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HomeMy WebLinkAboutNC0037508_Pretreatment_Annual_Report_20210204County of iiloore February 4, 2021 N 0 Ms. Litzenberger, Mr. Stephen Morgan, Superintendent, Moore County WPCP Pretreatment Annual Report NPDES Permit # NC0037508 Table of Contents Certification Statement N czt z Pretreatment Program Summary (PPS) Significant Non -Compliance Report (SNCR) Pretreatment Program Info Database Sheet Contact List Industrial Data Summary Forms (IDSF) for Erico a) H 0 E -8 Dm E 0 CI 0 H h-� o o w w 5 E ct ct .7)1 Q Q H 0 • t CD 4 4 Dental Compliance Report Spreadsheet P' k t4s." w E v,o -Cr) Ot Ct lca. ratii. 'A U ^U ti 0 'Ci a) y Ri U • ° rn n Q. gQ s. U 0 U o °' N o O •'O 'b oi c� 3'�' 0 o aw 0 fin- d�� o a) P, .o 1 'a I ,�' _J5 ° 50 0 o •q „ 0 0 o i g0 -� ° ' ti o Q cn cct Its .1 U 3 mow° �b o O CUC ..�7 P.,� O Ri O U OL"., j N UO 'O O . ,H ci p ,--i 'O O o C fti 'O rn a' cyC vi 75. U0 'O° g" 'l7 S. b›A O • � C b U 0 U '°a' a' 2 c te▪ j o- g 20 U N.)O -o by 4' �U ° " N ) air/0 0 L.+d' aJ m W' . , jri. a • ° 'd e 'v� •y z 'p Ct ` ° � � b a T w o �Uy N � 0 . o�-0���Qo o fl UUUcGC�OPTo _ O .U CP., ¢'CD O v z [ C Po W W Q•,,. a,-i ❑UU��W CT 7r February 4, 2021 February 4,2021 I ij SIU COMPLIANCE STATUS IUP # A005: Erico Incorporated (40 CFR 433) -0-0 P b vi 0 O • 0 y 0 4- o H o 0 Lt ' d°o a n 0 .n i, o H y U 3 3 L0.0a -y—oy, 3ti0P. o 0`' 00y.,E'abp bl'W N0OP p r. v as. P ° 0 0 U W 0 0 U ,• x-' ° U0 0 O t"i to ,z Q s20. •A 0 a o - 7' 0 0 o '� 5 0� N• ' ., 8 ti y 'y N0 ° 0 s. Ca 0 p ° ,o _- 3 N o o? • o A( o ^O o p 0 0 0 0 0. 0 0 a,N N o .0 pi 0 '0 NN o �' c -c 5 Oa,° 32030�ig� d •� ' 0 a `� -4 w 0 y. p 'a 0 5 W'- � 0 b 3 5 ; o"c. 0 a, °0sr, o o °}'l -> � 178 3 0 3 2 El lE 0 DI)0 N' U o 0 -' 0 o 03 .' �' N 0 0 0 0 P. 0 y , oO , N•U� wCa .. v, ti 5,.1. 5 o ❑ O tl 0 N. S. a 0 0 P3 p bq 0 0 P, N N 0 Crl 0 ti sa) ° � o 0 o 0 0 0 0 H.; HO o W W • County of Moore IUP # A008: Thermal Metal Treating, Inc. (40 CFR 433) o -a) d= a, 01 O N .^ 01 ° bp .75 .� 4.00 a> W 'al— 0 N H0 0-0 'o o 0 O O 0 �O �Q >- >C Wid ON 0 ell 2 N '5 i-i O N cV T id N° C E a0i N.. 3 a,3 9 cOd o .ycii °� oo .F ° VD C ,� HO L C ch., ,H .O Y .r4 y0 'O p, o d > -C t. chi oO a°.) 0'ta W° („9-°� •5 of vi "'HZQ ado b.0 E o E0 0 0 C N N N !�' tart p O V o N O >ad � N Uj N O �." g °° N ti=r (, M = C 3 3 v .. M ONs. o o N ^d o O G° LI a o W ° Y ow 1,2 o 0 3 3 o to '� 4 o O'... oon:i =, 0 Ld w N o tna N' Q cd o °'"' X .5,' o o,b.11 aa)i ° 0'ti .°J aj aid)ai ° cd Q 'O 0 2 0 .e, ' 0 . ° ti v, v� 3 n N ,O cd s. p 'O 4.o o �� C 3° O N '5 op-0c oo 3E" EUN,- a'N- W W r-i g' 0 ✓� M a y a y0• N al U '� .--i ti • • • • • • • IUP # A010: Southeastern Tool & Die (40 CFR 433) W it 0 ° W 0 t y 3 ti O 0 2 y 0 ad C rd W Hi : • q 0 ` ° >, O H G W '. own o cd Z 0ObiE°oa.0~fl 0o czt ° d ° rid ° c W ch 0 aa .!- O .. Pr' > W" ,) , 0 0 3 � o 3 , o ro 0 aa) 3 0 3 o 0 4:(21 °tanLZ. ti 4:, c0v °� ai 0 2 k P, -0 cd Q O 'o cd K ° . y0 p, O N 00 .0 ,L' .y' ° V] :'' 00 CID H a`)i F o .g ° 3 .0.1 ,—,H 'N 'RI .0 E, �+ ,, P, vi cd o 3 a ° ° 0 ° ti E 1.4 g M .> a"�+ Yam. q o 3 0 O O X k O H1 bpW 0 ° ° N ° O -So .0 N VD O N N O O ,T, O 0 G N O -0 >a a 0 > 0 3 I, ° o 0°° ,C N C '2 O O ° N O 0 0-1 sZ 3. _ '> `won o 0 y 3 yam. �a c•�OC2r :.+ pp0 Eso H _ SO. O 000 E1 ti,2 0" . ww NCO CO tit?, r%� V�; cC .s a 0 "w ra o 0 0 U' dQ CD .O' c ^. O 0 cd H O W0 O > 0 -0 • • • County of J1ioore IUP # A010: Southeastern Tool & Die (40 CFR 433) cont'd ÷o'>,��3dct�.a0 t O t b 0 O .p p a+ .-2 — 7 'a+ 9, bUA GL N -to p c.) y ti bA s, U cd 3 °� U ," rn NO a,' V] U '�_ '� rNryy O 3 cidN 0 EA rn U ��.' y �' G' -cr . 'r o g ° v, O o o o 5o .Pr c 'a 'bQ 79 O a) W .EO o NNG Fg U -co E CGN y U O Pi NcC t C bQ 0p °�' 3�a>O a� N yw ,. ° p o N p a)Q cd Cd O o,o y a) Evz aa)i G 3.n Eo U 0 3 9 c' 0 V.)o.� 8° .a.4 O, o o c dio o a ct °. U U d° 3 p p y 'p U a) y bA U ^,� 0 0 0 0 0 0 W O . cOc re' bpA ' rO• O O P. R H P +a in cd V] W V] • ermit expires October 31, 2024. 0 0 ( z [ A .174 \ Z \ch , NC00 37508 rei 4. _> 12/31/2020 (11 CD CD CD CD CD II II II II II II II II II II II II II Number of CIUs Number of SIUs included in Public Notice s. \ \/ o / t ct - ) 3 GO Li) \� 74 = e = 20 0 (' {//) { o Z 0 \ E % % % \ } / } - § § ®2 ) Q0 ZZZHZ ount of Civil Penalties Collected of IUs from which penalties collected ficant Industrial User Significant Non -Compliance cp Publicly Owned Treatmen a. IUP Industrial User Pretreatm istrative Orde PAR Pretreatment / ed 1/2018: PAR PPS 2018 Pretreatment Annual Report (PAR) Significant Non -Compliance Report (SNCR) WWTP = Wastewater Treatment Plant, use separate form for each WWTP. SIU = Significant Industrial User SNC = Significant Non -Compliance PAR covers this calendar year => 1/1/2020-12/31/2020 Control Authority=Program=Town Name => Moore County WWTP Name => Moore County WPCP NPDES # => NC0037508 A SNCR Form must be submitted with every PAR, please write "None" if you had No SIUs in SNC during calendar year IUP # Pipe # Industry Name Parameter or "Reporting" SNC ? ( Yes / No ) for each 6-month period. Jan. - June July - Dec. None Attach a copy of the Division's "SIUs in SNC Historical Report" for your POTW's SIUs behind this page . Is the database correct ? Notify the Division of any errors ! Database indicates SNC history for previous years. EVERY SNC MUST be explained in the Narrative, How was, is, or will it be resolved? REPEAT SNCs are serious matters that MUST be explained in the Narrative. Form name: PAR,SNCR,2001 Date Revised: 1/4/2001 printed on: 12/22/2020 te c as as CSC A' m :o t .+ m CC' _0 rn tto U o En- U N - O 00 0 �r' p o "co a. LL n :- O• cD -i+. Program Approval Date Pretreatment Status NC0037508 C .o {0 E ❑ U Z w ❑ z w 0 z PAR Due Date 03/01/2021 cn a. Audit Year Next19/20 o 0) In 0 0 0 N N N N CO 0 O O 0 �0oa CC ▪ LLwp , a t a Q `0 N N ▪ U } CO J Permitted SIU flow (mgd) [Pt_SIU N 0 M 0 ❑ ❑ a) a co 0) Z D N 0 N N N O (0 0 00 V) U ❑ o mr o E E m o I- o 0 co 0 m a .0 a` a p E a.,o N LT E o) N N a'y >> y V) U 0CL 0- a 0 CO 0) O N N 0 0 0 N 0 0 08/22/2019 0) 0 N 0) N O 0) N r 0 NPDES Expire Date M CO M 0 0 0) 0 0) Date Approved Adopt Date Required 0) 0 N O O 0 0. 0 0 (0 0 County Manager PO BOX 1927 28327 1910-947-1992 11 I I 1 Public Works Director PO BOX 1927 128327 Lab Supervisor 11094 Adder Road 28315 Mr. Stephen Morgan 910-947-4331 910-281-2047 snsorgan@rnoorecountync.gov WPCP Superintendent 1094 Addor Rd 28315 r 0 N w 0 0 v r Nt Nr 00 co N o o Mr Wayne Vest I 11910-947-6360 0 Mr. Randy Gould 1 11910-947-6315 rgould@moorecountync.gov Ms Connie Flowers 1Prim 11910-947-4332 cflowers@moorecountynd.gov 0 0' OF E 0 E co 0) 0 N .12 C 0 0 0 (0 C 0 0 CC O E d CO a) a 0 0 0 DWR Regional Contact NOD -failure to enforce 0 N Formal Name Primary Contact Mr. Wayne Vest Mr. Randy Gould Mr. Stephen Morgan Mrs. Connie Flowers Primary County of Moore Water Pollution Control Plant Title County Manager Public Works Director WPCP Superintendent Lab Supervisor Contact List Phone Fax (910) 947-6360 (910) 947-1874 (910) 947-6315 (910)947-1992 (910) 947-4331 (910) 281-2047 (910) 947-4345 (910) 281-2047 Email Address Date Attended PAR Workshop wvest smo o rec o unty nc. g o v Egould@moorecountync.gov smorgan@moorecountync.gov cflowers@moorecountync.gov 1/18/17 Pretreatment Annual Report (PAR) Industrial Data Summary Form (IDSF) Use separate forms for each industry/pipe Enter BDL values as < (value) * * * * Total # of samples => Maximum (mg/1) _> or Maximum (Ib/d) => or Average (mg/1) => or Average Loading (Ib/d) _> % violations,(chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> A % violations,(chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> Total # of samples => Maximum (mg/1) => * or Maximum (lb/d) _> * or Average (mg/1) _> or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> q % violations,(chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> Total # of samples => * Maximum (mg/1) _> * or Maximum (1b/d) _> * or Average (mg/1) _> * or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> q % violations,(chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> Control Authority, Town Name => Moore County WWTP Name => Moore County WPCP NPDES # _> NC 0037508 1st 6 months, dates => 1/1/20 to 6/30/20 2nd 6 months, dates => 7/1/20 to 12/31/20 Industry Name Erico, Inco .orated TUP # A005 Pipe # 001 Flow. med BOD TSS Ammonia 1st 6 months 2n1 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 130 121 1 1 1 1 1 0 0.01593 0.01796 35.3 13.9 9.0 2.5 0.59 0 0.00637 0.00774 35.3 13.9 9.0 2.5 0.59 0 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A Aluminum Cadmium Chromium COD 2nd 6 moT 1st 6 months 2nd b months 1st 6 months 2nd 6 months 1st 6 months 2nd months 1st 6 months 1 0 14 10 1 1 1 1 0.0250 0 0.0050 0.0100 0.0025 0.0250 38 27 0.0250 0 0.0035 0.0018 0.0025 0.0250 38 27 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 Copper Cyanide Lead Mercury 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 14 10 1 1 1 1 0 1 0.9570 0.0370 0.0025 0.0025 0.0050 0.0500 0 0.0000015 0.2366 0.0108 0.0025 0.0025 0.0050 0.0500 0 0.0000015 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A • POTW must enter at least one of these four rows, Please indicate how averages were calculated Avg period could be month, Qtr, or 6-month & if BDL , 1/2BDL, or zero values used. BDL => Below Detection Limit IUP => Industrial User Permit SNC => Significant Non -Compliance TRC => Technical Review Criteria mg/1 => milligram per liter lb/d => pounds pe day mgd => million g Ions per day WWTP => wastewater treatment plant Chapter: PAR Guidance Pile name: PM3mNpHIbal sidetGldiroleddlitrahtrgrft4elliAdB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of Pretreatment Annual Report (PAR) Industrial Data Summary Form (IDSF) Use separate forms for each industry/pipe Enter BDL values as < (value) Total # of samples => Maximum (mg/1) _> * or Maximum (lb/d) _> or Average (mg/1) => * or Average Loading (lb/d) => % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> .Q % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> Total # of samples => * Maximum (mg/1) _> * or Maximum (lb/d) _> * or Average (mg/I) _> * or Average Loading (Ib/d) => % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) => % violations, (cluonic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> Total # of samples => * Maximum (mg/1) _> or Maximum (1b/d) _> * or Average (mg/1) => * or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> Industry Name Erico, Incorporated IUP # A005 Pipe # 001 TKN Nitrate -Nitrite Total Phosphorus Chloride 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1 0 1 0 1 0 1 0 1.46 0 0.16 0 0.2550 0 495 0 1.46 0 0.16 0 0.2550 0 495 0 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Oil & Grease Iron Molybdenum 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1 1 1 0 1 0 17 2.5 0.1640 0 0.1290 0 17 2.5 0.1640 0 0.1290 0 0 0 N/A N/A N/A N/A 0 0 N/A N/A N/A N/A 0 0 N/A N/A N/A N/A 0 0 N/A N/A N/A N/A TTO 1st 6 months 2nd 6 months 'lst 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 0 0 N/A N/A Certifies Certifies for TTO for TTO not being not being present present * POTW must enter at least one of these four rows, Please indicate how averages were calculated Avg period could be month, Qtr, or 6-month & if BDL , 1/2BDL, or zero values used. BDL => Below D tection Limit IUP => Industrial User Permit SNC => Significant Non -Compliance TRC => Technical Review Criteria mg/I => milligram per liter lb/d => pounds pe day mgd => million ga Ions per day WWTP => wastewater treatment plant Chapter: PAR Guidance File name: PAPndipSTattRer('si iirledlhafitrgafdgctla94]3. pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of Pretreatment Annual Report (PAR) Industrial Data Summary Form (IDSF) Use separate forms for each industry/pipe Total # of samples => * Maximum (mg/1) => * or Maximum (lb/d) _> * or Average (mg/1) _> or Average Loading (1b/d) _> % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> * * * Total # of samples => Maximum => or Minimum => % violations, (chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> A % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> Total # of samples => * Maximum (mg/1) _> or Maximum (1b/d) _> * or Average (mg/1) _> or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> A % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> Industry Name Erico, Incorporated 1UP # A005 Pipe # 001 Nickel Silver Zinc 1st 6 months 2nct 6 months 1 st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 Ino11ms 14 10 1 1 1 1 0.2670 0.0500 0.00025 0.00025 0.0050 0.0500 0.0439 0.0118 0.00025 0.00025 0.0050 0.0500 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 pp 1s 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 14 10 10.82 10.8 N/A N/A N/A 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months * POTW must enter at least one of these four rows, Please indicate how averages were calculated Avg period could be month, Qtr, or 6-month & if BDL , I/2BDL, or zero values used. BDL => Below D tection Limit IUP => Industrial User Permit SNC => Significant Non -Compliance TRC => Technical Review Criteria mg/I => milligram per liter lb/d => pounds pe day mgd => million g Ions per day WWTP => wastewater treatment plant Chapter: PAR Guidance File name: PA1od1lftlhudaReineinc edaRbantegdAtshe1PBr1B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of Pretreatment Annual Report (PAR) Industrial Data Summary Form (IDSF) Use separate forms for each industry/pipe Enter BDL values as < (value) Total # of samples => Maximum (mg/1) _> or Maximum (lb/d) _> * or Average (mg/1) _> * or Average Loading (1b/d) _> % violations,(chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> q % violations,(chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> • Total # of samples => * Maximum (mg/1) _> * or Maximum (lb/d) _> or Average (mg/I) _> * or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) > Q % violations,(chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> * * 4: * Total # of samples => Maximum (mg/1) _> or Maximum (lb/d) _> or Average (mg/1) _> or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> o % violations,(chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> Control Authority, Town Name => Moore County WWTP Name => Moore County WPCP NPDES # _> NC 0037508 1st 6 months, dates => 1/1/2020 to 6/30/20 2nd 6 months, dates => 7/1/2020 to 12/31/20 Industry Name Thermal Metal Treatin IUP # A008 Pipe # 001 Flow. mad BOD TSS Ammonia 1st 6 months 2ncl 6 months 1st 6 months 2nct 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 39 48 3 3 3 3 1 2 0.00240 0.00250 3.4 8.0 2.5 5.4 16.9 6.5 0.00062 0.00112 1.8 4.0 2.5 3.5 16.9 6.5 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A Arsenic Cadmium Chromium COD 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1 1 8 8 7 7 3 3 0.0025 0.0025 0.0020 0.0010 0.0190 0.0100 40 34 0.0025 0.0025 0.0011 0.0009 0.0096 0.0036 35.7 18.7 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 Copper Cyanide Lead Mercury 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 8 8 7 7 7 7 1 0 0.0300 0.0220 0.0050 0.0070 0.0050 0.0050 0.00000565 0 0.0071 0.0065 0.0032 0.0036 0.0043 0.0039 0.00000565 0 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A * POTW must enter at least one of these four rows, Please indicate how averages were calculated Avg period could be month, Qtr, or 6-month & if BDL, 1/2BDL, or zero values used. BDL => Below D [action Limit IUP => Industrial User Permit SNC => Significant Non -Compliance TRC => Technical Review Criteria mg/I => milligram per liter lb/d => pounds pc day mgd => million gallons per day WWTP => wastewater treatment plant Chapter: PAR Guidance File name: PA jrfl13AlhaturtedihiidellaIllhatitrgifP.lsr,d9BtAB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of Pretreatment Annual Report (PAR) Industrial Data Summary Form (IDSF) Use separate forms for each industry/pipe Total # of samples => * Maximum (mg/1) _> * or Maximum (lb/d) => or Average (mg/1) => * or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> A % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> * * * Total # of samples => Maximum => or Minimum => % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> A % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> Total # of samples => * Maximum (mg/1) _> * or Maximum (lb/d) _> * or Average (mg/1) _> * or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> Q % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> A Industry Name Thermal Metal Treating IUP # A008 Pipe # 001 Nickel Selenium Silver Zinc 1st 6 months L11d 6 months 1 st b months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 8 8 1 1 7 7 7 7 0.0480 0.2090 0.0025 0.0025 0.0005 0.0005 0.9270 0.1580 0.0139 0.0382 0.0025 0.0025 0.0005 0.0004 0.2279 0.0409 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 6 tst months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 10 9 9.8 10.4 N/A N/A N/A Chloride Oil & Grease Iron Molybdenum 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1 1 3 3 1 1 1 1 650 330 2.5 2.5 0.0610 0.3920 0.0025 0.0025 650 330 2.5 2.5 0.0610 0.3920 0.0025 0.0025 N/A N/A 0 0 N/A N/A N/A N/A N/A N/A 0 0 N/A N/A N/A N/A N/A N/A 0 0 N/A N/A N/A N/A N/A N/A 0 0 N/A N/A N/A N/A * POTW must enter at least one of these four rows, Please indicate how averages were calculated Avg period could be month, Qtr, or 6-month & if BDL , 1/2BDL, or zero values used. BDL => Below Detection Limit IUP => Industrial User Permit SNC => Significant Non -Compliance TRC => Technical Review Criteria mg/I => milligram per liter Ib/d => pounds pe day mgd => million g Irons per day WWTP => wastewater treatment plant Chapte PAR Guidance Pile name: PFIRA aEllradatdeQiaiirledtQihaiitrg<Iktde,ciR9413, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of Pretreatment Annual Report (PAR) Industrial Data Summary Form (IDSF) Use separate forms for each industry/pipe Enter BDL values as < (value) Total # of samples => * Maximum (mg/1) => * or Maximum (lb/d) => * or Average (mg/1) => * or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) _> „ % TRC violations, (SNC is >= 33 %) _> A % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> Total # of samples => * Maximum (mg/1) _> * or Maximum (lb/d) _> * or Average (mg/1) => * or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> q % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> Total # of samples => * Maximum (mg/1) => * or Maximum (lb/d) _> or Average (mg/1) _> * or Average Loading (1b/d) _> % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> Q % violations, (chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> Industry Name Thermal Metal Treating IUP # A008 Pipe # 001 Aluminum TKN Nitrate -Nitrite Total Phosphorus 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 2 1 1 1 1 1 1 1 4.120 1.690 17 7.8 6.12 1.30 0.500 0.025 2.537 1.690 17 7.8 6.12 1.30 0.500 0.025 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A TTO 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 0 0 N/A N/A Certifies Certifies for TTO for TTO not being not being present present 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months lst 6 months 2nd 6 months 1st 6 months 2nd 6 months * POTW must enter at least one of these four rows, Please indicate how averages were calculated Avg period could be month, Qtr, or 6-month & if BDL , 1/2BDL, or zero values used. BDL => Below Detection Limit IUP —> Industrial User Permit SNC => Significant Non -Compliance TRC => Technical Review Criteria mg/I => milligram per liter Ib/d —> pounds pe day mgd => million g lions per day WWTP —> wastewater treatment plant Chapter: PAR Guidance File name: PAPoiffpfdl disiter6 irted 1haf trgat sY,ciR94B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of Pretreatment Annual Report (PAR) Industrial Data Summary Form (IDSF) Use separate forms for each industry/pipe Enter BDL values as < (value) Total # of samples => * Maximum (mg/I) => * or Maximum (lb/d) _> or Average (mg/1) => * or Average Loading (lb/d) _> % violations,(chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> .Q % violations,(chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> * * * * Total # of samples => Maximum (mg/1) _> or Maximum (lb/d) _> or Average (mg/1) _> or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> A % violations,(chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> Total # of samples => Maximum (mg/1) _> * or Maximum (lb/d) _> * or Average (mg/I) _> or Average Loading (lb/d) => % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> q % violations,(chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> Control Authority, Town Name => Moore County WWTP Name => Moore County WPCP NPDES # _> NC 0037508 1st 6 months, dates => 1/1/20 to 6/30/20 2nd 6 months, dates => 7/1/20 to 12/31/20 Industry Name Southeastern Tool & Die h P # A010 Pipe # 001 Flow. mpd BOD TSS Ammonia 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st b months 2nd 6 months 181 173 2 1 2 1 1 0 0.01321 0.0153 81.5 7.9 40.0 29.0 0.05 0 0.00367 0.0041 59.4 7.9 21.3 29.0 0.05 0 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A Cadmium Chromium COD Copner 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 2 1 2 1 2 1 2 1 0.0010 0.0010 0.0025 0.0025 200.0 25.0 0.0500 0.0270 0.0010 0.0010 0.0025 0.0025 139.5 25.0 0.0310 0.0270 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cyanide Lead Mercury Nickel 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 2 1 2 1 1 0 2 1 0.0025 0.0025 0.0050 0.0050 0.0000303 0 0.0160 0.0110 0.0025 0.0025 0.0050 0.0050 0.0000303 0 0.0130 0.0110 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A N/A 0 0 0 0 0 0 N/A _ N/A 0 0 • POTW must enter at least one of these four rows, Please indicate how averages were calculated Avg period could be month, Qtr, or 6-month & if BDL, 1/2BDL, or zero values used. BDL => Below Detection Limit IUP => Industrial User Permit SNC => Significant Non -Compliance TRC => Technical Review Criteria mg/I => milligram per liter lb/d => pounds pe day mgd => million gallons per day WWTP => wastewater treatment plant Chapter: PAR Guidance File name: PFNodl3Filhairekeshiinined9llra(itrgdAtslnc1RRAB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of Pretreatment Annual Report (PAR) Industrial Data Summary Form (IDSF) Use separate forms for each industry/pipe Total # of samples => * Maximum (mg/1) _> * or Maximum (lb/d) _> * or Average (mg/1) _> * or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> A % violations, (chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> * * * * Total # of samples => Maximum => or Minimum => % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> q % violations, (chronic SNC is >= 66%) => % TRC violations, (SNC is >= 33 %) _> Total # of samples => * Maximum (mg/1) _> * or Maximum (lb/d) _> * or Average (mg/1) _> * or Average Loading (lb/d) _> % violations, (chronic SNC is >= 66%) _> % TRC violations, (SNC is >= 33 %) _> .Q % violations, (chronic SNC is >= 66%) _> �T % TRC violations, (SNC is >= 33 %) _> Industry Name Southeastern Tool & Die IUP # A010 Pipe # 001 Silver Zinc Oil & Grease 1st 6 months 2nd b months 1st 6 months 2nd 6 months 1st 6 months 2nd b months 1st 6 months 2nd b months 2 1 2 1 2 1 0.0570 0.0120 0.0690 0.0330 6.0 2.5 0.0286 0.0120 0.0470 0.0330 5.5 2.5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 pH 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 2 1 8.8 7.3 N/A N/A N/A TTO 2nd 6 months 1 st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 0 0 N/A N/A Certifies Certifies for TTO for TTO not being not being present present * POTW must enter at least one of these four rows, Please indicate how averages were calculated Avg period could be month, Qtr or 6-month & if BDL , 1/2BDL, or zero values used. BDL => Below D tection Limit IUP => Industrial User Permit SNC => Significant Non -Compliance TRC => Technical Review Criteria mg/I => milligram per liter Ib/d => pounds pe day mgd => million ga Ions per day WWTP => wastewater treatment plant Chapter: PAR Guidance File name: PATorliphifudiskmaiirtedalthaMegtfkfsluclD94B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of POTW= NPDES# IUP Count 2 3 4 5 6 7 8 9 10 Workbook Name : HWA Updated AT 2020, Worksheet Name: AT Printed: 2/4/2021, 10:59 AM Page 1 of 5 Allocation Table Spreadsheet Instructions: Headworks last approved: 12/16/19'. 1) Applicable Values should be entered in the Heavy Bordered cells. Rest of worksheet is protected, password is Allocation Table updated: 06/02/20 2) Formulas are discussed in the Comprehensive Guidance, Chapter 6, Section C. Permits last modified: 06/01/20 3) HWA and AT worksheets in this workbook are linked. Pollutant Names, MAH Ls, Basis, and Uncontrollable load AT from the HWA This includes names in in this worksheet are automatically entered spreadsheet. pollutant columns AT through BK. Moore County WPCP NC0037508 Industry Type Renewal Modification Date FLOW Permit Limits BOD Permit Limits TSS Permit Limits INDUSTRY NAMES Permit (please !Lk alpbabeliely) number Pipe of Effective Effective Permit number Industry Date Date Expires MGD gal/day Conc. Load mg/1 lhs/day Cone. Load mg/1 lbs/day llrico, Inc A005 0001 433 7/1/2018 06/01/20 6/30/2023 0.0600 60,000 500.00 250.20 1000.00 500.40 Thermal Metal Treating A008 0001 433 7/1/2020 7/1/2020 6/30/2025 0.0100 10,000 500.00 41.70 1000.00 83.40 Southeastern Tool & Die A010 0001 433 11/7/2019 5/1/2020 10/31/2024 0.0100 10,000 500.00 41.70 1000.00 83.40 Column Totals => 0.0800 80,000 334 667 Basis=> MAT -IL from I -TWA (lbs/day) _> Uncontrollable Loading (Ibs/day) _> Total Allowable for Industry (MAIL) (lbs/day) Total Permitted to Industry (lbs/day) _> MAIL left (lbs/day) => Percent Allow. Ind. (MAIL) still available (%) _> Percent MAIIL still available (%) _> 5 Percent MAI-IL (Ibs/day) _> NPDES Permitted Plow=> NPDES 10.0000 5.7166 4.2834 0.0800 4.2034 98.1 % 42.0 % 0.5000 Design 19432 12730 6703 334 6369 95.0 % 32.8 % 972 Design 18765 13492 5273 667 4605 87.3 % 24.5 % 938 HWA.AT Revised:November 2005 Workbook Name : HWA Updated AT 2020, Worksheet Name: AT POTW= NPDEsn= IUP Count 1 2 3 4 5 6 7 8 9 10 Allocation Table Printed: 2/4/2021, 10:59 AM Page 2 of 5 Headworks last approved: Allocation Table updated: Permits last modified: 12/16/19 Pipe number 06/02/20 06/01/20 Moore County WPCP NC0037508 Industry INDUSTRY NAMES Permit (please list alphabetcly) number Ammonia Permit Limits Arsenic Permit Limits Cadmium Permit Limits Chromium Pennit Limits Copper Permit Limits Cyanide Permit Limits Conc. Load mg/I lbs/day Conc. Load mg/I lbs/day Conc. Load mg/1 Ibs/day Conc. Load mg/1 lhs/day Conc. Load mg/l lbs/day Conc. Load mg/1 Ibs/day Erico, Inc A005 0001 0.0700 0.0350 1.7100 0.8557 2.0700 1.0358 0.6500 0.3253 Thermal Metal Treating A008 0001 0.0700 0.0058 1.7100 0.1426 2.0700 0.1726 0.6500 0.0542 Southeastern Tool & Die A010 0001 0.0700 0.0058 1.7100 0.1426 2.0700 0.1726 0.6500 0.0542 Column Totals=> 0 0.0000 0.0467 1.1409 1.3811 0.4337 Basis=> MAIIL from IIWA (lbs/day) _> Uncontrollable Loading (Ibs/day) _> Total Allowable for Industry (MAIL) (lbs/day) _> Total Permitted to Industry (lbs/day) �> MAIL left (lbs/day) => Percent Allow. Ind. (NAIL) still available (%) _> Percent MAIIL still available (%) _> 5 Percent MAl-IL (lbs/day) _> Design 1886.51 1053.65 832.86 0.00 832.86 100.0 % 44.1 % 94.33 Digester Inhibition 1.7347 0.1192 1.6155 0.0000 1.6155 100.0 % 93.1 % 0.0867 Stream Std 0.3929 0.0381 0.3547 0.0467 0.3080 86.8 % 78.4 % 0.0196 Stream Std 8.0609 0.1573 7.9036 1.1409 6.7626 85.6 % 83.9% 0.4030 Stream Std 9.2334 2.9321 6.3013 1.3811 4.9202 78.1 % 53.3 % 0.4617 Stream Std 2.1275 0.1430 1.9845 0.4337 1.5508 78.1 % 72.9 % 0.1064 HWA.AT Revised:November 2005 Workbook Name : HWA Updated AT 2020, Worksheet Name: AT Poles. NPDESA= IUP Count 1 2 3 4 5 6 7 8 9 10 Allocation Table Printed: 2/4/2021, 10:59 AM Page 3 of 5 Headworks last approved: Allocation Table updated: Permits last modified: 12/16/19. Pipe number 06/02/20 06/01/20 Moore County WPCP NC0037508 Industry INDUSTRY NAMES Permit (please list alphaeeumy) number Lead Permit Limits Mercury Permit Limits Molybdenum Permit Limits Nickel Permit Limits Selenium Permit Limits Silver Permit Limits Conc. Load mg/l lbs/day Conc. Load mg/l lbs/day Conc. Load mg/1 Ibs/day Conc. Load mg/l lbs/day Conc. Load mg/1 lbs/day Conc. Load mg/1 lbs/day Erico, Inc A005 0001 0.4300 0.2152 2.0000 1.0008 0.1200 0.0600 Thermal Metal Treating A008 0001 0.4300 0.0359 2.0000 0.1668 0.1200 0.0100 Southeastem Tool & Die A010 0001 0.4300 0.0359 2.0000 0.1668 0.1200 0.0100 Column Totals=> 0.2869 0.000000 0.0000 1.3344 0.0000 0.0801 Basis=> MAI-IL from I-IWA (lbs/day) _> Uncontrollable Loading (lbs/day) _> Total Allowable for Industry (MAIL) (lbs/day) _> Total Permitted to Industry (lbs/day) _> MAIL left (lbs/day) _> Percent Allow. Ind. (MAIL) still available (%) Percent MAI-IL still available (%) _> 5 Percent MAI-IL (Ibs/day) _> Stream Std 2.1180 0.2575 1.8605 0.2869 1.5736 84.6 74.3 0.1059 Stream Std 0.026381 0.006198 0.020183 0.000000 0.020183 100.0 % 76.5 % 0.001319 Stream Std 31.4998 0.1273 31.3725 0.0000 31.3725 100.0 % 99.6 % 1.5750 Stream Std 5.6856 0.0858 5.5998 1.3344 4.2654 76.2 % 75.0 % 0.2843 Stream Std 1.3191 0.1240 1.1951 0.0000 1.1951 100.0 90.6 % 0.0660 Stream Std 0.0317 0.2384 -0.2067 0.0801 -0.2868 138.7 -905.9 % 0.0016 HWA.AT Revised:November 2005 Workbook Name : HWA Updated AT 2020, Worksheet Name: AT POTW= NPoestt= IUP Count 1 2 3 4 5 6 7 8 9 10 Allocation Table Printed: 2/4/2021, 10:59 AM Page 4 of 5 Headworks last approved: Allocation Table updated: Permits last modified: 12/16/19 Pipe number 06/02/20 06/01/20 Moore County WPCP NC0037508 Industry INDUSTRY NAMES Permit (please list aIphawamb) number Zinc Permit Limits Total Nitrogen Permit Limits Total Phos. Permit Limits c Permit Limits d Permit Limits e Permit Limits Conc. Load mg/1 lbs/day Conc. Load mg/I lbs/day Conc. Load mg/I Ibs/day Conc. Load mg/l Ibs/day Conc. Load mg/I Ibs/day Conc. Load mg/1 lbs/day Erica, Inc A005 0001 1.4800 0.7406 Thermal Metal Treating A008 0001 1.4800 0.1234 Southeastern 'Tool & Die A010 0001 1.4800 0.1234 Column Totals => 0.9875 0.00 0.00 0.0000 0.0000 0.0000 Basis=> MAI-IL from HWA (lbs/day) _> Uncontrollable Loading (Ibs/day) _> Total Allowable for Industry (MAIL) (lbs/day) _> Total Permitted to Industry (lbs/day) _> MAIL left (lbs/day) _> Percent Allow. Ind. (MAIL) still available (%) _> Percent MAI-IL still available (%) _> 5 Percent MAI-IL (lbs/day) _> Stream Std 47.1091 8.3434 38.7657 0.9875 37.7783 97.5 % 80.2 % 2.3555 0.00 0.00 ####### ####### 0.0000 0.0000 lifintItirtItt 0.0000 HWA.AT Revised:November 2005 Dental Amalgam Compliance Report Dentist Office Address Phone Number Date Report Mailed Date Report Received Subject to Rule Year Separator Installed Comments Drs. Allison & Hulihan 15 Aviemore Drive Pinehurst 28374 910-295-4343 5/14/18 6/22/18 Yes 2018 Aspen Dental 10868 US HWY 15/501 Southern Pines 28387 910-725-5825 12/11/19 2/3/20 Yes 2019 Bhat & Associates 3 Regional Circle Suite A Pinehurst 28374 910-215-2583 5/14/18 7/18/18 No Doesn't Place/Remove Amalgam Carolina Center for Cosmetic Dentistry 125 Murray Hill Rd Suite A Southern Pines 28387 910-692-5250 5/14/18 3/12/19 Yes 2019 Carolinas Dentist 292-B Turner St Aberdeen 28315 910-505-9062 5/14/18 4/2/19 Yes 2013 Dental Derby 10564 US HWY 15-501 Suite E Southern Pines 28387 910-693-3729 5/14/18 6/29/18 No Doesn't Place/Remove Amalgam Dental Design Innovations 10 Memorial Dr Pinehurst 28374 910-215-4554 5/14/18 9/27/18 No Doesn't Place/Remove Amalgam Dentistry of the Pines 100 Pavillion Way Suite G Southern Pines 28387 910-684-3687 5/14/18 5/22/18 Yes 2018 Dogwood Family Dental 908 N Sandhills Blvd Aberdeen 28315 910-944-5600 5/14/18 6/23/20 Yes 2020 Dr. Darrell Lee Powers D.D.S. PO Box 1060 Robbins 27325 910-948-2555 5/14/18 9/24/18 Yes 2018 Dr. Fred Ridge DDS 115 Turnberry Way Pinehurst 28374 910-695-3100 5/14/18 9/10/18 Yes 2018 Dr. Paul James DMD 116 South Middleton Street Robbins 27325 910-948-4655 5/14/18 Retiring/Office Will be Closed Dr. Pete McKay Family Dentistry PO Box 628 West End 27376 910-673-0113 5/14/18 5/24/18 No Septic Tank Dr. Thomas M Vicars Jr., D.D.S. 270 South Bennett Street Southern Pines 28387 910-695-1300 5/14/18 10/31/18 Yes 2018 Edward C. Monroe, D.D.S. 330 W Pennsylvania Ave Southern Pines 28387 910-695-3334 5/14/18 6/14/18 Yes 2018 Goodrich Dental 125 Murray Hill Rd Suite G Southern Pines 28387 910-693-1977 5/14/18 7/18/19 Yes 2018 Firsthealth Dental Care Center 105 Perry Drive Southern Pines 28387 910-692-5111 5/14/18 5/22/18 Yes 2018 Hometown Family Dental Centers 115 Southern Dunes Dr Vass 28394 910-693-8030 5/14/18 5/23/18 No Septic Tank Kuhn Dental Associates 1902 N Sandhills Blvd Suite H Aberdeen 28315 910-692-4450 5/14/18 7/30/18 Yes 2018 Lane & Associates Family Dentistry 10677 US HWY 15-501 Southern Pines 28387 910-295-5980 5/14/18 10/11/18 Yes 2018 Monroe & Monroe D.D.S. 12 Regional Dr Pinehurst 28374 910-295-4242 5/14/18 5/21/18 Yes 2017 Moubry Family Dentistry 530 NW Broad St Southern Pines 28387 910-692-0703 5/14/18 10/25/18 Yes 2018 NC Caring Dental Professionals PO Box 1258 Southern Pines 28388 910-944-1150 5/14/18 Not a dental office 02 Dental Group of Southern Pines 340 Capital Drive Unit D Carthage 28327 910-839-0055 10/23/20 11/23/20 Yes 2020 Olmstead Village Dental Care 295 Olmstead Blvd Suite 7 Pinehurst 28374 910-295-2750 5/14/18 12/18/18 Yes 2018 Pinehurst Dental 80 Memorial Drive Pinehurst 28374 910-295-9700 5/14/18 4/4/19 Yes 2019 Powers Pediatric Dentistry 110 Fox Hollow Court Pinehurst 28374 910-692-5329 5/14/18 6/17/20 Yes 2020 Pratt Family Dentistry 700 SW Broad St Southern Pines 28387 910-692-7761 5/14/18 6/28/18 Yes 2018 Sandhills Dental Rehabilitation Center 240 Davis Street Suite B Southern Pines 28387 910-692-4051 5/14/18 5/21/18 No Prosthodontics Sandhills Smiles 4824 US Hwy 15-501 Carthage 28327 910-947-2411 5/14/18 5/21/18 No Septic Tank Sandhills Weekend Dental 200 Westgate Drive Suite C West End 27376 910-687-4423 5/14/18 7/19/18 Yes 2018 Seven Lakes Family Dentistry 1064-B Seven Lakes Drive West End 27376 910-673-6030 5/14/18 5/21/18 No Septic Tank Southern Pines Family Dental 655 SW Broad St Southern Pines 28387 910-692-6500 5/14/18 5/23/18 No Doesn't Place/Remove Amalgam Southern Smiles Pediatric Dentistry 1512 NC Hwy 24-87 Cameron 28326 910-947-5433 5/14/18 10/22/18 No Doesn't Place/Remove Amalgam Dental Amalgam Compliance Report Dentist Office Address Phone Number Date Report Mailed Date Report Received Subject to Rule Year Separator Installed Comments Wellener Dental 305 Page Rd N Suite 2 Pinehurst 28374 910-295-1010 5/14/18 6/22/18 Yes 2018 William McDermott D.D.S. 155 Turnberry Way Pinehurst 28374 910-695-3050 5/14/18 10/5/18 Yes 2018