NCG500072_Regional Office Historical File 1996 to 2014

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•
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
Mr. David Stout
Heritage Home Group
815 Visionary St
Lenoir, NC 28645
Dear Mr. Stout:
John E. Skvarla III
Secretary
September 8, 2014
Subject:Rescission of Certificate of Coverage
NCG500072
Thomasville Lenoir Plant
Caldwell County
Division staff has confirmed that the subject Certificate of Coverage (CoC)
is no longer required. Therefore, in accordance with your request, NPDES
CoC NCG500072 is rescinded, effective immediately.
If in the future your company wishes to discharge wastewater to the
State's surface waters, it must first apply for and receive a new
NPDES permit.
If you have any questions concerning this matter, please contact Charles H.
Weaver at [phone] or via e-mail [[e-mail]].
Sin c rely,
F
r Thomas A. Reeder, Director
Division of Water Resources
RECEIVE
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Teresa S Ii SEP 1 9 2014
Water Quality Regional Operations
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Heritage Home Group
September 4, 2014
North Carolina Department of Environment and Natural Resources
DWQ — Surface Water Protection
Asheville Regional Office
Attention: Linda Wiggs
2090 U.S. Highway 70
Swannanoa, NC 28778
RE: Heritage Home Group, LLC — d.b.a. Thomasville Lenoir Plant
NPDES General Permit NCG500000, COC NCG500072
Permit Recession Request
Dear Ms. Wiggs:
David Stout
Director of Environmental Compliance
815 Visionary St.
Lenoir, NC 28645
828-759-8510 Tel
828-406-6079 Cell Phone
828-438-2623 Fax
Email address:
[e-mail]
I would like to ask for recession of NPDES Discharge Permit, Certificate of Coverage
NCG500072, for the Heritage Home Lenoir Wood Plant, d.b.a. Thomasville Furniture Lenoir
Plant. The discharge consisting of boiler blow down water has been routed to the City of Lenoir
POTW and is no longer being discharged into Blair Fork Creek.
If you have questions or want to discuss, please contact me.
Sincerely,
Heritage Home Group
David Stout
SEP - 5 2014
water &MfRy► "400 t Opp
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8zaq59-8510 Tet
8284W6019 Cell Phone
828-430-26Z� Fai
Email address.
North Carolina Department of Environment and Natural Resources
DWQ — Surface, Water Protection
Asheville Regional Office -
Attention: Linda Wiggs
209() US. 11j.0w4y 70,
Swarmanoa, NC 28778
AWPIant
I"tage-HoineGrou,p,LLC:—d.b.a.ThOM4$V�WIA
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perlItit Reces$j" Wq#ost
Dear , Ms. WiggS*
I would like to ask for recession of NPDES Discharge Permit, Certificate of Covet -age
NCG500072, for the Heritagre Home Lenoir Wood Plant, d.b.a. Thomasville Furniture, Lenoir
Plant. The discharge consisting of boiler blow down water has been routed to the City of Lenoir
POTW and is no longer being discharged into Blair Fork Creek,.
If you have questions or want to discuss, please contact me.
Sincerely,
Heritage I Home Group
David Stout

Wiggs, Linda
From:
Wiggs, Linda
-
Sent: Fh�d�September O5,2014lO:06AM
To: Weaver, Charles
RE: rescind NO3580O72
0 11 1 Z, � M, /A,
Environmental Senior Specialist
North Carolina Dept. ofEnvironment and Natural Resources
Asheville Regional Office
Division ofWater Resources - Water Quality Regional operations
2090 U.S� 70 Highway
Svvannanoe, NC 28778
Tel: [phone]
Fax: 828-299'7043
Link toDivision of Water Resources Home Page
Notice: E-mail corraspondence to and from this address maybe su��~biecttothe North Carolina Public Records Law and
therefore may bedisclosed tothird parties.
From: Weaver, Charles
Sent: Friday, SeptemberD5 2014 10:05AM
To: Wiggs, Linda
Subject: RE: rescind NCG500072
Yes, it's fine.
Does the AROagree with their request?
CHW
Fromm:VViggo Linda
Sent: Friday,September O5, 20149
Smptenn '.35AM
To: Weaver, Charles
Subject: rescind NCG500072
HI Charles,
is the attached letter enough for you to rescind this permit?
Environmental Senior Specialist
North Carolina Dept. ofEnvironment and Natural Resources
Asheville Regional Office
Division ofWater Resources Water Quality Regional Operations
1

2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Link to Division of Water Resources Home Page
httl2:ZZportal.ncdenr.org/web/wq
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
therefore may be disclosed to third parties.

Wiggs, Linda
Fox, James I <[e-mail]>
From:
Monday, September 23, 2013 8:48 AM
Sent:
Wiggs, Linda
To:
Stout, David
Cc:
Subject:
RE: temp
Thank you for calling this to my attention.
r had a mercury I calibrated the thermometer today and confirmed your readings.
them both and they are correct, mometer be off this
ave neve
much before . I have two more thermometers and have cal'
Meantime we are in communication with the city.
From: Wiggs, Linda [mailtodinda wiaa bncd_ enr Qov]
Sent: Thursday, September 19, 2013 2:47 PM
To: Fox, James I
Subject: temp
Hi James,
to Fahrenheit to compare with your temperature readings and it looks like your
I converted my temperature reading
temperature readings are off by —10 degrees on the cooler side.
Do you have another means of taking temperature readings?
If you are able to tie into the city system this will be a moot point,
eratu eill robe make note of it in the inspection report and
if you do maintain this permit you will need a more accurate temp p
Thanks Linda
Linda Wiggs - Linda Wills ncdenr.Iov
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Water Quality Section
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Link to Division of Water Quality Home Page
http:/lporta1.ncdenr.org/­weblwa
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
therefore may be disclosed to third parties.
1

M •
Oil
` jia
North Carolina Department of Environment and Natural Resources
Division of Water Resources
Water Quality Programs
Pat McCrory Thomas A, Reeder John E. SkII
Governor Director Secretaryr
September 20, 2013
James Fox
Thomasville Furniture Industries, Inc.
PO Box 640
Lenoir, NC 28645
SUBJECT: Compliance Sampling Inspection
Lenoir Plant Non -Contact Cooling Water
Permit No: NCG500072
Caldwell County
Dear Mr. Fox:
On August 27, 2013, I conducted a Compliance Sampling Inspection at the Lenoir facility.
We discussed possibly discharging the non -contact cooling water into the City of Lenoir's
sewer system. If you do decide to tie into the sewer system, let me know and I can advise
you how to rescind the subject permit. If you do not tie into the sewer, there are sampling
requirements that will need to be addressed. Please refer to the enclosed inspection
report for sampling comments. If you or your staff have any questions, please call me at
828-296-4500.
Sincerely,
Linda Wiggs
Environmental Senior Specialist
Asheville Regional Office
Enclosure
cc: Central Files
Asheville Files
David Stout a -copy
G:\WQ\SWP\Caldwell\Wastewater\General\Non-contact NCG50\Thomasville\CSI 08-2013. Ltr.doc
Water Quality Section — ASHEVILLE REGIONAL OFFICE One
Location: 2090 U.S. Highway 70, Swannanoa, NC 28778 NorthCarollina
Phone: [phone]TAX: 828 299-7043 Naturally
Internet: www.ncwatergualitv.org

- United States Environmental Protection Agency
Form Approved.
Washington, D.C. 20460
OMB No. 2040-0057
EPA
Water compiiance. Insned on Report
Approval expires 8-31-98
Section A: National Data System Coding (i.e., PCS)
Transaction Code NPDES yr/mo/day Inspection Type Inspector Fac Type
1 I N 2 1 5 I 31 NCG500072 111 121 13/08/27 117 18I S I 19I S I 20I II
!-)
Remarks
II16
21IIIIIIIIIIIIIIII I I I I I I I I I I I I IIIIIIIIIIIIIIII
Inspection Work Days Facility Self -Monitoring Evaluation Rating 61 QA -----------------------Reserved-------------------
701 71 I I 72I N I 73I ' j 74 751 I I I I I I 180
67I 169 I W
Section B: Facility Data
Name and Location of Facility Inspected (For Industrial Users discharging to POTW, also include
Entry Time/Date
Permit Effective Date
POTW name and NPDES permit Number)
10:00 AM 13/08/27
12/08/01
Lenoir Plant
Exit Time/Date
Permit Expiration Date
315 Elizabeth St NW
15/07/31
Lenoir NC 28645
01:00 PM 13/08/27
Name(s) of Onsite Representative(s)/Titles(s)/Phone and Fax Number(s)
Other Facility Data
Name, Address of Responsible Official/Title/Phone and Fax Number
Contacted
James Fox,315 Elizabeth St Lenoir NC 28645//828-757-2774/8287572723 Yes
Section C: Areas Evaluated During Inspection (Check only those areas evaluated)
Permit 0 Operations & Maintenance 0 Records/Reports 0 Self -Monitoring Program
Facility Site Review 0 Pretreatment N Effluent/Receiving Waters N Storm Water
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
(See attachment summary)
Name(s) and Signature(s) of Inspector(s) Agency/Office/Phone and Fax Numbers Date
ARO WQ//828-296-4500 Ext.4653///� '?
Linda S Wiggs
Signature of Management Q A Reviewer Agency/Office/Phone and Fax Numbers Date
JZ
EPA Form 3560-3 (Rev 9-94) Previous editions are obsolete.
Page # 1

NPDES yr/mo/day Inspection Type (cont.)
3 NCG500072 ill 12, 13/08/27 17 181
SI
Section D: Summary of Finding/Comments (Attach additional sheets of narrative and checklists as necessary)
Present during the inspection were James Fox, David Stout and Tom Gibson.
If the facility can work it out with the City of Lenoir, they should consider tying into the sewer system.
If the facility does not tie into the sewer and maintains this permit the items noted below will need to be
addressed:
*They will need to submit biocide/chemical worksheets for the chemicals currently used in the boiler system.
*Because chemicals are used in this system they will need to sample for Chemical Oxygen Demand (COD)
according to the permit.
* We clarified sampling procedures for representative samples upstream and downstream of the effluent
with regard to timing to make sure the downstream sample is obtained in concert with the boiler effluent
discharge.
*A new temperature probe will be needed. The current instrument is reading approximately 10 degrees
lower than the actual temperature.
Samples obtained during the inspection are as follows:
Effluent:
State readings - pH=9.76, T=33.8 C (92 F), COD 20 mg/I
Facility readings pH=9.7, T=78F
Upstream:
State readings — pH=8.40,
Facility readings — pH=8.1,
Downstream:
State readings — pH=8.75,
Facility readings — pH=8.8,
T=22.5 C (72 F)
T=64 F
T=25.0 C (77 F)
T=68 F
Page # 2

Permit: NCG500072 Owner - Facility: Lenoir Plant
Inspection Date: 08/27/2013 Inspection Type: Compliance Sampling
Operations & Maintenance Yes No NA NE
Is the plant generally clean with acceptable housekeeping? ❑ ❑ 0
Does the facility analyze process control parameters, for ex: MLSS, MCRT, Settleable Solids, pH, DO, Sludge 0 0 ■
Judge, and other that are applicable?
Comment:
Permit
(If the present permit expires in 6 months or less). Has the permittee submitted a new application?
Is the facility as described in the permit?
# Are there any special conditions for the permit?
Is access to the plant site restricted to the general public?
Is the inspector granted access to all areas for inspection?
Comment:
Effluent Pipe
Is right of way to the outfall properly maintained?
Are the receiving water free of foam other than trace amounts and other debris?
If effluent (diffuser pipes are required) are they operating properly?
Comment:
Effluent Sampling
Is composite sampling flow proportional?
Is sample collected below all treatment units?
Is proper volume collected?
Is the tubing clean?
# Is proper temperature set for sample storage (kept at less than or equal to 6.0 degrees Celsius)?
Is the facility sampling performed as required by the permit (frequency, sampling. type representative)?
Comment: Because chemical additives are used in the boiler system, COD needs to
be analyzed. However, it may be possible for this facility to tie into the sewer system.
See summary.
Yes No NA NE
pn■n
nn■n.
nn■n
0000
■000
Yes
No
NA
NE
■nnn
■nnrl
nn■n
Yes No NA NE
Upstream / Downstream Sampling Yes No NA NE
Is the facility sampling performed as required by the permit (frequency, sampling type, and sampling location)? ■ fl n
Comment:
Page # 3

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Wiggs, Linda
From:
Sent:
To:
Subject:
Wiggs, Linda
Wednesday, September 18, 2013 2:03 PM
'Fox, James I'
RE: Retest for NPDES
Hi James,
Thanks for these results. Something is altering the pH a fair amount as it passes under/near your building, but it appears
to recover at your downstream location.
I just spoke with Monty Wall with the City of Lenoir. He will be contacting you to discuss possibly tying into the sewer. If
that can be worked out that would be ideal.
I am working on your report, you should see it early next week.
Linda
Linda Wiggs - [e-mail]
North Carolina Dept. of Environment and Natural Resources Asheville Regional Office Division of Water Quality - Water
Quality Section
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Link to Division of Water Quality Home Page http://portal.ncdenr.org/web/wq
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
therefore may be disclosed to third parties.
-----Original Message -----
From: Fox, James I [mailto:[e-mail]]
Sent: Wednesday, September 18, 2013 1:51 PM
To: Wiggs, Linda
Cc: Stout, David; Farabee, Chris
Subject: Retest for NPDES
Linda, per your request,
Please see the note at the bottom of the sheet which at the point where the small un-named stream comes under the
road just below the pump station.
Additionally we went ahead and checked the stream at the same points as we did last time. You will see that the PH at
the point above the boiler output just beside the building is similar to before.
The boiler blow down was normal today compared to previous test that we do each year. I think the 9.7 last time was a
fluke.
Please send me your report of the COD test that we were talking about.
-----Original Message -----
From: James Fox [mailto:[e-mail]
Sent: Wednesday, September 18, 2013 1:52 PM
1

To: Fox, James
Subject: Message from "TVL-PL25-12"
This E-mail was sent from "TVL-PL25-12" (Aficio MP C3502).
Scan Date: 09.18.2013 13:52:19 (-0400)
Queries to: [e-mail]

I

�romm Fox James [<]Fox@henredonzom~
Sent: Thursday, August 08'2Ol3l2:21PK4
To: VWggs,Lindo
Cc: Stout, David
Subject: RE: Monday 8/12
'JrTe will see you on Me 27"'.
Thomasville Furniture
315 Elizabeth St. NW
Lenoir, NC
Go to Security Gate and you will be directed in.
Office 828-757-2774
From:Wigga Linda
Sent: Thursday, August 08, 2013 12:08 PM
To: Fox, James I; Stout, David
RE: Monday 8/12
(klet's doTuesday August 27"' at 10:00
We will need a place to meet initially, somewhere inside so we can go over paperwork, then we can head out to the
facility. | will need directions toour meeting place please.
David, this inspection is only for the NCG500072, not the Stormwater (SW) NCG180169. K4yrecords indicate that you
have never been inspected for either, but | will be there for the NPDES WCG500072. i know you and | have dealt with
SW permit before and I can assist you generally with that permit if you have any questions or I see anything that I feel
should bebrought toyour attention. Although | have toinform you the SWprogram has been taken away from the
Division ofWater Quality (now called Water Resources). Anyhow, there isalot ofchange going onwith usand the new
leadership has moved that program to the Division of Land Resources (now called DEMLR). Hovvever, to provide you
with good customer service and help you out I can answer questions you have about your SW situation at this facility but
keep inmind that program isnot under myDivision anymore.
With regard to the inspection I will be there for, I will go over the documents I have which are; the Notice of Intent from
20O7and the 8ioddp/[hemnica|Worksheets also from 2UO7. This isthe blueprint | have tolet noeknow how your facility
is operating. 20O7was along time ago, soifthings have changed | will need toknow. Please try tofind these
documents, ifyou cannot let nneknow.
Thanks Linda
Linda VViggs-
North Carolina Dept. ofEnvironment and Natural Resources
Asheville Regional Office
Division ofWater Quality - Water Quality Section
2O9OU.S.7OHighway
Svvannanoa,NC 28778

Link to Division of Water Quality Home Page
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
therefore may be disclosed to third parties.
From: Fox, James I
Sent: Thursday, August O8, 2013 10:43AM
To:VViggs Linda
Subject: RE: Monday 8/12
David said he was available on 27 th and 28th.
You pick the date and schedule the time.
RM
From:Wigos Linda
Sent: Thursday,AugustO8, 2013 10:33AM
To: Fox, James I
Subject: RE: Monday 8/12
| cannot dobthe following week. Let meknow if both of you are available onAug. 26, 27or28th?
Thanks Linda
UndaVVigas
North Carolina Dept. ofEnvironment and Natural Resources
Asheville Regional Office
Division ofWater Quality Water Quality Section
2O9OU.S.7OHighway
Svvannanoa,NC28778
Te|:82Q'Zy6-45OO
Fax:828-299'7O43
Link to Division of Water Quality Home Page
Notice: E-mail correspondence toand from this address may besubject tothe North Carolina Public Records Law and
therefore may bedisclosed tothird parties.
From: Fox James
Sent: Thursday, August D8, 2013 8:39AM
To: VViggs,Linda
there the following week.

/om: Wiggs, Linda [mailto:linda.wiggs ncdenr.gov]
Sent: Wednesday, August 07, 2013 12:30 PM
To: Fox, James I
Subject: Monday 8/12
Hi James,
I would like to schedule an inspection (boilers, kiln: NCG500072) next Monday August 12th after lunch at the Lenoir
Thomasville facility, are you available?
Thanks Linda
Linda Wiggs - [e-mail]
North Carolina Dept. of Environment and Natural Resources
Asheville Regional Office
Division of Water Quality - Water Quality Section
2090 U.S. 70 Highway
Swannanoa, NC 28778
Tel: [phone]
Fax: [phone]
Link to Division of Water Quality Home Page
http://Portal.ncdenr.org/web/wq
Notice: E-mail correspondence to and from this address may be subject to the North Carolina Public Records Law and
therefore may be disclosed to third parties.
3

STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NC 300000
TO DISCHARGE NON -CONTACT COOLING WATER, COOLING TOWER AND BOILER
BLOWDOWN, CONDENSATE, EXEMPT
OPERAT ONSCAND SIMIL AROOLING RS
ASSOCIATED WITH HYDROELECTRIC
WASTEWATERS UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended, this permit is hereby issued to all owners or operators, hereafter
Permittees, which are covered by this permit as evidenced by receipt of a Certificate of Coverage from the
Environmental Management Commission to allow the discharge of wastewater in accordance with the effluent
limitations, monitoring requirements, and other conditions set forth in Parts I, II, IIt and IV hereof.
This permit shall become effective August 1, 2012.
This permit shall expire at midnight on July 31, 2015.
Original signed by Matt Matthews
for Charles Wakild, P.E.
Director, Division of Water Quality
By Authority of the Environmental Management Commission

General Permit NCG50
PART
A. (1) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS FOR NON -CONTACT
COOLING WATER, COOLING TOWER AND BOILER BLOWDOWN, AIR COMPRESSOR
CONDENSATE AND SIMILAR WASTEWATERS
During the period beginning on Augustl, 2012 and lasting until expiration, the Permittee is authorized to discharge non -
contact cooling water, cooling tower and boiler blowdown, air compressor condensate and similar wastewaters from
outfalls numbered serially beginning with 001 (specific outfall numbers shall be assigned by the Permittee). Such
discharges shall be limited and monitored by the Permittee as specified below:
1. Effluent temperature will be regulated so that the temperature of the receiving stream does not increase more than:
Fresh water classifications 2.8°C above the natural water temperature raj
However, the receiving water temperature in no case to exceed 29°C at the
downstream monitoring location for mountain and upper piedmont waters.
However, the receiving water temperature in no case to exceed 320C at the
downstream monitoring location for lower piedmont and coastal plain waters.
Trout water classifications 0.5°C above the natural water temperature due to discharge of heated liquids
However, the receiving water temperature in no case to exceed 20°C at the
downstream monitoring location for trout waters.
Salt water classifications 0.8°C above the natural water temperature during the months of June, July and August
2.2°C above the natural water temperature during any other months
However, the receiving water temperature in no cases to exceed 32°C at the
downstream monitoring location for salt waters due to the discharge of heated
liquids.
The Permittee shall demonstrate compliance with the effluent temperature limitations by monitoring the temperature
of the receiving stream upstream and downstream of the discharge outfall. The Division should be consulted in
selecting representative upstream/downstream sampling locations. Upstream and downstream monitoring, is
not necessary if the discharge is to a receiving stream that does not contain any flowing water at the
time of dischar e
2. Limit and monitoring requirements apply only if chlorine is present in the discharge. The Division shall consider all
effluent TRC values reported below 50 µg/ L to be in compliance with the permit.
3. Monitoring requirement applies only for discharges ofpressor.con4ensate.
4. Monitoring requirement applies only'
scavengers, biocides or cleaning solvents are added to t e system; see A. (4) for discharge additive restriic ions.ygen
Page 2 of 6
8/1/2012

General Permit NCG500000
All non -contact cooling water sample locations shall provide representative samples of the discharge and require sampling
prior to discharge commingling with any other waters or substances, such as stormwater or surface water to enable
characterization of a pollutant of concern.
All samples collected should be from a representative discharge event, a measurable event that results in an actual
discharge from the permitted discharge outfall.
There shall be no discharge of floating solids or visible foam in other than trace amounts.
A. (2) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS FOR HYDROELECTRIC
FACILITIES — ONCE -THROUGH COOLING WATER AND SIMILAR WASTEWATERS
During the period beginning on August 1, 2012 and lasting until expiration, the Permittee is authorized to discharge once -
through cooling waters (including generator cooling water, generator thrust bearing cooling water, turbine guide cooling
water & transformer cooling water) and other similar waters associated with hydroelectric facilities from outfalls
numbered serially beginning with 001 (specific outfall numbers shall be assigned by the Permittee). Such discharges shall
be limited and monitored by the Permittee as specified below:
11 IN
G
Flow Semi-annually Estimate Effluent
Semi-annually Grab Effluent
Temperature U stream &Downstream
Total Residual Chlorine 17.0 pg/L (freshwater) Semi-annually Grab Effluent
(TRC) 2 13.0 pg/L (saltwater)
> 6.0 and < 9.0 standard units (freshwater) Semi-annually Grab Effluent
pH > 6.8 and < 8.5 standard units (saltwater)
Chemical Oxygen Demand Semi-annually Grab Effluent(COD) 3
1. Effluent temperature will be regulated so that the temperature of the receiving stream does not increase more than:
Fresh water classifications 2.8°C above the natural water temperature
However, the receiving water temperature in no case to exceed 29°C at the
downstream monitoring location for mountain and upper piedmont waters.
However, the receiving water temperature in no case to exceed 32°C at the
downstream monitoring location for lower piedmont and coastal plain waters.
Trout water classifications 0.5°C above the natural water temperature due to discharge of heated liquids
However, the receiving water temperature in no case to exceed 200C at the
downstream monitoring location for trout waters.
Salt water classifications 0.8°C above the natural water temperature during the months of June, July and August
2.2°C above the natural water temperature during any other months
However, the receiving water temperature in no cases to exceed 32°C at the
downstream monitoring location for salt waters due to the discharge of heated
liquids.
The Permittee shall demonstrate compliance with the effluent temperature limitations by monitoring the temperature
of the receiving stream upstream and downstream of the discharge outfall. The Division should be consulted in
selecting representative upstream/downstream sampling locations. Upstream and downstream monitoring is not
necessary if the discharge is to a receivinK stream that does not contain any flowing water at the time of
discharge.
Page 3 of 6
8/1/2012

General Permit NCG5
2. Limit and monitoring requirements apply only if chlorine is present in the discharge. The Division shall consider all
effluent TRC values reported below 50 µg/ L to be in compliance with the permit.
3. Monitoring requirement applies only if water treatment and/or chemical additives i.e. corrosion inhibitors, oxygen
scavengers, biocides or cleaning solvents are added to the system; see A. (4) for discharge additive restrictions.
All samples collected should be from a representative discharge event, a measurable discharge event that results in an
actual discharge from the permitted discharge outfall.
All non -contact cooling water sample locations shall provide representative samples of the discharge and require sampling
prior to discharge commingling with any other waters or substances, such as stormwater or surface water to enable
characterization of a pollutant of concern.
There shall be no discharge of floating solids or visible foam (other than trace amounts) in the effluent
A (3) EFFLUENT LIMITATIONS AND MONITORING REQUIREMENTS FOR HYDROELECTRIC
FACILITIES — SUMPS AND DRAINS AND OTHER MISCELLANEOUS WASTEWATERS
During the period beginning on August 1, 2012 and lasting until expiration, the Permittee is authorized to discharge
waters from sumps & drains (including powerhouse sumps & drains, wheel pit drains, head cover drains and gallery
sumps & drains) and other miscellaneous wastewaters (from sumps & drains associated with hydroelectric facilities) from
outfalls numbered serially beginning with 001 (specific outfall numbers shall be assigned by the Permittee). Such
discharges shall be limited and monitored by the Permittee as specified below:
c9: 1
Flow
Quarter)
Estimate
Effluent
Oil and Grease 1
15.0 mg/L 20.0 mg/L
Quarterly
Grab
Effluent
pH
> 6.0 and < 9.0 standard units (freshwater)
> 6.8 and < 8.5 standard units (saltwater)
Quarterly
Grab
Effluent
Total Residual Chlorine
17.0 pg/L (freshwater)
(TRC) 2
13.0 pg/L (saltwater)
Semi-annually
Grab
Effluent
Chemical Oxygen Demand
(COD) 3
Semi-annually
Grab
Effluent
The tailrace shall be visually inspected for oil sheens when a permitted discharge occurs immediately after the
lubrication of wicket gates (or other lubrication operations which might result in the discharge of oil and grease)
at the hydroelectric facility.
2. Limit and monitoring requirements apply only if chlorine is present in the discharge. The Division shall consider
all effluent TRC values reported below 50 µg/ L to be in compliance with the permit.
Monitoring requirement applies only if water treatment and/or chemical additives i.e. corrosion inhibitors,
oxygen scavengers, biocides or cleaning solvents are added to the system; see A. (4) for discharge additive
restrictions. -.
Chemical wheel pit cleaning is permitted on a monthly basis. When cleaning of the wheel pits occurs, the tailrace shall be
inspected visually for foam and oil. Cleaning shall be conducted only with solvents pre -approved by the Division. The
Permittee is responsible for retaining documentation of all solvent approvals. Should the Permittee wish to change
cleaning solvents (other than solvents previously approved) a written request should be made to the Division including the
MSDS for the proposed solvent.
Page 4 of 6
8/1/2012

General Permit NCG500000
Mechanical cleaning operations which do not contribute any wastewater to the discharge are not limited by this permit.
Non -discharging cleaning operations may be conducted as often as necessary to ensure safety and proper facility
operation.
All non -contact cooling water sample locations shall provide representative samples of the discharge and require sampling
prior to discharge commingling with any other waters or substances, such as stormwater or surface water to enable
characterization of a pollutant of concern.
All samples collected should be from a representative discharge event, a measurable discharge event that results in an
actual discharge from the permitted discharge outfall.
There shall be no discharge of floating solids or visible foam (other than trace amounts) in the effluent.
A (4) DISCHARGE ADDITIVE RESTRICTIONS
This permit does not authorize the discharge of water treatment or chemical additives (including but not limited to
chromium, zinc or copper) other than chlorine and approved de -chlorinating reagents without written approval from
the Division.
The Permittee shall obtain approval from the Division prior to the use of any chemical additive in the Permittee's systems
covered under this permit. To obtain approval the Permittee shall notify the Director in writing at least ninety (90) days
prior to instituting use of any new additive (other than additives previously approved by the Division). Such approval
requests shall include a completed Biocide Worksheet Form 101 or equivalent worksheet form approved by the Division, a
copy of the MSDS for the additive, and a map indicating the discharge point and receiving stream.
SECTION B. SCHEDULE OF COMPLIANCE
1. The Permittee shall comply with Final Effluent Limitations by the effective date of the Certificate of Coverage.
2. Permittee shall at all times provide the operation and maintenance necessary to operate the existing facilities in accordance
with Standard Conditions for NPDES Permits Section C.2. of this permit.
3. Permittee shall operate the existing facilities such that constituents and/or characteristics of the discharge qualify for
Certificate of Coverage under the General Permit in accordance with 15A NCAC 02H .0127. In accordance with NPDES
regulations at § 122,45, allowing detection of a pollutant: Instances could arise where the combination of process and
non -process wastewaters result in dilution of a pollutant of concern such that it would not be detectable using approved
analytical methods. Internal monitoring would enable characterization of the pollutant before dilution with other
wastewaters.
4. The upstream location for the natural water temperature shall be interpreted as the influent to the penstock or other
appropriate location in the impounded waterbody. Effluent is the outflow from the powerhouse. The temperature
change between these two values is considered the heat added and judged for compliance with Note 1 of the permit
and 15A NCAC 2H.0211 0).
SECTION C. APPLICABILITY
This permit is applicable to the following types of discharges defined below:
1, Non -contact cooling water and open recirculation cooling water systems used in industrial processes for the sole
purpose of cooling machinery and other equipment. Non -contact cooling water is defined as water used for cooling
which does not come into direct contact with any raw material, intermediate product, waste product or finished
product. Contact cooling water is defined as cooling water that comes into contact with raw material, intermediate
product, finished product, byproduct or waste product. Open recirculating cooling water systems, continuously reuse
the cooling water which passes through the heat transfer equipment. Open recirculating cooling water system
discharges to a Water Supply water body may require an individual NPDES permit. Contact cooling water discharges
require an individual NPDES permit.
2. Condensate wastewater from atmospheric cooling systems.
Page 5 of 6
8/1/2012

General Permit N
3. Blowdown wastewaters. Blowdown is defined as the minimum discharge of recirculating water for the purpose of
discharging materials contained in the water, the further buildup of which would cause concentration in amounts
exceeding limits established by best engineering practice.
4. Exempt stormwater, which is defined as discharges of stormwater which do not require permits under the state or
Federal NPDES programs. Exempt stormwater includes stormwater which accumulates in outdoor basins or ponds
designed for cooling water or other waters covered by this permit.
5. Water associated with hydroelectric power facilities, including cooling waters, waters from sumps and drains, dam
seepage and exempt stormwater.
6. Other similar wastewaters which may qualify for coverage under this General Permit.
SECTION D. NOTICE OF INTENT
Individuals who intend to obtain coverage under this general permit shall submit a Notice of Intent (NOI) applicable to this
general permit. A current version of the NOI for this general permit can be obtained by contacting the NPDES Permitting
Program at [phone] or can be downloaded from the internet at http://portal.iicdeiir ora/web/wq/swp/ps/npdes/permits.
NOIs must be signed and submitted to the NPDES Permitting Program 1617 Mail Service Center, Raleigh, NC 27699-1617.
Applicants who have submitted a completed NOI are not authorized to discharge until a Certificate of Coverage is issued. In
general, the NOI shall include the following information:
1. The mailing address and telephone number for the owner and/ or operator
2. The facility name, address and telephone number where the discharge will occur.
3. The permit number of any NPDES permit(s) for any discharge(s) from the site.
4. A description of the discharge, including the number of discharge points, the volume of discharge, the frequency of
discharge and any treatment methods applied prior to discharge.
5. The name of the receiving waters and the stream classification (s).
6. An analysis of non -discharge alternatives, including connection to a regional sewer collection system, subsurface
disposal and spray irrigation.
7. A 7.5 minute series USGS topographic map with the discharge location clearly indicated.
8. Final plans and specifications for the treatment system and all major components (if applicable).
9. A certification that the information contained in the NOI is true, complete and accurate.
10. A listing of all previously approved water treatment and/or chemical additives i.e. biocides, oxygen scavengers,
corrosion inhibitors, and cleaning solvents. Water treatment and chemical additives include any material that is added
to water used at the facility or to a wastewater generated by the facility to condition or treat water.
Page 6 of 6
8/1/2012

97'�t�Ill

, V,
Woodward -Clyde
Engineering & sciences applied to the earth & its environment
January 24, 1996
Mr. Preston Howard
Storm Water Permitting Group
North Carolina Department of Environmental Management
512 North Salisbury Street
Raleigh, North Carolina 27604
Subject: PETITION FOR REPRESENTATIVE OUTFALL STATUS
THOMASVILLE FURNITURE INDUSTRIES, INC.
LENOIR, NORTH CAROLINA
Dear Mr. Howard:
Woodward -Clyde Consultants, Inc. (WCC) is pleased to present this petition for
representative outfall status on behalf of Thomasville Furniture Industries, Inc. (TFI). for the
facility located in Lenoir, North Carolina.
The subject facility has 5 Drainage Areas, 4 of which are located in areas of industrial
activity as shown on the attached figure. Table 1 summarizes all of the Drainage Areas at the
subject facility. Drainage Area 5 is a small area with no industrial activity, situated near
Drainage Areas 2 and 4. Drainage Area 3 is an area of little industrial activity and is also
located next to Drainage Area 4. TFI requests that Drainage Area 4 (Outfall 4) be
representative of Drainage Areas 3 and 5 due to the close proximity of the areas —and f e ac
o in ustna activity in areas 3 and 5.
Drainage Area 2 covers a large portion of the facility and includes a variety of activities. The
unnamed tributary to Blair Fork splits Drainage area 2 as it flows through the facility. There
are 5 sub -drainage areas within Area 2 that discharge into the tributary at 5 locations, as
shown on the attached figure. In order to obtain a representative sample of the Drainage Area
2 storm water, the facility will sample Sub -drainage Areas 2a and 2b. A sample taken at
Outfall 2 would be co -mingled with stormwater from sources north of the facility.
Should this request be accepted by the DEM, the facility will sample outf41Y's"1 2a, 2b, and 4.
F -i
�. ems' (L 2 �► � `�
Woodward -Clyde Consultants, Inc. �G /
3109 Poplarwood Court, Suite 120 • Raleigh, North Carolina 27604-1043
919-850-9511 • Fax [phone]
S-\92C5059\LENOIR\PETITION.DOC / 01-24-961.1

Mr. Preston Howard
Storm Water Permitting Group
North Carolina Department of Environmental Management
January 24, 1996
Page 2
Thank you for your attention to this matter,
�t theforward
undes igned at (9 9) 850-9511Should have
any questions regarding this request, please conta
Sincerely,
David S. McLay, P.E.
Project Engineer
DSM:kas
Enclosures
cc: Rochelle Chisom, Thomasville
Woodward -Clyde Consultants
S:\92Ci059\LENOIR\PETITION.DOC 101-24-96 /.1

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I. PRODUCT IDENTIFICATION
TRADE NAME
CHEMICAL NAME
CHEMICAL FAMILY
COLORINDEX#
C. A. S. #
LAST REVISION DATE
COMPONENTS
COMPONENT
1) Sodium Hydroxide
1310-73-2 less than
2)
3)
4)
5)
6)
F.U. box 001
High Point NC 27261
Call During Working Hours Mon -Fri [phone]
After Hours Emergency Telephone # [phone]
Material Safety Data Sheet
B-247C BOILER TREATMENT
SODIUM HYDROXIDE, SOD SULFITE
ALKALI
MIXTURE
N/A
PERCENT
9
T. L. V.
N/E
Ill. PHYSICAL DATA
BOILING POINT
286-296-f (50%)
SOLUB, IN WATER
COMPLETE
VAPOR PRESSURE
N/A
ODOR
APPEARANCE
AMINE
WHITE TO SLIGHTLY COLORED LIQ.
VAPOR DENSITY
N/A
SPECIFIC GRAV
1.5 - 50% 1.7 - 73%
VOLATILITY
N/A
FREEZE POINT
N/A
EVAP. RATE
N/A
MELTING POINT
N/A
ph OF PRODUCT
N/A
IV. FIRE AND EXPLOSION DATA
FLASH POINT N/A
FLAMMABLE LIMITS N/A
IN CASE OF FIRE SOME OF THESE MATERIALS MAY REACT VIOLENTLY WITH WATER.
SMALL FIRES: Dry chemical, CO2 water spray, or regular foam.
LARGE FIRES: Water spray, fog or regular foam. Move
container from fire area if you can do it without risk.
Apply cooling water to sides of containers that are
exposed to flames until well after fire is out. Stay
away from ends of tanks.
PAGE 1 B-247C BOILER TREATMENT (CONTINUED ON NEXT PAGE)

i s
MATERIAL SAFETY DATA SHEET (CONTINUED)
IV. FIRE AND EXPLOSION DATA (CONTINUED)
FIRE- FIGHTING
PROCEDURES WEAR SELF-CONTAINED BREATHING APPARTUS AND FULL
PROTECTIVE CLOTHING.
FIRE AND EXPLOSION SOME OF THESE MATERIALS MAY BURN.
HAZARDS BUT NONE OF THEM IGNITES READILY.
FLAMMABLE/POISONOUS GASES MAY
ACCUMULATE IN TANKS AND HOPPER CARS.
SOME OF THESE MATERIALS MAY IGNITE
COMBUSTIBLES (WOOD,PAPER, OIL, ETC.).
V. REACTIVITY DATA
STABILITY STABLE
CONDITIONS TO AVOID NONE
INCOMPATIBILITY STRONG ACIDS AND ORGANIC ACIDS, ALUMINUM, ZINC, TIN AND
ORGANIC CHEMICALS INCLUDING CHLORINATED HYDROCARBONS SUCH
AS TRICHLOETHYLENE.
HAZARDOUS DECOMPOSITION
PRODUCTS WILL REACT WITH SOME METALS, E.G. ALUMINUM, TIN, ZINC TO
FORM FLAMMABLE HYDROGEN GAS.
HAZARDOUS
POLYMERIZARTION Will not occur.
CONDITIONS TO AVOID NONE
VI. HEALTH HAZARD DATA
THRESHOLD LIMIT VALUE
HAZARD WARNINGS
Limit is 2mg/m3 for sodium hydroxide.
Contact with eyes and skin may cause irritation.
CONTACT CAUSES BURNS TO SKIN AND
EYES.
IF INHALED MAY BE HARMFUL.
FIRE MAY PRODUCE IRRITATING OR
POISONOUS GASES. RUNOFF FROM FIRE
CONTROL OR DILUTION WATER MAY CAUSE
POLLUTION.
PAGE 2 B-247C BOILER TREATMENT (CONTINUED ON NEXT PAGE)

MATERIAL SAFETY DATA SHEET (CONTINUED)
EMERGENCY AND FIRST AID PROCEDURES
SKIN: REMOVE CONTAMINATED CLOTHING AND
WASH CONTAMINATED SKIN WITH LARGE
AMOUNTS OF SOAP AND WATER. IF
IRRITATION PERSISTS, CONTACT A
PHYSICIAN.
EYES: FLUSH EYES WITH WATER FOR AT
LEAST 15 MINUTES. CONTACT A
PHYSICIAN IMMEDIATELY.
INHALATION: REMOVE PATIENT FROM
CONTAMINATED AREA. IF BREATHING
HAS STOPPED, ARTIFICIAL RESPIRA-
TION, THEN OXYGEN IF NEEDED.
CONTACT A PHYSICIAN IMMEDIATELY.
INGESTION: DO NOT INDUCE VOMITING.
PATIENT SHOULD BE MADE TO DRINK
LARGE QUANTITIES OF WATER.
CONTACT A PHYSICIAN IMMEDIATELY.
VIII. SPECIAL PROTECTION INFORMATION
RESPIRATOR
NIOSH APPROVED RESPIRATOR FOR CAUSTIC
SODA MIST.
SKIN IMPERMEABLE GLOVES, RUBBER BOOTS, COTTON WORK CLOTHES,
RUBBER SUIT OR APRON, AND FACE SHIELD.
EYES CHEMICAL SAFETY GOGGLES.
VENTILATION Local Exhaust.
OTHER PROTECTION DELUGE SAFETY SHOWER AND EYE WASH STATION SHOULD BE
LOCATED NEAR WORK AREA.
PAGE 3 B-247C BOILER TREATMENT (CONTINUED ON NEXT PAGE)

MATERIAL SAFETY DATA $MEET (CONTINUED)
IX. SPILL OR LEAK PROCEDURES
STEPS TO BE TAKEN DO NOT TOUCH OR WALK THROUGH SPILLED MATERIAL.
STOP LEAK IF YOU CAN DO IT WITHOUT RISK.
SMALL SPILLS: TAKE UP WITH SAND OR OTHER NONCOMBUSTIBLE
ABSORBENT MATERIAL AND PLACE INTO CONTAINERS FOR LATER
DISPOSAL. SMALL DRY SPILLS: WITH CLEAN SHOVEL PLACE
MATERIAL INTO CLEAN, DRY CONTAINER AND COVER LOOSELY;
MOVE CONTAINERS FROM SPILL AREA.
LARGE SPILLS: DIKE FAR AHEAD OF LIQUID SPILL FOR LATER
DISPOSAL.
WASTE DISPOSAL METHOD NEUTRALIZE WITH DILUTE ACID, DILUTE WELL WITH WATER AND
FLUSH TO SEWER WITH PLENTY OF WATER, IF PERMITTED BY
DISPOSAL REGULATIONS.
CONTAINER REUSE METHOD CONTAINERS MAY CONTAIN PRODUCT RESIDUE AND
SHOULD NOT BE REUSED.
X. PRECAUTION MEASURES
KEEP UNNECESSARY PEOPLE AWAY
ISOLATE HAZARD AREA AND DENY
ENTRY. STAY UPWIND; KEEP
OUT OF LOW AREAS. POSITIVE
PRESSURE SELF-CONTAINED
BREATHING APPARATUS (SCBA)
AND STRUCTURAL FIREFIGHTERS'
PROTECTIVE CLOTHING WILL
PROVIDE LIMITED PROTECTION.
IF WATER POLLUTION OCCURS, NOTIFY THE
APPROPRIATE AUTHORITIES.
Xi. TRANSPORTATION INFORMATION
DOT HAZARD CLASS CORROSIVE
PROPER SHIPPING NAME CORROSIVE LIQUID, N.O.S.
CONTAINS CAUSTIC LIQUID
DOT IDENTIFICATION # UN1760
COMMODITY CLASS CORROSIVE
R/Q N/A
R/Q LBS 0
XII. REQULATORY INFORMATION
S.A,R.A NOT REPORTABLE
T.S.C.A.o IN COMPLIANCE
O.S.H.A. HASARD CLASIFICATION
ACUTE: YES CHRONIC: NO FLAMMABLE: NO REACTIVE: NO OXIDIZER: NO
HEALTH FLAMMABILITY REACTIVIT PERSONAL PROT
H.M.I.S. CLASSIFICATION: 2 1 0 E
N.F.P.A. CODES 2 1 0 N
PAGE 4 B-247C BOILER TREATMENT (CONTINUED ON NEXT PAGE)

ATES RIGHT TO KNOW
INGREDIENTS
SODIUM HYDROXIDE
INGREDIENTS
SODIUM SULFITE
WATER
XIV. OTHER INFORMATION
MATERIAL SAFETY DATA SHEE' CONTINUED)
* HAZARDOUS MATERIALS
STATE INFORMATION
1310-73-2
MA/PA/NJ
* NON -HAZARDOUS MATERIALS
STATE INFORMATION
7757-83-7
CA/MA/PA/NJ
7732-18-5
ALL INFORMATION AND DATA APPEARING ON THIS M.S.D.S. ARE
BELIVED TO BE RELIABLE AND ACCURATE. HOWEVER, IT IS
THE USER'S RESPONSIBILITY TO DETERMINE THE SAFTY.
TOXICITY, AND SUITABILITY FOR HIS OWN USE OF THE
PRODUCT DESCRIBED. SINCE THE ACTUAL USE BY OTHERS
IS BEYOND OUR CONTROL, NO GUARANTEE, EXPRSSED OR
IMPLIED, IS MADE BY PAUL'S WATER TREATMENT
USER ASSUMES ALL RISK AND RESPONSIBILITY.
PREPARED BY: DATE PRINTED: 11/19/2012
PAGE 5 B-247C BOILER TREATMENT (END OF MSDS)

I. PRODUCT IDENTIFICATION
TRADE NAME
CHEMICAL NAME
CHEMICAL FAMILY
COLOR INDEX #
C. A. S. #
LAST REVISION DATE
T
Paul's Water Treatment, LLC
P.O. Box 567
High Point NC 27261
Call During Working Hours Mon -Fri [phone]
After Hours Emergency Telephone # [phone]
Material Safety Data Sheet
B-38 STEAM LINE TREATMENT
N/A
MIXTURE
N/A
N/A
Il, COMPONENTS
COMPONENT PERCENT T. L. V.
1) CYCLOHEXYLAMINE
(108-91-8) GREATER THAN 1.00 N/A
2)
3)
4)
5)
6)
III. PHYSICAL DATA
BOILING POINT
N/A SOLUB, IN WATER SOLUBLE
VAPOR PRESSURE
N/A ODOR ODOR OF AMMONIA
VAPOR DENSITY
N/A APPEARANCE LIQUID
VOLATILITY
N/A SPECIFIC GRAY N/A
FREEZE POINT
N/A EVAP. RATE N/A
MELTING POINT
N/A ph OF PRODUCT 11.98
IV. FIRE AND EXPLOSION
DATA
FLASH POINT
TCC 127 DEG F
FLAMMABLE LIMITS
N/A
IN CASE OF FIRE
SOME OF THESE MATERIALS MAY REACT VIOLENTLY WITH WATER
SMALL FIRES: DRY CHEMNICAL, CO2, WATER SPRAY OR REGULAR FOAM
LARGE FIRES: WATER SPRAY, FOG OR REGULAR FOAM. MOVE
CONTAINER FROM FIRE AREA IF YOU CAN DO IT WITHOUT RISK.
APPLY COOLING WATER SIDES OF CONTAINERS THAT ARE
EXPOSED TO FLAMES UNTIL WELL AFTER FIRE IS OUT. STAY
AWAY FROM ENDS OF TANKS.
PAGE 1 B-38 STEAM LINE TREATMENT (CONTINUED ON NEXT PAGE)

MATERIAL SAFETY DATA SHEET (CONTINUED)
IV. FIRE AND EXPLOSION DATA (CONTINUED)
FIRE- FIGHTING
PROCEDURES WEAR SELF-CONTAINED BREATHING APPARATUS
FIRE AND EXPLOSION SOME OF THESE MATERIALS MAY BURN,
HAZARDS BUT NONE OF THEM IGNITES READILY.
FLAMMABLE/POISONOUS GASES MAY
ACCUMULATE IN TANKS AND HOPPER CARS,
SOME OF THESE MATERIALS MAY IGNITE
COMBUSTIBLE (WOOD, PAPER, OIL, ETC)
V. REACTIVITY DATA
STABILITY
CONDITIONS TO AVOID
INCOMPATIBILITY
HAZARDOUS DECOMPOSITION
PRODUCTS
HAZARDOUS
POLYMERIZARTION
'CONDITIONS TO AVOID
STABLE
NONE
OXIDIZING AGENTS. AVOID COPPER AND BRASS EXPOSURE:
INCOMPATIBLE WITH MOST RUBBER AND ELASTOMERING COMPOUNDS.
PROTECT FROM AIR. REACTS WITH ACIDS.
AMMONIA, CARBON DIOXIDE, CARBON MONOXIDE
Will not occur
NONE
VI. HEALTH HAZARD DATA
THRESHOLD LIMIT VALUE ORAL, RAT: LD50 - 710 mg/kg
CONTACT WILL CAUSE EYE AND SKIN IRRITATION
HAZARD WARNINGS CONTACT CAUSES BURNS TO SKIN AND
EYES. IF INHALED, MAY BE HARMFUL,
FIRE MAY PRODUCE IRRITATING OR
POISONOUS GASES. RUNOFF FROM FIRE
CONTROL OR DILUTION WATER MAY CAUSE
POLLUTION.
PAGE 2 B-38 STEAM LINE TREATMENT (CONTINUED ON NEXT PAGE)

MATERIAL SAFETY DATA SHEET (CONTINUED)
t
'Y AND FIRST AID PROCEDURES
SKIN: Remove contaminated clothing and
wash contaminated skin with large amounts
of soap and water. If irritation persists
contact a physician.
EYES: Flush eyes with water for at
least 15 minutes. Contact a
physician immediately.
INHALATION: Remove patient from
contaminated area. If breathing has
stopped give artificial respiration,
then oxygen if needed. Contact a
physician immediately.
INGESTION: Do not induce vomiting.
Patient should be made to drink
large quantities of water.
Contact a physician immediately.
VIII. SPECIAL PROTECTION INFORMATIO
RESPIRATOR
GAS MASK SUITABLE FOR AMMONIA FUMES
OR SELF-CONTAINED BREATHING
APPARATUS.
SKIN NEOPRENE GLOVES, FACE SHIELD, IMPERVIOUS
CLOTHING TO PROTECT EXPOSED BODY AREA.
EYES CHEMICAL SPLASH GOGGLES.
VENTILATION LOCAL EXHAUST
OTHER PROTECTION DELUGE SAFETY SHOWER AND EYE WASH STATION
SHOULD BE LOCATED NEAR WORK AREA.
PAGE 3 B-38 STEAM LINE TREATMENT (CONTINUED ON NEXT PAGE)

MATERIAL SAFETY DATA SHEET (CONTINUED)
IX. SPILL OR LEAK PROCEDURES
STEPS TO BE TAKEN DO NOT TOUCH OR WALK THROUGH SPILLED MATERIAL; STOP LEAK
IF YOU CAN DO IT WITHOUT RISK.
SMALL SPILLS: TAKE UP WITH SAND OR OTHER NONCOMBUSTIBLE
ABSORBENT MATERIAL AND PLACE INTO CONTAINERS FOR LATER
DISPOSAL. SMALL DRY SPILLS: WITH CLEAN SHOVEL PLACE
MATERIAL INTO CLEAN, DRY CONTAINER AND COVER LOOSELY;
MOVE CONTAINERS FROM SPILL AREA.
LARGE SPILLS: DIKE FAR AHEAD OF LIQUID SPILL FOR LATER
DISPOSAL.
WASTE DISPOSAL METHOD BIOLOGICAL TREATMENT OR INCINERATION ARE EFFECTIVE
DISPOSAL METHODS. METHOD MUST BE APPROVED BY LOCAL, STATE,
AND FEDERAL AGENCY. FOR DISPOSAL, CYCLOHEXYLAMINE IS A
HAZARDOUS WASTE UNDER CURRENT RCRA REGULATIONS.
CONTAINER REUSE METHOD CONTAINERS MAY CONTAIN PRODUCT RESIDUE AND SHOULD NOT
BE REUSED.
X. PRECAUTION MEASURES
KEEP UNNECESSARY PEOPLE AWAY
ISOLATE HAZARD AREA AND DENY
ENTRY. STAY UPWIND; KEEP
OUT OF LOW AREAS. POSITIVE
PRESSURE SELF-CONTAINED
BREATHING APPARATUS (SCBA)
AND STRUCTURAL FIREFIGHTERS'
PROTECTIVE CLOTHING WILL
PROVIDE LIMITED PROTECTION.
IF WATER POLLUTION OCCURS,
NOTIFY THE APPROPRIATE
AUTHORITIES.
XI. TRANSPORTATION INFORMATION
DOT HAZARD CLASS CORROSIVE
PROPER SHIPPING NAME CORROSIVE LIQUIDS, N.O.S.
DS, N.O.S. CYCLOHEXYLAMINE
DOT IDENTIFICATION # UN1760
COMMODITY CLASS CORROSIVE
R/Q N/A
R/Q LBS 0
XII. REQULATORY INFORMATION
S.A.R.A
T.S.C.A.0
NOT REPORTABLE UNDER
313
IN COMPLIANCE
O.S.H.A. HASARD CLASIFICATIO
ACUTE: YES CHRONIC: NO FLAMMABLE: YES REACTIVE: NO OXIDIZER: NO
HEALTH FLAMMABILITY REACTIVIT PERSONAL PROT.
H.M.I.S. CLASSIFICATION: 2 2 1 E
N.F.P.A. CODES 2 2 1 N
PAGE 4 B-38 STEAM LINE TREATMENT (CONTINUED ON NEXT PAGE)

MATERIAL SAFETY DATA SHEET (CONTINUED)
:'fATES RIGHT TO KNOW
* HAZARDOUS MATERIALS
INGREDIENTS STATE INFORMATION
CYCLOH EXYLAM IN E 108-91-8
PA-E, NJ, MA
INGREDIENTS
XIV. OTHER INFORMATION
PREPARED BY:
* NON -HAZARDOUS MATERIALS
STATE INFORMATION
ALL INFORMATION AND DATA APPEARING ON THIS M.S.D.S. ARE
BELIVED TO BE RELIABLE AND ACCURATE. HOWEVER, IT IS
THE USER'S RESPONSIBILITY TO DETERMINE THE SAFTY.
TOXICITY, AND SUITABILITY FOR HIS OWN USE OF THE
PRODUCT DESCRIBED. SINCE THE ACTUAL USE BY OTHERS
IS BEYOND OUR CONTROL, NO GUARANTEE, EXPRSSED OR
IMPLIED, IS MADE BY PAUL'S WATER TREATMENT
USER ASSUMES ALL RISK AND RESPONSIBILITY.
DATE PRINTED 3/8/2013
PAGE 5 B-38 STEAM LINE TREATMENT (END OF MSDS)
19

RCDENR
North Carolina Department of Environment and Natural Resotrces
Division of Water Quality
Michael F. Easley, Governor _Willlarrrn G Rass Jrf Secretary , ;,: ,
Alan W. Klimek; P.E. Director
Application for renewal of existing coverage under
Existing Certificate of Coverage (CoC)=
(Please print or type)
1) Mailing address" of facility owner/operator:
Company Name Thomasville Furniture Industries. Inc.
l P fr iti NCG500000
�1
MAR R - 1 2007 I � � z.
r
VC 50L0 72
tnJP l t_ ? C`t(_I i? Y S C T ION
OFFICE
Owner Name Furniture Brands International Contact: Rochelle Boyd
Street Address 405 East Main Street (PO Box 339)
City Thomasville
Telephone Number 336 _ 476-2264
Email address [e-mail]
" Address to which all permit correspondence should be mailed
2) Location of facility producing discharge:
State NC ZIP Code 27361-0339
Fax 336 _ 474-2906
Facility Name Thomasville Furniture Industries. Inc. — Lenoir Plant
Facility ContactK X
Street Address 315 Elizabeth Street
City Lenoir
County Caldwell
Telephone Number 828 _ 757-2774
Email address dfrazier(@,thomasville.com
3) Description of Discharge:
State NC ZIP Code 28645
Fax 828 _ 757-2723
a) Is the discharge directly to the receiving stream? 0 Yes ❑ No
(If no, submit a site map with the pathway to the potential receiving waters clearly marked. This includes tracing the pathway of the storm
sewer to the discharge point, if the storm sewer is the only viable means of discharge.)
b) Number of discharge outfalls (ditches, pipes, channels, etc. that convey wastewater from the
property) : 2
c) What type of wastewater is discharged? Indicate which discharge points, if more than one.
❑ Non -contact cooling water Outfall(s) #=
N Boiler Blowdown Outfall (s) #: 1
Porto 1 of R

NCG500000 renewal application
❑ Condensate
N Other
Outfall (s) #:
Outfall (s) #:
Outfall (s) #: 2
(Please describe "Other") DRY KILN
d) Volume of discharge per each discharge point (in GPD):
#001: 600 (Boilers) #002: 100 (Dry Kiln) #003: NA #004 NA
4) Please check the type of chemical [s] added to the wastewater for treatment, per each separate discharge
point (if applicable, use separate sheet):
❑ Chlorine ❑ Biocides 0 Corrosion inhibitors Algaecide ❑ Other
❑ None
5) If any box in item (4) above [other than None] was checked, a completed Biocide 101 Form and
manufacturers' information on the additive must be submitted to the following address for approval:
NC DENR / DWQ / Environmental Sciences Section
Aquatic Toxicology Unit
1621 Mail Service Center
Raleigh, NC 27699-1621
6) Is there any type of treatment being provided to the wastewater before discharge (i.e., retention ponds,
settling ponds, etc.)? ❑ Yes 0 No
(If yes, please include design specifics (i.e., design volume, retention time, surface area, etc.) with submittal package. Existing treatment
facilities should be described in detail. )
7) Discharge Frequency:
a) The discharge is: ❑ Continuous Intermittent ❑ Seasonal*
i) If the discharge is intermittent, describe when the discharge will occur:
The boilers are blown down 3 times per day (every 8 hours).
ii) *Check the month(s) the discharge occurs: ❑ Jan ❑ Feb ❑ Mar. ❑ Apr ❑ May ❑ Jun ❑ Jul
❑ Aug. ❑ Sept. ❑ Oct. ❑ Nov. ❑ Dec.
b) How many days per week is there a discharge? 7
c) Please check the days discharge occurs: Sat. N Sun. N Mon. N Tue. x❑ Wed. N Thu.
N Fri.
8) Receiving stream[s]:
a) To what body or bodies of water (creek, stream, river, lake, etc.) does the facility discharge
wastewater? If the site discharges wastewater to a separate storm sewer system (4S), name the
operator of the 4S (e.g. City of Raleigh). Blair Fork Creek
b) Stream Classification: C
Pnnc 9 of R

NCG500000 renewal application
Additional Application Requirements:
The following information must be included in triplicate [original + 2 copies] with this application or it
will be returned as incomplete.
➢ Site map. If the discharge is not directly to a stream, the pathway to the receiving stream must
be clearly indicated. This includes tracing the pathway of a storm sewer to its discharge point.
➢ Authorization for representatives. If this application will be submitted by a consulting engineer
(or engineering firm), include documentation from the Permittee showing that the consultant
submitting the application has been designated an Authorized Representative of the applicant.
Certification
I certify that I am familiar with the information contained in this application and that to the best of my
knowledge and belief such information is true, complete, and accurate.
Printed Name of Person Signing: Rochelle Boyd
Title: Manam of En ironmental Affairs
Z �d 6
(Signature fA -*Cant) (Date Signed
North Ca olina General Statute 143-215.6 b (i) provides that:
Any person who knowingly makes any false statement, representation, or certification in any application, record, report, plan or other document
filed or required to be maintained under Article 21 or regulations of the Environmental Management Commission implementing that Article, or
who falsifies, tampers with or knowingly renders inaccurate any recording or monitoring device or method required to be operated or maintained
under Article 21 or regulations of the Environmental Management Commission implementing that Article, shall be guilty of a misdemeanor
punishable by a fine not to exceed $25,000, or by imprisonment not to exceed six months, or by both. (18 U.&C. Section 1001 provides a
punishment by a fine of not more than $25,000 or imprisonment not more than 5 years, or both, for a similar offense.)
a&aeasasa&asasasasa&asa
This Notice of Renewal Intent does NOT require a separate fee.
The permitted facility already pays an annual fee for coverage under NCG500000.
asa$aEaEaEaEaeasmacasa
Mail the original and two copies of the entire package to:
Mr. Charles H. Weaver
NC DENR / DWQ / NPDES
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Pnnc 'l of Q

n
Sdh
-00
.W.
7-
i Zi:41
Aar*_- e town
SCALE
0 2000 .4000 FEET
Reference:
U.S. Geological Survey
Lenoir Quadrangle
North Carolina
7.5 Minute Series (Topographic)
National Geodetic Vertical Datum
1956 N
C.
QUADRANGLE LOCATION
Woodward —Clyde Consultants, Inc.j" FILE NO.
Thomasville Furniture ConeWtIng Enoew-s, Cod
Industries, Inc. and Environmental SGd%Z*,'* 92CS059
Lenoir Plant Raleigh, North Carolina Site Location Map FIG. NO.
Lenoir, NC SCALE* I DRAWN BY- DSW IDATE: 09/21/04
As Shown I ojKD. ay. Dsu IDATE: 09/21124

} ID: MAR 10' 97 12 :02 No .015 P . 02
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BIOCIDE/CHEMICAL TREATMENT
WORKSHEET-FORM 101
The following calculations are to be performed on any biocidal products ultimately discharged to the surface waters of
North Carolina. This worksheet must be completed separately for each biocidal product in use. This worksheet is to be
returned with all appropriate data entered into the designated areas with calculations performed as indicated.
I. Facility Name "'TFI
L—Q--nZIcc
NPDES # NC NC, 5 o Outfall #
County Cal UJ F..
Receiving Stream �1 �t1 �� 2 7Q10 • a7 (cfs)
(All above information supplied by the Division of Water Quality)
What is the Average Daily Discharge (A.D.D.) volume of the water handling systems to the receiving water body?
A.D.D. = •OO(OCO (in M.G.D.)
Please calculate the Instream Waste Concentration (IWC in percent) of this discharge using the data entered
above. e
o°
0
(A.D.D.) X 100 (' ) X 100 _ 0 31}3
IWC = (7Q10)(0.646) + (A.D.D) — (�,' )(0.646) + ( off)
o0
This value (IWC) represents the waste concentration to the receiving stream during low flow conditions.
II. Wha is the name of the whole product chemical treatment proposed for use in the discharge identified in Part I?
t"I i t C0 17 a-0 ©XU/I� t o 5CWe- Ka
Please list the active ingredients and percent composition:
,
-7 3 -
—5 kb —3a ono
%
ono
What feed or dosage rate (D.R.) is used in this application? The units must be converted to maximum grams
of whole product used in a 24hr period.
D.R.= grams/24hr period
Please note, fluid ounces (a volume) must be converted to grams (a mass). The formula for this conversion is:
Grams of product = fluid oz. of product X 1 gal. water X 8.34 lbs. X specific gravity of product X 451 .59g.
128 fl. oz. 1 gal. water

facility Name:
Estimate total volume of the water handling system between entry of biocidal product and NPDES discharge point.
On an attached sheet please provide justification for this estimate (system volume, average cycles per blowdown,
7 t_ \ - �-Q-V\ Del V NPDES#: NCy S()0-7
holding lagoon size, etc.)
Volume= • o a-43
million gallons
What is the pH of the handling system prior to biocide addition? If unknown, enter N/A. I n ' S
What is the decay rate (D.K.) of the product? If unknown, assume no decay (D.K.=O) and proceed to asterisk.
The degradation must be stated at pH level within 1 /2 pH standard unit within handling system. Enter the half life
(Half Life is the time required for the initial product to degrade to half of its original concentration). Please provide
copies of the sources of this data.
H.L. = a 60 3 Days
The decay rate is equal to H1L X 0.69 = 0�3 Q =Decay Rate (D.K.)
Calculate degradation factor (D.F.)
A.D.D.
* D.F. _ (Volume) + (D.K.) _
This is the first order loss coefficient.
+ (;30 ) _
a3a
Calculate Steady State Discharge Concentration:
Conc. (D.R.) W _ (_ ` ) _ . L -0 mg/I
_
Dischg (D.F.)(Volume)(3785) )( o,�.tk3)(3785)
Calculate concentration of biocide instream d nng low flow conditions.
(Receiving Stream Concentration)
(Dischg. Conc.) x (IWC%) _ (%� ) x ( ) _ , r700O j mg/I
100 - � 100
Receiving Stream Concentration
III. Calculate regulated limitation.
List all LC50 and EC50 data available for the whole product according to the following columns. (Note that units
should be in mg/1). Please provide copies of the sources of this data.
Organism Test Duration LC50/EC50 (mg/1)
2� r: i o� rwa �� . -7 9-S
D. W. Q. Form 101 (612000)
2

gracility Name: TIF 1 — LQ-n D)')Y
NPDES #: NC G J O V O 7 1
Choose the lowest LC50/EC50 listed above:
Enter the LC50/EC50: 3gi�
If the half life (H.L.) is less than 4 days, perform the following calculation.
Regulated Limitation = 0.05 x LC50 = mg/I
If the half life (H.L.) is greater than or equal to 4 days or unknown, perform the following calculation.
Regulated Limitation = 0.01 x LC50 = 3 , M mg/I
Choose the appropriate regulated limitation from the calculations immediately above and place in this blank:
3 ,' j 1 mg/liter
From Part II enter the receiving stream concentration:
*000c3I4
mg/liter
IV. Analysis.
If the receiving stream concentration is greater than the calculated regulated limitation, then this biocide is
unacceptable for use.
Person in Responsible Charge
//1-3bA 7
' Signature Date
Completing This Worksheet (If different from above)
c �- 7:�� ra
Name (Print)
Signature
Please submit to: Division of Water Quality
Aquatic Toxicology Unit
1621 Mail Service Center
Raleigh, NC 27699-1621
Attn: Todd Christenson
ll3%7
Date
D. W. Q. Form 101 (612000) 3

Faci ty Name: T� 1 '� �� 0�1 NPDES #: NC 6- S d O 07
Supplemental Metals Analysis
If copper, zinc, or chromium are present in the proposed biocidal compound, complete this worksheet. A separate form
must be used for each metal and/or metal compound present in the biocide. List the metal, its chemical formula, molecular
weight (MW), formula weight (FW), and the concentration of the metal compound in the biocide (MCC). Complete a
separate form for every metal present in the biocide.
Metal Chemical Formula Molecular Weight of Metal Formula Weight
EXAMPLE
Copper CuSO4 5H20 63.546 g/mole 249.680 g/mole
Dosage rate of Biocide (DR) (from page 1):
DR = grams/day No
Average Daily Discharge (ADD) (from page 1):
ADD = million gallons/day
Discharge Concentration (DC) of Biocide:
Concentration in Biocide
0.2 %
DR ( grams/day) _ grams/million gallons
DC = ADD = ( million gallons/day)
Convert DC to micrograms/liter (ppb):
1 x 106 lag/g _
DC (lag/l) = DC (grams/million gal) x 3.785 x 106 liters/million gal. lag/l
Calculate the fraction of metal in the metal -containing compound (MF):
MW ( grams/mole) _
MF = FW = ( grams/mole)
Calculate the fraction of metal in the biocidal compound (BF):
MCC %
BF=MFx 100
x (100)
Calculate the concentration of metal in the discharge (M):
M=DCxBF= lag/Ix
Calculate the instream metal concentration (IMC) at low -flow conditions:
ug/I
IWC % o
_ _
IMC = M x 100 - Pg/I x 100 pg/I
Regulated limitation of metal (from below): pgll
NC General Statutes 15A NCAC 213.0211 define:
Copper- 7 pg/I water quality action level* zinc- 50 pg/l water quality action level*
Chromium- 50 pg/l water quality standard
'Values which exceed action levels must be addressed directly by aquatic toxicity testing
D.W.Q. Form 101 (612000) 4

NALCO
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO 1720
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) (800) I-M-ALERT
1. CHEMICAL PRODUCT AND COMPANY IDENTIFICATION
PRODUCT NAME :
APPLICATION:
CHEMICAL DESCRIPTION:
COMPANY IDENTIFICATION:
NALCO 1720
OXYGEN SCAVENGER
Bisulfite, Sulfate, Water
Nalco Chemical Company
One Nalco Center
Naperville, Illinois
60563-1198
EMERGENCY TELEPHONE NUMBER: [phone] (24 Hours) (800) I-M-ALERT
NFPA 704M/HMIS RATING
HEALTH: 1/2 FLAMMABILITY: 0 /.0 REACTIVITY: 0/0 OTHER:
0 = Insignificant 1 = Slight 2 = Moderate 3 = High 4 = Extreme
2. 1 COMPOSITION/INFORMATION ON INGREDIENTS
Our hazard evaluation has identified the following chemical substance(s) as hazardous. Consult Section 15 for the
nature of the hazard(s).
Hazardous Substance(s)
Sodium Bisulfite
Potassium Bisulfite
3. HAZARDS IDENTIFICATION
"EMERGENCY
CAS NO % (w/w)
7631-90-5 10.0 - 30.0
7773-03-7 1.0 - 5.0
WARNING
Contains Sulfite. Irritating to respiratory system. May cause skin and eye irritation. Causes asthmatic signs and
symptoms in hyper -reactive individuals.
Avoid breathing vapor. Use with adequate ventilation. Do not take internally. Keep container tightly closed. In
case of contact with eyes, rinse immediately with plenty of water and seek medical advice. After contact with skin,
wash immediately with plenty of water. Protect product from freezing.
Wear suitable protective clothing, gloves and eye/face protection.
May evolve oxides of sulfur (SOx) under fire conditions. May evolve hydrogen sulfide (1-12S) under fire conditions.
PRIMARY ROUTES OF EXPOSURE:
Eye, Skin, Inhalation
Nalco Chemical Company One Nalco Center - Naperville, Illinois 60563-1198
[phone]
1/11

- )W
NALCO
HUMAN HEALTH HAZARDS - ACUTE:
EYE CONTACT:
Can cause mild irritation.
SKIN CONTACT:
Can cause mild irritation.
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO 1720
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) (800) I-M-ALERT
INGESTION:
Not a likely route of exposure. May cause asthmatic -like attack.
INHALATION:
Irritant to respiratory system. Causes asthmatic signs and symptoms in hyper -reactive individuals.
SYMPTOMS OF EXPOSURE
Acute :
A review of available data does not identify any symptoms from exposure not previously mentioned.
Chronic:
A review of available data does not identify any symptoms from exposure not previously mentioned.
AGGRAVATION OF EXISTING CONDITIONS:
A review of available data does not identify any worsening of existing conditions.
HUMAN HEALTH HAZARDS -CHRONIC:
Ingestion of sulfite can cause a severe allergic reaction in asthmatics and some sulfite sensitive individuals. The
resulting symptoms can include difficulty in breathing, flushed skin and a rash. Chronic exposure to sulfites may
cause symptoms of upper respiratory disease and affect sense of taste and smell.
4. 1 FIRST AID MEASURES
EYE CONTACT:
Immediately flush eye with water for at least 15 minutes while holding eyelids open. If irritation persists, repeat
flushing. Get immediate medical attention.
SKIN CONTACT:
Immediately flush with plenty of water for at least 15 minutes. If symptoms persist, call a physician.
INGESTION:
Do not induce vomiting without medical advice.. If conscious, washout mouth and give water to drink. Get medical
attention.
INHALATION:
Remove to fresh air, treat symptomatically. If breathing is difficult, administer oxygen. Get medical attention.
NOTE TO PHYSICIAN:
Based on the individual reactions of the patient, the physician's judgement should be used to control symptoms and
clinical condition.
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]'
2/11

_. )w
NALCO
5. 1 FIRE FIGHTING MEASURES
FLASH POINT:
None
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO 1720
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) (800) I-M-ALERT
EXTINGUISHING MEDIA:
Not expected to burn. Use extinguishing media appropriate for surrounding fire. Keep containers cool by spraying
with water.
FIRE AND EXPLOSION HAZARD:
May evolve oxides of sulfur (SOx) under fire conditions. May evolve hydrogen sulfide (H2S) under fire conditions.
SPECIAL PROTECTIVE EQUIPMENT FOR FIRE FIGHTING:
In case of fire, wear a full face positive -pressure self contained breathing apparatus and protective suit.
6. 1 ACCIDENTAL RELEASE MEASURES
PERSONAL PRECAUTIONS:
Restrict access to area as appropriate until clean-up operations are complete. Ensure clean-up is conducted by
trained personnel only. Ensure adequate ventilation. Do not touch spilled material. Stop or reduce any leaks if it is
safe to do so. Use personal protective equipment recommended in Section 8 (Exposure Controls/Personal
Protection). Notify appropriate government, occupational health and safety and environmental authorities.
METHODS FOR CLEANING UP:
SMALL SPILLS: Soak up spill with absorbent material. Place residues in a suitable, covered, properly labeled
container. Wash affected area. LARGE SPILLS: Contain liquid using absorbent material, by digging trenches or by
diking. Reclaim into recovery or salvage drums or tank truck for proper disposal. Wash site of spillage thoroughly
with water. Contact an approved waste hauler for disposal of contaminated recovered material. Dispose of material
in compliance with regulations indicated in Section 13 (Disposal Considerations).
ENVIRONMENTAL PRECAUTIONS:
Do not contaminate surface water.
7. 1 HANDLING AND STORAGE
HANDLING:
Avoid eye and skin contact. Do not take internally. Do not get in eyes, on skin, on clothing. Have emergency
equipment (for fires, spills, leaks, etc.) readily available. Ensure all containers are labelled. Keep the containers
closed when not in use. Use with adequate ventilation.
STORAGE CONDITIONS:
Store the containers tightly closed. Store in suitable labelled containers. Store separately from acids. Store
separately from oxidizers. Amine and sulfite products should not be stored within close proximity or resulting vapors
may form visible airborne particles.
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
3/11

-- )V
NALCO
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO 1720
EMERGENCY
[phone] (24 Hours) (800) I-M-ALERT
8. 1 EXPOSURE CONTROLS/PERSONAL PROTECTION
OCCUPATIONAL EXPOSURE LIMITS:
Exposure guidelines have not been established for this product. Available exposure limits for the substance(s) are
shown below. Exposure limits are listed for sulfur dioxide (S02) since this product evolves S02 when open to the
atmosphere.
ACGIH/TLV :
Substance(s)
Sodium Bisulfite
Sulfur Dioxide
OSHA/PEL :
Substance(s)
Sodium Bisulfite
Sulfur Dioxide
TWA: 5 mg/m3
TWA: 2 ppm , 5.2 mg/m3
STEL: 5 ppm , 13 mg/m3
TWA: 5 mg/m3
TWA: 2 ppm , 5 mg/m3
STEL: 5 ppm , 13 mg/m3
ENGINEERING MEASURES:
General ventilation is recommended. Use local exhaust ventilation if necessary to control airborne mist and vapor.
RESPIRATORY PROTECTION:
If significant mists, vapors or aerosols are generated an approved respirator is recommended. An acid gas cartridge
may be used. In event of emergency or planned entry into unknown concentrations a positive pressure, full-
facepiece SCBA should be used. If respiratory protection is required, institute a complete respiratory protection
program including selection, fit testing, training, maintenance and inspection.
HAND PROTECTION:
Neoprene gloves, Nitrile gloves, Butyl gloves, PVC gloves
SKIN PROTECTION:
Wear standard protective clothing.
EYE PROTECTION:
Wear chemical splash goggles.
HYGIENE RECOMMENDATIONS:
If clothing is contaminated, remove clothing and thoroughly wash the affected area. Launder contaminated clothing
before reuse. Keep an eye wash fountain available. Keep a safety shower available.
HUMAN EXPOSURE CHARACTERIZATION
Based on our recommended product application and personal protective equipment, the potential human exposure
is: Low
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
4/11

)w
NALCO
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO 1720
■:4J,1:4_ZH4:[aAfAR;j:NN1:11:[If L1111=1I
[phone] (24 Hours) (800) I-M-ALERT
9. 1 PHYSICAL AND CHEMICAL PROPERTIES
PHYSICAL STATE
APPEARANCE
ODOR
SPECIFIC GRAVITY
DENSITY
SOLUBILITY IN WATER
pH (100 %)
VISCOSITY
FREEZING POINT
BOILING POINT
Liquid
Clear Pink
Pungent, Sulfurous
1.22 - 1.28 @ 60 OF / 15.6 °C
10.1 - 10.7 lb/gal
Complete
3.5 - 4.1
5cps @ 60OF/15°C
11 °F / -11 °C
205 OF / 96 °C
10. 1 STABILITY AND REACTIVITY
STABILITY:
Stable under normal conditions.
HAZARDOUS POLYMERIZATION:
Hazardous polymerization will not occur.
CONDITIONS TO AVOID:
Freezing temperatures.
MATERIALS TO AVOID:
Contact with strong oxidizers (e.g. chlorine, peroxides, chromates, nitric acid, perchlorate, concentrated oxygen,
permanganate) may generate heat, fires, explosions and/or toxic vapors. Contact with strong acids (e.g. sulfuric,
phosphoric, nitric, hydrochloric, chromic, sulfonic) may generate heat, splattering or boiling and toxic vapors. S02
may react with vapors from neutralizing amines and may produce a visible cloud of amine salt particles.
HAZARDOUS DECOMPOSITION PRODUCTS:
Under fire conditions: Oxides of sulfur, Hydrogen sulfide (H2S)
11. 1 TOXICOLOGICAL INFORMATION
The following results are for a similar product.
ACUTE ORAL TOXICITY:
Species LD50 Tested Substance
Rat 4,112 mg/kg Similar Product
Rating : Non -Hazardous
Nalco Chemical Company One Nalco Center Naperville, Illinois 60563-1198
[phone]
5/11

NALGO
ACUTE DERMAL TOXICITY:
Species LD50
Rabbit > 3,000 mg/kg
Rating : Non -Hazardous
PRIMARY SKIN IRRITATION:
Draize Score
1.0 / 8.0
Rating : Minimally irritating
PRIMARY EYE IRRITATION:
Draize Score
9.4 / 110.0
Rating : Minimally irritating
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO 1720
NUMBER
[phone] (24 Hours) (800) I-M-ALERT
Tested Substance
Similar Product
Tested Substance
Similar Product
Tested Substance
Similar Product
SENSITIZATION:
This product is not expected to be a sensitizer.
CARCINOGENICITY:
None of the substances in this product are listed as carcinogens by the International Agency for Research on
Cancer (IARC), the National Toxicology Program (NTP) or the American Conference of Governmental Industrial
Hygienists (ACGIH).
HUMAN HAZARD CHARACTERIZATION:
Based on our hazard characterization, the potential human hazard is: Low
12. 1 ECOLOGICAL INFORMATION
ECOTOXICOLOGICAL EFFECTS:
The following results are for the product.
ACUTE FISH RESIJI TS -
S ecies
Ex osure
LC50
Tested Substance
Fathead Minnow
96 hrs
382 m /I
Product
mating; cssenuany non -toxic
ACUTE INVERTEBRATE RESULTS
S ecies
Exposure
LC50
EC50
Tested Substance
Daphnia ma na
48 hrs
728 m /I
Product
rcaung : cssenuauy non -toxic
MOBILITY AND BIOACCUMULATION POTENTIAL
The product will not bioaccumulate.
ENVIRONMENTAL HAZARD AND EXPOSURE CHARACTERIZATION
Based on our hazard characterization, the potential environmental hazard is: Low
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
6/11

NALCO
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO 1720
EMERGENCY TELEPHONE NUMBER.
.[phone] (24 Hours) (800) I-M-ALERT
Based on our recommended product application and the product's characteristics, the potential environmental
exposure is: High
If released into the environment, see CERCLA/SUPERFUND in Section 15.
13. 1 DISPOSAL CONSIDERATIONS
If this product becomes a waste, it is not a hazardous waste as defined by the Resource Conservation and Recovery
Act (RCRA) 40 CFR 261, since it does not have the characteristics of Subpart C, nor is it listed under Subpart D.
As a non -hazardous waste, it is not subject to federal regulation. Consult state or local regulation for any additional
handling, treatment or disposal requirements. For disposal, contact a properly licensed waste treatment, storage,
disposal or recycling facility.
14. 1 TRANSPORT INFORMATION
The information in this section is for reference only and should not take the place of a shipping paper (bill of lading)
specific to an order. Please note that the proper Shipping Name / Hazard Class may vary by packaging, properties,
and mode of transportation. Typical Proper Shipping Names for this product are:
LAND TRANSPORT:
1
Proper Shipping Name:
ENVIRONMENTALLY HAZARDOUS SUBSTANCE, LIQUID,
N.O.S.
Technical Name(s) :
SODIUM BISULFITE
UN/ID No:
3082
Hazard Class - Primary:
9
Packing Group:
III
Flash Point:
None
DOT Reportable Quantity (per package)
DOT RQ Component:
AIR TRANSPORT (ICAO/IATA) :
Proper Shipping Name:
Technical Name(s) :
UN/ID No:
Hazard Class - Primary:
Packing Group
IATA Cargo Packing Instructions
IATA Cargo Aircraft Limit:
MARINE TRANSPORT (IMDG/IMO) :
Proper Shipping Name:
18,000 Ibs
SODIUM BISULFITE
ENVIRONMENTALLY HAZARDOUS SUBSTANCE, LIQUID,
N.O.S.
SODIUM BISULFITE
3082
9
914
NO LIMIT (Max net quantity per package)
PRODUCT IS NOT REGULATED DURING
TRANSPORTATION
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
7/11

NALCQ
15. 1 REGULATORY INFORMATION
NATIONAL REGULATIONS, USA:
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO 1720
[phone] (24 Hours) (800) I-M-ALERT
OSHA HAZARD COMMUNICATION RULE, 29 CFR 1910.1200 :
Based on our hazard evaluation, the following substance(s) in this product is/are hazardous and the reason(s) is/are
shown below.
Sodium Bisulfite : Respiratory irritant
Potassium Bisulfite : Irritant
CERCLA/SUPERFUND, 40 CFR 117, 302 :
This product contains the following Reportable Quantity (RQ) Substance. Also listed is the RQ for the product.
RQ Substance
Sodium Bisulfite
RQ
18,000 Ibs
SARA/SUPERFUND AMENDMENTS AND REAUTHORIZATION ACT OF 1986 (TITLE III) - SECTIONS 302, 311,
312, AND 313:
SECTION 302 - EXTREMELY HAZARDOUS SUBSTANCES (40 CFR 355) :
This product does not contain substances listed in Appendix A and B as an Extremely Hazardous Substance.
SECTIONS 311 AND 312 - MATERIAL SAFETY DATA SHEET REQUIREMENTS (40 CFR 370) :
Our hazard evaluation has found this product to be hazardous. The product should be reported under the following
EPA hazard categories:
X Immediate (Acute) Health Hazard
- Delayed (Chronic) Health Hazard
- Fire Hazard
- Sudden Release of Pressure Hazard
- Reactive Hazard
Under SARA 311 and 312, the EPA has established threshold quantities for the reporting of hazardous chemicals.
The current thresholds are: 500 pounds or the threshold planning quantity (TPQ), whichever is lower, for extremely
hazardous substances and 10,000 pounds for all other hazardous chemicals.
SECTION 313 - LIST OF TOXIC CHEMICALS (40 CFR 372) :
This product does not contain substances on the List of Toxic Chemicals.
TOXIC SUBSTANCES CONTROL ACT (TSCA)
The chemical substances in this product are on the TSCA 8(b) Inventory (40 CFR 710).
FOOD AND DRUG ADMINISTRATION (FDA) Federal Food, Drug and Cosmetic Act:
When use situations necessitate compliance with FDA regulations, this product is acceptable under: 21 CFR
a
173.310 Boiler Water Additives
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
8/11

)w
NALGO
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO 1720
[phone] (24 Hours) (800)1-M-ALERT
Due to our commitment to Product Stewardship, we have evaluated the human and environmental hazards and
exposures of this product. Based on our recommended use of this product, we have characterized the product's
general risk. This information should provide assistance for your own risk management practices. We have
evaluated our product's risk as follows:
* The human risk is: Low
* The environmental risk is: Low
Any use inconsistent with our recommendations may affect the risk characterization. Our sales representative will
assist you to determine if your product application is consistent with our recommendations. Together we can
implement an appropriate risk management process.
This product material safety data sheet provides health and safety information. The product is to be used in
applications consistent with our product literature. Individuals handling this product should be informed of the
recommended safety precautions and should have access to this information. For any other uses, exposures should
be evaluated so that appropriate handling practices and training programs can be established to insure safe
workplace operations. Please consult your local sales representative for any further information.
REFERENCES
Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure indices, American
Conference of Governmental Industrial Hygienists, OH., (Ariel InsightTm CD-ROM Version), Ariel Research Corp.,
Bethesda, MD.
Hazardous Substances Data Bank, National Library of Medicine, Bethesda, Maryland (TOMES CPSTm CD-ROM
Version), Micromedex, Inc., Englewood, Co.
IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man, Geneva: World Health
Organization, International Agency for Research on Cancer.
Integrated Risk Information System, U.S. Environmental Protection Agency, Washington, D.C. (TOMES CPSM CD-
ROM Version), Micromedex, Inc., Englewood, CO.
Annual Report on Carcinogens, National Toxicology Program, U.S. Department of Health and Human Services,
Public Health Service.
Title 29 Code of Federal Regulations, Part 1910, Subpart Z, Toxic and Hazardous Substances, Occupational Safety
and Health Administration (OSHA), (Ariel InsightTA° CD-ROM Version), Ariel Research Corp., Bethesda MD.
Registry of Toxic Effects of Chemical Substances, National Institute for Occupational Safety and Health, Cincinnati,
OH, (TOMES CPSTm CD-ROM Version), Micromedex, Inc., Englewood, CO.
Ariel InsightTm (An integrated guide to industrial chemicals covered under major regulatory and advisory programs),
North American Module, Western European Module, Chemical Inventories Module and the Generics Module (Ariel
InsightTm CD-ROM Version), Ariel Research Corp., Bethesda, MD.
The Teratogen Information System, University of Washington, Seattle, WA (TOMES CPSTm CD-ROM Version),
} Micromedex, Inc., Englewood, CO
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
10 / 11

BIOCIDE/CHEMICAL TREATMENT
WORKSHEET-FORM 101
The following calculations are to be performed on any biocidal products ultimately discharged to the surface waters of
North Carolina. This worksheet must be completed separately for each biocidal product in use. This worksheet is to be
returned with all appropriate data entered into the designated areas with calculations performed as indicated.
I. Facility Name —TF' i LP— n o ( v-
NPDES # NC N C3— �J 0 0 0 -% -,k Outfall #
County Ca., v.) el � c.�
Receiving Stream ��� 1 `f� �t� �` �� ►=G K 7Q10 • �� (cfs)
(All above information supplied by the Division of Water Quality)
What is the Average Daily Discharge (A.D.D.) volume of the water handling systems to the receiving water body?
A.D.D. _ # '0100(o (in M.G.D.)
Please calculate the Instream Waste Concentration (IWC in percent) of this discharge using the data entered
above. D0�
0
(A.D.D.) X 100 (` ) X 100 _ �, 3 y-3
IWC = (7Q10)(0.646) + (A.D.D) — (�)(0.646) + (,o)
This value (IWC) represents the waste concentration to the receiving stream during low flow conditions.
II. What is the name of the whole product chemical treatme t proposed for
Ha.1Lo I�lp, oan `�2-310 Bole-`' �w
Please list the active Wgredients and percent composition:
N n Haz -&cA o s Co ,�-- Pov P—v,+s-
in the discharge identified in Part I?
W,K
What feed or dosage rate (D.R.) is used in this application? The units must be converted to maximum grams
of whole product used in a 24hr period.
D.R.= 458 grams/24hr period
Please note, fluid ounces (a volume) must be converted to grams (a mass). The formula for this conversion is:
Grams of product = fluid oz. of product X 1 gal. water X 8.34 lbs. X specific gravity of product X 453.59g.
128 fl. oz. 1 gal. water 1 lb.

Facility Name:
v\ o") f
NPDES #: NCy 5o n ©-7
Estimate total volume of the water handling system between entry of biocidal product and NPDES discharge point.
On an attached sheet please provide justification for this estimate (system volume, average cycles per blowdown,
holding lagoon size, etc.)
Volume= t 0 r-L�3 million gallons
What is the pH of the handling system prior to biocide addition? If unknown, enter N/A. 100,5
What is the decay rate (D.K.) of the product? If unknown, assume no decay (D.K.=O) and proceed to asterisk.
The degradation must be stated at pH level within 1 /2 pH standard unit within handling system. Enter the half life
(Half Life is the time required for the initial product to degrade to half of its original concentration). Please provide
copies of the sources of this data.
H.L. = NA Days
The decay rate is equal to H1L X 0.69 = =Decay Rate (D.K.)
Calculate degradation factor (D.F.). This is the first order loss coefficient.
Oab (#
A.D.D. () +
D.F. _ (Volume) + (D,K.) - ( ) ( � ) _
Calculate Steady State Discharge Concentration:
Dischg Conc. _ (D.F.)(Volume)(3785) _ ( �S )( n 0A3)(3785) _ mg/l
,0 ,
Calculate concentration of biocide instream during low flow conditions.
(Receiving Stream Concentration) PA
(Dischg. Conc.) x (IWC%) _ ( ) x (• ) _ • v mg/I
100 - 100
Receiving Stream Concentration
III. Calculate regulated limitation.
List all LC50 and EC50 data available for the whole product according to the following columns. (Note that units
should be in mg/1). Please provide copies of the sources of this data.
Organis&4n
Test Duration LC50/EC50 (mg/1)
l�l
D. W. Q. Form 101 (612000) 2

���, a'�r
Facility Name: TIF I - NPDES #: NC G S d0 0 7
Choose the lowest LC50/EC50 listed above:
Enter the LC50/EC50:
If the half life (H.L.) is less than 4 days, perform the following calculation.
Regulated Limitation = 0.05 x LC50 = mg/I
If the half life (H.L.) is greater than or equal to 4 days or unknown, perform the following calculation.
Regulated Limitation = 0.01 x LC50 = mg/I
Choose the appropriate regulated limitation from the calculations immediately above and place in this blank:
N Dmg/liter
From Part II enter the receiving stream concentration:
O &GS mg/liter
IV. Analysis.
If the receiving stream concentration is greater than the calculated regulated limitation, then this biocide is
unacceptable for use.
Person in Responsible Charge
e rint
Signat Date
Person Completing This Worksheet (If different from above)
Name (Print)
(� 1 /3,0107
Signature 15ate
Please submit to: Division of Water Quality
Aquatic Toxicology Unit
1621 Mail Service Center
Raleigh, NC 27699-1621
Attn: Todd Christenson
D. W. Q. Form 101 (612000) 3

Facility Name: Tl- — Lem o' I Y NPDES #: NC &-SOD 07 s�
Supplemental Metals Analysis
If copper, zinc, or chromium are present in the proposed biocidal compound, complete this worksheet. A separate form
must be used for each metal and/or metal compound present in the biocide. List the metal, its chemical formula, molecular
weight (MW), formula weight (FW), and the concentration of the metal compound in the biocide (MCC). Complete a
separate form for every metal present in the biocide.
Metal -
EXAMPLE
Copper
Chemical Formula Molecular Weight of Metal Formula Weight Concentration in Biocide
CuSO4.5H2O 63.546 g/mole 249.680 g/mole 0.2
Dosage rate of Biocide (DR) (from page 1):
DR = grams/day
Average Daily Discharge (ADD) (from page 1): 0vt S
ADD = million gallons/day
Discharge Concentration (DC) of Biocide:
DC = DR _ ( grams/day) _ grams/million gallons
ADD (_million gallons/day)
Convert DC to micrograms/liter (ppb):
DC (Ng/I) = DC (grams/million gal) x 1 x 106 u9/96 = Ng/I
3.785 x 10 liters/million gal.
Calculate the fraction of metal in the metal -containing compound (MF):
MW ( grams/mole)
MF = FW = ( grams/mole) _
Calculate the fraction of metal in the biocidal compound (BF):
BF = MF x MCC % _
100
x (100) _
Calculate the concentration of metal in the discharge (M):
M = DC BF = Ng/I x
Calculate the instream metal concentration (IMC) at low -flow conditions:
pg/I
IWC ( ) % /I
IMC = M x 100 - Ng/I x 100 = Ng
Regulated limitation of metal (from below): pg/l
NC General Statutes 15A NCAC 213.0211 define:
Copper- 7 pg/I water quality action level* Zinc- 50 pg/l water quality action level*
Chromium- 50 Ng/l water quality standard
(*Values which exceed action levels must be addressed directly by aquatic toxicity testing.)
D.W.Q. Form 101 (612000) 4

NALCO
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO NEXGEN 22310
NUMBER
[phone] (24 Hours) (800)1-M-ALERT
1. 1 CHEMICAL PRODUCT AND COMPANY IDENTIFICATION
PRODUCT NAMP :
APPLICATION:
CHEMICAL DESCRIPTION:
COMPANY IDENTIFICATION:
EMERGENCY TELEPHONE NUMBER:
NALCO NEXGEN 22310
BOILER WATER INTERNAL TREATMENT
Water, Acrylate polymer(s), Inorganic salt(s)
Nalco Chemical Company
One Nalco Center
Naperville, Illinois
60563-1198
[phone] (24 Hours) (800) I-M-ALERT
NFPA 704M/HMIS RATING
HEALTH: 0/1 FLAMMABILITY: 1 / 1 REACTIVITY: 0/0 OTHER:
0 = Insignificant 1 = Slight 2 = Moderate 3 High 4 = Extreme
2. 1 COMPOSITION/INFORMATION ON INGREDIENTS
Based on our hazard evaluation, none of the substances in this product are hazardous.
3. 1 HAZARDS IDENTIFICATION
**EMERGENCY OVERVIEW**
CAUTION
May cause irritation with prolonged contact.
Do not get in eyes, on skin, on clothing. Do not take intemally. Wear suitable protective clothing. Keep container
tightly closed. Flush affected area with water.
May evolve oxides of carbon (COx) under fire conditions. May evolve oxides of sulfur (SOx) under fire conditions.
PRIMARY ROUTES OF EXPOSURE:
Eye, Skin
HUMAN HEALTH HAZARDS - ACUTE:
EYE CONTACT:
May cause irritation with prolonged contact.
SKIN CONTACT :
May cause irritation with prolonged contact.
INGESTION:
Not a likely route of exposure. No adverse effects expected.
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
1/8

- )W
NALCO
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO NEXGEN 22310
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) (800) I-M-ALERT
INHALATION:
Not a likely route of exposure. No adverse effects expected.
SYMPTOMS OF EXPOSURE:
Acute :
A review of available data does not identify any symptoms from exposure not previously mentioned.
Chronic:
A review of available data does not identify any symptoms from exposure not previously mentioned.
AGGRAVATION OF EXISTING CONDITIONS:
A review of available data does not identify any worsening of existing conditions.
4. 1 FIRST AID MEASURES
EYE CONTACT:
Flush affected area with water. If symptoms develop, seek medical advice.
SKIN CONTACT:
Flush affected area with water. If symptoms develop, seek medical advice.
INGESTION:
Do not induce vomiting without medical advice. If conscious, washout mouth and give water to drink. If symptoms
develop, seek medical advice.
INHALATION:
Remove to fresh air, treat symptomatically. If symptoms develop, seek medical advice.
NOTE TO PHYSICIAN:
Based on the individual reactions of the patient, the physician's judgement should be used to control symptoms and
clinical condition.
5. 1 FIRE FIGHTING MEASURES
FLASH POINT:
None
EXTINGUISHING MEDIA:
This product would not be expected to burn unless all the water is boiled away. The remaining organics may be
ignitable. Use extinguishing media appropriate for surrounding fire.
FIRE AND EXPLOSION HAZARD:
May evolve oxides of carbon (COx) under fire conditions. May evolve oxides of sulfur (SOx) under fire conditions.
SPECIAL PROTECTIVE EQUIPMENT FOR FIRE FIGHTING:
In case of fire, wear a full face positive -pressure self contained breathing apparatus and protective suit.
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
2/8

)w
NALGO
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO NEXGEN 22310
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) (800) I-M-ALERT
6. 1 ACCIDENTAL RELEASE MEASURES
PERSONAL PRECAUTIONS:
Restrict access to area as appropriate until clean-up operations are complete. Stop or reduce any leaks if it is safe
to do so. Do not touch spilled material. Ventilate spill area if possible. Use personal protective equipment
recommended in Section 8 (Exposure Controls/Personal Protection).
METHODS FOR CLEANING UP:
SMALL SPILLS: Soak up spill with absorbent material. Place residues in a suitable, covered, properly labeled
container. Wash affected area. LARGE SPILLS: Contain liquid using absorbent material, by digging trenches or by
dyking. Reclaim into recovery or salvage drums or tank truck for proper disposal. Contact an approved waste
hauler for disposal of contaminated recovered material. Dispose of material in compliance with regulations indicated
in Section 13 (Disposal Considerations).
ENVIRONMENTAL PRECAUTIONS:
Do not contaminate surface water.
7. 1 HANDLING AND STORAGE 777-1
HANDLING:
Avoid eye and skin contact. Do not take internally. Ensure all containers are labelled. Keep the containers closed
when not in use.
STORAGE CONDITIONS:
Store the containers tightly closed.
8. 1 EXPOSURE CONTROLS/PERSONAL PROTECTION
OCCUPATIONAL EXPOSURE LIMITS:
This product does not contain any substance that has an established exposure limit.
ENGINEERING MEASURES:
General ventilation is recommended.
RESPIRATORY PROTECTION:
Respiratory protection is not normally needed.
HAND PROTECTION:
Neoprene gloves, Nitrile gloves, Butyl gloves, PVC gloves
SKIN PROTECTION:
Wear standard protective clothing.
EYE PROTECTION:
Wear chemical splash goggles.
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
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NALCO
- MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO NEXGEN 22310
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) (800) I-M-ALERT
HYGIENE RECOMMENDATIONS:
Keep an eye wash fountain available. Keep a safety shower available. If clothing is contaminated, remove clothing
and thoroughly wash the affected area. Launder contaminated clothing before reuse.
HUMAN EXPOSURE CHARACTERIZATION:
Based on our recommended product application and personal protective equipment, the potential human exposure
is: Moderate
19. 1 PHYSICAL AND CHEMICAL PROPERTIES 1
PHYSICAL STATE Liquid
APPEARANCE Yellow Orange Flourescent
ODOR None
SPECIFIC GRAVITY 1.19 @ 77 OF / 25 °C
DENSITY 9.9 lb/gal
SOLUBILITY IN WATER Complete
pH (100 %) 10.5
FREEZING POINT 22 OF / -6 °C
VAPOR PRESSURE Same as water
10. 1 STABILITY AND REACTIVITY
STABILITY:
Stable under normal. conditions.
HAZARDOUS POLYMERIZATION:
Hazardous polymerization will not occur.
CONDITIONS TO AVOID:
Freezing temperatures
MATERIALS TO AVOID:
Contact with strong oxidizers (e.g. chlorine, peroxides, chromates, nitric acid, perchlorate, concentrated oxygen,
permanganate) may generate heat, fires, explosions and/or toxic vapors.
HAZARDOUS DECOMPOSITION PRODUCTS:
Under fire conditions: Oxides of carbon, Oxides of sulfur
111. 1 TOXICOLOGICAL INFORMATION I
No toxicity studies have been conducted on this product.
Nalco Chemical Company One Nalco Center - Naperville, Illinois 60563-1198
[phone]
4/8

)W
NALCO
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO NEXGEN 22310
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) (800) I-M-ALERT
CARCINOGENICITY
None of the substances in this product are listed as carcinogens by the International Agency for Research on
Cancer (IARC), the National Toxicology Program (NTP) or the American Conference of Governmental Industrial
Hygienists (ACGIH).
HUMAN HAZARD CHARACTERIZATION
Based.on our hazard characterization, the potential human hazard is: Low
12. J ECOLOGICAL INFORMATION
ECOTOXICOLOGICAL EFFECTS :
No toxicity studies have been conducted on this product.
ENVIRONMENTAL HAZARD AND EXPOSURE CHARACTERIZATION
Based on our hazard characterization, the potential environmental hazard is: Low
Based on our recommended product application and the product's characteristics, the potential environmental
exposure is: High
If released into the environment, see CERCLA/SUPERFUND in Section 15
13. DISPOSAL CONSIDERATIONS
If this product becomes a waste, it is not a hazardous waste as defined by the Resource Conservation and
RecoveryAct (RCRA) 40 CFR 261, since it does not have the characteristics of Subpart C, nor is it listed under
Subpart D.
As a non -hazardous waste, it is not subject to federal regulation. Consult state or local regulation for any additional
handling, treatment or disposal requirements. For disposal, contact a properly licensed waste treatment, storage,
disposal or recycling facility.
14. TRANSPORT INFORMATION
Proper Shipping Name / Hazard Class may vary by packaging, properties, and mode of transportation. Typical
Proper Shipping Names for this product are:
LAND TRANSPORT:
Proper Shipping Name:
AIR TRANSPORT (ICAO/IATA) :
Proper Shipping Name:
PRODUCT IS NOT REGULATED DURING
TRANSPORTATION
PRODUCT IS NOT REGULATED DURING
TRANSPORTATION
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
5/8

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NALCO
MARINE TRANSPORT (IMDG/IMO) :
IMDG Page
Proper Shipping Name:
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO NEXGEN 22310
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) (800) I-M-ALERT
PRODUCT IS NOT REGULATED DURING
TRANSPORTATION
15. REGULATORY INFORMATION
NATIONAL REGULATIONS, USA:
OSHA HAZARD COMMUNICATION RULE, 29 CFR 1910.1200 :
Based on our hazard evaluation, none of the substances in this product are hazardous.
CERCLA/SUPERFUND, 40 CFR 117, 302 :
Notification of spills of this product is not required.
SARA/SUPERFUND AMENDMENTS AND REAUTHORIZATION ACT OF 1986 (TITLE III) - SECTIONS 302, 311,
312, AND 313 :
SECTION 302 - EXTREMELY HAZARDOUS SUBSTANCES (40 CFR 355) :
This product does not contain substances listed in Appendix A and B as an Extremely Hazardous Substance.
SECTIONS 311 AND 312 - MATERIAL SAFETY DATA SHEET REQUIREMENTS (40 CFR 370) :
Our hazard evaluation has found that this product is not hazardous under 29 CFR 1910.1200.
Under SARA 311 and 312, the EPA has established threshold quantities for the reporting of hazardous chemicals.
The current thresholds are: 500 pounds or the threshold planning quantity (TPQ), whichever is lower, for extremely
hazardous substances and 10,000 pounds for all other hazardous chemicals.
SECTION 313 - LIST OF TOXIC CHEMICALS (40 CFR 372) :
This product does not contain substances on the List of Toxic Chemicals.
TOXIC SUBSTANCES CONTROL ACT (TSCA)
The chemical substances in this product are on the 8(b) Inventory (40 CFR 710).
FEDERAL WATER POLLUTION CONTROL ACT, CLEAN WATER ACT, 40 CFR 401.15 / formerly Sec. 307,40
CFR / formerly Sec. 311 :
None of the substances are specifically listed in the regulation.
CLEAN AIR ACT, Sec. 111 (40 CFR 60, Volatile Organic Compounds), Sec. 112 (40 CFR 61, Hazardous Air
Pollutants), Sec. 602 (40 CFR 82, Class I and II Ozone Depleting Substances) :
None of the substances are specifically listed in the regulation.
CALIFORNIA PROPOSITION 65 :
This product does not contain substances which require warning under California Proposition 65.
MICHIGAN CRITICAL MATERIALS:
None of the substances are specifically listed in the regulation
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
6/8

NALGO
MATERIAL SAFETY DATA SHEET
PRODUCT
NALCO NEXGEN 22310
RGENCY
[phone] (24 Hours) (800)1-M-ALERT
STATE RIGHT TO KNOW LAWS:
None of the substances are specifically listed in the regulation.
NATIONAL REGULATIONS, CANADA :
WORKPLACE HAZARDOUS MATERIALS INFORMATION SYSTEM (WHMIS) :
This product has been classified in accordance with the hazard criteria of the Controlled Products Regulations
(CPR) and the MSDS contains all the information required by the CPR.
WHMIS CLASSIFICATION
Not considered a WHMIS controlled product.
16. 1 OTHER INFORMATION
Nalco Internal Number F105654
Due to our commitment to Product Stewardship, we have evaluated the human and environmental hazards and
exposuresof this product. Based on our recommended use of this product, we have characterized the product's
general risk. This informationshould provide assistance for your own risk management practices. We have
evaluated our product's risk as follows:
* The human risk is: Low
* The environmental risk is: Low
Any use inconsistent with our recommendations may affect the risk characterization. Our sales representative will
assist you to determine if your product application is consistent with our recommendations. Together we can
implement an appropriate risk management process.
This product material safety data sheet provides health and safety information. The product is to be used in
applications consistent with our product literature. Individuals handling this product should be informed of the
recommended safety precautions and should have access to this information. For any other uses, exposures should
be evaluated so that appropriate handling practices and training programs can be established to insure safe
workplace operations. Please consult your local sales representative for any further information.
REFERENCES
Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices, American
Conference of Governmental Industrial Hygienists, OH., (Ariel InsightTm CD-ROM Version), Ariel Research Corp.,
Bethesda, MD.
Hazardous Substances Data Bank, National Library of Medicine, Bethesda, Maryland (TOMES CPSTm CD-ROM
Version), Micromedex, Inc., Englewood, Co.
IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man, Geneva: World Health
Organization, International Agency for Research on Cancer.
Integrated Risk Information System, U.S. Environmental Protection Agency, Washington, D.C. (TOMES CPSTM CD-
ROM Version), Micromedex, Inc., Englewood, CO.
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
7/8

N
NALCO
MATERIAL SAFETY DATA SHEET
PRODUCT
I NALCO NEXGEN 22310
■ EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) (800) I-M-ALERT
Annual Report on Carcinogens, National Toxicology Program, U.S. Department of Health and Human Services,
Public Health Service.
Title 29 Code of Federal Regulations, Part 1910, Subpart Z, Toxic and Hazardous Substances, Occupational Safety
and Health Administration (OSHA), (Ariel InsightTm CD-ROM Version), Ariel Research Corp., Bethesda MD.
Registry of Toxic Effects of Chemical Substances, National Institute for Occupational Safety and Health, Cincinnati,
OH, (TOMES CPSTm CD-ROM Version), Micromedex, Inc., Englewood, CO.
Ariel InsightTm (An integrated guide to industrial chemicals covered under major regulatory and advisory programs),
North American Module, Western European Module, Chemical Inventories Module and the Generics Module (Ariel
InsightTM CD-ROM Version), Anel Research Corp., Bethesda, MD.
The Teratogen Information System, University of Washington, Seattle, WA (TOMES CPSTm CD-ROM Version),
Micromedex, Inc., Englewood, CO
Prepared By: Product Safety Department
Date issued : 09/30/1999
Replaces : 05/24/1999
Nalco Chemical Company One Nalco Center • Naperville, Illinois 60563-1198
[phone]
8/8

BIOCIDE/CHEMICAL TREATMENT
WORKSHEET-FORM 101
The following calculations are to be performed on any biocidal products ultimately discharged to the surface waters of
North Carolina. This worksheet must be completed separately for each biocidal product in use. This worksheet is to be
returned with all appropriate data entered into the designated areas with calculations performed as indicated.
Facility Name -ri, ors v , '[ �- V'OV-J UV`G -ZLIJ ,—TV %.G.
NPDES # NC KC G- 5 D D O-7 a Outfall #
County CpjJu-9001
Receiving Stream V�k0.I C i ©OT I� Ctv_e_k 7Q10 0::7 (cfs)
(All above information supplied by the Division of Water Quality)
What is the Average Daily Discharge (A.D.D.) volume of the water handling systems to the receiving water body?
A.D.D. = • ©00 (O (in M.G.D.)
Please calculate the Instream Waste Concentration (IWC in percent) of this discharge using the data entered
above.
(A.D.D.) X 100
IWC =
(M 10)(0.646) + (A. D. D)
606�
(' ) X 100
( )(0.646) + ( (�
O . 3 1 3 010
This value (IWC) represents the waste concentration to the receiving stream during low flow conditions.
II. What is the name of the whole product chemical treatment proposed for use in the discharge identified in Part I?
Please list the active ingredients and percent composition:
IV n 1"6az-ay-JrjU S Coo,-r->O �4s %
What feed or dosage rate (D.R.) is used in this application? The units must be converted to maximum grams
of whole product used in a 24hr period.
D.R.= grams/24hr period
Please note, fluid ounces (a volume) must be converted to grams (a mass). The formula for this conversion is:
Grams of product = fluid oz. of product X 1 gal. water X 8.34 lbs. X specific gravity of product X 453.59g.
128 fl. oz. 1 gal. water 1 lb.

.cility Name:
T IF I NPDES #: NCG'S9007�L
Estimate total volume of the water handling system between entry of biocidal product and NPDES discharge point.
On an attached sheet please provide justification for this estimate (system volume, average cycles per blowdown,
holding lagoon size, etc.)
Volume= e 0143 million gallons
What is the pH of the handling system prior to biocide addition? If unknown, enter N/A. � 0, S
What is the decay rate (D.K.) of the product? If unknown, assume no decay (D.K.=O) and proceed to asterisk.
The degradation must be stated at pH level within 1 /2 pH standard unit within handling system. Enter the half life
(Half Life is the time required for the initial product to degrade to half of its original concentration). Please provide
copies of the sources of this data.
H.L. _ _ A Days
The decay rate is equal to H1L X 0.69 = =Decay Rate (D.K.)
Calculate degradation factor (D.F.). This is the first order loss coefficient.
tP6
* D.F. = (Volume)
+ (D.K.) _ + S
.oa 1
Calculate Steady State Discharge Concentration: ,1
Disch Conc. (D.R.) - ( mg/I
g _ (D.F.)(Volume)(3785) - ( O�ij )(,Oa )(3785)
Calculate concentration of biocide instream during low flow conditions.
(Receiving Stream Concentration)
Disch . IWC% x ._
( Conc. g ) x ( ) 0 0 ( ) ( ) _ o � mg/I
100 - 100
Receiving Stream Concentration
III. Calculate regulated limitation.
List all LC50 and EC50 data available for the whole product according to the following columns. (Note that units
should be in mg/1). Please provide copies of the sources of this data.
Or anism
snn ++ •
Test Duration
I (v iA rS
"1(o � rS
4 '� ki-s
4 q kus
LC50/EC50 (mg/1)
1.000
450
(DOD
> e, 60
D.W.Q. Form 101 (612000) 2

ability Name: LSO + r NPDES #: NC G- 5o O O v,
Choose the lowest LC50/EC50 listed above:
Enter the LC50/EC50:
If the half life (H.L.) is less than 4 days, perform the following calculation.
Regulated Limitation = 0.05 x LC50 = mg/I
IV
If the half life (H.L.) is greater than or equal to 4 days or unknown, perform the following calculation.
Regulated Limitation = 0.01 x LC50 = 1+e S- mg/I
Choose the appropriate regulated limitation from the calculations immediately above and place in this blank:
mg/liter
From Part II enter the receiving stream concentration:
Ov 0 ` � mg/liter
Analysis.
If the receiving stream concentration is greater than the calculated regulated limitation, then this biocide is
unacceptable for use.
Person in Responsible Charge
j
Date
Person Completing This Worksheet (If different from above)
�s, Fct�,a,6-,
Name Print)
130lo -7
Signature Date
Please submit to: Division of Water Quality
Aquatic Toxicology Unit
1621 Mail Service Center
Raleigh, NC 27699-1621
Attn: Todd Christenson
D.W.Q. Form 101 (612000) 3

71-- L'a'A-0, if
NPDES #: NC (--SDO 0 -/o')-
supplemental Metals Analysis
If copper, zinc, or chromium are present in the proposed biocidal compound, complete this worksheet. A separate form
must be used for each metal and/or metal compound present in the biocide. List the metal, its chemical formula, molecular
weight (MW), formula weight (FW), and the concentration of the metal compound in the biocide (MCC). Complete a
separate form for every metal present in the biocide.
Metal Chemical Formula Molecular Weight of Metal Formula Weight Concentration in Biocide
EXAMPLE
Copper CuSO4.5H2O 63.546 g/mole 249.680 g/mole 0.2 %
Dosage rate of Biocide (DR) (from page 1):
DR = grams/day
Average Daily Discharge (ADD) (from page 1): v O ► a
ADD = million gallons/day
Discharge Concentration (DC) of Biocide:
DR ( grams/day)
DC = ADD = ( million gallons/day) = grams/million gallons
Convert DC to micrograms/liter (ppb):
DC (lag/1) = DC (grams/million gal) x 1 x 106 lag/g = lag/I
3.785 x 106 liters/million gal.
Calculate the fraction of metal in the metal -containing compound (MF):
MW ( grams/mole)
MF = FW = ( grams/mole) _
Calculate the fraction of metal in the biocidal compound (BF):
MCC (%) %
BF = MF x 100 — x (100) _
Calculate the concentration of metal in the discharge (M):
M = DC x BF = lag/I x = lag/I
Calculate the instream metal concentration (IMC) at low -flow conditions:
IMC = M x IW— %) = lag/I x 100 % = Pg/I
Regulated limitation of metal (from below): Ng/I
NC General Statutes 15A NCAC 2B.0211 define:
Copper- 7 Ng/l water quality action level* Zinc- 50 Ng/I water quality action level*
Chromium- 50 Ng/l water quality standard
(*Values which exceed action levels must be addressed directly by aquatic toxicity testing.)
D. W. Q. Form 101 (612000) 4

BIOCIDE/CHEMICAL TREATMENT
WORKSHEET-FORM 101
The following calculations are to be performed on any biocidal products ultimately discharged to the surface waters of
North Carolina. This worksheet must be completed separately for each biocidal product in use. This worksheet is to be
returned with all appropriate data entered into the designated areas with calculations performed as indicated.
—
Facility. Name 7T' LP— v1 o l
NPDES # NC N C, G— 5 0 0 0 7
County
Receivii
Outfall #
7Q10 • o / (cfs)
(All above information supplied by the Division of Water Quality)
What is the Average Daily Discharge (A.D.D.) volume of the water handling systems to the receiving water body?
A.D.D. = •"I (in M.G.D.)
Please calculate the Instream Waste Concentration (IWC in percent) of this discharge using the data entered
above. 1
IWC = (A.D.D.)X 100 = (`© ) X 100 _ 0.0577
(7Q10)(0.646) + (A.D.D) (�(0.646) + (oil)
,0
This value (IWC) represents the waste concentration to the receiving stream during low flow conditions.
II. What is the name of the whole product chemical treatment proposed for use in the discharge identified n Part I?
�S e o A CT 5 p-p I 1 Myaw�
Please list the active ingredients and percent composition:
tJO a Ott S -6 s Rio
What feed or dosage rate (D.R.) is used in this application? The units must be converted to maximum grams
of whole product used in a 24hr period. i
D.R.= I -# S grams/24hr period
Please note, fluid ounces (a volume) must be converted to grams (a mass). The formula for this conversion is:
Grams of product = fluid oz. of product X 1 gal. water. X 8.34 lbs. X specific gravity of product X 453.59g ..
128 fl. oz. 1 gal. water 1 Ib.

T - �.e�� f G
ctlity Name: vv oNPDES #: NC 50 n 0-7
Estimate total volume of the water handling system between entry of biocidal product and NPDES discharge point.
On an attached sheet please provide justification for this estimate (system volume, average cycles per blowdown,
holding lagoon size, etc.)
Volume= & 0;`%43 million gallons
What is the pH of the handling system prior to biocide addition? If unknown, enter NIA. 70
What is the decay rate (D.K.) of the product? If unknown, assume no decay (D.K.=O) and proceed to asterisk.
The degradation must be stated at pH level within 1 /2 pH standard unit within handling system. Enter the half life
(Half Life is the time required for the initial product to degrade to half of its original concentration). Please provide
copies of the sources of this data.
H.L. = iJ A Days
The decay rate is equal to - L. X 0.69 = =Decay Rate (D.K.)
H.Calculate degradation factor (D.F.). This is the first order loss coefficient.
* D.F. _ (Volume) + (D.K.) _ �� + ( O ) = )
oa`�3
Calculate Steady State Discharge Concentration: 000
Dischg Conc. _ (D.F.)(Volume)(3785) ( b X'OV43)(3785) mg/I
Calculate concentration of biocide instream during low flow conditions.
(Receiving Stream Concentration)
(Dischg. Conc.) x (IWC%) _ �x = 0 o003 mg/I
100 100
Receiving Stream Concentration
III. Calculate regulated limitation.
List all LC50 and EC50 data available for the whole product according to the following columns. (Note that units
should be in mg/1). Please provide copies of the sources of this data.
Organism Test
9ILl.�► ► 11 /I
D. W. Q. Form 101 (612000) 2

.cflity Name:
T IF I — LQ—n c)'jy
NPDES #: NC G S O0 0 71
Choose the lowest LC50/EC50listed
above:
Enter the LC50/EC50: 450
If the half life (H.L.) is less than 4 days, perform the following calculation.
Regulated Limitation = 0.05 x LC50 = mg/I
If the half life (H.L.) is greater than or equal to 4 days or unknown, perform the following calculation.
Regulated Limitation = 0.01 x LC50 = , S mg/I
Choose the appropriate regulated limitation from the calculations immediately above and place in this blank:
o, S mg/liter
From Part 11 enter the receiving stream concentration:
0 * 003 mg/liter
IV. Analysis.
If the receiving stream concentration is greater than the calculated regulated limitation, then this biocide is
unacceptable for use.
_R-erseraj,n Responsible Charge
o �r�ZcC KSdYD
ame rint)
c
Signatu Date
Completing This Worksheet (If different from above)
5-J-4sa���
Name (Print)
Signature
Please submit to: Division of Water Quality
Aquatic Toxicology Unit
1621 Mail Service Center
Raleigh, NC 27699-1621
Attn: Todd Christenson
I 1-3olo-7
Date
D. W. Q. Form 101 (612000) 3

Supplemental Metals Analysis
If copper, zinc, or chromium are present in the proposed biocidal compound, complete this worksheet. A separate form
must be used for each metal and/or metal compound present in the biocide. List the metal, its chemical formula, molecular
weight (MW), formula weight (FW), and the concentration of the metal compound in the biocide (MCC). Complete a
separate form for every metal present in the biocide.
Metal Chemical Formula Molecular Weight of Metal Formula Weight Concentration in Biocide
EXAMPLE
Copper CuSO4 5H20 63.546 g/mole 249.680 g/mole 0.2 %
Dosage rate of Biocide (DR) (from page 1):
DR = grams/day
Average Daily Discharge (ADD) (from page 1):
ADD = million gallons/day
Discharge Concentration (DC) of Biocide:
DC = DR _ ( grams/day) _ grams/million gallons
ADD - (_million gallons/day)
Convert DC to micrograms/liter (ppb):
DC (pg/1) = DC (grams/million gal) x 1 6106 ug/g = Ng/I
3.785 x 10 liters/million gal.
Calculate the fraction of metal in the metal -containing compound (MF):
MW ( prams/mole)
MF = FW = ( grams/mole) _
Calculate the fraction of metal in the biocidal compound (BF):
BF=MFxMCC 100%
x (100) _
Calculate the concentration of metal in the discharge (M):
M = DC x BF = Pg/I x
= Pg/I
Calculate the instream metal concentration (IMC) at low -flow conditions:
IMC = M x IWC (% = N9/I x 100 % _ Pg/I
Regulated limitation of metal (from below): pg/l
NC General Statutes 15A NCAC 26.0211 define:
Copper- 7 pg/1 water quality action level* Zinc- 50 pg/I water quality action level*
Chromium- 50 pg/l water quality standard
(*Values which exceed action levels must be addressed directly by aquatic toxicity testing.)
D. W. Q. Form 101 (612000)
4

©,�XONDEO
Nalco
MATERIAL SAFETY DATA SHEET
PRODUCT
Nalco ACT® 52211
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) CHEMTREC
1. CHEMICAL PRODUCT AND COMPANY IDENTIFICATION
PRODUCT NAME : Nalco ACT® 52211
APPLICATION: ADVANCED CONDENSATE TREATMENT
COMPANY IDENTIFICATION: ONDEO Nalco Company
ONDEO Nalco Center
Naperville, Illinois
60563-1198
EMERGENCY TELEPHONE NUMBER: [phone] (24 Hours) CHEMTREC
NFPA 704M/HMIS RATING
HEALTH: 0/1 FLAMMABILITY: 1/1 REACTIVITY: 0/0 OTHER:
0 = Insignificant 1 = Slight 2 = Moderate 3 = High 4 = Extreme
2. 1 COMPOSITION/INFORMATION ON INGREDIENTS
Based on our hazard evaluation, none of the substances in this product are hazardous.
i 3. HAZARDS IDENTIFICATION
"EMERGENCY OVERVIEW"
CAUTION
May cause irritation with prolonged contact.
Do not get in eyes, on skin, on clothing. Do not take internally. Wear suitable protective clothing. Keep container
tightly closed. Flush affected area with water. Protect product from freezing.
May evolve oxides of carbon COx under fire conditions.
PRIMARY ROUTES OF EXPOSURE:
Eye, Skin
HUMAN HEALTH HAZARDS - ACUTE:
EYE CONTACT:
May cause irritation with prolonged contact.
SKIN CONTACT:
May cause irritation with prolonged contact.
INGESTION:
Not a likely route of exposure. No adverse effects expected.
INHALATION:
Not a likely route of exposure. No adverse effects expected.
ONDEO Nalco Company ONDEO Nalco Center • Naperville, Illinois 60563-1198
[phone]
1/9

o
©� ONDEO
o' Nalco
1
MATERIAL SAFETY DATA SHEET
PRODUCT
Nalco ACT® 52211
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) CHEMTREC
SYMPTOMS OF EXPOSURE:
Acute
A review of available data does not identify any symptoms from exposure not previously mentioned.
Chronic:
A review of available data does not identify any symptoms from exposure not previously mentioned.
AGGRAVATION OF EXISTING CONDITIONS:
A review of available data does not identify any worsening of existing conditions.
4. 1 FIRST AID MEASURES
EYE CONTACT:
Flush affected area with water. If symptoms develop, seek medical advice..
SKIN CONTACT:
Flush affected area with water. If symptoms develop, seek medical advice.
INGESTION:
Do not induce vomiting without medical advice. If conscious, washout mouth and give water to drink. If symptoms
develop, seek medical advice.
INHALATION:
Remove to fresh air, treat symptomatically. If symptoms develop, seek medical advice.
NOTE TO PHYSICIAN:
Based on the individual reactions of the patient, the physician's judgement should be used to control symptoms and
clinical condition.
5. 1 FIRE FIGHTING MEASURES
FLASH POINT:
>200OF/>93.3°C(PMCC)
EXTINGUISHING MEDIA:
This product would not be expected to burn unless all the water is boiled away. The remaining organics may be
ignitable. Use extinguishing media appropriate for surrounding fire.
FIRE AND EXPLOSION HAZARD:
May evolve oxides of carbon (COx) under fire conditions.
SPECIAL PROTECTIVE EQUIPMENT FOR FIRE FIGHTING:
In case of fire, wear a full face positive -pressure self contained breathing apparatus and protective suit.
ONDEO Nalco Company ONDEO Nalco Center • Naperville, Illinois 60563-1198
[phone]
2/9

ONDE0
o Nalco
MATERIAL SAFETY DATA SHEET
PRODUCT
Nalco ACT® 52211
EMERGENCY
[phone] (24 Hours) . CHEMTREC
6.I ACCIDENTAL RELEASE MEASURES
PERSONAL PRECAUTIONS
Restrict access to area as appropriate until clean-up operations are complete. Stop or reduce any leaks if it is safe
to do so. Do not touch spilled material. Ventilate spill area if possible. Use personal protective equipment
recommended in Section 8 (Exposure Controls/Personal Protection).
METHODS FOR CLEANING UP:
SMALL SPILLS: Soak up spill with absorbent material. Place residues in a suitable, covered, properly labeled
container. Wash affected area. LARGE SPILLS: Contain liquid using absorbent material, by digging trenches or by
diking. Reclaim into recovery or salvage drums or tank truck for proper disposal. Contact an approved waste hauler
for disposal of contaminated recovered material. Dispose of material in compliance with regulations indicated in
Section 13 (Disposal Considerations).
ENVIRONMENTAL PRECAUTIONS:
Do not contaminate surface water.
7. 1 HANDLING AND STORAGE
HANDLING:
Avoid eye and skin contact. Do not take internally. Ensure all containers are labelled. Keep the containers closed
when not in use.
STORAGE CONDITIONS:
Store the containers tightly closed.
18. 1 EXPOSURE CONTROLS/PERSONAL PROTECTION I
OCCUPATIONAL EXPOSURE LIMITS:
This product does not contain any substance that has an established exposure limit
ENGINEERING MEASURES:
General ventilation is recommended.
RESPIRATORY PROTECTION:
Respiratory protection is not normally needed.
NAND PROTECTION:
Neoprene gloves, Nitrile gloves, Butyl gloves, PVC gloves
SKIN PROTECTION:
Wear standard protective clothing.
EYE PROTECTION:
Wear chemical splash goggles.
ONDEO Nalco Company ONDEO Nalco Center • Naperville, Illinois 60563-1198
[phone]
3/9

©R ONDEO
o Nalco
MATERIAL SAFETY DATA SHEET
PRODUCT
Nalco ACT® 52211
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) CHEMTREC
HYGIENE RECOMMENDATIONS:
Keep an eye wash fountain available. Keep a safety shower available. If clothing is contaminated, remove clothing
and thoroughly wash the affected area. Launder contaminated clothing before reuse.
HUMAN EXPOSURE CHARACTERIZATION:
Based on our recommended product application and personal protective equipment, the potential human exposure
is: Low
9. 1 PHYSICAL AND CHEMICAL PROPERTIES
PHYSICAL STATE Liquid
APPEARANCE Milky
ODOR Slight
SPECIFIC GRAVITY
1.005
DENSITY
8.37 lb/gal
SOLUBILITY IN WATER
Dispersible
pH (100 %)
6.5
FREEZING POINT
32 OF / 0 °C
BOILING POINT
> 212 OF / > 100 °C
VOC CONTENT
0.00 %
10. 1 STABILITY AND REACTIVITY
STABILITY:
Stable under normal conditions.
HAZARDOUS POLYMERIZATION:
Hazardous polymerization will not occur.
CONDITIONS TO AVOID:
Freezing temperatures.
MATERIALS TO AVOID:
None known.
HAZARDOUS DECOMPOSITION PRODUCTS:
Under fire conditions: Oxides of carbon
111. 1 TOXICOLOGICAL INFORMATION
No toxicity studies have been conducted on this product.
SENSITIZATION:
This product is not expected to be a sensitizer.
ONDEO Nalco Company ONDEO Nalco Center • Naperville, Illinois 60563-1198
[phone]
4/9

ONDEO
Nalco
MATERIAL SAFETY DATA SHEET
PRODUCT
Nalco ACT® 52211
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) CHEMTREC
CARCINOGENICITY:
None of the substances in this product are listed as carcinogens by the International Agency for Research on
Cancer (IARC), the National Toxicology Program (NTP) or the American Conference of Governmental Industrial
Hygienists (ACGIH).
HUMAN HAZARD CHARACTERIZATION:
Based on our hazard characterization, the potential human hazard is: Low
12. 1 ECOLOGICAL INFORMATION
ECOTOXICOLOGICAL EFFECTS:
The following results are for the product.
ACUTE FISH RESULTS
Species
Exposure
LC50
Tested Substance
Shee shead Minnow
96 hrs
> 1,000 m /I
Product
Rainbow Trout
96 hrs
450 m /l
Product
r-auny. . r=ssenuauy non -toxic
1 ACUTE INVERTEBRATE RESULTS:
S ecies
Exposure
LC50
EC50
Tested Substance
Daphnia ma na
48 hrs
> 1,000 m /I
Product
Cerioda hnia dubia
48 hrs
> 1,000 m /I
Product
ruauny. . r=tisanuauy non -Toxic
PERSISTENCY AND DEGRADATION:
Biological Oxygen Demand (BOD):
Incubation Period JValue Tested Substance
210,000 m /I Product
ENVIRONMENTAL HAZARD AND EXPOSURE CHARACTERIZATION
Based on our hazard characterization, the potential environmental hazard is: Low
Based on our recommended product application and the product's characteristics, the potential environmental
exposure is: Low
If released into the environment, see CERCLA/SUPERFUND in Section 15.
13. DISPOSAL CONSIDERATIONS
If this product becomes a waste, it is not a hazardous waste as defined by the Resource Conservation and Recovery
Act (RCRA) 40 CFR 261, since it does not have the characteristics of Subpart C, nor is it listed under Subpart D.
As a non -hazardous waste, it is not subject to federal regulation. Consult state or local regulation for any additional
handling, treatment or disposal requirements. For disposal, contact a properly licensed waste treatment, storage,
disposal or recycling facility.
ONDEO Nalco Company ONDEO Nalco Center • Naperville, Illinois 60563-1198
[phone]
5/9

®� ONDEO
Nalco
MATERIAL SAFETY DATA SHEET
PRODUCT
Nalco ACT® 52211
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) CHEMTREC
14. TRANSPORT INFORMATION
The information in this section is for reference only and should not take the place of a shipping_ paper (bill of lading)
specific to an order. Please note that the proper Shipping Name / Hazard Class may vary by packaging, properties,
and mode of transportation. Typical Proper Shipping Names for this product are:
LAND TRANSPORT:
Proper Shipping Name: PRODUCT IS NOT REGULATED DURING
TRANSPORTATION
AIR TRANSPORT (ICAO/IATA) :
Proper Shipping Name: PRODUCT IS NOT REGULATED DURING
TRANSPORTATION
MARINE TRANSPORT (IMDG/IMO) :
Proper Shipping Name: PRODUCT IS NOT REGULATED DURING
TRANSPORTATION
15. REGULATORY INFORMATION
NATIONAL REGULATIONS, USA:
OSHA HAZARD COMMUNICATION RULE, 29 CFR 1910.1200 :
Based on our hazard evaluation, none of the substances in this product are hazardous
CERCLA/SUPERFUND, 40 CFR 117, 302 :
Notification of spills of this product is not required.
SARA/SUPERFUND AMENDMENTS AND REAUTHORIZATION ACT OF 1986 (TITLE III) - SECTIONS 302,311
312, AND 313 :
SECTION 302 - EXTREMELY HAZARDOUS SUBSTANCES (40 CFR 355) :
This product does not contain substances listed in Appendix A and B as an Extremely Hazardous Substance.
SECTIONS 311 AND 312 - MATERIAL SAFETY DATA SHEET REQUIREMENTS (40 CFR 370) :
Our hazard evaluation has found that this product is not hazardous under 29 CFR 1910.1200.
Under SARA 311 and 312, the EPA has established threshold quantities for the reporting of hazardous chemicals.
The current thresholds are: 500 pounds or the threshold planning quantity (TPQ), whichever is lower, for extremely
hazardous substances and 10,000 pounds for all other hazardous chemicals.
SECTION 313 - LIST OF TOXIC CHEMICALS (40 CFR 372) :
This product does not contain substances on the List of Toxic Chemicals.
ONDEO Nalco Company ONDEO Nalco Center • Naperville, Illinois 60563-1198
[phone]
6/9

4
�40IONDEO
Nalco
MATERIAL SAFETY DATA SHEET
PRODUCT
Nalco ACT® 52211
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) CHEMTREC
TOXIC SUBSTANCES CONTROL ACT (TSCA) :
The chemical substances in this product are on the TSCA 8(b) Inventory (40 CFR 710).
FOOD AND DRUG ADMINISTRATION (FDA) Federal Food, Drug and Cosmetic Act:
When use situations necessitate compliance with FDA regulations, this product is acceptable under: 21 CFR
173.310 Boiler Water Additives
The following limitations apply:
Maximum dosaoe
600 PPM
Limitation
in the steam.
NSF INTERNATIONAL:
This product is acceptable for use in meat, poultry, and other food processing areas as a Boiler Treatment Product
(G6); for treating boiler and steam lines where the steam produced may contact edible products. Acceptable usage
shall be in accordance with the dosage limitations specified on the product label. NSF Registration number for this
product is 119471.
FEDERAL WATER POLLUTION CONTROL ACT, CLEAN WATER ACT, 40 CFR 401.15 / formerly Sec. 307,40
CFR / formerly Sec. 311
None of the substances are specifically listed in the regulation.
CLEAN AIR ACT, Sec. 111 (40 CFR 60, Volatile Organic Compounds), Seca 112 (40 CFR 61, Hazardous Air
Pollutants), Sec. 602 (40 CFR 82, Class I and II Ozone Depleting Substances) :
None of the substances are specifically listed in the regulation.
CALIFORNIA PROPOSITION 65 :
This product does not contain substances which require warning under California Proposition 65.
MICHIGAN CRITICAL MATERIALS:
None of the substances are specifically listed in the regulation.
STATE RIGHT TO KNOW LAWS:
The following substances are disclosed for compliance with State Right to Know Laws:
Water 7732-18-5
Sorbitan Monostearate 1338-41-6
Ethoxylated Sorbitan Monostearate 9005-67-8
Ethoxylated Sorbitan Monolaurate 9005-64-5
NATIONAL REGULATIONS, CANADA :
WORKPLACE HAZARDOUS MATERIALS INFORMATION SYSTEM (WHMIS) :
This product has been classified in accordance with the hazard criteria of the Controlled Products Regulations
(CPR) and the MSDS contains all the information required by the CPR.
WHMIS CLASSIFICATION:
Not considered a WHMIS controlled product.
ONDEO Nalco Company ONDEO Nalco Center • Naperville, Illinois 60563-1198
[phone]
7/9

0 0
(:), X ONDEO
Nalco
MATERIAL SAFETY DATA SHEET
PRODUCT
Nalco ACT® 52211
EMERGENCY TELEPHONE NUMBER
[phone] (24 Hours) CHEMTREC
CANADIAN ENVIRONMENTAL PROTECTION ACT (CEPA) :
All substances in this product are listed on the Domestic Substances List (DSL), are exempt, or have been reported
in accordance with the New Substances Notification Regulations.
INTERNATIONAL CHEMICAL CONTROL LAWS
AUSTRALIA
All substances in this product comply with the National Industrial Chemicals Notification & Assessment Scheme
(NICNAS) and are listed on the Australian Inventory of Chemical Substances (AICS).
EUROPE
All substances in this product comply with the notification requirements of the European Commission Directive
67/548/EEC and amendments and are listed on the European Inventory of Existing Commercial Substances
(EINECS).
JAPAN
All substances in this product comply with the Law Regulating the Manufacture and Importation Of Chemical
Substances and are listed on the Ministry of International Trade & industry List (MITI).
KOREA
All substances in this product comply with the Toxic Chemical Control Law (TCCL) and are listed on the Existing
Chemicals List (ECL)
THE PHILIPPINES
All substances in this product comply with the Republic Act 6969 (RA 6969) and are listed on the Philippine
Inventory of Chemicals & Chemical Substances (PICCS).
16. OTHER INFORMATION
Due to our commitment to Product Stewardship, we have evaluated the human and environmental hazards and
exposures of this product. Based on our recommended use of this product, we have characterized the product's
general risk. This information should provide assistance for your own risk management practices. We have
evaluated our product's risk as follows:
* The human risk is: Low
* The environmental risk is: Low
Any use inconsistent with our recommendations may affect the risk characterization. Our sales representative will
assist you to determine if your product application is consistent with our recommendations. Together we can
implement an appropriate risk management process.
This product material safety data sheet provides health and safety information. The product is to be used in
applications consistent with our product literature. Individuals handling this product should be informed of the
recommended safety precautions and should have access to this information. For any other uses, exposures should
be evaluated so that appropriate handling practices and training programs can be established to insure safe
workplace operations. Please consult your local sales representative for any further information.
REFERENCES
ONDEO Nalco Company ONDEO Nalco Center • Naperville, Illinois 60563-1198
[phone]
8/9

© 0 N D E 0
Nalco
MATERIAL SAFETY DATA SHEET
PRODUCT
Nalco ACT® 52211
TELEPHONE
[phone] (24 Hours) CHEMTREC
Threshold Limit Values for Chemical Substances and Physical Agents and Biological Exposure Indices, American
Conference of Governmental Industrial Hygienists, OH., (Ariel Insight# CD-ROM Version), Ariel Research Corp.,
Bethesda, MD.
Hazardous Substances Data Bank, National Library of Medicine, Bethesda, Maryland (TOMES CPS# CD-ROM
Version), Micromedex, Inc., Englewood, Co.
IARC Monographs on the Evaluation of the Carcinogenic Risk of Chemicals to Man, Geneva: World Health
Organization, International Agency for Research on Cancer.
Integrated Risk Information System, U.S. Environmental Protection Agency, Washington, D.C. (TOMES CPS# CD-
ROM Version), Micromedex, Inc., Englewood, CO.
Annual Report on Carcinogens, National Toxicology Program, U.S. Department of Health and Human Services,
Public Health Service.
Title 29 Code of Federal Regulations, Part 1910, Subpart Z, Toxic and Hazardous Substances, Occupational Safety
and Health Administration (OSHA), (Ariel Insight# CD-ROM Version), Ariel Research Corp., Bethesda MD.
Registry of Toxic Effects of Chemical Substances, National Institute for Occupational Safety and Health, Cincinnati,
OH, (TOMES CPS# CD-ROM Version), Micromedex, Inc., Englewood, CO.
Ariel Insight# (An integrated guide to industrial chemicals covered under major regulatory and advisory programs),
North American Module, Western European Module, Chemical Inventories Module and the Generics Module (Ariel
Insight# CD-ROM Version), Ariel Research Corp., Bethesda, MD.
The Teratogen Information System, University of Washington, Seattle, WA (TOMES CPS# CD-ROM Version),
Micromedex, Inc., Englewood, CO
Prepared By: Product Safety Department
Date issued 10/09/2000
Replaces : 06/09/1999
ONDEO Nalco Company ONDEO Nalco Center • Naperville, Illinois 60563-1198
[phone]
9/9

5j
r
State of North Ca, Dina
..Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
A. Preston Howard, Jr., P.E., Director
Ms. Rochelle Chisom
Thomasville Furniture Industries, Inc.
401 E. Main St.
Thomasville, NC 27361
A14
1:3EHNFi
March 18, 1996
Subje : Representative Outfall Status
Thomasville Furn. Lenoir Plant
5VI NCG180169
Caldwell County
`� sp
nUN�„ap�,
Dear Ms. Chisom: � � Cd � �
,L 7�
s ro,e..0 w /e -� �
I am responding to a letter received by this office on December 6, 1995 requesting S✓•�/e
representative outfall status for Thomasville Furniture Industries, Inc.'s (TFI) Lenoir Plant. - -h �j�
The letter and accompanying site map describe and show seven different stormwater -e rj4,xj& outfalls. Of these seven TFI is petitioning that only four outfalls be monitored for the
stormwater permits' analytical monitoring requirements. bfe 1-,. 4
The site map that was provided and subsequent visit made to the site by Mr. Jame..
Reid confirmed that drainage from outfalls 1, 2a, 2b, and 4 are representative of the
activities occurring at the facility. Therefore, TFI Lenoir Plant is granted representative
outfall status for outfall numbers 1, 2a, 2b, and 4 as requested.
If you have any questions regarding the above information please contact Aisha Lau
at [phone] ext. 578.
r
cc: David McLay, P.E., Woodward -Clyde
James Reid, Asheville Regional Office
Central Files
Sincerely,
A. Preston Howard, Jr., P.E.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment,
Health and Natural Resources
Division of Environmental Management
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Asheville Regional Office
MEMORANDUM
1D1=HNFR
WATER QUALITY SECTION
March 8, 1996
TO: Aisha Lau
Environmental Engineer
THROUGH: Forrest R. Westa
Water Quality Re&i ervisor
FROM: James R. R d
Environmen al neer
SUBJECT: Thomasville's Lenoir Plant - Stormwater
Outfalls, Representative Status
Caldwell County
On March 8, 1996, I toured subject facility with the
Company's Mr. Mitch Cook. Based upon the fact that all
observed industrial activities and storage (with the
exception of lumber handling) are under roof, stormwater
outfalls appeared to be essentially equivalent (for
parameters in NCG180000).
Conseauently regional staff recommend granting
Thomasville's request to sample onlv outfalls 1, 2a, 2b,
and 4 at the Lenoir Plant. Please contact me at 704-251-
6208 if additional information is required.
Interchange Building, 59 Woodfin Place N%f
��FAX [phone]
Asheville, North Carolina 28801 An Equal Opportunity/Affirmative Action Employer
Voice 704-251-6208 50% recycled/10% post -consumer paper

Permit No. NCG180000
STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT AND NATURAL
RESOURCES
DIVISION OF WATER QUALITY
4'.rz;; llp� i`vrLL.
GENERAL PERMIT N
TO DISCHARGE STORMWATER UNDER THE
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful
standards and regulations promulgated and adopted by the North Carolina Environmental
Management Commission and the Federal Water Pollution Control Act, as amended, this permit
is hereby issued to all owners or operators, hereafter permittees, which are covered by this
permit as evidenced by receipt of a Certificate of Coverage by the Environmental Management
Commission to allow the discharge of stormwater to the surface waters of North Carolina or
separate storm sewer systems conveying stormwater to surface waters in accordance with the
terms and conditions set forth herein.
Coverage under this General Permit is applicable to all owners or operators of stormwater point
source discharges associated with activities classified as establishments primarily engaged in
manufacturing Furniture and Fixtures [standard industrial classification (SIC) 25] or Wood
Kitchen Cabinets [standard industrial classification (SIC) 2434]; and like activities deemed by
the division of Water Quality to be similar in the process and/or the exposure of raw materials,
products, by-products, or waste materials.
The General Permit shall become effective on September 1, 2009.
The General Permit shall expire at midnight on August 31, 2014.
Signed this day July 7, 2009.
Original signed by Chuck Wakild
Coleen H. Sullins, Director
Division of Water Quality
By the Authority of the Environmental Management Commission

Permit No. NCG180000
TABLE OF CONTENTS
PART I INTRODUCTION
Section A: General Permit Coverage
Section B: Permitted Activities
PART II MONITORING, CONTROLS, AND LIMITATIONS FOR PERMITTED
DISCHARGES
Section A: Stormwater Pollution Prevention Plan
Section B: Qualitative Monitoring Requirements
Section C: On -Site Vehicle Maintenance Monitoring Requirements
PART III STANDARD CONDITIONS FOR NPDES STORMWATER GENERAL PERMITS
Section A: Compliance and Liability
1.
Compliance Schedule
2.
Duty to Comply
3.
Duty to Mitigate
4.
Civil and Criminal Liability
5.
Oil and Hazardous Substance Liability
6.
Property Rights
7.
Severability
8.
Duty to Provide Information
9.
Penalties for Tampering
10.
Penalties for Falsification of Reports
Section B: General Conditions
1. General Permit Expiration
2. Transfers
3. When an Individual Permit May be Required
4. When an Individual Permit May be Requested
5. Signatory Requirements
6. General Permit Modification, Revocation and Reissuance, or
Termination
7. Certificate of Coverage Actions
i

Permit No. NCG180000
Section C: Operation and Maintenance of Pollution Controls
1. Proper Operation and Maintenance
2. Need to Halt or Reduce not a Defense
3. Bypassing of Stormwater Control Facilities
Section D: Monitoring and Records
1.
Representative Sampling
2.
Recording Results
3.
Flow Measurements
4.
Test Procedures
5.
Representative Outfall
6.
Records Retention
7.
Inspection and Entry
Section E: Reporting
Requirements
1.
Discharge Monitoring Reports
2.
Submitting Reports
3.
Availability of Reports
4.
Non-Stormwater Discharges
5.
Planned Changes
6.
Anticipated Noncompliance
7.
Bypass
8.
Twenty-four Hour Reporting
9.
Other Noncompliance
10.
Other Information
PART IV LIMITATIONS REOPENER
PART V ADMINISTERING AND COMPLIANCE MONITORING FEE
REQUIREMENTS
PART VI DEFINITIONS
11

Permit No. NCG180000
PART I INTRODUCTION
SECTION A: GENERAL PERMIT COVERAGE
All persons desiring to be covered by this General Permit must register with the Division of
Water Quality by the filing of a Notice of Intent (NOI) and applicable fees. The NOI shall be
submitted and a certificate of coverage issued prior to any discharge of stormwater associated
with industrial activity that has a point source discharge to the surface waters of the state.
Any owner or operator not wishing to be covered or limited by this General Permit may make
application for an individual NPDES permit in accordance with NPDES procedures in 15A
NCAC 2H .0100, stating the reasons supporting the request. Any application for an individual
permit should be made at least 180 days prior to commencement of discharge.
This General Permit does not cover activities or discharges covered by an individual NPDES
permit until the individual permit has expired or has been revoked. Any person conducting an
activity covered by an individual permit but which could be covered by this General Permit may
request that the individual permit be revoked and coverage under this General Permit be
provided.
If industrial materials and activities are not exposed to precipitation or runoff as described in 40
CFR § 122.26(g), the facility may qualify for a No Exposure Exclusion from NPDES stormwater
discharge permit requirements. Any owner or operator wishing to obtain a No Exposure
Exclusion must submit a No Exposure Certification NOI form to the Division, must receive
approval by the Division, must maintain no exposure conditions unless authorized to discharge
under a valid NPDES stormwater permit, and must reapply for the No Exposure Exclusion once
every five (5) years.
Any facility may apply for new or continued coverage under this permit until a Total Maximum
Daily Load (TMDL) for pollutants for stormwater discharges is established. A TMDL sets a
pollutant loading limit that affects a watershed, or portion of a watershed, draining to an
impaired water. For stormwater discharges to watersheds affected by a TMDL, coverage
under this permit may depend on the facility demonstrating it does not have reasonable
potential to violate applicable water quality standards for those pollutants as a result of
discharges. If the Division determines that discharges have reasonable potential to cause water
quality standard violations, the facility shall apply for an individual permit 180 days prior to the
expiration date of this general permit, and once that permit is effective, will no longer have
coverage under this general permit. [Note the facility must identify impaired waters (scheduled
for TMDL development) and waters already subject to a TMDL in the Site Plan, as outlined in
the Stormwater Pollution Prevention Plan (SPPP), in Part II, Section A. I]
During the period beginning on the effective date of the permit and lasting until expiration, the
Permittee is authorized to discharge stormwater associated with industrial activity. Such
discharges shall be controlled, limited, and monitored as specified in this permit.
Part I Page 1 of 2

Permit No. NCG180000
SECTION B: PERMITTED ACTIVITIES
Until this permit expires or is modified or revoked, the permittee is authorized to discharge
stormwater to the surface waters of North Carolina or separate storm sewer system which has
been adequately treated and managed in accordance with the terms and conditions of this
General Permit. All discharges shall be in accordance with the conditions of this permit.
Any other point source discharge to surface waters of the state is prohibited unless it is an
allowable non-stormwater discharge or is covered by another permit, authorization, or approval.
The stormwater discharges allowed by this General Permit shall not cause or contribute to
violations of Water Quality Standards. This General Permit does not allow discharges
determined by the Division of Water Quality to be wastewaters.
This permit does not relieve the permittee from responsibility for compliance with any other
applicable federal, state, or local law, rule, standard, ordinance, order, judgment, or decree.
Part I Page 2 of 2

Permit No. NCG180000
PART II MONITORING, CONTROLS, AND LIMITATIONS FOR
PERMITTED DISCHARGES
SECTION A: STORMWATER POLLUTION PREVENTION PLAN
The Permittee shall develop a Stormwater Pollution Prevention Plan, herein after referred to as the Plan.
This Plan shall be considered public information in accordance with Part III, Standard Conditions,
Section E, Paragraph 3 of this General Permit. The Plan shall include, at a minimum, the following
items:
Site Plan. The site plan shall provide a description of the physical facility and the potential
pollutant sources which may be expected to contribute to contamination of stormwater
discharges. The site plan shall contain the following:
(a) A general location map (USGS quadrangle map or appropriately drafted equivalent
map), showing the facility's location in relation to transportation routes and surface
waters, the name of the receiving water(s) to which the stormwater outfall(s) discharges,
or if the discharge is to a municipal separate storm sewer system, the name of the
municipality and the ultimate receiving waters, and accurate latitude and longitude of
the point(s) of discharge. The general location map (or alternatively the site map) shall
identify whether each receiving water is impaired (on the state's 303(d) list of impaired
waters) or is located in a watershed for which a TMDL has been established, and
what the parameter(s) of concern are.
(b) A narrative description of storage practices, loading and unloading activities, outdoor
process areas, dust or particulate generating or control processes, and waste disposal
practices. A narrative description of the potential pollutants which could be expected to
be present in the stormwater discharge from each outfall.
(c) A site map drawn at a scale sufficient to clearly depict: the site property boundary, the
stormwater discharge outfalls, all on -site and adjacent surface waters and wetlands,
industrial activity areas (including storage of materials, disposal areas, process areas,
loading and unloading areas, and haul roads), site topography, all drainage features and
structures, drainage areas for each outfall, direction of flow in each drainage area,
industrial activities occurring in each drainage area, buildings, existing BMPs, and
impervious surfaces. The site map shall include a distance legend and must indicate the
percentage of each drainage area that is impervious.
(d) A list of significant spills or leaks of pollutants that have occurred at the facility during
the three (3) previous years and any corrective actions taken to mitigate spill impacts.
(e) Certification that the stormwater outfalls have been evaluated for the presence of non-
stormwater discharges. The certification statement will be signed in accordance with the
requirements found in Part III, Standard Conditions, Section B, Paragraph 5. The
permittee shall re -certify annually that the stormwater outfalls have been evaluated for
the presence of non-stormwater discharges.
2. Stormwater Management Plan. The stormwater management plan shall contain a narrative
description of the materials management practices employed which control or minimize the
Part II Page I of 8

Permit No. NCG 180000
exposure of significant materials to stormwater, including structural and nonstructural measures.
The stormwater management plan, at a minimum, shall incorporate the following:
(a) Feasibility Study. A review of the technical and economic feasibility of changing the
methods of operations and/or storage practices to eliminate or reduce exposure of
materials and processes to stormwater. Wherever practical, the permittee shall prevent
exposure of all storage areas, material handling operations, and manufacturing or fueling
operations. In areas where elimination of exposure is not practical, the stormwater
management plan shall document the feasibility of diverting the stormwater runoff away
from areas of potential contamination.
(b) Secondary Containment Requirements and Records. Secondary containment is required
for: bulk storage of liquid materials; storage in any amount of Section 313 of Title III of
the Superfund Amendments and Reauthorization Act (SARA) water priority chemicals;
and storage in any amount of hazardous substances, in order to prevent leaks and spills
from contaminating stormwater runoff. A table or summary of all such tanks and stored
materials and their associated secondary containment areas shall be maintained. If the
secondary containment devices are connected to stormwater conveyance systems, the
connection shall be controlled by manually activated valves or other similar devices
(which shall be secured closed with a locking mechanism), and any stormwater that
accumulates in the containment area shall be at a minimum visually observed for color,
foam, outfall staining, visible sheens and dry weather flow, prior to release of the
accumulated stormwater. Accumulated stormwater shall be released if found to be
uncontaminated by any material. Records documenting the individual making the
observation, the description of the accumulated stormwater, and the date and time of the
release shall be kept for a period of five years.
(c) BMP Summary. A listing of site structural and non-structural Best Management
Practices (BMP) shall be provided. The installation and implementation of BMPs shall
be based on the assessment of the potential for sources to contribute significant quantities
of pollutants to stormwater discharges and data collected through monitoring of
stormwater discharges. The BMP Summary shall include a written record of the specific
rationale for installation and implementation of the selected site BMPs. The BMP
Summary shall be reviewed and updated annually.
3. Spill Prevention and Response Plan. The Spill Prevention and Response Plan (SPRP) shall
incorporate an assessment of potential pollutant sources based on a materials inventory of the
facility. Facility personnel (or the team) responsible for implementing the SPRP shall be
identified in a written list incorporated into the SPRP and signed and dated by each individual
acknowledging their responsibilities for the plan. A responsible person shall be on site at all
times during facility operations that have the potential to contaminate stormwater runoff through
spills or exposure of materials associated with the facility operations. The SPRP must be site
stormwater specific. Therefore, an oil Spill Prevention Control and Countermeasure plan
(SPCC) may be a component of the SPRP, but may not be sufficient to completely address the
stormwater aspects of the SPRP. The common elements of the SPCC with the SPRP may be
incorporated by reference into the SPRP.
4. Preventative Maintenance and Good Housekeeping Program. A preventative maintenance and
good housekeeping program shall be developed. The program shall list all stormwater control
systems, stormwater discharge outfalls, all on -site and adjacent surface waters and wetlands,
Part II Page 2 of 8

Permit No. NCG180000
industrial activity areas (including material storage areas, material handling areas, disposal areas,
process areas, loading and unloading areas, and haul roads), all drainage features and structures,
and existing structural BMPs. The program shall establish schedules of inspections,
maintenance, and housekeeping activities of stormwater control systems, as well as facility
equipment, facility areas, and facility systems that present a potential for stormwater exposure or
stormwater pollution. Inspection of material handling areas and regular cleaning schedules of
these areas shall be incorporated into the program. Timely compliance with the established
schedules for inspections, maintenance, and housekeeping shall be recorded in writing and
maintained in the SPPP.
Employee Training. Training programs shall be developed and training provided at a minimum
on an annual basis for facility personnel with responsibilities for: spill response and cleanup,
preventative maintenance activities, and for any of the facility's operations that have the potential
to contaminate stormwater runoff. Facility personnel (or team) responsible for implementing the
training shall be identified, and their annual training shall be documented by the signature of
each employee trained.
6. Responsible Party. The Stormwater Pollution Prevention Plan shall identify a specific
position(s) responsible for the overall coordination, development, implementation, and revision
to the Plan. Responsibilities for all components of the Plan shall be documented and position
assignments provided.
7. Plan Amendment. The permittee shall amend the Plan whenever there is a change in design,
construction, operation, or maintenance which has a significant effect on the potential for the
discharge of pollutants to surface waters. All aspects of the Stormwater Pollution Prevention
Plan shall be reviewed and updated on an annual basis. The annual update shall include an
updated list of significant spills or leaks of pollutants for the previous three years, or the notation
that no spills have occurred. The annual update shall include written re -certification that the
stormwater outfalls have been evaluated for the presence of non-stormwater discharges. Each
annual update shall include a re-evaluation of the effectiveness of the BMPs listed in the BMP
Summary of the Stormwater Management Plan.
The Director may notify the permittee when the Plan does not meet one or more of the minimum
requirements of the permit. Within 30 days of such notice, the permittee shall submit a time
schedule to the Director for modifying the Plan to meet minimum requirements. The permittee
shall provide certification in writing (in accordance with Part III, Standard Conditions, Section
B, Paragraph 5) to the Director that the changes have been made.
8. Facility Inspections. Inspections of the facility and all stormwater systems shall occur as part of
the Preventative Maintenance and Good Housekeeping Program at a minimum on a semi-annual
schedule, once during the first half of the year (January to June), and once during the second half
(July to December), with at least 60 days separating inspection dates (unless performed more
frequently than semi-annually). These facility inspections are different from, and in addition to,
the stormwater discharge characteristic monitoring required in Part II of this permit.
9. Implementation. The permittee shall implement the Plan. Implementation of the Plan shall
include documentation of all monitoring, measurements, inspections, maintenance activities, and
training provided to employees, including the log of the sampling data and of actions taken to
implement BMPs associated with the industrial activities, including vehicle maintenance
Part II Page 3 of 8

Permit No. NCG 180000
activities. Such documentation shall be kept on -site for a period of five years and made
available to the Director or the Director's authorized representative immediately upon request.
SECTION B: QUALITATIVE MONITORING REQUIREMENTS
Qualitative monitoring requires a visual inspection of each stormwater outfall regardless of
representative outfall status and shall be performed as specified below in Table 1. No analytical tests
are required. Qualitative monitoring of stormwater outfalls must be performed during a representative
storm event.
A representative storm event is a storm event that measures greater than 0.1 inches of rainfall. The
time between this storm event and the previous storm event measuring greater than 0.1 inches must
be at least 72 hours. A single storm event may have a period of no precipitation of up to 10 hours.
For example, if it rains but stops before producing any collectable discharge, a sample may be
collected if the next rain producing a discharge begins within 10 hours.
Table 1. Qualitative Monitoring Requirements
Discharge Characteristics
Frequency
Monitoring
Locationl
Color
Semi -Annual
SDO
Odor
Semi -Annual
SDO
Clarity
Semi -Annual
SDO
Floating Solids
Semi -Annual
SDO
Suspended Solids
Semi -Annual
SDO
Foam
Semi -Annual
SDO
Oil Sheen
Semi -Annual
SDO
Erosion or deposition at the
outfall
Semi -Annual
SDO
Other obvious indicators
of stormwater pollution
Semi -Annual
SDO
Footnotes:
1 Monitoring Location: Qualitative monitoring shall be performed at each stormwater discharge outfall (SDO) regardless
of representative outfall status.
If the permittee's qualitative monitoring indicates either that existing stormwater BMPs are ineffective,
or that significant stormwater contamination is present, the permittee shall investigate potential causes,
evaluate the feasibility of corrective actions, and implement those corrective actions appropriate. A
written record of the permittee's investigation, evaluation, and response actions shall be kept in
the Stormwater Pollution Prevention Plan.
Part II Page 4 of 8

Permit No. NCG180000
Qualitative monitoring is for the purposes of evaluating the effectiveness of the Stormwater
Pollution Prevention Plan (SPPP), assessing new sources of stormwater pollution, and
prompting the permittee's response actions to pollution. If the permittee repeatedly fails to
respond effectively to correct problems identified by qualitative monitoring, or if the discharge
causes or contributes to a water quality standard violation, DWQ may:
• require that the permittee revise, increase, or decrease the monitoring frequency for the
remainder of the permit;
• rescind coverage under the General Permit, and require that the permittee apply for an
individual stormwater discharge permit;
• require the permittee to install structural stormwater controls;
• require the permittee to implement other stormwater control measures; or
• require that the permittee implement site modifications to qualify for the No Exposure
Exclusion.
Qualitative monitoring will be performed twice per year, in accordance with the schedule in
Table 2. A minimum of 60 days must separate Period 1 and Period 2 monitoring dates, unless
monthly sampling has been instituted under a Tier Two response for vehicle maintenance activity areas.
Table 2. Monitorine Schedule
Monitoring periodi'Z
Event Number
Start
End
Year 1 — Period 1
1
August 1, 2009
December 31, 2009
Year 1— Period 2
2
January 1, 2010
June 30, 2010
Year 2 — Period 1
3
July 1, 2010
December 31, 2010
Year 2 — Period 2
4
January 1, 2011
June 30, 2011
Year 3 — Period 1
5
July 1, 2011
December 31, 2011
Year 3 — Period 2
6
January 1, 2012
June 30, 2012
Year 4 — Period 1
7
July 1, 2012
December 31, 2012
Year 4 — Period 2
8
January 1, 2013
June 30, 2013
Year 5 — Period 1
9
July 1, 2013
December 31, 2013
Year 5 — Period 2
10
January 1, 2014
July 31, 2014
Footnotes:
I Maintain semi-annual monitoring during permit renewal process. If at the expiration of the General Permit, the
permittee has submitted an application for renewal of coverage before the submittal deadline, the permittee will be
considered for renewed coverage. The applicant must continue semi-annual monitoring until the renewed
Certificate of Coverage is issued.
2 If analytical monitoring applies, but no discharge occurs during the monitoring period, the permittee must submit a
monitoring report indicating "No Flow" within 30 days of the end of the six-month monitoring period.
Part II Page 5 of 8

Permit No. NCG180000
SECTION C: ON -SITE VEHICLE MAINTENANCE MONITORING REQUIREMENTS
Facilities which have any vehicle maintenance activity occurring on -site which uses more than 55
gallons of new motor oil per month when averaged over the calendar year shall perform analytical
monitoring as specified in Table 3. This monitoring shall be performed at all outfalls which discharge
stormwater runoff from the vehicle maintenance areas, and in accordance with the schedule presented in
Table 2. All analytical monitoring shall be performed during a representative storm event.
Table 3. Analvtical Monitoring Requirements for On -Site Vehicle Maintenance
Discharge Characteristics
Units
Measurement
Fre uenc 1
Sample
Type2
Sample
Location3'
H
standard
semi-annual
Grab
SDO
Oil and Grease
Mg/1
semi-annual
Grab
SDO
Total Suspended Solids
mg/1
semi-annual
Grab
SDO
Total Rainfa114
inches
semi-annual
Rain gauge
New Motor Oil Usagegallons/month
semi-annual
Estimate
-
Footnotes:
I Measurement Frequency: Twice per year during a representative storm event.
2 If the stormwater runoff is controlled by a stormwater detention pond a grab sample of the discharge from the pond shall be
collected within the first 30 minutes of discharge from the pond.
3 Sample Location: Samples shall be collected at each stormwater discharge outfall (SDO) that discharges stormwater
runoff from area(s) where vehicle maintenance activities occur.
4 For each sampled representative storm event the total precipitation must be recorded. An on -site or local rain gauge
reading must be recorded.
In all cases, the permittee shall report the analytical results from the first sample with valid results within
the monitoring period. The permittee shall compare those results to the benchmark values in Table 4.
Exceedences of benchmark values require the permittee to increase monitoring, increase management
actions, increase record keeping, and/or install stormwater Best Management Practices (BMPs) in a tiered
program. See below the descriptions of Tier One and Tier Two.
Table 4. Benchmark Values for On -Site Vehicle Maintenance Activities
Discharge Characteristics
Benchmark Value
H
Within range 6.0 - 9.0
Oil and Grease
30 mg/1
Total Suspended -Solids
100 mg/1
Part II Page 6 of 8

Permit No. NCG 180000
Tier One
If. The first valid sampling results are above a benchmark value, or outside of the benchmark
for any parameter at
Then: The permittee shall:
1. Conduct a stormwater management inspection of the facility within two weeks of receiving
sampling results.
2. Identify and evaluate possible causes of the benchmark value exceedence.
3. Identify potential and select the specific: source controls, operational controls, or physical
improvements to reduce concentrations of the parameters of concern, or to bring
concentrations to within the benchmark range.
4. Implement the selected actions within two months of the inspection.
5. Record each instance of a Tier One response in the Stormwater Pollution Prevention Plan.
Include the date and value of the benchmark exceedence, the inspection date, the personnel
conducting the inspection, the selected actions, and the date the selected actions were
implemented.
Tier Two
If: During the term of this permit, the first valid sampling results from two consecutive monitoring
periods are above the benchmark values, or outside of the benchmark range, for any specific
parameter at a specific discharge outfall;
Then: The permittee shall:
1. Repeat all the required actions outlined above in Tier One.
2. Immediately institute monthly monitoring for all parameters at every outfall where a
sampling result exceeded the benchmark value for two consecutive valid samples. Monthly
(analytical and qualitative) monitoring shall continue until three consecutive sample results
are below the benchmark values, or within the benchmark range.
3. If no discharge occurs during the sampling period, the permittee is required to submit a
monthly monitoring report indicating "No Flow" to comply with reporting requirements.
4. Maintain a record of the Tier Two response in the Stormwater Pollution Prevention Plan.
Part II Page 7 of 8

Permit No. NCG 180000
During the term of this permit, if the valid sampling results required for the permit monitoring
periods exceed the benchmark value, or are outside the benchmark range, for any specific
parameter at any specific outfall on four occasions, the permittee shall notify the DWQ Regional
Office Supervisor in writing within 30 days of receipt of the fourth analytical results. DWQ may:
• require that the permittee revise, increase, or decrease the monitoring frequency for the
remainder of the permit;
• rescind coverage under the General Permit, and require that the permittee apply for an
individual stormwater discharge permit;
• require the permittee to install structural stormwater controls;
• require the permittee to implement other stormwater control measures; or
• require that the permittee implement site modifications to qualify for the No Exposure
Exclusion.
Part II Page 8 of 8

Permit No. NCG 180000
PART III STANDARD CONDITIONS FOR NPDES STORMWATER
GENERAL PERMITS
SECTION A: COMPLIANCE AND LIABILITY
1. Compliance Schedule
The permittee shall comply with Limitations and Controls specified for stormwater discharges in
accordance with the following schedule:
Existing facilities already operating, but applying for coverage under this General Permit for the first
time: The Stormwater Pollution Prevention Plan shall be developed and implemented within 12 months of
the effective date of the initial Certificate of Coverage issued pursuant to this General Permit and updated
thereafter on an annual basis. Secondary containment, as specified in Part II, Section A, Paragraph 2(b)
of this permit, shall be accomplished within 12 months of the effective date of the initial Certificate of
Coverage.
New facilities applying for permit coverage for the first time and existing facilities previously permitted
and applying for renewal under this General Permit: All requirements, conditions, limitations, and
controls contained in this permit become effective immediately upon issuance of the Certificate of
Coverage. The Stormwater Pollution Prevention Plan shall be developed and implemented prior to the
beginning of discharges from the operation of the industrial activity and be updated thereafter on an
annual basis. Secondary containment, as specified in Part II, Section A, Paragraph 2(b) of this permit
shall be accomplished prior to the beginning of discharges from the operation of the industrial activity.
2. Duty to Comply
The permittee must comply with all conditions of this General Permit. Any permit noncompliance
constitutes a violation of the Clean Water Act and is grounds for enforcement action; for certificate of
coverage termination, revocation and reissuance, or modification; or denial of a certificate of coverage
upon renewal application.
a. The pennittee shall comply with standards or prohibitions established under section 307(a) of the Clean
Water Act for toxic pollutants within the time provided in the regulations that establish these standards or
prohibitions, even if the permit has not yet been modified to incorporate the requirement.
b. The Clean Water Act provides that any person who violates a permit condition is subject to a civil penalty
not to exceed $25,000 per day for each violation. Any person who negligently violates any permit
condition is subject to criminal penalties of $2,500 to $25,000 per day of violation, or imprisonment for
not more than 1 year, or both. Any person who knowingly violates permit conditions is subject to
criminal penalties of $5,000 to $50,000 per day of violation, or imprisonment for not more than 3 years,
or both. Also, any person who violates a permit condition may be assessed an administrative penalty not
to exceed $10,000 per violation with the maximum amount not to exceed $125,000. [Ref: Section 309 of
the Federal Act 33 USC 1319 and 40 CFR 122.41(a).]
c. Understate law, a daily civil penalty of not more than ten thousand dollars ($10,000) per violation may
be assessed against any person who violates or fails to act in accordance with the terms, conditions, or
requirements of a permit. [Ref: North Carolina General Statutes 143-215.6A]
d. Any person may be assessed an administrative penalty by the Director for violating section 301, 302, 306,
307, 308, 318, or 405 of the Act, or any permit condition or limitation implementing any of such sections
in a permit issued under section 402 of the Act. Administrative penalties for Class I violations are not to
exceed $10,000 per violation, with the maximum amount of any Class I penalty assessed not to exceed
Part III -VI Page I of 13

Permit No. NCG180000
$25,000. Penalties for Class II violations are not to exceed $10,000 per day for each day during which
the violation continues, with the maximum amount of any Class II penalty not to exceed $125,000.
3. Duty to Mitigate
The permittee shall take all reasonable steps to minimize or prevent any discharge in violation of this
General Permit which has a reasonable likelihood of adversely affecting human health or the
environment.
4. Civil and Criminal Liability
Except as provided in Section D of this permit regarding bypassing of stormwater control facilities,
nothing in this General Permit shall be construed to relieve the permittee from any responsibilities,
liabilities, or penalties for noncompliance pursuant to NCGS 143-215.3,143-215.6A, 143-215.613, 143-
215.6C or Section 309 of the Federal Act, 33 USC 1319. Furthermore, the permittee is responsible for
consequential damages, such as fish kills, even though the responsibility for effective compliance may be
temporarily suspended.
5. Oil and Hazardous Substance Liability
Nothing in this General Permit shall be construed to preclude the institution of any legal action or relieve
the permittee from any responsibilities, liabilities, or penalties to which the permittee is or may be subject
to under NCGS 143-215.75 et seq. or Section 311 of the Federal Act, 33 USC 1321.
Pro e�rtghts
The issuance of this General Permit does not convey any property rights in either real or personal
property, or any exclusive privileges, nor does it authorize any injury to private property or any invasion
of personal rights, nor any infringement of federal, state or local laws or regulations.
Severability
The provisions of this General Permit are severable, and if any provision of this General Permit, or the
application of any provision of this General Permit to any circumstances, is held invalid, the application
of such provision to other circumstances, and the remainder of this General Permit, shall not be affected
thereby.
Duty to Provide Information
The permittee shall furnish to the Director, within a reasonable time, any information which the Director
may request to determine whether cause exists for modifying, revoking and reissuing, or terminating the
certificate of coverage issued pursuant to this General Permit or to determine compliance with this
General Permit. The permittee shall also furnish to the Director upon request, copies of records required
to be kept by this General Permit.
Penalties for Tampering
The Clean Water Act provides that any person who falsifies, tampers with, or knowingly renders
inaccurate, any monitoring device or method required to be maintained under this General Permit shall,
upon conviction, be punished by a fine of not more than $10,000 per violation, or by imprisonment for not
more than two years per violation, or by both. If a conviction of a person is for a violation committed
after a first conviction of such person under this paragraph, punishment is a fine of not more that $20,000
per day of violation, or by imprisonment of not more than 4 years, or both.
10. Penalties for Falsification of Reports
Part III -VI Page 2 of 12

Permit No. NCG 180000
The Clean Water Act provides that any person who knowingly makes any false statement, representation,
or certification in any record or other document submitted or required to be maintained under this General
Permit, including monitoring reports or reports of compliance or noncompliance shall, upon conviction,
be punished by a fine of not more than $10,000 per violation, or by imprisonment for not more than two
years per violation, or by both.
SECTION B: GENERAL CONDITIONS
1. General Permit Expiration
The permittee is not authorized to discharge after the expiration date. In order to discharge beyond the
expiration date, the permittee shall submit forms and fees as are required by the agency authorized to
issue permits no later than 180 days prior to the expiration date. Any permittee that has not requested
renewal at least 180 days prior to expiration, or any permittee that does not have a permit after the
expiration and has not requested renewal at least 180 days prior to expiration, will be subjected to
enforcement procedures as provided in NCGS §143-2153.6 and 33 USC 1251 et. seq.
2. Transfers
The certificate of coverage issued pursuant to this General Permit is not transferable to any person except
after notice to and approval by the Director. The Director may require modification or revocation and
reissuance of the certificate of coverage to change the name and incorporate such other requirements as
may be necessary under the Clean Water Act. Permittee is required to notify the Division in the event
the permitted facility is sold or closed.
3. When an Individual Permit May be Required
The Director may require any owner/operator authorized to discharge under a certificate of coverage
issued pursuant to this General Permit to apply for and obtain an individual permit or an alternative
General Permit. Any interested person may petition the Director to take action under this paragraph.
Cases where an individual permit may be required include, but are not limited to, the following:
a. The discharger is a significant contributor of pollutants;
b. Conditions at the permitted site change, altering the constituents and/or characteristics of the
discharge such that the discharge no longer qualifies for a General Permit;
C. The discharge violates the terms or conditions of this General Permit;
d. A change has occurred in the availability of demonstrated technology or practices for the control
or abatement of pollutants applicable to the point source;
e. Effluent limitations are promulgated for the point sources covered by this General Permit;
f. A water quality management plan containing requirements applicable to such point sources is
approved after the issuance of this General Permit.
g. The Director determines at his or her own discretion that an individual permit is required.
4. When an Individual Permit MU be Requested
Part III -VI Page 3 of 12

Permit No. NCG 180000
Any permittee operating under this General Permit may request to be excluded from the coverage of this
General Permit by applying for an individual permit. When an individual permit is issued to an
owner/operator the applicability of this General Permit is automatically terminated on the effective date of
the individual permit.
5. Signatory Requirements
All applications, reports, or information submitted to the Director shall be signed and certified.
a. All notices of intent to be covered under this General Permit shall be signed as follows:
(1) For a corporation: by a responsible corporate officer. For the purpose of this Section, a
responsible corporate officer means: (a) a president, secretary, treasurer or vice president
of the corporation in charge of a principal business function, or any other person who
performs similar policy or decision making functions for the corporation, or (b) the
manager of one or more manufacturing production or operating facilities employing more
than 250 persons or having gross annual sales or expenditures exceeding 25 million (in
second quarter 1980 dollars), if authority to sign documents has been assigned or
delegated to the manager in accordance with corporate procedures.
(2) For a partnership or sole proprietorship: by a general partner or the proprietor,
respectively; or
(3) For a municipality, state, federal, or other public agency: by either a principal executive
officer or ranking elected official.
b. All reports required by the General Permit and other information requested by the Director shall
be signed by a person described above or by a duly authorized representative of that person. A
person is a duly authorized representative only if:
(1) The authorization is made in writing by a person described above;
(2) The authorization specified either an individual or a position having responsibility for the
overall operation of the regulated facility or activity, such as the position of plant
manager, operator of a well or well field, superintendent, a position of equivalent
responsibility, or an individual or position having overall responsibility for
environmental matters for the company. (A duly authorized representative may thus be
either a named individual or any individual occupying a named position.); and
(3) The written authorization is submitted to the Director.
Any person signing a document under paragraphs a. or b. of this section shall make the following
certification which shall not be modified in any way:
"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 fines and imprisonment for knowing violations."
General Permit Modification, Revocation and Reissuance, or Termination
Part III -VI Page 4 of 12

Permit No. NCG 180000
The issuance of this General Permit does not prohibit the Director from reopening and modifying the
General Permit, revoking and reissuing the General Permit, or terminating the General Permit as allowed
by the laws, rules, and regulations contained in Title 40, Code of Federal Regulations, Parts 122 and 123;
Title 15A of the North Carolina Administrative Code, Subchapter 2H .0100; and North Carolina General
Statute 143-215.1 et. al.
After public notice and opportunity for a hearing, the General Permit may be terminated for cause. The
filing of a request for a General Permit modification, revocation and reissuance, or termination does not
stay any General Permit condition. The certificate of coverage shall expire when the General Permit is
terminated.
7. Certificate of Coverage Actions
The certificate of coverage issued in accordance with this General Permit may be modified, revoked and
reissued, or terminated for cause. The notification of planned changes or anticipated noncompliance does
not stay any General Permit condition.
SECTION C: OPERATION AND MAINTENANCE OF POLLUTION CONTROLS
Proper Operation and Maintenance
The permittee shall at all times properly operate and maintain all facilities and systems of treatment and
control (and related appurtenances) which are installed or used by the permittee to achieve compliance
with this General Permit. Proper operation and maintenance also includes adequate laboratory controls
and appropriate quality assurance procedures. This provision requires the operation of back-up or
auxiliary facilities or similar systems which are installed by a permittee only when the operation is
necessary to achieve compliance with the General Permit.
Need to Halt or Reduce not a Defense
It shall not be a defense for a permittee in an enforcement action that it would have been necessary to halt
or reduce the permitted activity in order to maintain compliance with the condition of this General Permit.
Bypassing of Stormwater Control Facilities
Bypass is prohibited and the Director may take enforcement action against a permittee for bypass unless:
a. Bypass was unavoidable to prevent loss of life, personal injury or severe property damage; and
b. There were no feasible alternatives to the bypass, such as the use of auxiliary control facilities,
retention of stormwater or maintenance during normal periods of equipment downtime or dry
weather. This condition is not satisfied if adequate backup controls should have been installed in
the exercise of reasonable engineering judgment to prevent a bypass which occurred during
normal periods of equipment downtime or preventive maintenance; and
C. The permittee submitted notices as required under Section E of this Part.
If the Director determines that it will meet the three conditions listed above, the Director may approve an
anticipated bypass after considering its adverse effects.
SECTION D: MONITORING AND RECORDS
1. Representative Sampling
Part III -VI Page 5 of 12

Permit No. NCG180000
Samples collected and measurements taken, as required herein, shall be characteristic of the volume and
nature of the permitted discharge. Analytical sampling shall be performed during a representative storm
event. Samples shall be taken on a day and time that is characteristic of the discharge. All samples shall
be taken before the discharge joins or is diluted by any other waste stream, body of water, or substance.
Monitoring points as specified in this permit shall not be changed without notification to and approval of
the Director.
2. Recordiniz Results
For each measurement, sample, inspection or maintenance activity performed or collected pursuant to the
requirements of this General Permit, the permittee shall record the following information:
a. The date, exact place, and time of sampling, measurements, inspection or maintenance activity;
b. The individual(s) who performed'the sampling, measurements, inspection or maintenance
activity;
C. The date(s) analyses were performed;
d. The individual(s) who performed the analyses;
e. The analytical techniques or methods used; and
f. The results of such analyses.
3. Flow Measurements
Where required, appropriate flow measurement devices and methods consistent with accepted scientific
practices shall be selected and used to ensure the accuracy and reliability of measurements of the volume
of monitored discharges.
4. Test Procedures
Test procedures for the analysis of pollutants shall conform to the EMC regulations published pursuant to
NCGS 143-215.63 et. seq, the Water and Air Quality Reporting Acts, and to regulations published
pursuant to Section 304(g), 33 USC 1314, of the Federal Water Pollution Control Act, as Amended, and
Regulation 40 CFR 136.
To meet the intent of the monitoring required by this General Permit, all test procedures must produce
minimum detection and reporting levels and all data generated must be reported down to the minimum
detection or lower reporting level of the procedure.
5. Representative Outfall
If a facility has multiple discharge locations with substantially identical stormwater discharges that are
required to be sampled, the permittee may petition the Director for representative outfall status. If it is
established that the stormwater discharges are substantially identical and the permittee is granted
representative outfall status, then sampling requirements may be performed at a reduced number of
outfalls.
6. Records Retention
Visual monitoring shall be documented and records maintained at the facility along with the Stormwater
Pollution Prevention Plan. Copies of analytical monitoring results shall also be maintained on -site. The
Part III -VI Page 6 of 12

Permit No. NCG 180000
permittee shall retain records of all monitoring information, including all calibration and maintenance
records and all original strip chart recordings for continuous monitoring instrumentation, and copies of all
reports required by this General Permit for a period of at least 5 years from the date of the sample,
measurement, report or application. This period may be extended by request of the Director at any time.
7. Inspection and Entry
The permittee shall allow the Director, or an authorized representative (including an authorized contractor
acting as a representative of the Director), or in the case of a facility which discharges through a
municipal separate storm sewer system, an authorized representative of a municipal operator or the
separate storm sewer system receiving the discharge, upon the presentation of credentials and other
documents as may be required by law, to;
a. Enter upon the permittee's premises where a regulated facility or activity is located or conducted,
or where records must be kept under the conditions of this General Permit;
b. Have access to and copy, at reasonable times, any records that must be kept under the conditions
of this General Permit;
C. Inspect at reasonable times any facilities, equipment (including monitoring and control
equipment), practices, or operations regulated or required under this General Permit; and
d. Sample or monitor at reasonable times, for the purposes of assuring General Permit compliance or
as otherwise authorized by the Clean Water Act, any substances or parameters at any location.
SECTION E: REPORTING REQUIREMENTS
Discharge Monitoring_ Reports
Samples analyzed in accordance with the terms of this permit shall be submitted to the Division on
Discharge Monitoring Report forms provided by the Director. Submittals shall be delivered to the
Division no later than 30 days from the date the facility receives the sampling results from the laboratory.
The permittee shall submit an Annual Summary Data Monitoring Report to the appropriate DWQ
Regional Office in February of each year. The submittal shall be on the forms supplied by the Division.
When no discharge has occurred from the facility during the report period, the permittee is required to
submit a discharge monitoring report, within 30 days of the end of the six-month sampling period, giving
all required information and indicating "NO FLOW" as per NCAC T15A 02B .0506.
The permittee shall record the required qualitative monitoring observations on the SDO Qualitative
Monitoring Report form provided by the Division, and shall retain the completed forms on site. Visual
monitoring results should not be submitted to the Division, except upon DWQ's specific requirement to
do so.
Submitting Reports
Two signed copies of Discharge Monitoring Reports (DMRs), shall be submitted to:
Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
Part III -VI Page 7 of 12

In addition, a separate signed Annual Summary DMR copy shall be submitted to the local DWQ
Regional Office (RO) by March I of each year.
Addresses for each RO and the counties covered by each RO can be found here:
http://www.enr.state.nc.us/html/regionaloffices.html. The permittee shall retain the completed
originals on site. Visual monitoring results should not be submitted to the Regional Offices or Central
Files unless specifically requested by DWQ.
Availability of Reports
Except for data determined to be confidential under NCGS 143-215.3(a)(2) or Section 308 of the Federal
Act, 33 USC 1318, all reports prepared in accordance with the terms shall be available for public
inspection at the offices of the Division of Water Quality. As required by the Act, analytical data shall
not be considered confidential. Knowingly making any false statement on any such report may result in
the imposition of criminal penalties as provided for in NCGS 143-215.613 or in Section 309 of the Federal
Act.
4. Non-Stormwater Discharges
If the storm event monitored in accordance with this General Permit coincides with a non-stormwater
discharge, the permittee shall separately monitor all parameters as required under the non-stormwater
discharge permit and provide this information with the stormwater discharge monitoring report.
5. Planned Chan es
The permittee shall give notice to the Director as soon as possible of any planned changes at the permitted
facility which could significantly alter the nature or quantity of pollutants discharged. This notification
requirement includes pollutants which are not specifically listed in the General Permit or subject to
notification requirements under 40 CFR Part 122.42 (a).
6. Anticipated Noncompliance
The pennittee shall give notice to the Director as soon as possible of any planned changes at the permitted
facility which may result in noncompliance with the General Permit requirements.
7. Bypass
a. Anticipated bypass. If the permittee knows in advance of the need for a bypass, it shall submit
prior notice, if possible at least ten days before the date of the bypass; including an evaluation of
the anticipated quality and affect of the bypass.
b. Unanticipated bypass. The permittee shall submit notice within 24 hours of becoming aware of
an unanticipated bypass.
8. Twenty-four Hour Reporting
The permittee shall report to the central office or the appropriate regional office any noncompliance
which may endanger health or the environment. Any information shall be provided orally within 24
hours from the time the permittee became aware of the circumstances. A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
The written submission shall contain a description of the noncompliance, and its causes; the period of
noncompliance, including exact dates and times, and if the noncompliance has not been corrected, the
Part III -VI Page 8 of 12

Permit No. NCG180000
anticipated time compliance is expected to continue; and steps taken or planned to reduce, eliminate, and
prevent reoccurrence of the noncompliance.
The Director may waive the written report on a case -by -case basis if the oral report has been received
within 24 hours.
9. Other Noncompliance
The permittee shall report all instances of noncompliance not reported under 24 hour reporting at the time
monitoring reports are submitted.
10. Other Information
Where the permittee becomes aware that it failed to submit any relevant facts in a Notice of Intent to be
covered under this General Permit or in any report to the Director, it shall promptly submit such facts or
information.
PART IV LIMITATIONS REOPENER
This General Permit shall be modified or alternatively, revoked and reissued, to comply with any applicable
effluent guideline or water quality standard issued or approved under Sections 302(b) (2) (c), and (d), 304(b) (2)
and 307(a) of the Clean Water Act, if the effluent guideline or water quality standard so issued or approved:
a. Contains different conditions or is otherwise more stringent than any effluent limitation in the General
Permit; or
b. Controls any pollutant not limited in the General Permit.
The General Permit as modified or reissued under this paragraph shall also contain any other requirements in the
Act then applicable.
PART V ADMINISTERING AND COMPLIANCE MONITORING FEE
REQUIREMENTS
The permittee must pay the administering and compliance monitoring fee within 30 (thirty) days after being billed
by the Division. Failure to pay the fee in timely manner in accordance with 15A NCAC 21-1.0105(b)(4) may
cause this Division to initiate action to revoke the Certificate of Coverage.
PART VI DEFINITIONS
1. Act
See Clean Water Act.
2. Allowable Non-Stormwater Discharges
This permit regulates stormwater discharges. Non-stormwater discharges which shall be allowed in the
stormwater conveyance system are:
(a) All other discharges that are authorized by a non-stormwater NPDES permit.
Part III -VI Page 9 of 12

Permit No. NCG 180000
(b) Uncontaminated groundwater, foundation drains, air -conditioner condensate without added
chemicals, springs, discharges of uncontaminated potable water, waterline and fire hydrant
flushings, water from footing drains, flows from riparian habitats and wetlands.
(c) Discharges resulting from fire -fighting or fire -fighting training.
Best Management Practices (BMPs)
Measures or practices used to reduce the amount of pollution entering surface waters. BMPs may take the
form of a process, activity, or physical structure. More information on BMPs can be found at:
http://cfpub.epa.gov/npdes/stonnwater/menuofbmps/index.cfm.
4. Bypass
A bypass is the known diversion of stormwater from any portion of a stormwater control facility
including the collection system, which is not a designed or established operating mode for the facility.
5. Bulk Storage of Liquid Products
Liquid raw materials, manufactured products, waste materials or by-products with a single above ground
storage container having a capacity of greater than 660 gallons or with multiple above ground storage
containers located in close proximity to each other having a total combined storage capacity of greater
than 1,320 gallons.
6. Certificate of Coverage
The Certificate of Coverage (COC) is the cover sheet which accompanies the General Permit upon
issuance and lists the facility name, location, receiving stream, river basin, effective date of coverage
under the permit and is signed by the Director.
7. Clean Water Act
The Federal Water Pollution Control Act, also known as the Clean Water Act (CWA), as amended, 33
USC 1251, et. seq.
8. Division or DWQ
The Division of Water Quality, Department of Environment and Natural Resources.
9. Director
The Director of the Division of Water Quality, the permit issuing authority.
10. EMC
The North Carolina Environmental Management Commission.
11. Grab Sample
An individual sample collected instantaneously. Grab samples that will be analyzed (quantitatively or
qualitatively) must be taken within the first 30 minutes of discharge.
12. Hazardous Substance
Any substance designated under 40 CFR Part 116 pursuant to Section 311 of the Clean Water Act.
13. Landfill
A disposal facility or part of a disposal facility where waste is placed in or on land and which is not a land
treatment facility, a surface impoundment, an injection well, a hazardous waste long-term storage facility
or a surface storage facility.
14. Municipal Separate Storm Sewer System
A stormwater collection system within an incorporated area of local self-government such as a city or
town.
15. No Exposure
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Permit No. NCG180000
A condition of no exposure means that all industrial materials and activities are protected by a storm
resistant shelter or acceptable storage containers to prevent exposure to rain, snow, snowmelt, or runoff.
Industrial materials or activities include, but are not limited to, material handling equipment or activities,
industrial machinery, raw materials, intermediate products, by-products, final products, or waste products.
DWQ may grant a No Exposure Exclusion from NPDES Stormwater Permitting requirements only if a
facility complies with the terms and conditions described in 40 CFR § 122.26(g)
16. Notice of Intent
The state application form which, when submitted to the Division, officially indicates the facility's notice
of intent to seek coverage under a General Permit.
17. Permittee
The owner or operator issued a certificate of coverage pursuant to this General Permit.
18. Point Source Discharge of Stormwater
Any discernible, confined and discrete conveyance including, but not specifically limited to, any pipe,
ditch, channel, tunnel, conduit, well, or discrete fissure from which stormwater is or may be discharged to
waters of the state.
19. Representative Storm Event
A storm event that measures greater than 0.1 inches of rainfall. The time between this storm event and the
previous storm event measuring greater than 0.1 inches must be at least 72 hours. A single storm event may have
a period of no precipitation of up to 10 hours. For example, if it rains but stops before producing any collectable
discharge, a sample may be collected if the next rain producing a discharge begins within 10 hours.
20. Representative Outfall Status
When it is established that the discharge of stormwater runoff from a single outfall is representative of the
discharges at multiple outfalls, the DWQ may grant representative outfall status. Representative outfall
status allows the permittee to perform analytical monitoring at a reduced number of outfalls.
21. Secondary Containment
Spill containment for the contents of the single largest tank within the containment structure plus
sufficient freeboard to allow for the 25-year, 24-hour storm event.
22. Section 313 Water Priority Chemical
A chemical or chemical category which:
a. Is listed in 40 CFR 372.65 pursuant to Section 313 of Title III of the Superfund Amendments and
Reauthorization Act (SARA) of 1986, also titled the Emergency Planning and Community Right -
to -Know Act of 1986;
b. Is present at or above threshold levels at a facility subject to SARA title III, Section 313 reporting
requirements; and
C. Meets at least one of the following criteria:
(1) Is listed in appendix D of 40 CFR part 122 on Table II (organic priority pollutants), Table
III (certain metals, cyanides, and phenols) or Table IV (certain toxic pollutants and
hazardous substances);
(2) Is listed as a hazardous substance pursuant to section 311(b)(2)(A) of the CWA at 40
CFR 116.4; or
(3) Is a pollutant for which EPA has published acute or chronic water quality criteria.
23. Severe Property Damage
Means substantial physical damage to property, damage to the control facilities which causes them to
become inoperable, or substantial and permanent loss of natural resources which can reasonably be
expected to occur in the absence of a bypass. Severe property damage does not mean economic loss
caused by delays in production.
Part III -VI Page 11 of 12

Permit No. NCG 180000
24. Significant Materials
Includes, but is not limited to: raw materials; fuels; materials such as solvents, detergents, and plastic
pellets; finished materials such as metallic products; raw materials used in food processing or production;
hazardous substances designated under section 101(14) of CERCLA; any chemical the facility is required
to report pursuant to section 313 of Title III of SARA; fertilizers; pesticides; and waste products such as
ashes, slag and sludge that have the potential to be released with stormwater discharges.
25. Significant Spills
Includes, but is not limited to: releases of oil or hazardous substances in excess of reportable quantities
under section 311 of the Clean Water Act (Ref: 40 CFR 110.10 and CFR 117.21) or section 102 of
CERCLA (Ref: 40 CFR 302.4).
26. Stormwater Runoff
The flow of water which results from precipitation and which occurs immediately following rainfall or as
a result of snowmelt.
27. Stormwater Associated with Industrial Activity
The discharge from any point source which is used for collecting and conveying stormwater and which is
directly related to manufacturing, processing or raw material storage areas at an industrial site. Facilities
considered to be engaged in "industrial activities" include those activities defined in 40 CFR
122.26(b)(14). The term does not include discharges from facilities or activities excluded from the
NPDES program.
28. Stormwater Pollution Prevention Plan
A comprehensive site -specific plan which details measures and practices to reduce stormwater pollution
and is based on an evaluation of the pollution potential of the site.
29. Total Maximum Daily Load (TMDL)
TMDLs are written plans for attaining and maintaining water quality standards, in all seasons, for a
specific water body and pollutant. (A list of approved TMDLs for the state of North Carolina can be
found at http://h2o.enr.state.nc.us/tmdl/)
30. Toxic Pollutant
Any pollutant listed as toxic under Section 307(a)(1) of the Clean Water Act.
31. Vehicle Maintenance Activity
Vehicle rehabilitation, mechanical repairs, painting, fueling, lubrication, vehicle cleaning operations, or
airport deicing operations.
32. Visible Sedimentation
Solid particulate matter, both mineral and organic, that has been or is being transported by water, air,
gravity, or ice from its site of origin which can be seen with the unaided eye.
33. 25-year, 24 hour storm event
The maximum 24-hour precipitation event expected to be equaled or exceeded, on the average, once in 25
years.
Part III -VI Page 12 of 12

FurnitureBrands
David Stout
Director of Environmental Compliance
October 5, 2010
Ms. Linda Wiggs
NC Department of Environment and Natural Resouces
Division of Water Quality
2090 U.S. Highway 70
Swannanoa, North Carolina 28778
Dear Ms. Wiggs:
Furniture Brands International
One Broyhill Park
Lenoir, NC 28633
828-758-3374 Tel
828-221-5448 cell
828-758-3110 Fax
[e-mail]
Furniture Brands International is pleased to inform you that we have adopted the American Home Furnishing Alliance
(AHFA) EFEC Program at the Thomasville Lenoir Plant No. 25 in Lenoir, North Carolina. EFEC is an acronym for
Enhancing Furniture's Environmental Culture. EFEC is a voluntary environmental management system (EMS developed by
the AHFA. For more information, please see www.ahfa.us/efec. Our EFEC program has the following management
systems in place:
• Environmental Policy
• Environmental Goals
• Environmental Awareness Training for Employees
• Incident Preparedness Plans
• Public Communication Policy
• Supplier Interaction
• Regulatory Agency Notification
• Information and Technology Exchange
• Measurement of Progress and Performance.
• Corrective Action Plans
If you would like to discuss our program further, please feel free to contact me.
Sincerely
David Stout

7hotmsdUeo
October 20, 2008
Mr. Roger Edwards
NC DENR - Division of Water Quality
Asheville Regional Office
2090 US HWY 70
Swannonoa, NC 28778
Subject: Designation of Signatory Authority
Thomasville Furniture Industries, Inc. — Plant Lenoir
Certificate of Coverage NCG500072
Caldwell County
Thomasville Furniture Industries, Inc. wishes to designate Chris Farabee as the
Signatory Authority for Plant Lenoir in Caldwell County.
If you have any questions concerning the above information, please contact
Chris Farabee at [phone] or [e-mail]
Best Regards,
Thurman Lowry
Plant Manager - Lenoir
cc:
Donnie Frazier, Lenoir
Chris Farabee, Engineering
�L nON
IF-GIONAL OFF ICE
Thomasville Furniture Industries, Inc. 401 East Main Street P.O. Box 339 Thomasville, North Carolina 27361 T 336.472.4000

_......._ .... .
............ _... .
June 9, 2009
Fran McPherson
NC-DENR — Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1641
Ms. McPherson,
Thomasville Furniture Ind. has a new bill to address for the following facilities:
Thomasville Furniture Ind.
401 East Main. Street
Thomasville, NC 27360
Contact: Chris Farabee
Plant
SWP3 Permit #
C/M
NCG180163
CDF/CDK/CPS
NCG210298
E/CMF
NCG210309
Lenoir
NCG180169
N
NCG 180167
New V
NCG210297
Plant NPDES Permit number
C/M
NCG500339
CDK
NCG500340
Lenoir
NCG500072
Best U41-jarabee"Z4.'�n-'r gardsC
Environmental Engineer
Cc:""'v NC-DENR, Asheville Regional Office
NC-DENR, Mooresville Regional Office
NC-DENR, Winston-Salem Regional Office
Ec: David Stout- FBn
J U N 12 2009jj�
WATER QUALITY SECTION
AcN EVILLE c EiP I !L OFFICE
r ,
Thomasville Furniture Industries, Inc. 401 East Main Street P.O. Box 339 Thomasville, North Carolina 27361 T 336.472.4000

7Wwsvifle-
June 9, 2009
Phillystine Spinks
NC Hazardous Waste Section
401 Oberlin Rd., Suite 150
Raleigh, NC 27605
Ms. Spinks,
Thomasville Furniture Ind. has a new bill to address. It is:
Thomasville Furniture Ind.
401 East Main Street
Thomasville, NC 27360
Contact: Chris Farabee
Please update this contact information for the following facilities:
Plant
EPA ID number
C
NCD003219165
CDK
NCR000138172
E
NCD000828855
Lenoir
NCDO54290770
New V
NCR000138172
Upholstery Plant #9
NCDO03227352
Best regards,
Chris Farabee
Environmental Engineer
Cc NC-DENR, Asheville Regional Office
NC-DENR, Mooresville Regional Office
NC-DENR, Winston-Salem Regional Office
Ec: David Stout- FBn
j WATER C�JFLiTY S TGE OIV
(— ASHEVILLE R��iC?NRL O FIGE
Thomasville Furniture Industries, Inc. 401 East Main Street P.O. Box 339 Thomasville, North Carolina 27361 T 336.472.4000

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Gregory J. Thorpe, Ph.D., Acting Director
11/26/2001
ROCHELLE CHISOM
THOMASVILLE FURNITURE CO/LENOI
401 EAST MAIN ST
THOMASVILLE, NC 27361
Dear Permittee:
1•�
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Your facility is currently covered for wastewater discharge under General Permit NCG500000. This permit expires
on July 31, 2002. Division of Water Quality (DWQ) staff is in the process of rewriting this permit with a
scheduled reissue in the summer of 2002. Once the permit is reissued, your facility would be eligible for continued
coverage under the reissued permit.
In order to assure your continued coverage under the general permit, you must apply to the DWQ for renewal of
your permit coverage. To make this renewal process easier, we are informing you in advance that your permit
coverage will be expiring. Enclosed you will find a general permit coverage renewal application form. This
will serve as your application for renewal of your permit coverage. The application must be completed and
returned with the required information by February 01, 2002 in order to assure continued coverage under the
general permit. There is no renewal fee associated with this process. Your facility will be invoiced for the annual
permit fee at a later date.
Failure to request renewal within this time period may result in a civil assessment of at least $250.00. Larger
penalties may be assessed depending on the delinquency of the request. Discharge of wastewater from your facility
without coverage under a valid wastewater NPDES permit would constitute a violation of NCGS 143-215.1 and
could result in assessments of civil penalties of up to $10,000 per day.
If the subject wastewater discharge to waters of the state has been terminated, please complete the enclosed
rescission request form. Mailing instructions are listed on the bottom of the form. You will be notified when the
rescission process has been completed.
If you have any questions regarding the permit coverage renewal procedures please contact the Asheville Regional
Office at 828-251-6208 or Delonda Alexander of the Central Office Stormwater Unit at [phone], ext. 584
Sincerely,
Bradley Bennett, Supervisor
cc: Central Files Stormwater and General Permits Unit
Stormwater and General Permits Unit Files
Asheville Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

State of North Carolina
Department of Environment
and Natural Resources
Asheville Regional Office 4 O
Michael F. Easley, Governor
William G. Ross, Jr., Secretary NCDENR
Gregory' J. Thorpe, Ph.D., Acting Director
Division of Water Quality NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND. NATURAL. RESOURCES
WATER QUALITY SECTION
October 5, 2001
MEMORANDUM
TO: Bradley Bennett
Stormwater & General Permits Unit
THROUGH: Forrest Westall
Water Quality Reg. pervisor
FROM: Jim Reid
Environme?al ngineer
SUBJECT: Thomasville Furniture
NCG21029>9 (Stormwater Permit)
NCG500220 (Gen -Permit Boiler 'Blowdown)
Caldwell Co
In accordance with theattachedrequest from subject permit holder, ARO
recommendsrecisionof the two subject permits. Please contact me if
additional information is required.
Enclosure
59 Woodfin Place, Asheville North Carolina 28801
Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/10% post -consumer paper

7homasvilkSeptember 28, 2001
Mr. Forrest Westall
NCDENR --
f,
Water Quality Section }
59 Woodfin Place OCT J 2001
Asheville, NC 28801
Certified Mail # 7001 1140 0002 4827 2582
Subject: Plant Closing
Thomasville Furniture Industries, Inc. �� a o M i42 k S
Location: Sawmills (Caldwell Veneer) JR�
County: Caldwell
Storm Water Permit: Certificate of Coverage#
General Permit: Boiler Blowdown: Certificate of Coverage# NCG500220
Dear Mr. Westall:
The Sawmills facility, previously owned by Thomasville Furniture Ind. Inc. has been closed. The
facility was sold to Mr. Martin Webb on August 31 st. His address is 4003 Hwy. 321-A, Hudson, N C,
28638.
We are hereby asking that you rescind the current stormwater and General NPDES permit for
boiler blowdown and similar discharges, since we no longer own the facility or operate the permitted
sources. We also wanted to let the owner know that he may need to contact your office should he have
any operations that may require a permit to operate. If you have any questions, please feel free to call me
at [phone].
Sincerely,
Rochelle I. Chisom, Manager
Environmental Affairs
CC: Martin Webb, Owner
Thomasville Furniture Industries, Inc. • P.O. Box 339 • Thomasville, North Carolina 27361-0339 336.472.4000

State of North Carolina
Department of Environment
and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
William G. Ross Jr., Secretary
Alan W. Klimek, P.E., Director
ROCHELLE CHISOM'11
THOMASVILLE FURNITURE CO - LENOIR
401 EAST MAIN ST
THOMASVILLE, NC 27361
Dear Permittee:
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL, RESOURCES
July 26, 2002
JUL
Subject: Reissue - NPDES Wastewater Discharge Permit
Thomasville Furniture Co - Lenoir
COC Number NCG500072
Caldwell County
In response to your renewal application for continued coverage under general permit NCG500000, the Division of
Water Quality (DWQ) is forwarding herewith the reissued wastewater general permit Certificate of Coverage
(COC). This COC is reissued pursuant to the requirements of North Carolina General Statute 143-215.1 and the
Memorandum of Agreement between the state of North Carolina and the U.S. Environmental Protection Agency,
dated May 9, 1994 (or as subsquently amended).
The following information is included with your permit package:
* A copy of the Certificate of Coverage for your treatment facility
* A copy of General Wastewater Discharge Permit NCG500000
* A copy of a Technical Bulletin for General Wastewater Discharge Permit NCG5000oo
Your coverage under this general permit is not transferable except after notice to DWQ. The Division may require
modification or revocation and reissuance of the Certificate of Coverage. This permit does not affect the legal
requirements to obtain other permits which may be required by DENR or relieve the permittee from responsibility
for compliance with any other applicable federal, state, or local law rule, standard, ordinance, order, judgment, or
decree.
If you have any questions regarding this permit package please contact Aisha Lau of the Central Office Stormwater
and General Permits Unit at [phone], ext. 578
Sincerely,
for Alan W. Klimek, P.E.
cc: Central Files
Stormwater & General Permits Unit Files
Asheville Regional Office
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
An Equal Opportunity Affirmative Action Employer An 919-733-5083 FAX 3-0719
/° 50 recycled/ 10% post-consumer
pappaper

HCDENK
North Carolina Department of Environment and Natural Resources
Division of Water Quality
Michael F. Easley, Governor
November 15, 2006
Rochelle Boyd
Thomasville Furniture Industries, Inc.
P O Box 339
Thomasville, NC 27361
William G. Ross, Jr., Secretary
Alan W. Klimek, P.E., Director
Subject: NPDES Permit NCG500000 renewal
Certificate of Coverage (CoC) NCG500072
Lenoir plant
Caldwell County
Dear Permittee:
The facility listed above is covered under NPDES General Permit NCG500000. NCG500000 expires
on July 31, 2007. Federal (40 CFR 122.41) and North Carolina (15A NCAC 2H.0105(e)) regulations require
that permit renewal applications must be filed at least 180 days prior to expiration of the current permit. If
you have already mailed a renewal request, you may disregard this notice.
To satisfy this requirement, the Division must receive a renewal request postmarked no later than
February 1 2007. Failure to request renewal by this date may result in a civil penalty assessment. Larger
penalties may be assessed depending upon the delinquency of the request. This renewal notice is being sent
well in advance of the due date so that you have adequate time to prepare your application.
If any discharge previously covered under NCG500000 will occur after July 31, 2007, the
CoC must be renewed. Discharge of wastewater without a valid permit would violate North Carolina
General Statute 143-215.1; unpermitted discharges of wastewater may be assessed civil penalties of up to
$25,000 per day.
If all discharge has ceased at your facility and you wish to rescind this CoC [or if you have other
questions], contact me at the telephone number or e-mail address listed below.
Sincerely,
Charles H. Weaver, Jr.
NPDES Unit
cc: Central Files
NPDES File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617
512 North Salisbury Street, Raleigh, North Carolina 27604
Phone: [phone], extension 511 / FAX [phone] / [e-mail]
An Equal Opportunity/Affirmative Action Employer— 50% Recycled/10% Post Consumer Paper
w
NorthCarOl
Natiti4i!Z