NC0025984_Pretreatment_Annual_Report_20210218

Pretreatment Annual Report
L VLVr/llVlltr Ti.
E-mall iacobhodge"to!w"' arestcitv.COM
I have.Personally examined and a far' with the information submitted
in this document,and attachments: ` B_:ased upon _my inquiry of those
4
individuals.mmediately' responsible, for obtaining the.,informat"on reported
herein, I believe that the; submitted information is true, Iaccurate, and
complete. I ant. -aware that. there are significant penalties'for submitting false
information.
Signature Date_02/ 18/2021 _

Town of Forest City
NPDES # NCO025984 & NCO087084
Narrative:
During this PAR period (Jan. 1 2020 — Dec. 31 2020,) the following summarizes the
status of each Industrial User, and any changes that have occurred.
IUP #0008 American Zinc Products Riverstone WWTP:
AZP came out of their consent order December 31, 2019. AZP was issued a new permit
in February 2020. AZP had continued violations for BOD, Ammonia, flow, and TSS in
2020. After continued violations we modified there permit to temporarily raise their
Ammonia limit from 70mg/1 to 100mg/l. This limit was in affect from 4-27-2020 to 10-
27-2020. During this time AZP continued to violate Ammonia and other pollutants.
They also cleaned their sewer system and did some small tracing of the pollutants in that
time frame. From our knowledge the flow violations are from toilets hanging up. The
BOD and TSS are sporadic but usually high TRC violations. After the temporary limits
ran out AZP continued to violate parameters. As of this time I have been told they have
contracted McGill & Associates to potentially track the Ammonia, as well as other
avenues to treat the waste. AZP was in SNC for ammonia both six-month periods. AZP
was fined a total of $19,500.00 this year. Our billing department and AZP billing
department is working to get these fines paid. I am currently putting together an
Administrative Order to send to AZP.
IUP #0009 Everest Textile FC WWTP:
Everest Textile was issued a new permit February 2020. Everest had a few violations for
O&G during 2020. However, they have worked hard and got their DAF up and going
consistently and have not had any violations since August 2020.
IUP #0002 Danfoss Power Solutions FC WWTP:
No issues full compliance. Eaton's was issued a new permit in February 2020. February
1, 2021 Eaton changed their name to Danfoss Power Solutions, LLC.
IUP #0006 Parker Hannifin FC WWTP:
Parker had one violation for zinc and total phosphorus during the first six months which
put them in SNC. The violations were from the sampling the Town conducted. We did
not sample until June 17 due to Covid-19. We usually sample around March so if any
violations occur there is time to sample back into compliance. With the late sampling
Parker did not have time to sample back into compliance. During the second six months
Parker had two more violations for zinc which put them into SNC again. Parker will be
issued a NOV and fine for consecutive SNC violations.
IUP #0007 ProAmpac Riverstone:
ProAmpac was issued a new permit February 2020. ProAmpac permit was dropped in
December 2020 due to the print line that required the permit being removed permanently.

IUP #0005 WestRock FC WWTP:
WestRock was in full compliance the first six months. During the second six months
they had violations for TSS, Zinc, and O&G. They were fined $250.00. They sampled
themselves back into compliance for everything except for O&G due to spreadsheet error
on my part. They are in SNC for O&G for the second six months. They have taken
actions to correct the issues.
Forest City WWTP
Forest City WWTP had no compliance issues from the violations; however, we are
working hard with the industries to help correct the compliance issues. FC WWTP has
had issues with our SAM unit in our big digester. We are hoping to have it rebuilt and
back in the digester very soon. There was an error on the end of year mailing I received,
for the historical SNC for parker. This has been corrected.
Riverstone WWTP:
Riverstone had no violations during 2020. We are still concerned AZP will affect the
efficiency of the plant with their discharge.
Dental Amalgam Rule:
I have visited all 4 dentists in the FC area. We have received 3 responses. I will reach
back out to the other one and get their response before March Is.

Chapter 9, PAR Guidance
Pretreatment Performance Summary (PPS)
1.
Pretreatment Town Name: Town of Forest City
2.
"Primary" NPDES Number NC00 25984 & NC 0087084
or Non -Discharge Permit # if applicable =>
3.
PAR Begin Date, please enter 01 /01 /yyyy
3. =>
1 /1 /2020
4.
PAR End Date, please enter 12/31/yyyy
4. =>
12/31/2020
5.
Total number of SIUs, includes Cl Us
5. =>
6
6.
Number of CIUs
6. =>
2
7.
Number of SIUs with no IUP, or with an expired IUP
7. =>
0
8.
Number of SIUs not inspected by POTW
8. =>
0
9.
Number of SIUs not sampled by POTW
9. =>
0
10.
Number of SIUs in SNC due to IUP Limit violations
10. =>
3
11.
Number of SIUs in SNC due to Reporting violations
11. =>
0
12.
Number of SIUs in SNC due to violation of a Compliance Schedule, CO, AO or similar
12. =>
0
13.
Number of CIUs in SNC
13. =>
2
14.
Number of SIUs included in Public Notice
14. =>
3
15
Total number of SIUs on a compliance schedule, CO, AO or similar
15. =>
0
16.
Number of NOVs, NNCs or similar assesed to SIUs
16. =>
20
17.
Number of Civil Penalties assessed to SIUs
17. =>
20
18.
Number of Criminal Penalties assessed to SIUs
18. =>
0
19.
Total Amount of Civil Penalties Collected 19. =>
$
0
20.
Number of lUs from which penalties collected
20. =>
0
Votes:
AO Administrative Order IUP Industrial User Pretreatment Permit POTW
CIU Categorical Industrial User NNC Notice of Non -Compliance SIU
Publicly Owned Treatment Works
Significant Industrial User
CO Consent Order NOV Notice of Violation SNC
Significant
Non -Compliance
IU Industrial User PAR Pretreatment Annual Report
revised 1/2018: PAR PPS 2018

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PUBLIC NOTICE OF SIGNICICANT INDUSTRIAL USER PERMIT VIOLATION
The Town of Forest City, in accordance with federal and state regulations, is
hereby giving public notice. Listed below are "Significant Industrial Users (SIU's)"
that were in "Significant Non -Compliance (SNC)" with the Industrial User Permits,
40 CFR Part 403, and state pretreatment regulations during Period of January 1,
2020 thru June 30, 2020 - American Zinc Products LLC for Ammonia & BOD and
Parker Hannifin for Zinc. During reporting Period of July 1, 2020 thru December
31, 2020 - American Zinc Products LLC for Ammonia, Parker Hannifin for Zinc, and
WestRock for Oil & Grease
A continuing effort is being made by the listed industries and Town of Forest City
to achieve full compliance. No compliance issues resulted for the Forest City
Wastewater Treatment Plant.
Jacob Hodge
Town of Forest City
Pretreatment Coordinator

PUBLIC NOTICE OF
SIGNIFICANT INDUSTRIAL
USER PERMIT VIOLATION
The Town of Forest City, in
accordance with federal and
state regulations, is hereby
giving public notice. Listed
below are "Significant
Industrial Users (SIU's)" that
were in "Significant
Non -Compliance (SNC) if with
the Industrial User Permits, 40
CFR Part 403, and state
pretreatment regulations
during Period of January 1,
2020 thru June 30, 2020 -
American Zinc Products LLC
for Ammonia & BOD and
Parker Hannifin for Zinc.
During reporting Period of
July 1, 2020 thru December
31, 2020 - American Zinc
Products LLC for Ammonia,
Parker Hannifin for Zinc, and
WestRock for Oil & Grease.
A continuing effort is being
made by the listed industries
and Town of Forest City to
achieve full compliance. No
compliance issues resulted for
the Forest City Wastewater
Treatment Plant.
Jacob Hodge
Town of Forest City
Pretreatment Coordinator
February 17, 2021

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A 7, P � 000s'
Industrial User Wastewater Survey
& Permit Application -
Current
Pro'ected
Code
Description
x
x
W52
Modified equipment, layout, or piping
W53
Use of a different process catalyst
W54
Instituted better controls on operating bulk containers to minimize
discarding of empty containers
W55
Changed from small volume containers to bulk containers to
minimize discarding of empty containers
W58
Other process modifications (explain briefly in comments)
W59
Modified stripping / cleaning equipment
W60
Changed to mechanical stripping / cleaning devices {from solvents or
other materials
x
W61
Changed to aqueous cleaners from solvents or other materials
W62
Reduced the number of solvents used to make waste more amenable
to recycling
x
x
W63
Modified containment procedures for cleaning units
x
x
W64
Improved draining procedures
W65
Redesigned parts racks to reduce dra out
x
W66
Modified or installed rinse systems
x
W67
Ina roved rinse equipment design
x
W68
Improved rinse a ui meat operation
W71
Other cleaning and degreasing -o eration (explain briefly in comments)
x
W72
Modified spray stems orequipment
W73
Substituted coating materials used
W74
I n roved application techniques
W75
Changed from spray to others stem
W78
Other surface preparation and finishin (explain briefly in comments
W81
Changed product specifications
W82
Modified design or composition of product
W83
Modified packa
W89
Other product modifications (explain briefly in comments
W99
Other (specify in comments
Comments (Please list corresponding code)
Title: IU Wastewater Survey & Pennit Application
File name: K:1Environmental\Sanitary Sewer\Permit\Permit Application\Operadons12019 Industrial Wastewater Survey W Permit Application Rev. 2
Final.docx
Revision date: 12/30/97 Page 19 of 198
2103696 2.doex

0005
Industrial User Wastewater Survey
& Permit Application
Part V, Waste Reduction Information
State Pretreatment Rule 15A NCAC 2H.0916 (c)(1)(K requires Significant Industrial
Users to include a description of current and projected waste reduction (pollution
prevention) activities. The codes listed are standard EPA codes found on Toxic Release
Inventory and other environmental forms. Please check all applicable codes for your
facility related to wastewater discharge.
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W21
instituted procedures to ensure that materials do not stay in inventory
beyond shelf -life
W22
Began to test outdated material -continue to use if still effective
W23
Eliminated shelf -life re uirements for stable materials
x
x
W24
Instituted better labeling procedures
W25
Instituted clearinghouse to exchange materials that would otherwise
be discarded
W29
Other changes in Inventory control (explain briefly in comments
x
x
W31
Improved storage or stackin rocedures
x
x
W32
Im roved rocedures for loading, unloading and transfer operations
x
W33
Installed overflow alarms or automatic shutoff valves
x
W34
Installed secondary containment
W3 5
Installed vapor recovery stems
x
x
W36
Implemented inspection or monitoring program of potential spill or
leak sources
W39
Others ill and leak prevention (explain briefly in comments
W41
Increased purity of raw materials
W42
Substituted raw materials
W49
Other raw material modifications (explain briefly in comments
W51
Instituted recirculation within 'a process
Title: 1U Wastewater Survey & Permit Application
File name: KAEnvironmentahSanitary Sewer\Permit\permit Applicationloperauons\2019 Industrial Wastewater Survey IUP
Permit Application Rev. 2 Final.docx
Revision date: 12/30/97 Page 18 of 18
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Industrial User Wastewater Survey
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Part V, Waste Reduction Information :
State Pretreatment Rule 15A NCAC 2H.0916 (c)(1)(M) requires Significant Industrial
Users to include a description of current and projected waste reduction (pollution
prevention) activities. The codes listed are standard EPA codes found on Toxic Release
Inventory and other environmental forms. Please check all applicable codes for your
facility related to wastewater discharge.
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Instituted procedures to ensure that materials do not stay in inventory
beyond shelf -life
X
W22
Began to test outdated material -continue to use if still effective
W23
Eliminated shelf -life requirements for stable materials
W24
Instituted better labeling procedures
W25
Instituted clearinghouse to exchange materials that would otherwise
be discarded
W29
Other changes in Inventory control ex lain briefly in comments
W31
Improved storage or stacking procedures
W32
Improved procedures for loading, unloading and transfer operations
X
W33
Installed overflow alarms or automatic shutoff valves
W34
Installed second9a containment
W35
Installed vapor recovery systems
W36
Implemented inspection or monitoring program of potential spill or
leak sources
W39
Others ill and leak prevention (explain briefly in comments
W41
Increased purity of raw materials
W42
Substituted raw materials
W49
Other raw material modifications (explain briefly in comments
W51
Instituted recirculation within a process
Title: IU Wastewater Survey & Permit Application
File name: K:1Eaton Business System\Operational Excellence\Environment, Health, & Safety MESH13.0 Water Managment13.1
Water management and conservationlTesting120191Permit renewal 20191Industrial Wastewater Survey
IUP Permit Application (Long Form).docx
Revision date: 12/30/97 Page 20 of 18

Industrial User Wastewater Survey
& Permit Application
�t oa o a-
Da,4ass
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Description
W52
Modified equipment, layout, or piping
W53
Use of a different process catalyst
W54
Instituted better controls on operating bulk containers to minimize
discarding of empty containers
W55
Changed from small volume containers to bulk containers to
minimize discarding of empty containers
W58
Other process modifications (explain briefly in comments)
W59
Modified stripping / cleaning equip ment
W60
Changed to mechanical stripping / cleaning devices (from solvents or
other materials
W61
Changed to aqueous cleaners from solvents or other materials
W62
Reduced the number of solvents used to make waste more amenable
to recycling
W63
Modified containment procedures for cleaning units
W64
Improved draining procedures
W65
Redesigned parts racks to reduce dra out
W66
Modified or installed rinses stems
W67
Improved rinse equipment design
W68
Improved rinse equipment operation
W71
Other cleaning and degreasing operation (explain briefly in comments)
W72
Modified spray systems ore ui ment
W73
Substituted coating materials used
W74
Improved application techniques
W75
Changed from spray to others stem
W78
Other surface preparation and finishing (explain briefly in comments
W81
Changed product specifications
W82
Modified design or composition of product
W83
Modified packaging
W89
Other product modifications (explain briefly in comments
W99
Other (specify in comments
Comments (Please list corresponding code)
Title: I Wastewater Survey & Permit Application
File name: KAEaton Business Systemloperational Excellence\Environment, Health, & Safety MESH13.0 Water Managment13.1
Water management and conservationlTesting120191Permit renewal 20191Industrial Wastewater Survey IUP
Permit Application (Long Form).docx
Revision date: 12/30/97 Page 22 of 238

F--V¢roS+" 0001
Industrial User Wastewater Survey
& Permit Application
Part V, Waste Reduction Information :
State Pretreatment Rule 15A NCAC 2H.0916 (c)(1)(M) requires Significant Industrial
Users to include a description of current and projected waste reduction. (pollution
prevention) activities. The codes listed are standard EPA codes found on Toxic Release
Inventory and other environmental forms. Please check all applicable codes for your
facility related to wastewater discharge.
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Im roved maintenance scheduling recordkeeping, or procedures
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W 19
Other changes in operating ractices (explain briefly in comments
W21
Instituted procedures to ensure that materials do not stay in inventory
beyond shelf -life
W22
Began to test outdated material -continue to use if still effective
W23
Eliminated shelf -life requirements for stable materials
X
W24
Instituted better labeling procedures
W25
Instituted clearinghouse to exchange materials that would otherwise
be discarded
W29
Other changes in Inventory control (explain brieflY in comments
W31
Improved storage or stackin procedures
W32
!moved procedures for loading, unloading and transfer operations
W33
Installed overflow alarms or automatic shutoff valves
W34
Installed secondary containment
X
W35
Installed vapor recovery systems
W36
Implemented inspection or monitoring program of potential spill or
leak sources
W39
Others ill and leak prevention (explain briefly in comments
W41
Increased purity of raw materials
W42
Substituted raw materials
W49
Other raw material modifications (explain briefly in comments
X
W51
Instituted recirculation within a process
Title: 1U Wastewater Survey & Permit Application
File name: Z:IC-E1EverestTextilellWorkinglForest City, NOPermitsMastewater PermitMastewater Discharge Survey— Final — BCM.docx
Revision date: 12/30/97 Page 17 of 18

.11:: 0001
Industrial User Wastewater Survey
& Permit Application
Current
Projected
Code
Description
W52
Modified equipment, layout, or RiPing
W53
Use of a different process catal st
W54
Instituted better controls on operating bulk containers to minimize
discarding of empty containers
W55
Changed from small volume containers to bulk containers to
minimize discarding of containers
W58
-eMPV
Other process modifications (explain briefly in comments)
W59
Modified stripping / cleaning equipment
W60
Changed to mechanical stripping / cleaning devices (from solvents or
other materials
X
W61
Changed to a ueous cleaners from solvents or other materials
W62
Reduced the number of solvents used to make waste more amenable
to recycling
W63
Modified containment procedures for cleaning units
W64
improved draining procedures
W65
Redesigned j2arts racks to reduce dra out
W66
Modified or installed rinses stems
W67
improved rinse equipment design
W68
Improved rinse a ui ent o eration
W71
Other cleaning and degreasing operation (explain briefly in comments
W72
Modified spray systems orequipment
W73
Substituted coating materials used
W74
Improved a lication techniques
W751
Changed from spray to others stem
W78
Other surface preparation and finishing (explain briefly in comments
W81
Changed product specifications
W82
Modified design or composition of product
W83
Modified Packa '
W89
Other product modifications ex lain briefly in comments
W99
Y in comments
Other (specl*f
Comments (Please list corresponding code)
Title: IU Wastewater Survey & Permit Application
File name: Z:1C-E1EvesestTexdlellWorldnglForest City, NMermitsMastewater Permit\Wastewater Discharge Survey - Final — BCM.docx
Revision date: 12/30/97 Page 18 of 18

Pairr%-er 0 0 0 6
Industrial User Wastewater Survey
& Permit Application
Part V, Waste Reduction Information :
State Pretreatment Rule 15A NCAC 2H.0916 (c)(1)(M) requires Significant Industrial
Users to include a description of current and projected waste reduction (pollution
prevention) activities. The codes listed are standard EPA codes found on Toxic Release
Inventory and other environmental forms. Please check all applicable codes for your
facility related to wastewater discharge.
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Other changes in operating ractices (explain briefly in comments
W21
Instituted procedures to ensure that materials do not stay in inventory
beyond shelf -life
W22
Began to test outdated material -continue to use if still effective
W23
Eliminated shelf -life requirements for stable materials
W24
Instituted better labeling procedures
W25
Instituted clearinghouse to exchange materials that would otherwise
be discarded
W29
Other changes in Inventory control (explain briefly in comments
W31
Improved storage or stacking procedures
W32
Improved procedures for loading, unloading and transfer operations
W33
Installed overflow alarms or automatic shutoff valves
W34
Installed secondary containment
W35
Installed vapor recov2g systems
W36
Implemented inspection or monitoring program of potential spill or
leak sources
W39
Other spill and leak prevention (explain briefly in comments
W41
Increased purity of raw materials
W42
Substituted raw materials
W49
Other raw material modifications (explain briefly in comments
W51
Instituted recirculation within a process
Title: IU Wastewater Survey & Permit Application
Filename:\\HVD028Fol1commonlForestCity Controlled Documents\EHS\Wastewater12018 PERMIT1Permit Renewal\10-11-
2017 Permit Renewal.docx
Revision date: 12/30/97 Page 19 of 18

Aar Ifer () 006
Industrial User Wastewater Survey
& Permit Application
Current
Projected
Code
Description
✓
W52
Modified equipment, layout, or piping
W53
Use of a different rocess catalyst
W54
Instituted better controls on operating bulk containers to minimize
discardin of empty containers
W55
Changed from small volume containers to bulk containers to
minimize discarding of STpty containers
W58
Other process modifications (explain briefly in comments)
W59
Modified stripping / cleaning equipment
W60
Changed to mechanical stripping / cleaning devices (from solvents or
other materials
W61
Changed to aqueous cleaners from solvents or other materials
W62
Reduced the number of solvents used to make waste more amenable
to recycling
W63
Modified containment procedures for cleaning units
W64
Improved draining procedures
W65
Redesigned parts racks to reduce dra out
W66
Modified or installed rinses stems
W67
Im roved rinse equipment design
W68
Improved rinse equipment operation
W71
Other cleaning and degreasing operation (explain briefly in comments)
W72
Modified Tray systems orequipment
W73
Substituted coating materials used
W74
Improved application techniques
W75
Changed from spray to others stem
W78
Other surface preparation and finishing (explain briefly in comments
W81
Changed product specifications
W82
Modified design or composition of product
W83
Modified pkc4ging
W89
Other product modifications (explain briefly in comments
W99
Other (specify in comments
Comments (Please list corresponding code)
W19, upgraded system with better controls
W52, installed new pumas and wing

Pro Ao, r-, 000 7
Industrial User Wastewater Survey
& Permit Application
Part V, Waste Reduction Information : f
State Pretreatment Rule 15A NCAC 2H.0916 (c)(1)(M) requires Significant Industrial
Users to include a description of current and projected waste reduction (pollution
prevention) activities. The codes listed are standard EPA codes found on Toxic Release
Inventory and other environmental forms. Please check all applicable codes for your
facility related to wastewater discharge.
rurrent Prniprtprl rnapp 'Maprintinn
W 13
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W 14
Changed production schedule to minimize equipment and feedstock
changeovers,
W 19
Other changes in operating ractices ex lain briefly in comments
W21
Instituted procedures to ensure that materials do not stay in inventory
beyond shelf -life
W22
Began to test outdated material -continue to use if still effective
W23
Eliminated shelf -life requirements for stable materials
W24
Instituted better labeling procedures
W25
Instituted clearinghouse to exchange materials that would otherwise
be discarded
W29
Other changes in Inventog control (explain briefly in comments
W31
Improved stora a or stacking rocedures
W32
Improved procedures for loading, unloading and transfer operations
W33
Installed overflow alarms or automatic shutoff valves
W34
Installed secon containment
W35
Installed vapor recovery systems
W36
Implemented inspection or monitoring program of potential spill or
leak sources
W39
Others ill and leak prevention (explain briefly in comments
W41
increased pEri of raw materials
W42
Substituted raw materials
W49
Other raw material modifications (ex lain briefly in comments
W51
Instituted recirculation within a process
Title: IU Wastewater Survey & Permit Application
File name: C:1UsersUaMichael.McCantslAppDatal =W\Microsoft\Windows\INetCache\Content.Outlook128LOAPB611ndustrial
Wastewater Survey IUP Permit Application (Long Form) (002).docx
Revision date: I2JNW Page 19 of 18

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Industrial User Wastewater Survey
& Permit Application
Current
Projected
Code
Description
W52
Modified a ui went, layout, or piping
W53
Use of a different process catalyst
W54
Instituted better controls on operating bulk containers to minimize
discarding of qMpty containers
W55
Changed from small volume containers to bulk containers to
minimise discarding of empty containers
W58
Other process modifications (explain briefly in comments)
W59
Modified stripping/ cleaning equipment
W60
Changed to mechanical stripping / cleaning devices (from solvents or
other materials
W61
Changed to aqueous cleaners from solvents or other materials
W62
Reduced the number of solvents used to make waste more amenable
to recycling
W63
Modified containment procedures for cleaning units
W64
Im roved draining procedures
W65
Redesigned parts racks to reduce dra out
W66
Modified or installed rinses stems
W67
Improved rinse equipment design
W68
Improved rinse equipment operation
W71
plain briefly in comments
Other -cleaning and degreasing operation (ex
W72
Modified spray systems orequipment
W73
Substituted coating materials used
W74
Improved application techniques
W75
Changed from spray to others stem
W78
Other surface preparation and finishing (ex lain briefly in comments
W81
Changed product specifications
W82
Modified design or composition of product
W83
Modified acka '
W89
Other product modifications ex lain brieflyin comments
W99
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(,J,3- -�,"t,- 0 00 5
Industrial User Wastewater Survey
& Permit Application
Part V, Waste Reduction Information :
State Pretreatment Rule 15A NCAC 2H.0916 (c)(1)(M) requires Significant Industrial
Users to include a description of current and projected waste reduction (pollution
prevention) activities. The codes listed are standard EPA codes found on Toxic Release
Inventory and other environmental forms. Please check all applicable codes for your
facility related to wastewater discharge.
Current Proiected Code DescriDtion
W 13
Improved maintenance scheduling recordkee in , or procedures
W 14
Changed production schedule to minimize equipment and feedstock
changeovers
W 19
Other changes in operating ractices (explain briefly in comments
W21
Instituted procedures to ensure that materials do not stay in inventory
beyond shelf -life
W22
Began to test outdated material -continue to use if still effective
W23
Eliminated shelf -life requirements for stable materials
W24
Instituted better labeling procedures
W25
Instituted clearinghouse to exchange materials that would otherwise
be discarded
W29
Other changes in Inventory control (explain briefly in comments
W31
Improved storage or stacking procedures
W32
Improved procedures for loading, unloading and transfer operations
W33
installed overflow alarms or automatic shutoff valves
W34
Installed secondary containment
W35
Installed vapor recoveKy systems
X
W36
Implemented inspection .or monitoring program of potential spill or
leak sources
W39
Others ill and leak prevention (explain briefly m comments
W41
Increased purity of raw materials
W42
Substituted raw materials
W49
Other raw material modifications (explain briefly in comments
W51
Instituted recirculation within a process
Title: IU Wastewater Survey & Permit Application
File name: C:1Userslajhooper\Desktop\lndustrial Wastewater Survey IUP Permit Application (Long Form).docx
Revision date: 12/30/97 Page 20 of 18

(Alai " Koch, 0005
Industrial User Wastewater Survey
& Permit Application
Current
Pro'ected
Code
Description
W52
Modified equipment, layout, or piping
W53
Use of a different process catalyst
W54
Instituted better controls on operating bulk containers to minimize
discarding of empty containers
W55
Changed from small volume containers to bulk containers to
minimize discarding of empty containers
W58
Other process modifications (explain briefly in comments)
W59
Modified stripping / cleaning equipment
W60
Changed to mechanical stripping / cleaning devices (from solvents or
other materials
W61
Changed to aqueous cleaners from solvents or other materials
W62
Reduced the number of solvents used to make waste more amenable
to recycling
W63
Modified containment procedures for cleaning units
W64
Improved draining procedures
W65
Redesigned parts racks to reduce dra out
W66
Modified or installed rinses stems
W67
Improved rinse equipment design
W68
Improved rinse equipment operation
W71
Other cleaning and degreasing operation (explain briefly in comments)
W72
Modified spray systems orequipment
W73
Substituted coating materials used
W74
Improved application techniques
W75
Changed from spray to others stem
W78
Other surface preparation and finishing (explain briefly in comments
W81
Changed product specifications
W82
Modified design or composition of product
W83
Modified packaging
W89
Other product modifications (explain briefly in comments
W99
Other (specify in comments
Comments (Please list corresponding code)
Title: IU Wastewater Survey & Permit Application
File name: C:1Userslajhoopet\Desktop\Industrial Wastewater Survey IUP Permit Application (Long Form).docx
Revision date: 12/30/97 Page 21 of 218

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Prot reattumt Program. Info l e
for Program Name Forest City r
WWTP Name Town of Forest City I ,
Program Approval Date 03/15/1983
Pretreatment Status Full
Region ARO
County Rutherford
NPDES Number
printed on: 12/22/2020
IWC % at 7Q10 18.05
ow cfs / mgd 34.8 / 22.48
1Q10 Flow cfs / mgd 28.62 / 18.49
Stream Classification WS-IV
Basin Number BRD02
Receiving Stream Name SECOND BROAD RIVER
NPDES Effective Date 04/01/2016 NC0025984 Last PAR Red 02/18/2020
mercury
PAR Due Date 03/01/2021 m1631
Current Fiscal 05/01/2019
Expire Date 07/31/2019 Year PCI Done
requiredNPDES
es
POTW is Primary WWTP TRUE Last Audit on 02/09/2017
Audit Year Next21/22
Design Flow mgd 4.9500 % Design mgd is SIU permitted F23237
Permitted SIU flow (mgd) [Pt_SIU) 1.15
VWVTP SIU's
P Program SIUs '-
'I
�'�•`�
WWTP CIU's
Program CIUs LTMP
pI
IWS. SUO 7
date Inactive Date Next Due 03/01/2024
09/01/2023 0
Date Received by DWR 08/16/201-81 08/22/2018
08/31/2018 ', 12/31/2012 F 10/28/2019
Date Approved 0 /17/2018 08/29/2018
10/05/2018 j 02/25/2013 02/05/2020
Adopt Date Required
Date Adopted
02/18/2013.
Info in this Box from Pt Contacts Date Date Date
PT Pro Attended Attended Attended
Formal Name 9.Prime Phonel ext Fax HWA Wksp IUP Wksp PAR Wksp
Mr. Sonny Person
1 11(828)248-5217
1 [phone] 11
1
11/26/2010
[e-mail] JORC JPC, Box 728 8043
Mr. Jeff Dotson
1 11(828)
248-5217 1
1(828) 247-1626 11
1
1 1/26/2010
P.O. Box 728 8043
Mr. Jacob Hodge 1prim
28-289-0115
10124/2013
6/13/2012
[e-mail] Pretreatment Coordinator PO Box 728 8043
Mr. Thomas Wilson
I 6/13/2012
[e-mail] IPO Box 728 8043
DWR Central Office Contact Vivien Zhong
DWR Regional Contact IMikal Willmar

Piretmat mt Program lufoiRvAse
for Program Name Forest City r
WWiP Name Riverstone Industrial Park I 1
Program Approval Date
NPDES
03/15/1983
Pretreatment Status
Full
Region
ARO
County
Rutherford
N b
printed on: 12/22/2020
IWC % at 7Q10 0.08
ow cis /mgd 195 / 125.97
1Q10 Flow cfs / mgd 158.43 / 102.39
Stream Classification C
Basin Number BRD02
Receiving Stream Name Broad River
um er NCO087084
Last PAR Rec 02/18/2020
PAR Due Date 03/01/2021
mercury
NPDES Effective Date 08/01/2018
1631
NPDES Expire Date 07/31/2023
Current Fiscal
05/01/2019
Year PCI Done
required
Fes
POTW is Primary WWFALSE
Last Audit on 02/09/2017
Audit Year Nex
t21/22TP
Design Flow mgd 0.1000 % Design mgd is SIU permitted 10.00
Permitted SIU flow (mgd) [Pt_SIU) .01
WWTP SIU's
P Program SIUs
- �
� �—
WJJiP CIU's
Program CIUs `"`�LL��JJJ
R
LTMP
�
IWS SUO
date Inactive Data Next Due 12/31/2022
09/01/2023
r�
Date Received by DWR
01/24/2018 10/28/2014
08/31/2018 12/31/2012
10/28/2019
Date Approved
02/08/2018 �',• 12/29/2014
10/05/2018 02/25/2013
02/05/2020
Adopt Date Required
Date Adopted
02/18/2013
Info in this Box from Pt Contacts Date Date Date
PT —Pro Attended. Attended Attended
Formal Name n Pri Phonel ext Fax HWA Wkso II IP Wksn PAR Wksn
Mr. Sonny Person
1 11(828)248-5217
1
828)247-1626 1
L—TPLOBox
1 1/2612010
[e-mail] JORC
728 8043
Mr. Jeff Dotson
1 11(828)
248-5217
828) 247-1626
1/26/2010
P.O.Box 728 8043
Mr. Jacob Hodge
Prim
28-289-0115
10/24/2013
6/13/2012
[e-mail] I Pretreatment Coordinator JPO Box 728 8043
Mr. Thomas Wilson
1 6/13/2012
[e-mail] JPO Box 728 8043
DWR Central Office Contact ivien Zhong
DWR Regional Contact IMikal %milmer

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SIU INSPECTION FORM
Name Of Industry: AA A✓ + w G 1 A c IUP # 000 r
Address Of Industry: �o vjt I P xpiration Date:
ro C
Industry Re resentativf II f Title L 1 ��j
C h a� �1 — L w.L 6 l r-;dl!/ t v� 0K W'q -mot + A ►Qdaq'-Q ✓'
POTW retatives: T' e
a se Lie
Date Of Inspection: 1�- -y- Time Of Inspection: C7100 QIpm
Purpose of Inspection: Annual ther (Describe Q 70 br
POTW to which IU discharges W LV NPDES #
IsU currently in SNC? N If yes, for what? I
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES /
Raw materials used YES /
Manufacturing processes YES /
Categorical, if applicable YES / NO
Production rate NO 76 r
Number of employees NO
Number of shifts YES / NO
Comments: Asuow: 01 $0%&4?jeS
00. CAcC-; 11
40 .40/f-
aex+ wec' a—
roud5 0-F 3 dad!
C6VjFM►*4#%s
CSag�a���wl
saMJf1W)
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? 1(Q NO Where do they go? 4 Z r s;
2. Are production areas diked, contai d, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? YNO Comments:
3. AreS there oor drains in the storage area? l� / NO Where do they go? -e f
e
4. Are storage tanks and areas diked, contained, or otherwise constructed in such a wa36W4�
to prevnt harm to the
WWTP, especially from spills or slugs? Y� NO Comments: a .IC v
r0 C /
5. Are proless and storage tanks and pipes labeled? CUIS4 NO
6. Hcyyv�re off?pec w materials, an ro ucts tsposed
/'' l a ✓► Tac -iti �Q of =ial � ,JL is k U/Q.I
7. When is the production area cleaned? "I �
8. Is the wastewater from cleaning the production area disc6arged to the POW. YESI/
9. What non -process wastewaters are discharged to POTW? n. j. P
Comments:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-1)
Revision data: August 1, 1994 Page I

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the systena? YES / NO Comments:
2. Are all units operatidnal? YES / NO '
3. How often does operator/maintenance person check system? C-o n 4-,r* -k o vs
4. Is there an operator for each shift? YES / N
fl
5. How and when is slud a disposed V U/u Csn G d Pdl ��
S Ad C4
6. Is there a schedule for preventative maintenance? YES / NO
Comments:
PART II - Plant Tour Section C - SAMPLING POINTS) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? 6RWO If yes, name of lab. I
2. if' dustry comple es sampling,,a k the industry rrepresenta ' r escrribe sa lin procedures. Comments:
[[ 6 ii..
3. Is flowAtn surement equip ent operatipnaJ NO Comments:
4. Is there Ycalibration log for the flokv meter? YES / NO Comments:
Comments: CRC t'[. t A q a �&Lfi- &Ce-tZ 40 d j(/-1 Vt x Or
4rok RS of ; T w i n w T I
PART III - EXIT INTERVIEW
Review monitoring records and other SIU records required by IUP/
1. Are files well organized? �/ NO Comments: 0A l � Imo. st' U
Ut
2. Are sample collection / chain -of -custody forms filled out properly? / NO Comments:
3. Do results in files agree with reports sent to POTW? %y.FS 1 NO Comments:
4. has authori.o $hut down rodugtion s ,uld a spill or slug discharge occur?
(. d
5. How does SIU inform employes ofluv)io� to call at OTW in case of spill/slug?
If slug/spill plan is already required by POTW, review procedures.
6. Is SIU imilementing slug/spill plan? YES / NO Comments: j 11 a 14 GC•
Comments: Sd �Mi :
INSPECTION RESULTS
Slug/Spill Control Plan Needed? YES / NO
Comments, Required Or Recommended Actions:
Signature Of Inspectors)
zrPe
TAW I ace
Date: 4 - E •o�O
Date:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 2

SIU INSPECTION FORM
Name Of Industry: f a44 C o r IUP # Gd a a —
Address Of Industry: IUP E Oration Date:
r C a- u+f3
Indus tr rAr-0110
Representatives: tie
POTj�� Representatives: TttU
(vlGy'�C V/'
Date Of Inspection: Time Of Inspection: T010 am/pm
Purpose of Inspection. Annual Other (D cribe)
POTW to which IU discharges O G wv NPDES # AIC 00
Is SIU currently in SNC? If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product
YES / 4P
Raw materials used
YES / to
Manufacturing processes
YES /&P
Categorical, if applicable
YES / NO
Production rate
4D / NO
Number of employees
Number of shifts
<M/ NO
el'a/ NO
Comments: 0 1 a 7p- P �oe�,lJ o'✓1 5 j �`
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Aretherefloor drains in the produ on area?j - 7 I NO Where do they go?
.L.r.�.l. e ✓' �-- (/1/ W fi ex v 7'� m .,J_ �- � '610 lily 4A
2. Are production areas diked, contained, or otherwise constructed in s}tc�i a �]'ay ZA1,41--cyr
prevent harm to the P,
especially from spills or slugs? � NO Comments: 4.*t tri �IJ' p j nvT
3. Are there floor drains in the storage area? YES / Where do they go?
4. Are storage tanks and areas diked, contained or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? iv/4 O Comments:
5. Are process and storage tanks and pipes labeled? NO
6. How are off -spec raw materials, and products disposed o . 2f i (4 -e_
7. When is the production area cleaned? V n,
8. Is the wastewater from cleaning the production area disch
9. What non-process,wastewaters are discharged to POTW?
Comments:
t the PO ? YE / NO
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? (Cu) NO Comments:
2. Are all units operational? `�.]=S��0
3. How often does operator/maintenance pS=ozcheck system?
4. Is there an operator for each shift? 6
gt5ow0 L,*A
5. How and when is sludge disposed of? ,trls Sf11 ,L 1'AD [� Imo,-
6. Is there a schedule for preventative maintenance? NO �v [ ���,, year G-o w
Comments: w -V-
PART II - Plant Tour Section C - SAMPLING POINTS) AND FLOW MEASUREMENT
(Collect a sample if desired.) i
1. Does an outside lab complete sampling? / NO If yes, name of lab. A Mai bit C
2. If industry completes sampling, ask the industry representative to describe sampling Pro edures. Comments: 5mmpt
3. Is flow measurement equipmy�=operationaL7 � � / NO Comments:
4. Is there a calibration to f(,.�t// aLow metP
9 YES / NO Comments:
g W 4 de.�
Comments:
PART III - EXIT INTERVIEW
Review monitoring records and er SIU records required by IUP.
1. Are files well organized? W/ NO Comments:
2. Are sample collection / chain -of -custody forms filled out properly? / NO Comments:
3. Do results in files agree with reports sent to POTW? OLF..Vl NO Comments:
4. o as author" to shut down pr�oductiPn should a spill or slug discharge occur?
/� Id1a( .d L-f�
5. How does SIU inform employees of whomto call at POTW in case of spill/slug?
If slug/spill plan is already required by POTW, review procedures.
6. Is SIU implementing slug/spill plan? O Commen : sd
e-wwt t i t r,e -fit=' tee_ t'JEL4Cowt iQ'4k
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? YES / NO /
Comments, Required Or Recommended Actions: n j C
Signature Of Inspector(s) Date: t f'-,)j-U
Date:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 2

SIU INSPECTION FORM
Name Of Industry: IUP # 06101
Address Of Industry: 131 ul. /til,,,; S 4. IUP Expiration Date:
�o.psf cAIC 2-1re.)g S-
Industry Representatives: Title
'L
POTW Representatives: Tithe
'Geoll Ltad a P �id.'t �na�rtttr f ' Ceo�C�
Date Of Inspection: it -,2.4. s a Time Of Inspection: 01700 am/pm
Purpose of Inspection: Annual ✓ Other (Describe)
POTW to which IU discharges n2 rC W UITp NPDES # NCOOdSON q
Is SIU currently in SNC? /V /A If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES / bV
Raw materials used YES / 4P
Manufacturing processes YES / Iq
Categorical, if applicable YES / NO
Production rate / NO
Number of employees / NO
Number of shifts YES / NO '9L �s
Comments: P iO A/G T c-o/1 A ICVP4 P * , W Y 44 GCl ut d
ei 'cu O�-V.S LA�er-e.
i s k. IOatk P u/ rM i t �-ur �- lvtckd fit),
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area CO / NO Where do they go? -j6 OA- F
2. Are production areas diked, contained, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? YES / Q, Comments: Cee Rbovk
3. Are there floor drai1#-RA
in the storage area? PINO Where do they go? +jie ! ail 1�awe
d_Irrn6A 0 e.oJ
4. Are storage tanks and areas diced, `l oniat , or otAc!rwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? ta/ NO Comments:
5. Are process and storage tanks and pipes labeled? V.91 NO p
6. How are off -spec raw materials, and products disposed of?
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production are discharged to the POTW? YES / CCU e f
9. What non -process wastewaters are discharged to POTW? ja L ar a-�.
Comments:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? / NO Comments:
2. Are all units operational? )(LD NO
3. How often does operator/maintenance person check system? r&
4. Is there an operator for each shift? �G/ NO
5. How and when is sludge disposed of?akC4 #
6.' Is there a schedule for preventaKe /maintenance? VES /0
C mments: -2.C.o rn Wl¢.vj Q G� !it � at ec"i (/i �` d �e pA
Ki 014 i n 5 vW 4txz e S i tl n l/� � (J )j�I t S-�n�r/� (i +Q ' v ✓' °, oil 00 -C
PART II - Plant Tour Section C - SAMPLING POINTS) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? �/ NO If yes, name of lab. �S
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3. Is flow measureMent equipment operational? YES / NO Continents:
W,LJW Ilke+vr
4. Is there a calibration log for the flow meter? ES/NO Comments:
Comments:
PART III - EXIT INTERVIEW
Review monitoring records and other SIU records required by IUP.
1. Are files well organized? 0 / NO Comments:
2. Are sample collection / chain -of -custody forms filled out properly? / NO Comments:
3. Do results in files agree with reports sent to POTW? (XgeNo Comments:
4. Who has lanuthori Ltofs ut do roductio1n1 should a stUill or slug discharge occur?
,)nT A Ckt dv-% im&4 L+,..nL. ..lif.len 1 Qe A
5. How does SIU inform employees of/whom to still at POTW in case of spill/slug?
F'. Al. 5.
If slug/spill plan is already required by POTW, review procedures.
6. Is SIU/ implementing slug/spill plan? V!a/ NO Comments: V gA � & ,ta A m f
at V% SerJenc-, N
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? 6R/ NO
Comments, Required Or Recommended Actions: up old 4 t'nci ner rr�l'�
5 QAd
Signature Of Inspectors)
Date: t l - �Lq-�d
Date:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 2

SIU INSPECTION FORM
Name Of Industry:
Address Of Industry: _
IUP # nad
IU Expi ati Date:
Industry Repre� illtives: tl 1_ ' /� Title
II f►<< E 14J /0a s t ei-
U 1 t/Y.l
POT epresentaii ` tle,1. J
Date Of Inspection: 1 - G " Time Of Inspection: D 0/0 D (Wpm
Purpose of Inspection: Annual f Other (Describe)
POTW to which IU discharges U/IF NPDES # Al C. dads 9s�f
Is SIU currently in SNC? If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product
Raw materials used
Manufacturing processes
Categorical, if applicable
Production rate
Number of employees
Number of shifts
Comments: P ` O5
YES / 40)
YES /
YES / NO
YES / N�
YES / NO 0L d a/o
YES/N
YES / NO '-u
(t rz do1,tl '1' 6 �
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? YES /0 Where do they go?
2. Are production areas diked, conta or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs. O Comments:
3. Are there floor drains in the storage area? YES / � Where do they go?
4. Are storage tanks and areas diked, contai r otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? Comments:
5. Are process and storage tanks and pipes labeled? of
6. How are off -spec raw materials, and products dispose @9
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production area
9. What non -process wastewaters are discharged to PC
Comments:
,ed1#141gle'e
the POTW? YES / NO It - cu
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? ES NO Comments:
2.
3.
4.
5.
6. Is there a schedule for preventative maintenance? )(PNO I -pie. r .51S
Comments:
Are all units operational? Y/EVNO
How often does operator/main nance p,e,=,n check system? �/t R
Is there an operator for each shift? �LNO ,
How and when is sludge disposed of?. C, 5 J Q e4144
PART II - Plant Tour Section C - SAMPLING POINTS) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES A;;Z If yes, name of lab.
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3. Is flow measurement equipment operational? WNO Comments:
4. Is there a / alibrati n log for & Cow me (r? � NO Comments:
Comments:
PART III - EXIT INTERVIEW
Review monitoring records an SIU records required by IUP.
1. Are files well organized / NO Comments:
2. Are sample collection / chaff -of -custody forms filled out properly? / NO Comments:
3. Do results in files agree with reports sent to POTW? / NO Comments:
4. Who has authority yttos but down produc i �Ihould a sp'll or sluff di h ge occur?
W4090 ,tA
5. Ho does SJU info employees f whom to L11 at OTW in case of spill/slug?
If slug/spill plan is already required by POTW review procedures. S 6. Is SIU implementing slug/spill plan? �/ NO Comments:-0k &
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? / NO l J
Comments, Required Or Recommengections: fm A I� ` ; /b G )odd Co 1/4
Signature Of Inspector(s)
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
Date: a -16 - d Q
Date:
Page 2

SIU INSPECTION FORM
Name Of Industry: IUP #
Address Of Industry: IUP Expiration Date:
Al
Industry Representatives: Title
�L/Aa���'�( Mc C4��s 14S /11ce61am.Q1-000"
POTW Re pre entatives: Title
Date Of Inspection: Q Time Of Inspection: f) i0o ffpm
Purpose of Inspection: Annual Other (Describe) 6 St PgZ to o -,K
POTW to which IU discharges a . S. LV l,t) rt_h NPDES # , 2 C pn s:3 e 1nd-
Is SIU currently in SNC? If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product
YES /
Raw materials used
YES /
Manufacturing processes
YES / 14D
Categorical, if applicable
YES / NO
Production rate
YES / V
Number of employees
YES / NO
Number of shifts YES / NO
Comments: o c4 Pow-^ d—,
.01
::C—F at f/ /+e.. ca o r
�T a� e
Pet"%; T
ojawl WQ WIN �lSI•�
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? YES /� Where do they go?
2. Are production areas diked, contained, or otherwise constructed in
especially from spills or slugs? (0 / NO Comments:
a way as to prevent harm to the WWTP,
3. Are there floor drains in the storage area? YES ItKD Where do they go?
4. Are storage tanks and areas diked, containqLZr otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? YIO Comments:
5. Are process and storage tanks and pipes labeled?
6. How are off -spec raw materials, and products dis
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production area disdh
9. What non -process wastewaters are discharged to POTW?
Comments:
/NO
Lty V&I11� Gf
irged to the POTW? NO
f �'1 an ...�. ems- .. [� K► na � ✓t
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? jam$ / NO Comments:
2. Are all units operational? O / NO
3. How often does operator/main` a ance person check system? W kf-n
4. Is there an operator for each shift? (%R� / NO
5. How and when is sludge disposed of? G, Q55
6. Is there a schedule for preventative maintenance? YES / &5 pis p1 �.e 4 vp�
Comments: CovA4 A(/-e 4, rv✓1 iet I_ am 4.6vV9ti .S/ 4evn
PART II - Plant Tour Section C - SAMPLING POINTS) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? (17/ NO If yes, name of lab. CA f c
2. If industry completes sampling, ask the industry representative to describe sampling p�bcedures. Comments:
3. Is flow measuremen equip pnt operatio al?4N Comments:
4. Is there a calibration log for the fl meter? YFS / O Comments:
Comments:
S IM..9mrA "=171A
PART III - EXIT INTERVIEW
Review monitoring records and other SIU records required by IUP.
1. Are files well organized? j F2/ NO Comments:
2. Are sample collection / chain -of -custody forms filled out properly? xE,5)/ NO Comments:
3. Do results in files agree with reports sent to POTW?(gEyS,/ NO Comments:
4. Who has authority to shut down production should n mill or slug di
5. How
.4pes SIU inforn f emplo♦ye�s Qf w�om to fall at POTW in cash of spill/slug?
If slug/spill plan is already required by POTW, review procedures.
6. Is SIU implementing slug/spill plan? (M? NO Comments:
Comments: _ _ I .
INSPECTION RESULTS
Slug/Spill Control Plan Needed? YES / NO
Comments, Required Or Recommended Actions:
2. WIAA
ignature Of Inspector(s)
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
, o^4 5411 I1 / s (u�► OC u d1
;h PLa&e
Jdr,d (A k 1 A a Pf eo�S ]eta r., 4o,
,heind 4a Q ui-C., 61 4'er"%'kof
Date: nae,�e)
Date: ) 1-1 fr' ;d
Page 2

SIU INSPECTION FORM
Name Of Industry: (il/ IUP # a C9
Address Of Industry: Expiration Date:
Industry Representatives: Title
AN' ; ov11 AA a!1!m or
POTW Rsentative : T' le e re
Date Of Inspection: — 1 Time Of Inspection: 10 I 7: ®6pm
Purpose of Inspection: Annual Other (Describ
POTW to which IU discharges C7C, W tAl t P NPDES # G 0 4 a—S c l Yq
Is SIU currently in SNC? VOLA If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES /
Raw materials used YES /ESP
Manufacturing processes YES /NO
Categorical, if applicable YES /
Production rate MS
Number of employees I NO
Number of shifts NO i + ;Ls-hAs
Comments:
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? �NO Where do they go? /' �►��a A
2. Are production areas diked, conta' ed, or otherwise constructp4 in such a way
especially fro 400r-raain
o slu E NO Comments: tk
3. Are there s inthe storage are ! YES / NO Where do they go?
to prevent harm to he WWTP,
tub �iCc t p
4. Are storage tanks and areas diked, contained or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? �0 Comments:
5. Are process and storage tanks and pipes labeled? YES / NO
6. How are off -spec raw materials, and products disposed of? Q,/r
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production area discharged Athe POT ? Y r
/ 1�jE�
9. What non process wastewaters are discharged to POTW? ij r" GV►�^ ,I�'ddii�
Comments:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
Page I

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? (!PNO Comments:
2. Are all units operational? / NO
3. How often does operator/maintenance person check system? k cr% iVVl h
4. Is there an operator for each shift? E / NO
5. How and when is sludge disposed of?
-ho
6. Is there a schedule for preventative maintenance? YES / NO
Comments:
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES / NO If yes, name of lab. L
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3. Is flow measurement equipment operational? NO Comments:
4. Is there a calibration log for the flow meter? 11M / NO Comments:
Comments:
PART III - EXIT INTERVIEW
Review monitoring records and other SIU records required by IUP.
1. Are files well organized? (5�NO Comments:
2. Are sample collection / chain -of -custody forms filled out properly? NO Comments:
3. Do results in files agree with reports sent to POTW? Tj%$d NO Comments:
in case of spill/slug?
If slug/spill "plan is lilready required by POTW, review procedures.
6. Is SIU implementing slug/spill plan? YES / NO Comments:
Comments:
I Sa IL ISG
.T
INSPECTION RESULTS
Slug/Spill Control Plan Needed? YES / NO
Comments, Required Or Recommended Actions:
Signature Of Inspector(s)
Date:
Date:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 2