managing compliance with
pretreatment standard for TTOs, I certify that to the best of my knowledge and belief, this
facility does not store, use, or discharge to the sanitary sewer system any toxic organic
chemicals.
CERTIFYING OFFICAL:
Signature
Printed Name & Title
EXECUTIVE OFFICER:
J/
Signature
Printed Name & Title
Date
J
Date f"/V 1 A-0'R ,
U

SIU INSPECTION FORM
Name Of Industry: r [ Y __ C _ IUP # oo Li
Address Of Industry: IUP Expiration Date:
Industry Re prg sentatives: Title
POTW Representatives: itl
in-8—
61
Date Of Inspection: Time Of Inspection: 10 : 1_0 am/pm
Purpose of Inspection: Annual Other (Describe)
POTW to which IU discharges W NPDES # 5
Is SIU currently in SNC? ! r If yes, for what.
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product
YES /
Raw materials used
YES _.
Manufacturing processes
YES _
Categorical, if applicable
YES /
Production rate
YES / O
Number of employees
�/
Number of shifts YES /l
0 -
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? OES / NO Where do they go?
2. Are production areas diked, cont ' ed, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? / NO Com en�
3. Are there floor drains in the storage area?
Where do they go?
4. Are storage tanks and areas diked, con or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs?CqE/NO Comments:
5. Are process and storage tanks and pipes labeled? (yEy/ NO ��
6. How are off -spec raw materials, and products dispo of?'. G.i(� �
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production area discharged to the POTW? YES k&IJ�^
9. What non -process wastewaters are discharged to POTW?
Comments:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 1

SILT INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? E / NO Comments:
2. Are all units operational? / NO
3. How often does operator/maintenance n check system? as
4. Is there an operator for each shift? / NO 5. How and yvhen issssludge dis d of? [f 42A!ZJ [ L') C4e"'- - �, (2tk.'
6. Is there a edule for preventative maintenance? ' W NO
Comments: '-'O�
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES 0If yes, name of lab.
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
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 er SIU records required by IUP.
1. Are files well organized? NO Comments:
2. Are sample collection / chain -of -custody forms filled out properly?
YES / NO , Comments:
3. Do results in files agree with reports sent to POTW? YES / NO Comments:
4. Who has authority to shut4dow�production should a spill or slug discharge occur?
5. How does SIU inform e4loyees of wai% to call allbTW in case of spill/slug?
If slug/spill plan is already required by POreview procedures.
6. Is SIU implementing slug/spill plan? YE / NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? YIF / NO
Comments, Required Or Recomme Actions:
Signature Of Inspector(s)
Title: SIU Inpsection Fonn
File name: COMP.INSP App 7-13
Revision data: August 1, 1994
Date: I Z- ( --) IC
Date:
Page 2

HAZ~MAT Manifest No.-1��S7S7�L.
� r
ENVIRONMENTAL SERVICES
P.O. BOX 37392 • CHARLOTTE, N.C. 28237 R 0. No.—_—_.--.—
EANI141Dli+MEN%IL [phone]
FAX [phone]—4904
Job Na.------------
NON -HAZARDOUS SPECIAL WASTE 24904
Sr�ti�n I. - -- ��-- - GENEIZ4TU'R a,�er.w,ra,n.r•k...11e b..tk.,,. -- _-----_ ----- �.�
- WORK CONTRACTED BY
GENERATOR LOCATION
Bill To (if different from information at left)
NAME Am Fmck &mp=y
ORIGINATING ADDRESS - ---
IkiAlUNGADDRESS ------ ---- ---
rMWE
ADDRESS-----------
. Mtn CITY _ -_- STATE _ ZIP
CITY -.-.ii_r7E�4f�(fTt- - � -- .._ STATE.— � �- - �---._.-__-- -
DHONE NO. Q 4 PHONE NO.-------------,
qq2
CONTACTNAME_- --- - CONTACT NAME-------�� - - -- - -
DES. OF WASTE: � � - ` did
No. Type Units Quantity
Section II. INVOICE INF01EVAT1OP: _ GALLONS _DRUMS
DESCRIPTION^-----
1. PETROLEUM CONTACT WATER
2. OFF -SPEC LIGHT OIL. DIESEL OR GAS_--
3. NON -HAZARDOUS LIQUIDS
s
4. SEDIMENTORSOUDS-
5. 55-GALLON DRUM REMOVED - SOLID OR EMPTY I 153. 55-GALLON DRUM REMOVED-LIQUIp-
--A
7. �L - —
1t?�ARRIVALTIME: , DEPAKTURETIME:M
GENERATOR'S CERTIFICATION: 1 Itsreby ce 1ify tt•;at the ,Cove ramed matenai is not -1 h2zarc'ous NASte as r;etined by 30 CFR °art 261 or arty applicable state !aw. has been pre; ar'i
e�c :Y d, classified ana , arkwjed and is 'r pro,. F r condition fcr transportation ac^ udtt g to l;tpllcatle rergtilatior s. GPr irptor,'Customr^ Shall reimburse HAZAIAT ;Is reasonahie expensr s
ZIPA charges for handling, aratyrng ;oadtng, -repanng. 'rensporting, star-rg or .sing Ggr nonnonfnrrring or off afnn waste irctuding toss of decontamination and cieaninq of eeuipment.
Generators must no�tiffy, ► ALZ-AIAT of any changes to the waste stream xio- to shipment
.generator AultiurizLdd Agent Wi r!e ( Signature
I [yl lir����)(lrl L:� '1 i+."Wh01, rr�. �vr 7t1011. •. r1a.s•.o- �_ -�
sccti nt� III. �i';. "rr,rs.
- HAZ-MAT TRANSPORTER II------- —
ENVIRONMENTAI SERVICES
P.O. X ' • CHARLOTF, N.C. 28237 f. Address,
r
a. Drover Name'Tit!e-_---flf � �/'_1.-�-+'J, - -- - ----------- -,--- __- -_--
_ g DriverNarre'Ti?le------------ ----_ -.
U. Phone No. - _, r. Truck No.-------
h. Phone No._ - 1. Truck No.
Hazardous Waste Transporter Permits
EPA NCD04 1370 j. Transporter II Permit Nos.
r� -.. -- -- ____-"-` Stic•reat male - --_.__._ '-'-___ gt•� Ere
r.ilCf � . 'd'' `IrvYK Si�Sfi,Irw ��
Se on W. FAC11,17F r INFORNIATION t�'�T[) CERTil 4'('ATE OF L�ISI'OSAI.
Site Narne: Hoz-Maj Envirg=.DjO!_.$e,rvices a. Phone No. 1_Q4-, .3Z `!5i22
Physics! Address: 1j U ! on Av nywt to Mailing Address: P Q-.13 17.39
.hit a C 82')6 Qhdff6tte N C. 24237
e. Discrepancy indication Space_—_ - -- - -- -- -- --- -- --- - - - - - - _-_ _ _ -- -
T` M-* tg aotal;d7sftus !Tln-"A wand f"Sf! &P,,.' b= *, ta-4 THAW ai5J V.'.i W c4(bet d c 3?iJllic' m VP oil* to, Stilt V t.'d� mgAtm fl #>eftAfy't13mil (11 ?ejuke, WW JZ
are t 4 xi°d i+`A a b�efa l rrxs'dde fart fo use n a ge r�Tca eta terra s. ;mot Wasie h:�+s are tD tY V_*A Ht) poMy* . pH 415L s. and a ttx eta s !lszcx$1 a a ly�u+ sy lent kx pletl�^laf sepw 1byi.
rote the C%WD sanitation sewer system under cermit IUPr+53 t3t Sludces f rn? treatment systern: are hauled to E PA. app?rred fac l+! es fur p eper disposal. Mantfesl arvt ce ufttate of c115, nsof a e fi-"
14: Our ireatment system operates on a erst in, first otq b ms and Morttxt shad, be pmoe ed vrtfsr seven siays. - -- - - -- - - --._---
,;;r.;hJATURE(1PFAC1L1Tl'AC+FNT - -- -. � -^�-------i 1
DATE i MONTH !YEAk--
•`- - - - �— - ORIG1.'IAL •• FtNAI. yELt oW - L11SPo8ER •PINK • :ST T.3.0. GDLb •GENE RATORS

ENf4RONMENTAL
GENERATOR LOCATION
Manifest No,1 99121
ENVIRONAIFNTAL SERVICES
P.O. SOX 37392 - CHARLOTTE, N.C.10237
[phone]
FAX [phone]-4904
Job No. --- -- - ---- -- --
NON -HAZARDOUS SPECIAL WASTE 24904
GENERATOK.t.,...,eK,-,tr.,.�.,1 an
- ! WORK CONTRACTED BY
511; To [if iint-rent from udnrrna!,on at 10)
HAZ—MAT
(ORIGINATING ADDRESS��.--------
MA1LING ADDRESS
NAME —_._ _
ADDRESS
CITY S rArE_. Na_ ZIP CITY - STATC ZIP
PHONE NQ..'-
PHONE NO. -_ �7- 48"4 2' - -- -.. _-�_ j,- - --
CONTACTNAME- ------------- CONTACT NAME -� L`�JJ-._._.----
DEiS. OF'NASTE' - �' �rC�'t"- a(}S-_.�ii"�Lia -- -..-. ---
gq No. 'type Units Qu ntity
LscCtir.+n II. I.N'VOiCE INFORNIAT1ON — — GALLONS DRUMS _-
__.-- _--- -- r --- QUANTITY- ILTOTAL
- ---.- _
1. PETROLEUM CONTACT WATER - - -
2.OFF-SPEC LIGHT OIL, DIESEL OR GAS -- ---
3. NON -HAZARDOUS LIQUIDS--
4. SEUIME NTOR SOLIDS--
5. 55-GALLON DRUM REMO'JED - SOLID OR EMPTY - fi 1 -- -----.
6- 55-GALLON DRUM REMOVED-LIQUID---
7.
19.
10. ARRIVALTIME. _---DFPARTl1RET*,F_-:
GE, JERATOR'S CER.TIFICATIGN. I hereby cernFy that ttse above named material is : of a hazardous waste as defined by 4r1 CFI' part 261 or any aopli4:nI2e state tan. has 3• r , roper','..
drscrir�:d. class+ie" and packaged, ale 7S In r' -'er condition for transt'e13"�1 arx,trIc to ippicanle regulatiotts GerteratorlClstomar shalt rermburse HAZ h1AT as =easonabk expense.
:,rill rNargcs for handling. a Jy,ing, loa'!rnc crepar.nq !ranspprtng. slon'19 or .arm^ for no.'tnforrr;ng or .,ft spor, waste. inr'udirg -)sts of deC ntnrninatian and cle:intnq of
Ge!:eiator mu,' rrot HA.Z-1,tAT of any .hanges to Itit .r,,5tttr stream prcr ;o si;iprnv, t.
le
Generator Authorized Agent Nam. sgrratury
'IIS%N1 ,.
,t..w,R...[4o fr,s,n..t, ram,• ...
HAZ-r MAT TRANSPORTER n
e. Name -•--
ENVIRONMENTAL_ SERVICES
P.O. BOX 373C12 • CHARLOTTE. `N C.28237 Adtlress ---- ---• - -----.___. _ _ _--.-------
a. Driver Name,TiCe-�l � �
. _ �c tAillrs -- _ _ --_- --- ---- - —_-=-----_. -.-
g. Drver Name, Tit:e-• .. --------.---._.-
b. ?haste NO _ L�+=..� 3 5�7 (iv ------ c '!'rt ck N=,. _ ._.-- --
h. Phone No._ __.i. Truck No. -
rfezardous VVaste Transporter Permits
EPA NCDO48461370 j. Transporter 11 Permit Nos.
11
Sn;»I i
ectic:tt I�'. £.lC'II.I'I1-itiEC?RAi: TI(? AND CF'RTIF(CATF, C)F.DI51'0-AT, —__)
Site Name: - - Ns2�nvirgrrxteg a,( , karvi e- a. Phone No. 704-3a2,-itM
21�(-Qalton AvE;n.�;, b. M.t?ling Address
Physical Address: ChFirl tle.. ���7
Ct�.tllntt�, N.Ct,. ,'�•�2f.ii
Dis::rapanry tnrl•avon Space _ ----- s
tp -,
T� s r; t!; tfla' ai rtxrl rho 'w +f ^�n aC:,� I h� try rc xd N, ' �"1r q d a)TARe rt
n r a xr+�0 r t ty xXI kWd re�raM hft ildovttto marr+er It; Pr!+J� rn rd
we U; Ivk_i ri, a bqgvW reek. fold fx tee :1 69,j %, d o taxis a a J h io9J"J MCt tx is fH a ti say+ a'ri ts�" B !1 vS r)h a d5a Fes) a< r t on 5fVm ix `si -+' r
11:a ; rr:lU I)t y (I SUC san ta: cn Y .tier SySte^ ur-der ,v r;: !UF r`C 12. (Y Sludges Ircm vewaiem vy lEms ..re t a�fed to C-.l' A. 3,_vro:ed fa ;Uss fc y., .a r diFTcsal. hla,;!est w d M2rf at.. of dispx3
i41 t r treatrnont sy ten td,.a•ales on a W in. 5rt tr d'as-s and prrtJ:tct st'rr:d G pressed wIl n 5 ti2n ±ays.
- _ __--_. _ _. --- ------------ ------ -- _-__- 1 DATE ---i
Fil:iNATtJFEGF FACILIT+rAGENT A4GN'1}t _ .DAY (YEAR --_--_
---------- -"-- ------ - -- -� aPJRt • Fs!:At_ Ts.O. •YELLOW - nISPOSER PINK - 15T I.S.D. • G(a_0 . GENERATOR- ---- -- -

Egger Wood Products, LLC
I U P #0014

Sample Location:
Egger Wood Products
MGD
Sample Date
1
3/7-3/8/2022
Spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells.
Rest of
worksheetis
protected,
password is
'2"•
2) For below
detection data,
enter'V'in "<"
column, and
enter detection
level in Influent
or Effluent m
----------
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 12 value
entered.
0.02527
3/8-3/9/2022
0.02434
3/9-3/10/2022
0.02613
3/10-3/11/2022
0.02543
3/28/2022
0.33032
0.03298
6/13-6/14/2022
6/14-6/15/2022
0.03298
6/15-6/16/2022
6/16-6/17/2022
6 month Avg
0.03362
0.03295
0.0627
<
mg/L
d in Calculated
lbs/day
323030
FCalculatiOD
680.78
327070
663.74
294040
640.77
388080
823.02
5240
5240
1441.06
5370
5370
1476.86
3775
3775
1058.48
2488
2488
683.67
3774.13
3774.13
933.55
Column Averages => 0.0627 3774.13 3774.13 933.55
Maximum 0.3303 5370.00 5370.00 1476.86
in Calculated
<7m"OLCalculation lbs/dav
695.88 695.88 176.13
1390.00 1390.00 1 382.27

AMMONIA
.-
Used in Calculated
< mgJL. Calculation lbs/day
1 11
�
1 111
1 11
�
1 111
1 11
1 11
1 111
1 11
1 11
1 111
1 11
1 '.
1 111
1 11
1 11
1 111
1 11
11
1 11
a
1 11
�
1 111
CADMIUM
CalculationUsed in Calculated
1 11.
11.
1 1
1 1•
1 11.
11
1 11
11
11 1'
11
�
11 1
11
11
111
35.20 1 35.20 1 0.0025 0.0006 0.0096 1 0.0096 1 0.0025
44.80 1 44.80 1 12.10 1 0.0025 0.0007 0.0200 1 0.0200 1 0.0055

CHROMIUM
11
11
11
11
11
11
11
11
111�
11
11
111
COPPER
Used in Calculat :.
. . �.
1 1
1 t
11
NOW, =
1 1•
11
CYANIDE
0.1305 0.1305 0.0325 0.245 0.245 10.439
0.078 0.078 0.0158 0.2270 1 0.227 0.0624 0.300 1 0.300 1 0.826
0.0394
0.0394
0.00 77

Used in Calculated
< mg/L I Calculation lbs/day
11
11
11
11.
11.
11
1 1�'
11�•
11 1�
1 •
1 •
11
0.0766
0.0766
0.0190
0.1390
0.1390
0.0382
MERCURY
Used in Calculated
< mJL Calculation lbs/day
1 111
1 111
1 1111
KIT, 711
1 111
1 1111
KIT, 17
1 1
1 1111
1 111
11
1 1111
a
1 111
, 11
, 1111
1 111
, 11
, 1111
1 111
�
, 1111
1 111
�
1 1111
0.0001 0.00002
0.00010 0.00003

NICKEL
Used in Calculated
< mg/L Calculation lbs/day
1 1 '
11 •
111�1
11
11
111 '
�_I
11
11
111 •
-�
11
111
11
11
111
11
11
111:
0.0196
0.0196
0.0049
0.030
0.030
0.0083
SELENIUM
SILVER
1 11
�
1 111 •
1 11
1 11
1 1
1 11
111 •
1 111
1 11
11
1 11
1 11:
1 1.
1 11
1 11
�
1 11
11
0.0038
0.0038
0.0010
0.0080
1 0.008
0.0022

ZINC OIL & GREASE
Chlorides

Sample Location.
•
Egger Wood Products
MGD
Sample Date
8/8-8/9/2022
Spreadsheet
Instructions:
1) Data
entered only in
HeaBordered cells,0.01882
Rest of
worksheet is
protected,
password is
IT.
z) For below
detection data,
enter "<" in "<"
column, and
enter detection
level in Influen
or Effluentmc
columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 12 valu
entered.
0.03307
8/9-8/10/2022
0.022'89
8/10-8/11/2022
8/11-8/17022
0.02755
10/31-11/1/2022
0.03899
11/1-11/2/2022
0.03895
11/2-11/3/2022
0.03885
0.03898
11/3-11/4/2022
6 month Avg
0.03226
<
Used in Calculated
mg/L Calculation lbs/day
4090
4090
1128.11
2525
2525
482.09
8105
8105
1272.35
10400
10400
2389.14
3315
3315
1077.91
2125
2125
690.31
2920
2920
946.13
1918
1918
623.59
4424.8
4424.8
1076.20
TSS
I Used in Calculated
Calculation d.
Column Averages => 0.03226 4424.75 4424.75 10,76.20 445.63 445.63 97.88
Maximum 0.03899 10400.00 10400.00 2389.14 1920.00 1920.00 441.07

AMMONIA
111.10 111.10 31.08
--]
230.00 230.00 63.44
ARSENIC,
CADMIUM
0.0070 0.0016
0.0290 0.0067

CHROMIUM
Use/in Calculated
. .
1 11.
1 li.
1 11
a
1 11
, 11
1 111
11
11
111 .
11
11
111
1 1
1 1
1 1,•
11 .
11 .
111
11
11
, 11
0.0151 0.0043
0.027 1 0.0075
COPPER
Used in Calculated
Calculation lbs/day
, 1•
1 1•
, 11:1
11
11
11 :•
0.103
0.103
0.0241
0.3450
0.3450
0.0793
CYANIDE
Used in Calculated
Calculation lbs/day
1 11 1

LEAD MERCURY MOLYB
111' 111' 111 � 1111 111 11111 --
111` 111' 111 � 1111 1111 11111 --
1 .. 1 .. 11 1� � 1111 1111 11111 --
, � , 1 1 a 1 111 1 11 1 1111 --
1--
1 , 11 a 1 111 1 111 11111 --
, ,,. 1 11. , 11 • � 1 111 1 111 1 1111 --
a--

Used in Calculated
Calculation lbs/day
NICKEL
Used in Calculated
Calculation d.
11
11
111 1
,a
11
111
111 1
11
11
111::
11
11 .
111
11
11
I11
11
11
111
0.060
0.059
0.013
0.210
0.210
0.037

SILVER
Used in Calculated
< mg/L I Calculation lbs/day
a
1 11
1 111
1 111
Ia
11
1 111
1 111
MOM
1 11
1 111
111
111
111 .
1 11
1 11
1 111
a
1 11
1 111
1 111
a
1 11
1 111
1 111
1 11
1 111
1 111
1 11
1 11
1 111•
L 1 1 1
1 11
1 11
ZINC
Use,in Calculated
. ..
1
1
1
1 1
1
1 •
1 �
1
11 11
mom
1 1
11.
,-
1 1':
l i':
1 1 •
0.941
0.941
1 0.217
4.011
4.011
0.921
E

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations,(chronic SNC is >= 66%) _> ,
% TRC violations, (SNC is >= 33 %) _> o
% violations,(chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _> o
% violations,(chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _> o
% violations,(chronic SNC is >= 66%) _> E
% TRC violations, (SNC is >= 33 %) _>
Control Authority,
Town Name => City of Lexington
WWTP Name => LRWWTP
- NPDES # _> NCO055786
1st 6 months, dates => l/l/2022 to 6/30/2022
2nd 6 months, dates => 7/1/2022 to 12/31/2022
Industry
Namel Egger Wood Products, LLC
IUP # 14
Pipe # 1
Flow, mgd
BOD
TSS
Ammonia
st mont
n mon s
st mon s
n mon s
st mon s
n mont s
st mont s
2nd6months
9
8
8
8
8
8
8
8
1476.9
2,389
382.87
441.1
12.10
63.44
933.55
1,076
166.52
97.88
8.49
31.08
rsemc
a m ium
romium
st 6 mon d I
n Mmomno rs
st MomnNsm
Inn mont s
I st 6 m o n t h s
n mon s
st mon s
n mon s
8
8
8
8
8
0.0007
0.0055
0.0067
0.158
0.0075
0.0006
0.0025
0.0016
0.0087
0.0043
opper
Uyamde
Lead
Mercur
st 6 month
n months
st mon s
2nd 6 mont s
st mont s
2nd 6 months
st 6 months
2nd 6 months
8
8
1
8
8
8
8
0.0624
0.0793
0.826
0.382
0.501
0.00003
0.00003
0.0325
0.024
0.439
0.0766
0.0096
0.00002
0.00003
BOL => below Detection Limit mg/l => milligrams per liter
* Pof pWgt PARM6ftdwWvsGuidE4eCAmpzst91 stOgAn B, pages 12, 1 p14$lgp(l r y and use in your PAR Nu4jbw:oqAmkKpp&a&4UP pipe - Page of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) => ,
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66%) => z
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum =>
* or Minimum =>
% violations, (chronic SNC is >= 66%) => ,
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) => MO
Industry Name Egger Wood Products, LLC
IUP # 14
Pipe # 1
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BDL => Below Detection Limit mg/l => milligrams per liter
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SIU INSPECTION FORM
Name Of Industry: — e.,Y' V � ` S l Le- IUP # OD 1 9
Address Of Industry: �j ._ . IUP Expiration Date:
90 W
Industry epresentativ�s: Title S1 Q4�
`�J/I.tEL
z tl' ,
PoiV Repre§entatives, Ti le
nprr Yl
e.
Date Of Inspection: 1 / 22— Time Of Inspection: am/pm
Purpose of Inspection: Annual Other D cribe)
POTW to which IU discharges _ 1_ 1n%kiv NPDES # AIC ,6'
Is SIU currently in SNC? L/ If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES
Raw materials used YES AJU
Manufacturing processes YES N
Categorical, if applicable YES / NO
Production rate / NO
Number of employees W1 NO
Number of shifts YES
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? (29/ NO Where do they go?
2. Are production areas diked,
especially from spills or slugs?
or otherwise constructed in such a way as to prevent harm to the WWTP,
Are there floor drains in the storage area?
YES ,(NOJ Where do they go?
4. Are storage tanks and areas diked, contai e , or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? S NO Comments: _
5. Are process and storage tanks and pipes labeled? YES / NO p
6. How are off -spec raw materials, and products disposed of? P—CCA.,
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production areaikAarged to the POTW? YES '
9. What non -process wastewaters are discharged to POTW?
Comments:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August I, 1994 Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? (20NO Comments:
2. Are all units operational? E / NO
3. How often does operator/maintenance s check system?�°'
4. Is there an operator for each shift' / NO
5. How and when is sludge disposed of? _ N�
6. Is there a schedule for preventative maintenance? YE /
Comments: Qg
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES 110 If yes, name of lab.
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3. Is flow measurement equipment operational?
4. Is there a calibration log for the flow meter?
Comments:
Comments:
NO Comments:
PART III - EXIT INTERVIEW
Review monitoring records and other SIU records required by I
1. Are files well organized? YES / NO Comments: C•�
2. Are sample collection / chain -of -custody forms filled out properly? YES / NO Comments:
Do results in files agree with reports sent to POTW? YES / NO
4. Who has authofity to shut down production should a spill or slug discharge occur?
5. How does SIU inform employees V wPom to cfll at PQTW in case of spill/slug?
If slug/spill plan is already required by POT eview procedu
6. Is SIU implementing slug/spill plan? S_ NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? S NO
Comments, Required Or Recomme Actions:
Signature Of Inspector(s)
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
Date: 2 � 1Q -Z
Date: _ 1-)-, - f 3 -- 2 .L
Page 2

POTW=
NPDES#=
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name : BOD,TSS Updated- HWA AT_Approved_06162020-modified_05202022, Works hL?6itNdMW20g3f3:52 PM
"gage 1 of 7
Allocation Table
Headworks last approved: 06/16/20
Allocation Table updated: 06/11/22
Permits last modified: 06/11/22
L RWWTP
NCO055786
Spreadsheet Instructions:
1) Applicable Values should be entered in the Heavy Bordered cells. Rest of worksheet is protected, password is
2
2) Formulas are discussed in the Comprehensive Guidance, Chapter 6, Section C.
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.
Pipe
number
Type Renewal
of Effective
I ndustry Date
Modification Date
Effective Permit
Date Expires
Industry
INDUSTRY NAMES Permit
(plEacelist alphabaidy) number
FLOW
Permit Limits
B D
Permit Limits
TSS
Permit Limits
MGDgal/day
Conc. Load
m I Ibstd
Conc. Load
m I bstday
ASCO Power Technologies
0038
0001
433
05/31/19
05/31/24
0.012
12,000
Shutz Container Services
0010
0001
05/31/19
01/31/21
05/31/24
0.050
50,000
1050
Hollywood Bed & Spring MFG. C
0028
0001
433
05/31/19
02/05/21
05/31/24
0.020
20,000
Matcor Metal Fabrication
0012
0001
433
05/31/19
05/31/24
0.017
17,000
Tier Rack
0045
0001
433
05/31/19
05/31/24
0.017
17,000
Egger Wood Products, L L C
0014
1 0000
429
03/16/21
06/21/22
03/16/26
0.0500
50,000
Col umn Total s =>
1 0.16601
166,000
1 1050
0
Basis=>
MAHL from HWA (lbstday) =>
Uncontrollable Loading (lbstday) =>
Total Allowablefor Industry (MAIL) (lbstday) =>
Total Permitted to Industry (Ibstday) =>
MAIL left (lbstday) =>
Percent Allow. Ind. (MAIL) still available(%) =>
Percent MAHL still available(%) =>
5 Percent MAHL (I bs/dav) =>
HWA.AT
Revised: November 2005
NPDES Permitted Flow=>
NPDES
3.2580 6354 -5022
0.1660 1050 0
3.0920 5304 -5022
94.9% 83.5% 100%
47.6 % 24.1 % -36.5 %
0.32501 11021 687

POTW=
NPDES#=
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name : BOD,TSS Updated- HWA AT_Approved_06162020-modified_05202022, Works hL?6itNdMW?O 3T3:52 PM
"gage 2 of 7
Allocation Table
Headworks last approved:
Allocation Table updated:
Permits last modified:
06/16/20
Pipe
number
06/11/22
06/11/22
LRWWTP
NCO055786
Industry
INDUSTRY NAMES Permit
(plEacelist alphabaidy) number
Ammonia
Permit Limits
Arsenic
Permit Limits
Cadmium
Permit Limits
Chromium
Permit Limits
Copper
Permit Limits
Conc. Load
m I Ibs/d
Conc. Load
m I Ibs/d
Conc. Load
m I Ibs/d
Conc. Load
m I Ibs/d
Conc. Load
m I bstday
ASCO Power Technologies
0038
0001
0.070
0.007
1.710
0.171
2.070
0.207
Shutz Container Services
0010
0001
0.023
1.140
0.285
Holl ywood Bed & Spri ng MFG. C
0028
0001
0.070
0.012
1.710
0.285
2.070
0.345
M atcor Metal Fabrication
0012
0001
0.070
0.010
1.710
0.242
2.070
0.293
Tier Rack
0045
0001
0.070
0.010
1.710
0.242
2.070
0.293
Egger Wood Products, L L C
0014
0000
0.0250
1 1.1500
1 0.2500
Col umn Total s =>
01
1 0.0000
1 0.087
3.231
1.674
Class A,
Basis=>
M A H L from HWA (I bs/day) =>
Uncontrollable Loading (lbstday) =>
Total A I I owabl e f or Industry (MAIL) (I bs/day) =>
Total Permitted to Industry (Ibstday) =>
M A I L I eft (I bstday) =>
Percent Allow. Ind. (MAIL) still available(%) _>
Percent MAHL still avaiIabla(%) _>
5 Percent MAHL (Ibs/dav) =>
Design
Class A, Mon. Avg.
Stream Std
Stream Std
Mon. Avg.
711.51
0.4578
0.1921
5.6478
7.6966
432.61
0.0541
0.0324
0.3866
4.2234
278.89
0.4037
0.1597
5.2611
3.4732
0.00
0.0000
0.0865
3.2313
1.6744
278.89
0.4037
0.0732
2.0299
1.7988
100 %
100 %
3%
39.2%
88.2%
M45.8
%
235.24
35.58
24
0.3848
0.0229
HWA.AT
Revised: November 2005

POTW=,
NPDES#=>
IUP
Count
1
2
8
9
10
Workbook Name : BOD,TSS Updated- HWA AT_Approved_06162020-modified_05202022, Works hL?6itNdMW?O 3T3:52 PM
"gage 3 of 7
Allocation Table
Headworks last approved:
Allocation Table updated:
Permits last modified:
06/16/20
Pipe
number
06/11/22
06/11/22
LRWWTP
NCO055786
Industry
INDUSTRY NAMES Permit
(plEacelist alphabaidy) number
Cyanide
Permit Limits
Conc. Load
m I bstday
ASCO Power Technologies
0038
0001
0.650
0.065
Shutz Container Services
0010
0001
Holl ywood Bed & Spri ng MFG. C
0028
0001
0.650
0.108
M atcor Metal Fabrication
0012
0001
0.650
0.092
Tier Rack
0045
0001
0.650
0.092
Egger Wood Products, L L C
0014
0000
Col umn Total s =>
0.358
Basis=>
Stream Std
MAHL from HWA (lbstday) =>
1.0227
Uncontrollable Loading (lbstday) =>
0.0676
Total Allowablefor Industry (MAIL) (lbstday) =>
0.9551
Total Permitted to Industry (Ibstday) =>
0.3578
MAIL left (lbstday) =>
0.5973
Percent Allow. Ind. (MAIL) still available(%) =>
62.5 %
Percent M A H L sti I I avai I abl a(%) =>
58.4 %
5 Percent M A H L (lbstday) =>
HWA.AT
Revised: November 2005

POTW=
NPDES#=
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name : BOD,TSS Updated- HWA AT_Approved_06162020-modified_05202022, WorkshL?61t'NdMW?O 3:52 PM
"cage 4 of 7
Allocation Table
Headworks last approved:
Allocation Table updated:
Permits last modified:
06/16/20
Pipe
number
06/11/22
06/11/22
LRWWTP
NCO055786
Industry
INDUSTRY NAMES Permit
(pl- ist alphabdidy) number
Lead
Permit Limits
Mercury
Permit Limits
Molybdenum
Permit Limits
Nickel
Permit Limits
Selenium
Permit Limits
-9I
Permit
Conc. Load
m I I bs/d
Conc. Load
m I I bs/d
Conc. Load
m I I bs/d
Conc. Load
m I I bs/d
Conc. Load
m I I bs/d
Conc.
m I
ASCO Power Technologies
0038
0001
0.430
0.043
1.500
0.150
0.240
Shutz Container Services
0010
0001
0.50
0.00041
0.380
Hollywood Bed & Spring MFG. C
0028
0001
0.430
0.072
1.500
0.250
0.240
M atcor Metal Fabrication
0012
0001
0.430
0.061
1.500
0.213
0.240
Tier Rack
0045
0001
0.430
0.061
1
1.500
0.213
0.240
Egger Wood Products, L L C
0014
1 0000
0.5000
0.00045
1
0.400
Col umn Total s =>
1
1 1.237
1 0.00086
0.0000
1.606
0.0000
Class A,
Class A,
Sludge
Sludge
Basis=>
Mon. Avg.
Mon. Avg.
Ceiling
Ceiling
Stream Std
MAHL from HWA (I bs/day) =>
1.6459
0.085593
1.1419
2.8939
0.6341
Uncontrollable Loading (lbstday) =>
0.6462
0.017034
0.1514
0.2947
0.0541
Total A I I owabl e f or Industry (MAIL) (I bs/day) =>
0.9997
0.068559
0.9905
2.5992
0.5800
Total Permitted to Industry (Ibstday) =>
1.2367
0.000860
0.0000
1.6057
0.0000
M A I L I eft (I bstday) =>
-0.2370
0.067699
0.9905
0.9935
0.5800
Percent Allow. Ind. (MAIL) still available(%) _>
-23.7 %
98.7 %
100 %
100Percent
MAHL still available(%) _>
-14.4%
79.1 %
86.7 %
M38.2
91.55
Percent MAHL (Ibs/dav) =>
0.0823
0004280
0.0571
0.0317
HWA.AT
Revised: November 2005

POTW=
NPDES#=
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name : BOD,TSS Updated- HWA AT_Approved_06162020-modified_05202022, WorkshL?61t'NdMW?O 3:52 PM
"cage 5 of 7
Allocation Table
Headworks last approved:
Allocation Table updated:
Permits last modified:
06/16/20
Ver
Limits
Pipe Load
number bs/day
06/11/22
06/11/22
LRWWTP
NCO055786
Industry
INDUSTRY NAMES Permit
(plEacelist alphabaidy) number
ASCO Power Technologies
0038
0001
0.024
Shutz Container Services
0010
0001
Holl ywood Bed & Spri ng MFG. C
0028
0001
0.040
M atcor Metal Fabrication
0012
0001
0.034
Tier Rack
0045
0001
0.034
Egger Wood Products, L L C
0014
0000
1 0.0010
col umn I otal s => I U.1331
Basis=>
Stream Std
MAHL from HWA (lbstday) =>
0.0152
Uncontrollable Loading (lbstday) =>
0.1190
Total Allowablefor Industry (MAIL) (lbstday) =>
-0.1038
Total Permitted to Industry (Ibstday) =>
0.1331
MAIL left (lbstday) =>
-0.2369
Percent Allow. Ind. (MAIL) still available(%) =>
228 %
Percent MAHL still available(%) =>
-1556 %
5 Percent MAHL (I bstdav) =>
HWA.AT
Revised: November 2005

POTW=
NPDES#=
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name : BOD,TSS Updated- HWA AT_Approved_06162020-modified_05202022, Works hL?6itNdMW?O 1r3:52 PM
"gage 6 of 7
Allocation Table
Headworks last approved:
Allocation Table updated:
Permits last modified:
06/16/20
Pipe
number
06/11/22
06/11/22
LRWWTP
NCO055786
Industry
INDUSTRY NAMES Permit
(plEacelist alphabaidy) number
Zinc
Permit Limits
Total Nitrogen
Permit Limits
Total Phos.
Permit Limits
c
Permit Limits
d
Permit Limits
e
Permit Limits
Conc. Load
m I Ibs/d
Conc. Load
m I Ibs/d
Conc. Load
m I Ibs/d
Conc. Load
m I Ibs/d
Conc. Load
m I Ibs/d
Conc. Load
m I bstday
ASCO Power Technologies
0038
0001
1.480
0.148
Shutz Container Services
0010
0001
1.500
Hollywood Bed & Spring MFG. C
0028
0001
1.480
0.247
M atcor Metal Fabrication
0012
0001
1.480
0.210
Tier Rack
0045
0001
1.480
0.210
Egger Wood Products, L L C
0014
1 0000
1.5000
f
—
1
1
1
1
I
I
Col umn Total s =>
1
1 3.8151
1 0.00
0.00
0.00001
1 0.0000
-
0.0000
AS/Nit/TF
Basis=>
inhibition
NPDES
MAHL from HWA (lbs/day) =>
27.2968
239.06
Uncontrollable Loading (lbs/day) =>
14.3573
200.57
Total Allowablefor Industry (MAIL) (lbs/day) =>
12.9395
38.49
Total Permitted to Industry (Ibs/day) =>
3.8147
0.00 0.00 0.0000 0.0000
M A I L I eft (I bs/day) =>
9.1248
38.49
Percent Allow. Ind. (MAIL) sti I I avai I abl e (%) =>
70.5 %
##### 100.0 % ##### #�####
Percent M A H L sti I I avai I abl e (%) =>
33.4 %
5 Percent M A H L (I bs/dav) =>
1.3648
11.9528
HWA.AT
Revised: November 2005

POTW-
NPDES#-
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name: BOD,TSS Updated- HWA AT_Approved_06162020-modified_05202022, Works h66ftfNdfR?OA3r3:52 PM
Page 7 of 7
Allocation Table
Headworks last approved:
Allocation Table updated:
Permits last modified:
06/16/20
Pipe
number
06/11/22
06/11/22
L RWWTP
NCO055786
Industry
INDUSTRY NAMES Permit
(Pi�iistalPhal-aidy) number
f
Permit Limits
g
Permit Limits
h
Permit Limits
I
Permit Limits
Conc. Load
mg/I Ibsida
Conc. Load
mg/I Ibsida
Conc. Load
mg/I Ibsida
Conc. Load
mg/I Ibsida
ASCO Power Technologies
0038
0001
Shutz Container Services
0010
0001
HolI ywood Bed & Spring MFG. C
0028
0001
Matcor Metal Fabrication
0012
0001
Tier Rack
0045
0001
Egger Wood Products, L L C
0014
0000
Column Totals =>
0.0000
0.00001
0.00001
0.0000
Basis=>
MAHL from HWA (lbsiday) =>
Uncontrollable Loading (Ibs/day) =>
Total Allowablefor Industry (MAIL) (Ibsiday) =>
Total Permitted to Industry (Ibs/day) =>
MAIL left (Ibs/day) =>
Percent Allow. Ind. (MAIL) still available(%) =>
Percent M A H L sti I I avai I abl e(%) =>
5 Percent MAHL (lbs/dav) =>
HWA.AT
Revised: November 2005
None IUIII
####### 1#######
####### #######
Now IIIUIII
#######1 1#######
#######1 1#######