NCS000570_Application Resubmittal_20190930

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
Form U.S Environmental Protection Agency
2F V0EPA Application for NPDES Permit to Discharge Wastewater
NPDES STORMWATER DISCHARGES ASSOCIATED WITH INDUSTRIAL ACTIVITY
SECTIONOUTFALL LOCATIONI
1.1 Provide information on each of the facilit 's outfalls in the table below
Outfall Receiving Water Name Latitude Longitude
Number
°
0
De- c1.-,,7-7
i6
w
SECTION
'• I
2.1 Are you presently required by any federal, state, or local authority to meet an implementation schedule for constructing,
upgrading, or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
❑ Yes 9 No 4 SKIP to Section 3.
2.2 Briefly identify each applicable project in the table below.
Brief Identification and Affected outfalls Source(s) of Discharge Final Compliance Dates
Description of Project (list outfall numbers)
Required Projected
N
c
d
E
d
0
E
2.3 Have you attached sheets describing any additional water pollution control programs (or other environmental projects
that may affect your discharges) that you now have underway or planned? (Optional Item)
❑ Yes K No
EPA Form 3510-2F (Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
SECTION1' 1
3.1 Have you attached a site drainage map containing all required information to this application? (See instructions for
0 � A specific guidance.)
05 C3 o Yes ❑ No
SECTIONPOLLUTANT SOURCES
4.1 Provide information on the facility's pollutant sources in the table below.
Outfall
Impervious Surface Area
Total Surface Area Drained
Number
(within a mile radius of the facility)
(within a mile radius of the facility)
specify units
specify units
l I
c, c•r�
pecify units
specify units
specify units
specify units
specify units
specify units
specify units
specify units
specify units
specify units
4.2
Provide a narrative description of the facility's significant material in the space below. (See instructions for content
n-
requirements.) S o c1� '� T 1 ra fiz a-f
S aGP r t, ; l 1 y .c Ile.,/J �
UL�� r
S �O • T"'� I O t�i i v 4 C� /� 2 t, t^I O- S C c ,t �A : ,•. {r� r�Yvr1— 7�, �i r
�u;uPr.iU '� �lt,�+ '1r tlTr+,e.,t 4r
c
IN Pfe ee 4:^ S,)l v — u�tcD i 5;6c �+�n t4y�+�.<<�,ic , !i1\1l�Ple, t daF�
CaL-,ee-
%C tv 0 [a-A-F `r /xc ti-,L-a/`F If, :G 6d 1 v:-. 14ydl-c i(, cr -e_ a f��.etaS
w
fi) Po,rill. ®r s d, r[C , e� d : tc ,'1, 0 s q S 11 ­7 H 6 'o
a
Po, IT if;/Scc� Cc3.�2;, ,1�G,� /�'N� ��-o�c�., ;�I SJ ilk 7���i` P�u��—
4.3
Provide the location and a description of existing structural and non-structural control measures to reduce pollutants in
stormwater runoff. See instructions forspecificguidance.)
Stormwater Treatment
Codes
Outfall
Number
Control Measures and Treatment
from
Exhibit
2F-1
list
EPA Form 3510-2F (Revised 3-19) Page 2
N r-

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
SECTION•N
STORMWATER 1 I
5.1
I certify under penalty of law that the outfall(s) covered by this application have been tested or evaluated for the
presence of non-stormwater discharges. Moreover, I certify that the outfalls identified as having non-stormwater
discharges are described in either an accompanying NPDES Form 2C, 2D, or 2E application.
Name (print or type first and last name)
Official title
DA v , � , ��s
P/C, ' �- ��V-�
S' n re 1 l
V
Date signed
9/3�
N
G C i
E,
5.2
Provide the testing information requested in the table below.
cc
Outfall
Onsite Drainage Points
An
Number
Description of Testing Method Used
Date(s) of Testing
Directly Observed
During Test
€
c 11 V o 6 a'l
0
=
5�
z
^-z�^ i (� 2 C 34—
c6ti
SECTION
OR I 1
6.1
Describe any significant leaks or spills of toxic or hazardous pollutants in the last three years.
H
L
Nf
Y
N
J
t6
V
W
SECTIONDISCHARGE
INFORMATIONI
See the
instructions to determine the pollutants and parameters you are required to monitor and, in turn, the tables you must
o
complete.
Not all applicants need to complete each table.
7.1
Is this a new source or new discharge?
`o
❑ Yes -+ See instructions regarding submission of Q No 4 See instructions regarding submission of
estimated data. Kx actual data.
Tables A, B, C, and D
N
7.2
Have you completed Table A for each outfall?
Yes ❑ No
EPA Form 3510-2F (Revised 3-19) Page 3

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
7.3
Is the facility subject to an effluent limitation guideline (ELG) or effluent limitations in an NPDES permit for its process
wastewater?
XYes VTl Op-, IV ❑ No 4 SKIP to Item 7.5.
�� t
7.4
Have you completed Table B by providing quantitative data for those pollutants that are (1) limited either directly or
indirectly in an ELG and/or (2) subject to effluent limitations in an NPDES permit for the facility's process wastewater?
Yes 5 .e `rt rz���`F `�r ❑ No
7.5
Do you know or have reason to believe any pollutants in Exhibit 2F-2 are present in the discharge?
❑ Yes No 4 SKIP to Item 7.7.
7.6
Have you listed all pollutants in Exhibit 2F-2 that you know or have reason to believe are present in the discharge and
provided quantitative data or an explanation for those pollutants in Table C?
❑ Yes ❑ No
7.7
Do you qualify for a small business exemption under the criteria specified in the Instructions?
❑ Yes ►SKIP to Item 7.18. 9 No -
7.8
Do you know or have reason to believe any pollutants in Exhibit 2F-3 are present in the discharge?
❑ Yes , No 4 SKIP to Item 7.10.
7.9
Have you listed all pollutants in Exhibit 2F-3 that you know or have reason to believe are present in the discharge in
Table C?
C
❑ Yes ❑ No
U
0
7.10
Do you expect any of the pollutants in Exhibit 2F-3 to be dischar ed in concentrations of 10 ppb or greater?
E
`o
❑ Yes No 4 SKIP to Item 7.12.
7.11
Have you provided quantitative data in Table C for those pollutants in Exhibit 2F-3 that you expect to be discharged in
concentrations of 10 ppb or greater?
cc
❑ Yes ❑ No
Cn
7.12
Do you expect acrolein, acrylonitrile, 2,4-dinitrophenol, or 2-methyl-4,6-dinitrophenol to be discharged in concentrations
of 100 ppb or greater?
❑ Yes No 4 SKIP to Item 7.14.
7.13
Have you provided quantitative data in Table C for the pollutants identified in Item 7.12 that you expect to be
discharged in concentrations of 100 ppb or greater?
❑ Yes ❑ No
7.14
Have you provided quantitative data or an explanation in Table C for pollutants you expect to be present in the
discharge at concentrations less than 10 ppb (or less than 100 ppb for the pollutants identified in Item 7.12)?
❑ Yes �10 No
7.15
Do you know or have reason to believe any pollutants in Exhibit 2F-4 are present in the discharge?
❑ Yes 9 No 4 SKIP to Item 7.17.
7.16
Have you listed pollutants in Exhibit 2F-14 that you know or believe to be present in the discharge and provided an
explanation in Table C?
❑ Yes ❑ No
7.17
Have you provided information for the storm event(s) sampled in Table D?
❑ Yes 0 No
EPA Form 3510-2F (Revised 3-19) Page 4

EPA Identification Number
NPDES Permit Number
Facility Name
Form Approved 03/05/19
OMB No. 2040-0004
.a
Used or Manufactured Toxics
CD
7.18
Is any pollutant listed on Exhibits 2F-2 through 2F--4 a substance or a component of a substance used or
omanufactured
as an intermediate or final product or byproduct?
❑ Yes No 4 SKIP to Section 8.
0
co
7.19
List the pollutants below, including TCDD if applicable.
1. 4. 7.
d
R
2. 5. 8.
0
3. 6. 9.
SECTION•
• • i
8.1
Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made on
any of your discharges or on a receiving water in relation to your discharge within the last three years?
o
c
_
❑ Yes No 4 SKIP to Section 9.
8.2
Identify the tests and their purposes
below.
Test(s)
Purpose of Test(s)
Submitted to NPDES
Date Submitted
x
Permitting Authority?
0
F-
❑ Yes ❑ No
El Yes El No
0
m
❑ Yes ❑ No
SECTION•
•• • r
9.1
Were any of the analyses reported in Section 7 (on Tables A through C) performed by a contract laboratory or
consulting firm?
0 Yes ❑ No 4 SKIP to Section 10.
9.2
Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1
Laboratory Number 2
Laboratory Number 3
Name of laboratory/firm
E
L
.FO
N
Laboratory address
a(ALk
cG «,L-toLjAT-
J)e� ifs
c
Phone number
U
Pollutant(s) analyzed
EPA Form 3510-21' (Revised 3-19) Page 5

EPA Identification Number
NPDES Permit Number Facility Name Form Approved 03/05/19
OMB No. 2040-0004
SECTION1
CHECKLIST
AND CERTIFICATION STATEMENT (40
In Column 1 below, mark the sections of Form 2F that you have completed and are submitting with your application. For
10.1
each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note that not
all applicants are required to com lete all sections or provide attachments.
Column 1
Column 2
❑- Section 1
❑ w/ attachments (e.g., responses for additional outfalls)
d Section 2
❑ w/ attachments
fSection 3
'❑, wl site drainage map
Section 4
❑ w/ attachments
Section 5
�- w/ attachments
..
Section 6
❑ w/ attachments
c
E
m
Section 7
❑ Table A ❑ w/ small business exemption request
R
r_
❑ Table B w/ analytical results as an attachment
0
❑ Table C ❑ Table D
Kr Section 8
❑ w/attachments
N
�a Section 9
El w/attachments (e.g., responses for additional contact laboratories or firms)
Y
s
�
9Section 10
❑
U
10.2
Certification Statement
1 certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or type first and last name)
Official title
grrature
D to signed v
EPA Form 3510-2F (Revised 3-19) Page 6