WQ0031725_Renewal Application_20210225

Initial Review
Reviewer Thornburg, Nathaniel
Is this submittal an application? (Excluding additional information.)*
r Yes r No
Permit Number (IR)* WQ0031725
Applicant/Permittee Scott Overbeck
Applicant/Permittee Address PO Box 1390 Marion, NC 28752
Is the owner in BIMS? r Yes r No Is the facility in BIMS? r Yes r No
Owner Type Organization
Facility Name Baxter Healthcare Corporation
County McDowell
Fee Category Minor
Is this a complete
application?*
r Yes r No
Signature Authority
Signature Authority Title
Signature Authority Email
Document Type (if non -application)
Email Notifications
Does this need review bythe hydrogeologist?* r Yes r No
Regional Office
CO Reviewer
Admin Reviewer
Fee Amount $0
Complete App Date 02/25/2021
Below list any additional email address that need notification about a new project.
Email Address
Comments to be added to email notfication
Comments for Kendall
Comments for RO

Comments for Reviewer
Comments for Applicant

Submittal Form
Project Contact Information
Rease provide information on the person to be contacted by NI3 Staff
Name * Zach Key
Email Address*
[e-mail]
electronic subnittal, confirmation of receipt, and other correspondence.
Project Information
........ .....................................................................................................................................................
Application/Document Type* r New (Fee Req ui red)
r Modification - Major (Fee Required)
r Renewal with Major Modification (Fee
Required)
r Annual Report
r Additional Information
r Other
Phone Number*
3369577871
O Modification - Minor
G Renewal
C GW-59, NDMR, NDMLR, NDAR-1,
NDAR-2
r Residual Annual Report
r Change of Ownership
We no longer accept these monitoring reports through this portal. Please click on the link below and it will take you to the correct form.
https://edocs.deq.nc.gov/Forms/NonDischarge_Monitoring_Report
Permit Type:*
r Wastewater Irrigation
r High -Rate Infiltration
r Other Wastewater
r Reclaimed Water
r Closed -Loop Recycle
r Residuals
r Single -Family Residence Wastewater
r Other
Irrigation
Permit Number:*
WQ0031725
Has Current Existing permt number
Applicant/Permittee*
Scott Overbeck
Applicant/Permittee Address*
PO Box 1390 Marion, NC 28752
Facility Name *
Baxter Healthcare Corporation RLAP
Please provide comments/notes
on your current submittal below.
Attached is the land application permit
WQ0031725 renewal for Baxter Healthcare
Corporation
At this time, paper copies are no longer required. If you have any questions about what is required, please contact Nathaniel Thornburg
at [e-mail].
Please attach all information required or requested for this submittal to be reviewed here.*
(Application Form Engineering Hans, Specifications, Calculations, Bc.)
WQ0031725 Renewal.pdf 6.39MB
Upload only 1 RCFdocurrent (less than 250 NE). Nuftiple documents nest be corrbined into one RJFfile unless file is larger than
upload limit.
* W By checking this box, I acknowledge that I understand the application will not be
accepted for pre -review until the fee (if required) has been received by the Non -
Discharge Branch. Application fees must be submitted by check or money order
and made payable to the North Carolina Department of Environmental Quality
(NCDEQ). I also confirm that the uploaded document is a single PDF with all parts
of the application in correct order (as specified by the application).
Mail payment to:
NCDEQ — Division of Water Resources
Attn: Non -Discharge Branch
1617 Mail Service Center
Raleigh, NC 27699-1617
Signature

Submission Date 2/25/2021

PO Box 146 Ronda, NC 28670
336-777-6909
vvvwv.usbiosolids.corri
Monday, February 22, 2021
North Carolina Department of Environmental Quality
Division of Water Resources
Water Quality Permitting Section
Non -Discharge Permitting Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Reference: Permit Renewal for Baxter Healthcare Corporation
Land Application Permit No. WQ0031725
Baxter Healthcare Corporation is applying for a renewal of its current land application permit
WQ0031725.
There are no changes in this permit renewal package since the last issuance.
Your attention to this permit application package is greatly appreciated. If you have any questions or
concerns, please feel free to contact me at 336-957-7871 or at [e-mail]
Sincerely,
Zach Key
US 8iosolids, Inc.

State of North Carolina
1111117M DWDepartment of Environmental Quality KDivision of Water Resources
Division of Water Resources 15A NCAC 02T.] 100 — RESIDUALS LAND APPLICATION PROGRAM
INSTRUCTIONS FOR FORM: RLAP 06-16 & SUPPORTING DOCUMENTATION
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
summirtinz documentation
P'or more information, visit the R Rater Quality Perntining Section's Xon-Dischat e Pernutlink Unit
General — This application is for treatment, storage, transport, and/or land application of Class B residuals (may include residuals that
are generated from a water treatment plant or other type facilities) on the proposed or currently approved land application site(s) under
15A NCAC 02T .I 100.
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Land Application Program (FORM: RLAP 06-16) Application: (AII Application Packages):
❑ Submit the completed and appropriately executed Residuals Land Application Program (FORM: RLAP 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ The Applicant's Certification on Page 5 of this form shall be signed in accordance with 15A NCAC 02T .0106(b). An alternate
person may be designated as the signing official if a delegation letter is provided from a person who meets the criteria in 15A
NCAC 02T .0106(b).
❑ if this project is for a modification of an existing permit, submit one copy of the existing permit.
❑ Please submit this application form at least I $0 days prior to the expiration date on the existing permit, or 90 clads prior to
operation of proposed facility(ies) for application packages involving new or changes to treatment and storage units.
B. Application Fee (New and Major Modification Application Packages)
[� Submit a check, money order or electronic funds transfer made payable to: North Carolina Department of Environmental
Quality (NCDEQ).
Facility Classification New Permit Major Modification'
Major (land are permitted for = 300 acres) $1,310 $395
Minor (land are permitted for < 300 acres) $810 S245
° - A major modification shall be defined as any perrait modification that: increases the generating facility's residuals dry tonnage, -
adds additional land application areas not previously approved for that particular program [including transferring of field(s) from
one program to another]; adds additional residuals sources. or includes the addition of new treatment or storage units/processes not
previously permitted. There is no fee for minor modifications to a permit.
C. Cover Letter (All Application Packages)
❑ List all items included in the application package, as well as a brief description of the requested permitting action.
D. Environmental Assessments (May be Required — See 15A NCAC IC .0300)
❑ Submit a copy of the Findings of No Significant Impact (FONSI) or Environmental Impact Statement (EIS). Also, include
information on any mitigating factor(s) from the Environmental Assessment (EA) that impact the construction of the residuals
treatment and storage facilities. An EA may also be required for private systems ifany public funds and/or lands are used for
the construction of the subject facilities.
INSTRUCTIONS FOR FORM: RLAP 06-16 Page I of3

E. Operation and Maintenance Plan (New and Renewal Application Packages)
For Modification Application, if there are any changes to the existing plan, submit an updated O&M plan.
Submit the O&M Plan in accordance with 15A NCAC 02T .I 110 and include at a minimum:
❑ Operational functions; describe the operation of the program to show what operations are necessary for the program to
function and by whom the functions are to be conducted.
❑ Maintenance schedules; may include equipment calibration, maintenance of signs, etc.
Safety measures; may include safety training program, manuals, signs, etc.
[❑ Spill response plan; including control, containment, remediation, emergency contact information, etc.
❑ Inspection plan including the following information;
❑ Names and titles of personnel responsible for conducting the inspections.
❑ Frequency and location of inspections, including those to be conducted by the ORC, and procedures to assure that the
selected location(s) and inspection frequency are representative of the residuals management program.
❑ Detailed description of inspection procedures including record keeping and actions to be taken by the inspector in the event
that noncompliance is observed.
Sampling and monitoring plan including the following information;
Names and titles of personnel responsible for conducting the sampling and monitoring.
❑ Detailed description of monitoring procedures including parameters to be monitored.
[❑ Sampling frequency and procedures to assure that representative samples are being collected. Fluctuation in temperature,
flow, and other operating conditions can affect the quality of the residuals gathered during a particular sampling event. The
sampling plan shall account for any foreseen fluctuations in residuals quality and indicate the most limiting times for
residuals to meet pathogen and vector attraction reduction requirements (e.g. facilities that land apply multiple times per
year but have an annual sampling frequency, may need to sample during winter months when pathogen reduction is most
likely to be negatively affected by cold temperatures.
THE FOLLOWING ADDITIONAL ITEMS (G to M) ARE REQUIRED FOR DEDICATED PROGRAM ONLY.
F. Program Determination
❑ Dedicated residuals land application programs are ones in which land application sites meet the criteria in 15A NCAC 02T
.1102(121. Specifically, a residuals land application program is designated as dedicated if"any of the following are applicable:
❑ Any land application site certified for the residuals land application program that receives residuals at rates or frequencies
greater than agronomic rates.
❑ Any land application site certified for the residuals land application program that is used primarily for residuals disposal,
and agricultural crop production is of secondary importance.
❑ Any land application site certified for the residuals land application program that receives residuals through fixed irrigation
facilities or irrigation facilities fed through a fixed supply system.
❑ Please contact the Non -Discharge Permitting Unit if you need any assistance in determining whether your residuals program
falls under the dedicated program definitions.
G. Program Information
❑ Provide an explanation of why a dedicated system is required instead of a conventional non -dedicated system.
❑ Provide an explanation of the dedicated system and its operation.
H. Detailed Site Maps i All New or Modification Application Packages)
❑ Submit three (3) sets of standard size plans and two (2) sets of I I" by 17" plans (electronic format is acceptable - Adobe PDF
only). For Modifications, submit plans specific to the modification(s) only.
❑ Plans must include the following minimum items:
❑ A general location map, a vicinity map and a topographic map with contours not exceeding 10 feet or 25% of the total site
relief and showing all facility related structures and fences within the land application area.
❑ The location of all wells (including usage and construction details if available), streams (ephemeral, intermittent, and
perennial), springs, lakes, ponds, and other surface drainage features within 500 feet of the land application site(s).
❑ Delineation of the review and compliance boundaries
❑ Setbacks as required by 15A NCAC 02T.1108
❑ Site property boundaries within 500 feet of all waste treatment, storage, and disposal site(s).
❑ A map showing the entire irrigation area with an overlay of the suitable irrigation area depicted by the soil scientist's
evaluation. The irrigation plans shall show each nozzle/emitter and wetted area (when applicable). Clearly label spray
irrigation zones as they will be operated.
❑ Plans must depict a completed design and not be labeled with preliminary phrases (e.g., FOR REVIEW ONLY, NOT FOR
CONSTRUCTION, etc.) that indicate that they are anything other than final plans. However, the plans may be labeled with
the phrase: FINAL DESIGN - NOT RELEASED FOR CONSTRUCTION
INSTRUCTIONS FOR FORM: RL.AP 06-I6 Page 2 of

11
J.
K.
L.
Project Evaluation and Receiver Site Management Plan (All New Application Packages or Modifications that include new sites)
Submit a project evaluation and a receiver site management plan (if applicable) with recommendations concerning cover crops
and their ability to accept the proposed application rates.
Hydrogeologic Report (All New Application Packages or Modifications involving increasing the total design capacity)
❑ Submit a detailed hydrogeologic evaluation in accordance with 15A NCAC.02'1'..l 104(d){4) and current Division Policy
available at: htti)://www.newater.org/Rules Policies and Re ulations/. The document shall be signed, sealed and dated by a
qualified professional.
Engineering Design Documents (All New or Modification Application Packages with fixed irrigation facilities or irrigation
facilities fed through fixed supply system)
❑ Submit engineering design documents that have been signed, sealed, and dated by a NC licensed Professional Engineer and/or
Professional Land Surveyor in accordance with 15A NCAC 02T .1104(d)(2), For Modifications, submit an updated site map
specific to the modification(s) only.
❑ The design documents most include the following minimum items:
❑ Engineering plans for the facility and equipment except those previously permitted unless they are directly tied into the new
units or are critical to the understanding of the complete process;
❑ Specifications describing materials to be used, method of construction, and means for ensuring quality and integrity of the
finished product including leaking testing; and
❑ Engineering calculations including hydraulic and pollutant loading, sizing criteria, hydraulic profile, total dynamic head
curve analysis for each pump, and irrigation design.
❑ Soil mapping units shown on all disposal sites.
Water Balance (All New Application Packages or Modifications that include new sites utilizing fixed irrigation facilities or
irrigation facilities fed through fixed supply systems)
❑ Submit a completed and accurate water balance in accordance with 15A NCAC 021' .l 104(d)(5) and current Division Policy
available at: http://www.newater.orp,/Roles Policies and Re ulations/.
Property Ownership Documentation (All New or Modification Application Packages involving new and/or relocated treatment
or irrigation components)
❑ Property ownership documentation shall consist of one of the following:
❑ Legal documentation of ownership (i.e.. GIS, deed or article of incorporation), or
❑ Written notarized intent to purchase agreement signed by both parties with a plat or survey map, or
An easement running with the land specifically indicating the intended use of the property and meeting the requirements of
15A NCAC 02L .0107(f), or
❑ A written notarized lease agreement signed by both parties, indicating the intended use of the property, as well as a plat or
survey map.
ONE ORIGINAL AND TWO COPIES OF THE COMPLETEDAPPLICATION PACKAGE, INCLUDING ALL
SUPPORTING INFORMATION AND MATERIALS, SHALL BE SENT TO THE FOLLOWING ADDRESS:
NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
DIVISION OF WATER RESOURCES
WATER QUALITY PERMITTING SECTION
NON -DISCHARGE PERMITTING UNIT
By U.S. Postal Service:
1617 MAIL SERVICE CENTER
RALEIGH, NORTH CAROLINA 27699-1617
TELEPHONE NUMBER: [phone]
By Courier/Special Delivery:
512 N. SALISBURV STREET
RALEIGH, NORTH CAROLINA 27604
FAX NUMBER: [phone]
INSTRUCTIONS FOR FORM: RLAP 06-16 Page 3 of 3

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — RESIDUALS LAND APPLICATION PROGRAM
FORM: RLAP 06-16
1. APPLICANT INFORMATION:
I. Applicant's name: Baxter Healthcare Corporation
Applicant type: ❑ Individual E Corporation ❑ General Partnership ❑ Privately -Owned Public Utility
El Federal ❑ State ❑ Municipal ❑ County
Signature authority's name per 15A NCAC 02T .0106: Scott Overbeck Title: Site Director
Applicant's mailing address: PO Box 1390
City: Marion State:NC Zip: 28752
Telephone number: [phone] Email Address: scott [e-mail]
2. Consultant's name: Zach Key License Number (for P.E.):
Affiliation: ❑ On Staff 0 Retained (Firm: U.S. Biosolids.com)
Consultant's mailing address: 958 Hoots Road
City: Roaring River State: NC Zip: 28669
Telephone number: [phone] Email Address: zachkeykusbiosolids.com
3. Agronomist's name:
Affiliation: ❑ NIA [] On Staff
Agronomist's mailing address:
City: State:
Telephone number: (_)
License Number:
Ej Retained (Firm: )
Zip:
Email Address:
4. Soil Scientist's name: License Number:
Affiliation: [] NIA ❑ On Staff ❑ Retained (Firm: )
Soil Scientist's mailing address: _
City: State: Zip: ---
Telephone number: (_) Email Address:
5. Fee submitted: $0.00 (See Instruction B)
11. PERMIT INFORMATION:
1. Application is for (check all that apply): ❑ new, ❑ modified,
® renewed permit
2. If this application is being submitted to renew or modify an existing permit, provide the following:
Permit number: WQ0031725
Date of most -recently issued permit: 7-14-2016
Date of most -recently certified Attachment A (if different than the permit): 7-14-2016
Date of most -recently certified Attachment B (if different than the permit): 7-14-2016
FORM: RLAP 06-16 Page 1 of 5

Ill. RESIDUALS LAND APPLICATION PROGRAM INFORMATION:
1. Residuals Processing Facility's physical address: 65 Pitts Station Road
City: Marion State: NC Zip: 28752
Coordinates: Latitude: 35' 50' 17.80" Longitude: 81' 59' 54.75"
Datum: NAD83 Level of accuracy:.01
Method of measurement: MAP
2. County where residuals land application program is headquartered: McDowell
3. List the Operator In Responsible Charge (ORC) and all Back -Up ORCs for the residuals land application program, their
certification numbers, and their affiliations in the following table:
Designation
Name
Affiliation
Certification Number
ORC
Dennis Key
US Biosolids, Inc.
15704
Back -Up ORC
Zach Key
US Biosolids, Inc.
27660
Additional Back -Up
ORCs
(if applicable)
If an ORC and at least one Back -Up ORC are not currently designated for this residuals land application program, provide the
candidates' names, affiliations, and an estimated time schedule for each candidate's completion of the required training school
and certification test:
4. Complete the following tables regarding management of the residuals land application program:
a. Plant Available Nitrogen Summary: Determine the maximum plant available nitrogen (PAN) generated by all residuals
source -generating facilities as currently certified and proposed for certification with this application and list the results in the
following table:
Maximum amount of residuals to be certified: 200 dry tons per year.
PAN
Pounds of PAN per Dry Ton
(Weighted Average)
Pounds of PAN per Year
Surface
Incorporation
or Injection
Surface
Incorporation
or Injection
First -Year
68.2
72.0
13640
14400
Five -Year Maximum Adjusted
76.0
79.8
15200
15960
b. Land Application Site Use Summary: Summarize information regarding the land application sites as currently certified and
proposed for certification with this application:
Category
Use
Acres
Comments
Crops
Forest or Plantation
0
Row Crops
6.7
Hay
8.7
Pasture
54.2
Total:
69.6
Methods
Surface
62.9
Incorporation or Injection
6.7
Total:
69.6
FORM: RLAP 06-16 Page 2 of 5

c. Residuals Land Ap2lication Sumntar : Determine the minimum acreage required to land apply the residuals as currently
certified and proposed for certification assuming the scenarios listed in the following table:
Assumed
Acres Required Using
Acres Required Using
Application Rate
First -Year PAN Concentrations
Five -Year Maximum Adjusted PAN
(16s PAN/ac-yr)
Concentrations
Surface
Incorporation or
Surface
Incorporation or
Injection
Injection
50
272.8
288
304
319.2
100
136.4
144
152
106.4
150
90.9
96
101.3
101.3
200
68.2
72
76
19.8
6. If applicable, provide a plan and a schedule to resolve any known issues that would prevent land application of the proposed
residuals due to the violation ofNorth Carolina Administrative Code (e.g. not enough storage, not enough land, vector reduction
practices not in place, etc.):
7. Specify type of residuals program (See Instruction F): ® Non -dedicated ❑ Dedicated
If Dedicated, specify the following (check all that apply):
Residuals program contains any land application site(s) that receives residuals at rates or frequencies greater than agronomic
rates, explain;
Residuals program contains any land application site(s) that is used primarily for residuals disposal, and agricultural crop
production is of secondary importance, explain;
El Residuals program contains any land application site(s) that receives residuals through fixed irrigation facilities or irrigation
facilities fed through a fixed supply system, explain;
IV, RESIDUALS SOURCE INFORMATION: (Required for all new, renewed, or modified residuals source)
Complete and submit the following Residuals Source Certification and all associated documentation.
Residuals Source
Certification
V. LAND APPLICATION SITE INFORMATION: (Required for all new, renewed, or modified land application site)
Complete and submit the following Land Applications Site Certification and all associated documentation.
Land Application Siite
Certification. doc
FORM: RLAP 06-16 Page 3 of 5

Note: Item VI. Applicable to Dedicated Program with fixed irrigation_system only.
VI. DESIGN INFORMATION FOR FIXED IRRIGATION SYSTEM
1. I'he irrigation system is: ❑ Spray ❑ Drip
2. Disposal system is: ❑ existing ❑ proposed.
3. Minimum depth to mean seasonal high water table (SH WT) within irrigation sites(s) per Soil Scientist's Evaluation: feet
below ground surface. Rules 15A NCAC 02T .0505 requires at least one -foot vertical separation between SH WT and ground
surface.
4. Are there any artificial drainage or water movement structures within 200 feet of any irrigation area?
❑ Yes or ❑ No If Yes, please explain if the soil scientist report addresses artificial structures and please indicate if
structures are to be maintained or modified:
5. Loading rates recommended by the Soil Scientist Evaluation:
Soil Series
Fields within Soil Area
Recommended
Loading Rate
in/h r
Recommended
Loading Rate
in/vr
6. Design loading rates are equal or less than the loading rates recommended by Soil Scientist?
❑ Yes or ❑ No If No, explain why 15A NCAC 02T .0505(n) is not met:
7. Non -dedicated System Design (fill in the appropriate information for either a spray or drip irrigation system):
Design Area
Number of
Maximum Application
Design Annual Loading
Field /.Zone
ftz
Nozzles
Rate allons/hr
Rate(gallans/ r
1'olal
Spray Irrigation Design Element
Plan Sheet
Number
Specification
Page Number
Wetted diameter of nozzles
ft
Wetted area of nozzles
ft'-
Nozzle capacity
gpm
Nozzle manufacturer / model
1
Elevation of highest nozzle
ft
FORM: RLAP 06-16 Page 4 of 5

Applicant's Certification (signing suihority must be in compliance* i1h 154A NCA(' 02T .0106):
The applicant or any affiliate has not been convicted of an environmental crime, has not abandoned a wastewater facility without proper
closure, does not have an outstanding civil penalty where all appeals have been exhausted or abandoned, are compliant with any active
compliance schedule, and do not have any overdue annual fees under Rule 15A NCAC 02T .0105,
I@ Yes ❑ No, Explain;
(Signature Authority's Name PLEASE PRINT) (Title)
attest that this application for BaNtgr HolthElU Corvoration
(Facility Name)
has been reviewed by me and is accurate and complete to the best of my knowledge. I understand that the Division of Water Resources
may not conduct a technical review of this program and approval does not constitute a variance to any rules or statutes unless specifically
granted in the permit. further, any discharge of residuals to surface waters or the land will result in an immcdiate enforcement action,
which may include civil penalties, injunctive relief, and:or criminal prosecution, 1 will make no claim against the Division of Water
Resources should a condition of this permit be violated. I also understand that if all required pans of this application are not completed
and that if all required supporting information and attachments are not included, this application package will be returned to me as
incomplete.
Note: In accordance with North Carolina General Statutes § 143-215.6A and � 143.215.6B. any person who knowingly makes any false
statement, representation, or certification in any application shall be guilty of Class 2 misdemeanor, which may include a fine not to
exceed S10,000 as well as civil penalties up to S25,000 per violation.
F].wtr: C � .'
w .Z, 5� l
Signature:
�,c2-
�-
FORM: RLAP 06-16 Page 5 of 5

Operation and Maintenance Plan
Baxter Healthcare Corporation
Permit No. WQ0031725
In accordance with the requirements set forth by the North Carolina
Department of Environmental and Natural Resources using
NCGS 143-215.1 and 143-215.3(a) based on 15A NCAC 02T .1 10, U.S.
Biosolids, Inc. and Baxter Healthcare are implementing this Operation
and Maintenance Plan.
The project manager of the land application event will make sure a daily
check off is performed at the start of each workday. This inspection is to
prevent any spills, leaks, or run-offs.
The daily check -off will consist of inspection the following items:
Access to the facility will be controlled with a locked gate and
signs to prevent any unauthorized entry into the complex.
2. All pumps and hose will be checked at the start of each day for
leaks or loose fittings.
3. All tanker valves are closed prior to loading and lids are closed
prior to transport.
4. All dump trailers or dump trucks gates are tightly fastened and
do not leak prior to transport.
5. All on road equipment is check as per DOT regulations for any
safety or mechanical hazards or issues.
6. All equipment is secured at the end of each working day to
prevent any tampering or unauthorized use.
The ORC or back up ORC will inspect the field after each land application
event to make sure all regulations as required by the permit are followed.
Also, the project manager at the end of each working day during a land
application event will make sure that all gates if present are closed.
All samples shall be taken as early as possible before the first application
event of the calendar year to make sure the facility is compliance.

The samples will be taken in a matter that is representative of the residuals
and all grab samples will be mixed prior to be placed into the containers
that will go to the laboratory. These samples must be collected and
transported as outlined in the Sampling Plan attached to this O&M Plan.
All records of these laboratory results as well as the annual report and
loading rates will be kept on file for a minimum of five (5) years.
Also, in the unlikely event of a spill or unintended release of residuals,
actions should be immediately taken as outlined in a copy of the
spill control plan attached.

SPILL CONTROL PLAN- U.S. Biosolids_, I_nc.
Baxter Healthcare Corporation Permit No. WQ0031725
In the event of a spill, the following should be taken IMMEDITALY.
1. Make sure all personal and bystanders are safe- if not contact emergency
services
2. Halt the source of the spill- overturned truck, leaking valve, ruptured tank.
3. Contain the spill. Use straw bales or earthen barrier to forma dike to contain the
spill.
4. Cleanup. Employ vacuum trucks, dump trucks, and loaders to remove as much
of the spilled material as possible. Use straw to soak -up the remaining material.
Dispose of the same in a landfill.
5. Flush the roadways with water if needed. If the spill occurred on a tillable area, till
the same into the soil and spread lime if necessary. If a spill occurs on private
property, final clean-up should be to the satisfaction of the owner.
6. Notification. (This should be done as soon as safely possible.)
A. U.S Biosolids, Inc. Main Office [phone]
B. Baxter Healthcare [phone]

C. NCDEQ-Asheville Regional Office- [phone]
D. County Emergency Services (Sheriff, Fire Dept.) 911
7. Reporting:
The Permittee shall report by telephone to the Asheville Regional Office,
telephone number [phone], as soon as possible, but in no case more than
24 hours or on the next working day following the occurrence or first knowledge
of the occurrence of any of the following:
A. Surface disposal of residuals abnormal in quantity or characteristic.
B. Any failure of the surface disposal program resulting in a release of
material to surface waters.
C. Any time self -monitoring indicates the facility has gone out of compliance
with its permit limitations.
D. Any process unit failure, due to known or unknown reasons, rendering the
facility incapable of adequate residual treatment
E. Any spill or discharge from a vehicle or piping system during residuals
transportation.
Any emergency requiring immediate reporting (e.g., discharges to surface
waters, imminent failure of a storage structure, etc.) outside of normal business
hours shall be reported to the Division's Emergency Response personnel at
telephone number [phone], [phone], or [phone]. Persons
reporting such occurrences by telephone shall also file a written report in letter
form within five days following first knowledge of the occurrence. This report shall
outline the actions taken or proposed to be taken to ensure that the problem
does not recur.
8. Spill Prevention. The easiest way to clean a spill is to prevent one.
A. Ensure loading personal watch the vehicle being loaded.
B. Ensure all valves and lids are closed
C. Inspect all seals and replace if necessary.

Baxter Healthcare Corporation
Permit No. WQ0031725
SAMPLING PLAN
Annually, if a land application event occurs, grab samples are collected from the aerobic
digesters and the belt press. These samples will be combined to form individual grab samples to be sent
to a laboratory for analysis.
These individual grab samples are collected and tested for fecal coliform analysis, volatile solids
reduction, nutrient analysis, and a TCLP test. These tests will be taken by U.S. Biosolids, Inc. All samples
apart from the composite residual sample will be taken to Statesville Analytical. The composite residual
sample will be sent to Waypoint Analytical. All samples taken will be taken in the same condition as the
residuals are to be land applied.
The volatile solids reduction requirement will first be attempted by using option 1 [503.33(b)
(1)1; Reduction of volatile solids by at least 38%. The "IN" sample will be taken from the residuals
pumped from the clarifiers and the "OUT" sample from aerobic digester No. 1. If this requirement can't
be met, a gallon of residuals will be sampled from the aerobic digester and analyzed for option 3
503.33(b) (3); known as a 30 day bench scale. This test requires less than 15% additional volatile solids
reduction during bench -scale aerobic batch digestion for 30 days.
Fecal Coliform are gathered in seven (7) individual samples from the aerobic digester and tested
to meet the requirements of [503.32(b)(2)]. This requirement is for the geometric mean fecal coliform
density of the samples be less than two million (2,000,000) MPN per gram. These samples will be placed
in 250ml containers and placed on ice, in a cooler for transport to the laboratory before 1600 hours
(4pm) the same day the samples are obtained.
Annually, if land application occurs, a composite residual sample will be collected from the belt
press and analyzed, prior to a land application event for: Cadmium, Copper, Lead, Mercury,
Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia Nitrogen, Calcium, Nitrate Nitrogen,
Magnesium, % total Solids, pH, Phosphorus, Potassium, TKN, Sodium. From this information, the Plant
Available Nitrogen (PAN) and a Sodium Absorption Ratio (SAR) will be calculated. This sample will
collected in a non -breakable container, at least one quart in size.
A full TCLP test, including corrosivity, ignitability, and reactivity will be taken in two (2) gallon
containers from the aerobic digester. This test will be run annually unless prior approval is granted from
the division to reduce this requirement to once per permit cycle.

State of North Carolina
= in DWK Department of Environmental Quality
Division of Water Resources
Division of Water Resources RESIDUALS SOURCE CERTIFICATION
INSTRUCTIONS FOR FORM: RSC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application„and
supporting documentation
For more iglbrmution, visit the Water Quality 1'eriniaing Section's Noa-Dischyt,ge Perminina Y Unit
General -- This certification provides detailed information of residuals source generatin- facility and its residuals quality for land
application, distribution, or disposal in accordance with 15A NCAC 021• .1 100, Do not submit this certification for review without
a corresponding application form (FORM: RLAP 11-15, FORM: DCAR 11-15, or FORM: SDR 11-1.5).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Residuals Source Certification (FORM: RSC 11-15):
❑ Submit the completed and appropriately executed Residuals Source Certification (FORM: RSC 1 1-15) form. Please do not
make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to the
application may be made, as long as the attachments are numbered to correspond to the section and item to which they refer.
❑ For new or renewed permits, submit a separate certification for each source facility.
❑ For modified permits, submit a separate certification for only those facilities that arc affected by the proposed modification.
❑ Complete the residuals source facility summary page. List all new, renewed, or modified facilities.
B. Residuals Source -Generating Facility Information:
❑ For each source facility, attach the following:
❑ Vicinity map - A vicinity map that shows the location of the facility and meets all of the criteria in the "Map Guidance for
Restd,uals l and_Application Permits".
❑ Process flow diagram and/or narrative - A detailed narrative and/or process flow diagram that describes how the residuals
are to be generated, treated, processed, and stored at the facility.
❑ Quantitative justification for residuals production rate - A quantitative justification for the value provided in Item 1. 8.
Ensure that the amount of residuals listed is the maximum amount expected to be generated by the facility for the life of
the permit. In addition, ensure that this amount is equivalent to that which is actually to be land applied, distributed,
and/or disposed, including any chemicals, amendments. or other additives that are added to the residuals during
processing.
❑ Sampling plan - A detailed sampling plan for the residuals source-generatint, facility. Ensure that the plan identifies
sampling points, sampling frequency, sample type, as well as the Division -certified laboratory to be used. In addition,
ensure that the plan details how the facility and/or the residuals are monitored for any applicable pathogen reduction and
vector attraction reduction requirements. Note that all sampling and monitoring must be completed on the residuals as
they are to be land applied, distributed, and/or disposed.
C. Residuals Quality Information:
❑ For each source facility, attach the following:
❑ Laboratory analytical reports and operational data - reports for all laboratory analyses used to complete this certification.
ElDocumentation that the facility complies and/or the residuals comply with any applicable pathogen reduction and vector
attraction reduction requirements.
❑ For new facility that may have not yet been constructed and analytical results of residuals cannot be obtained, please
attach analytical results of residuals ,generated from a similar facility alonV with the description of similarities of the two
facilities.
iNSTRUCTIONS FOR FORM: RSC 06-16 Pa,,e I of

RESIDUALS SOURCE FACILITY SUMMARY
Applicant's name: Baxter Healthcare Corporation
Status Maximum Dry Tons Per Year
Facility Permit Holder Facility Name County Permit Number
Code' Current n Proposed
Baxter 1{ealthcare Baxter Healthcare
R Corporation Corporation McDowell NC0006564 200 200
I
l
I
I i
I
� � I
i
i II
i
'Status Code for source lacilit, are: ♦N (New) ♦ R )IteneiNed) ♦ M (Modified) ♦ D (Deleted)
t'The amount of'residuals currently permitted fir distribution. land application. or disposal (i.e. not applicable to ne%% facilitv).
SUMMARY FOR FORM: RSC 06-I6 Pa<(ve I

Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
RESIDUALS SOURCE CERTIFICA'rION
FORM: RSC 06-16
I. RESIDUALS SOURCE -GENERATING FACILITY INFORMATION (See Instruction B.):
1. Facility Name: Baxter Healthcare Corporation
2. Facility permit holder is: [] Federal, ❑ State, ❑ Local Government, or Ej Private.
Facility permit issued by: ZDiv. of Water Resources, Div. of Environmental Health,
or 0 Other (explain).
3. Facility contact person and title: Brian Valiquette, Wastewater Treatment Supervisor
Complete mailing address: PO Box 1390
City; Marion State: NC Zip: 28752
Telephone number: [phone] E-mail address: brian_valiquette a baxter.com
4. Facility physical address: 65 Pitts Station Road
City: Marion State: NC Zip: 28752
Coordinates: Latitude: 35' 50' 17.80" Longitude: 81' 59' 54.75"
Datum: NAD83 Level of accuracy:.01
Method of measurement: MAP
5. Purpose of the facility:
0 treatment of municipal wastewater, [ treatment of 100% domestic wastewater,
[] treatment of potable water, ( treatment of 100% industrial wastewater,
treatment of industrial wastewater mixed with domestic wastewater,
(approximate percentages: 81 % industrial and 19 % domestic)
0 other (explain: ).
6. Does the facility have an approved pretreatment program: Yes ❑ No
7. Facility permitted/design flow: 1.2 MGD and facility average daily flow: 0.8 MGD
8. Average amount of residuals being generated at this facility 149.68 dry tons per year.
9. Specify the following regarding treatment and storage volumes available at the facility:
Type and volume of residuals treatment: 2 digesters-307,000 gallons
Type and volume of residuals storage (i.e., outside of residuals treatment units): 3_Sludge Drying Beds
11. RESIDUALS QUALITY INFORMATION (See Instruction C.):
L Specify if residuals are regulated under:
El 40 CFR Part 503 or ❑ 40 CFR Part 257.
Note: Only residuals that are generated during domestic/municipal wastewater treatment processes are regulated under 40
CFR Part 503, otherwise, the residuals are regulated under 40 CFR Part 257.
2. Specify if residuals are defined under 15A NCAC 02T.1 102(6) as:
Biological ❑ Non -Biological
Note: Biological residuals are residuals that have been generated during the treatment of domestic wastewater, animal
processing wastewater, or the biological treatment of industrial wastewater (biological treatment is a system that utilizes
biological processes including lagoons, activated sludge systems, extended aeration systems, and fixed film systems).
FORM: RSC 06-16 Page 1 of 5

I Hazardous Waste Determination: Complete the following to demonstrate that the residuals are non -hazardous under
RCRA: (Note - this item does not have to be completed for facilities that are less than 0.5 MGD in design flow that treat
100% non -municipal, domestic wastewater only)
a. Are the residuals listed in 40 CFR §261.31-§261.33: ❑ yes 0 no.
If yes, list the number(s):
b. Specify whether or not the residuals exhibit any of the characteristics defined by 40 CFR §261.21-
261.24: 0 yes Z no.
Fill in the following tables with the results of the latest toxicity characteristic leaching procedure ('fCLP) analysis as
well as those for corrosivity. ignitability, and reactivity:
Laboratory: Pace Analytical and Date of analysis: 2-1-2021
Passed corrosivity test: 0 yes ❑ no. pH: s.u. (2 < pH < 12.5)
Passed ignitability test: Z yes ❑ no. Flashpoint: 200 T (> 140T)
Passed reactivity test: 0 yes []no. HCN: ND mg/kg (<250) & H,S: ND mglk; (<500)
'rCLP Parameter
Arsenic
Limit
(mg/l)
Result
(rngll)
TCLP Parameter
Limit
(mg/1)
Result
(mgil)
5.0
ND
Hexachlorobenzene
0.13
ND
Barium
100.0
ND
Hexachloro-1.3-Butadiene
0.5
ND
Benzene
0.5
ND
Hexachloroethane
3.0
ND
Cadmium
Carbon Tetrachloride
Chlordane
1.0
0.5
0.03
ND
ND
ND
ND
Lead
Lindane
Mercury
Methoxychlor
Methyl Ethyl Ketone
5.0
ND
ND
0.4
0.2
ND
T Chlorobenzene Y
100.0
10.0
ND
Chloroform
6.0
ND
200.0
ND
Chromium
5.0
ND
Nitrobenzene
2.0
ND
m-Cresol
200.0
ND
Pentachlorophenol
100.0
ND
o-Cresol
200.0
ND
Pyridine
Selenium
5.0
1.0
ND
ND
p-Cresol
200.0
ND
Cresol
200.0
ND
Silver
5.0
ND
2A-D
10.0
ND
Tetrachloroethylene
0.7
ND
1,4-Dichlorobenzene
7.5
ND
Toxaphene
0.5
ND
1,2-Dichloroethane
0.5
ND
Trichloroethylene
0.5
ND
1,1-Dichloroethylene
0.7
ND
2,4,5-Trichlorophenol
400.0
ND
2,4-Dinitrotoluene W
0.13
ND
2,4,6-1'richlorophenol
2.0
ND
Endrin
0.02
ND
2.4.5-TP (Silvex)
Vinyl Chloride
1.0
ND
Heptachlor and its Hydroxide
0.008
ND
0.2
ND
FORM: RSC 06-16 Page 2 of 5

4. Metals Determination: Complete one of the following tables (i.e., as applicable) to demonstrate that the residuals do not
violate the ceiling concentrations for metals regulated under 15A NCAC 02T_.1 105.
a. For Distribution/Land Application: Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: Waypoint Analytical and Date of analysis: 2_1-2021
Parameter
Ceiling
Concentration Limits
(ClassA & ClassB)
(mg/kg)
Monthly Average
Concentration Limits
(Class A Only)
(mg/k 0
Result
f mg/kg)
Arsenic
75
41
8.03
Cadmium
85
39
0.73
Copper
4,300
1,500
123
Lead
840
300
11.9
Mercury
57
17
0.1 13
Molybdenum
75
n/a
5.34
Nickel
420
420
20.6
Selenium
100
100
3.65
Zinc
7,500
2,800
134
b. For Surface Disposal Unit (landfill): Fill in the following table with the results of the latest analyses (i.e., on a dry weight
basis) for the following metal parameters:
Laboratory: and Date of analysis:
Distance from Disposal
Unit to Boundary to
Closest Property Line
(melers, check one)
Arsenic
(mg/kg)
Chromium
(mg/kg)
Nickel
(mg/kg)
El > 0 but < 25
30
200
220
260
210
_ - 240
270
320
390
❑ ? 25 but < 50
34
❑ > 50 but < 75
> 75 but < 100
39
46
300
> 100 but < 125
53
360
E] > 175
62
450
470
Result (ing/kg)
FORM: RSC 06-16 Page 3 of 5

5. Nutrient/Micronutrient Determination: Complete the following:
a. Total solids: 13.7 %.
b. Fill in the following table with the results of the latest analyses (i.e., on a dry weight basis) for the following nutrient and
micronutrient parameters:
Laboratory: Waypoint Analytical and Date of analysis: 2-1-2021
Parameter
Aluminum
Result
(M91k9)
1900
Ammonia -Nitrogen
3820
Calcium
10500
Magnesium
Nitrate -Nitrite Nitrogen
4910
36.5
pH (Standard Unit)
7•8
Phosphorus
19800
Potassium
8100
Sodium
2540
Total Kjeldahl Nitrogen
11 i000
c. Using the results listed in Item 11, 5b. above, calculate the sodium adsorption ration (SAR): 1.89
[Note: If residuals contain SAR of 10 or higher, the applicant shall obtain recommendations from the local Cooperative
Extension Office, the Department of Agriculture and Consumer Services, the Natural Resource Conservation Service, a
North Carolina Licensed Soil Scientist, or an agronomist, prior to land application of residuals. The recommendations shall
address the sodium application rate, soil amendments (e.g., gypsum, etc.). or a mechanism for maintaining site integrity
and conditions conducive to crop growth].
d. Specify the mineralization rate to be used in calculating the plant available nitrogen (PAN) of the residuals: 30 %. This
rate is a (check one): Z default value, or 1:1 actually established.
If the residuals are not generated from the treatment of municipal or domestic wastewater, explain or provide technical
justification as to why the selected default value is appropriate to be applied to these residuals: Default for aerobic
di_ esg tion.
e. Calculate the PAN for the residuals (i.e., on a dry weight basis) and fill the results in the following table:
Application Method
First (1") Year PAN
Five -Year
Maximum Adjusted PAN
(mg1kg)
(nagikg)
Surface
34100.5
35660
InjectionAncorporation
36010.5
37570
6. Other Pollutants Determination: Specify whether or not there are any other pollutants of concern in the residuals and provide
the results of the latest analyses:
FORM: RSC 06-16 Page 4 of 5

7. Patho en Reduction: Per 15A NCAC 02T.1 106, specify how residuals will meet the pathogen reduction requirements:
a. For Distribution/Land Application of Class A or E uivalent:
❑' A fecal coliform density that is demonstrated to be less than 1,000 MPN per gram of total dry solids,
or
A salmonella sp. density that is demonstration to be less than 3 MPN per 4 grams of total dry solids.
AND one of the followings (except for non -biological residuals):
❑ Alternative I [15A NCAC 02T.1 I06(b)(3)(A)] - Time/Temperature Compliance.
Ej Alternative 2 [ 15A NCAC 02T. 1106(b)(3)(B)] - Alkaline Treatment.
Alternative 3 [15A NCAC 02T.I 106(b)(3)(C)] - Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 4 [15A NCAC 02T.1 106(b)(3)(D)] - No Prior Testing for Enteric Virus/Viable Helminth Ova.
Alternative 5 [15A NCAC 02T.1 106(b)(3)(E)-(K)] - Process to Further Reduce Pathogens (PFRP).
Specify one: ❑ composting, ❑ heat drying, ❑ heat treatment,
thermophilic aerobic digestion.. ❑ beta ray irradiation.
❑ gamma ray irradiation. or ❑ pasteurization.
b. For Land Application of Class B:
Alternative 1 [15A NCAC 02T.I 106(c)(1)] - Fecal Coliform Density Demonstration.
Alternative 2 [15A NCAC 02T. i i 06(c)(2)] - Process to Significantly Reduce Pathogens (PSRP).
Specify one: 0 aerobic digestion, ❑ air drying, ❑ anaerobic digestion,
composting, or ❑ lime stabilization.
c. For Surface Disposal:
Select One of the Class A or Equivalent Pathogen Reduction Alternatives in Item 11. 7a. above.
❑ Select One of the Class B or Equivalent Pathogen Reduction Alternatives in Item ]I. 7b. above.
Ej Exempt - If Daily Cover Alternative is chosen in Item 11.8. below [15A NCAC 02T.1 106(a)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
8. Vector Attraction Reduction (VAR): Per 15A NCAC 02T,1 107, specify how residuals will meet the VAR requirements:
Alternative l [15A NCAC 02T.1 107(a)(1)] - 38% Volatile Solids Reduction (Aerobic!Anaerobic Digestion).
❑ Alternative 2 [15A NCAC 02T. 1107(a)(2)] - 40-Day Bench Scale Test (Anaerobic Digestion).
Alternative') [15A NCAC 02T.1 107(a)(3)] - 30-Day Bench Scale Test (Aerobic Digestion).
Alternative 4 [ 15A NCAC 02T.I 107(a)(4)] - Specific Oxygen Uptake Rate Test (Aerobic Digestion).
Alternative 5 [15A NCAC 02T.I I07(a)(5)] - 14-Day Aerobic Processes.
d Alternative 6 [15A NCAC 02T.I 107(a)(6)] - Alkaline Stabilization.
❑ Alternative 7 [15A NCAC 02T.I ]07(a)(7)] - Drying of Stabilized Residuals.
❑ Alternative 8 [15A NCAC 021".] 107(a)(8)] - Drying of Unstabilized Residuals.
[] Alternative 9 [15A NCAC 02T.1 ]07(a)(9)] - Injection.
Alternative 10 [I5A NCAC 02T.1 107(a)(l0)] - Incorporation.
[Q Alternative for Surface Disposal Units Only - Soil/Other Material Cover [15A NCAC 02T.I 107(b)(2)].
Not Applicable - Non -Biological Residuals with NO Domestic Wastewater Contribution.
Note: For animal processing residuals, only alternatives 9 or 10 may be chosen due to the nuisance conditions that typically
occur when these residuals are applied and left on the land surface.
FORM: RSC 06-16 Page 5 of 5

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red �/ T�
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r
Q
n
(,
n
90GPM
Q
SSOGPM
Q
650 GPM
Q
650 GPM
650 GPM
650 GPM J
RAW WATER
1.442
(01
Sanitary / Domestic
^150
Sterilization (SCW)
137
Extruder Troughs
86
Cooling Tower 1
Cooling Tower 7 & 8
Cooling Tower 9
Cooling Tower 10 & 11
Cooling Tower 12
Water Softeners
Boiler Feedwater/
Potable
329
NORTH COVE WATER VALUE STREAM
Updated:10/23/09
Deionized Water Distilled Water Product
826 6DO 350
DW Auxiliary (EBR,
Flush, Rinse, Waste)
CFT Backwash — 34
Slowdowns - 70 "250
Cation Regen. — 25
Anion Regen.- 25 Silo Dumps- 10
Cooling
Extruder Return Recirculation
79 k I
Condensate Return
—128
EVAPORATION
65
SPRAY PONDS
NEUTRALIZATION
TANK
I
W WTP
Influent - 745
L---- —► Ponds-175
EFFLUENT TO RIVER
920

BAXTER HEALTHCARE CORPORATION
MARION, NC 28752
NCO006564
SLUDGE MANAGEMENT PLAN
Waste activated sludge is pumped to one of two aerobic digesters. The sludge is digested and
thickened by repeatedly allowing the solids to settle out and draining off the excess treatable
water. The digested sludge is then dewatered through a centrifuge to a 14%-20% cake.
Drainage from the sludge and wash down water from the centrifuge is pumped back to the
equalization basin for recirculation through the aeration basins and membrane filtration
process. The cake is conveyed to a dump trailer positioned under a roof at the centrifuge
dewateNng building. Once this trailer is filled, it is picked up by Southem Soil Builders, Inc.
and transported to the Catawba County where it is land applied to four field sites totaling 80.8
net acres. Our sludge land application permit number is WQ0031725.
Stephen Gou e
Environmental 'alth & Safety Manager

Quantitative Justification for Residuals Production Rate:
Since the last issuance of permit WQ0031725 in 2016, Baxter Healthcare Corporations has produced the
following amounts of residuals:
YEAR
DRY TONS
2020
149.68
2019
160.39
2018
167.51
2017
147.03
2016
136.19
This comes out to an average of 152.16 Dry Tons per year, which is under the 200 Dry Tons that is
currently allowed by Permit WQ00031725.

Baxter Healthcare Corporation
Permit No. WQ0031725
SAMPLING PLAN
Annually, if a land application event occurs, grab samples are collected from the aerobic
digesters and the belt press. These samples will be combined to form individual grab samples to be sent
to a laboratory for analysis.
These individual grab samples are collected and tested for fecal coliform analysis, volatile solids
reduction, nutrient analysis, and a TCLP test. These tests will be taken by U.S. Biosolids, Inc. All samples
apart from the composite residual sample will be taken to Statesville Analytical. The composite residual
sample will be sent to Waypoint Analytical. All samples taken will be taken in the same condition as the
residuals are to be land applied.
The volatile solids reduction requirement will first be attempted by using option 1 [503.33(b)
(1)]; Reduction of volatile solids by at least 38%. The "IN" sample will be taken from the residuals
pumped from the clarifiers and the "OUT" sample from aerobic digester No. 1. If this requirement can't
be met, a gallon of residuals will be sampled from the aerobic digester and analyzed for option 3
503.33(b) (3); known as a 30 day bench scale. This test requires less than 15% additional volatile solids
reduction during bench -scale aerobic batch digestion for 30 days.
Fecal Coliform are gathered in seven (7) individual samples from the aerobic digester and tested
to meet the requirements of [503.32(b)(2)]. This requirement is for the geometric mean fecal coliform
density of the samples be less than two million (2,000,000) MPN per gram. These samples will be placed
in 250ml containers and placed on ice, in a cooler for transport to the laboratory before 1600 hours
(4pm) the same day the samples are obtained.
Annually, if land application occurs, a composite residual sample will be collected from the belt
press and analyzed, prior to a land application event for: Cadmium, Copper, Lead, Mercury,
Molybdenum, Nickel, Selenium, Zinc, Aluminum, Ammonia Nitrogen, Calcium, Nitrate Nitrogen,
Magnesium, % total Solids, pH, Phosphorus, Potassium, TKN, Sodium. From this information, the Plant
Available Nitrogen (PAN) and a Sodium Absorption Ratio (SAR) will be calculated. This sample will
collected in a non -breakable container, at least one quart in size.
A full TCLP test, including corrosivity, ignitability, and reactivity will be taken in two (2) gallon
containers from the aerobic digester. This test will be run annually unless prior approval is granted from
the division to reduce this requirement to once per permit cycle.

waypointo
ANALYTICAL
46381
Southern Soil Builders
Dennis Key
958 Hoots Road
Roaring River , NC 28669
Report Number : 21-033-0008
Lab No : 74906
Sample ID : Baxter
Project Baxter
Information :
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° fax [phone]
www.waypointanalytical,com
REPORT OF ANAL PSIS
Report Date : 02/10/2021
Received : 02/02/2021
TAw,t MC &toar�/
Pauric Mc Groary Ph.D., CPA
Agronomist
Matrix: Solids
Sampled: 2/ 1/2021 11:45
Test Results Units MQL OF Date I Time By Analytical
Analyzed Method
Moisture 86.3 % 0.010 1 02/04/2116:32 FMM SM-2540G
Test Results Units MDL OF Date ! Time By Analytical
Analyzed Method
Ammonia Nitrogen
3820
mg/Kg - dry
730
1
02/08/21 13:00
JPJ
SM-4500-NH3C
Nitrate+Nitrite-N
<36.5
mg/Kg - dry
36.5
1
02/08/21 16:38
ZBD
4500NO3F-2011
Organic N
107000
mg/Kg - dry
1820
1
02/08/21 10:00
CALCULATION
pH
7.8
S.U.
1
02/09/2116:21
CxC
9045D
Total Solids
13.7
%
4.010
1
02/04/21 16:32
FMM
SM-254OG
Total Kjeidahl Nitrogen
111000
mg/Kg - dry
1820
1
02/08/21 10:00
JPJ
�M-4500-NH3C-TKP
Phosphorus
19800
mg/Kg - dry
36.5
1
02/06/21 03:16
JTR
6010D
Aluminum
1900
mg/Kg - dry
36.5
1
02/06/21 03:16
JTR
6010D
Arsenic
8.03
mg/Kg - dry
3.65
1
02/06/21 03:16
JTR
6010D
Calcium
10500
mg/Kg - dry
365
1
02/06/21 03:16
JTR
6010D
Cadmium
<0.730
mg/Kg - dry
0.730
1
02/06/21 03:16
JTR
6010D
Chromium
42.0
mg/Kg - dry
1.82
1
02/06/21 03:16
JTR
6010D
Copper
123
mg/Kg - dry
3,65
1
02/06/21 03:16
JTR
6010D
Iron
6040
mg/Kg - dry
73.0
1
02/06/21 03:16
JTR
6010D
Lead
11.9
mg/Kg - dry
2.19
1
02/08/21 21A4
JTR
6010D
Magnesium
4910
mg/Kg - dry
36.5
1
02/06/21 03:16
JTR
6010D
Manganese
78.8
mg/Kg - dry
3.65
1
02/06/21 03:16
JTR
6010D
Qualifiers/ DF
Dilution Factor
L
Limit Exceeded
Definitions MQL
Method QuantitatiDn Limit
Page 3 of 6

Waypointo
ANALYTICAL
46381
Southern Soil Builders
Dennis Key
958 Hoots Road
Roaring River , NC 28669
Report Number: 21-033-0008
Lab No : 74906
Sample ID : Baxter
Test
Project Baxter
Information ;
7621 Whitepine Road, Richmond, VA 23237
Main 804-743-9401 ° Fax [phone]
www.waypointanalytical.com
REPORT OFANAL YSIS
Results Units MQL
Report Date : 02/10/2021
Received : 02/02/2021
TAWIc M( &106wM�
Pauric Mc Groary Ph.D., CPA
Agronomist
Matrix: Solids
Sampled: 2/ 1/ 2021 11:45
DF Date / Time By Analytical
Analyzed Method
Mercury
<0.113
mg/Kg - dry
0,113
1
02/08/21 13:36
DDB
SW-7471B
Molybdenum
5.34
mg/Kg - dry
1.82
1
02/06/21 03:16
JTR
6010D
Nickel
20.6
mg/Kg - dry
1.82
1
02/06/21 03:16
JTR
6010D
Potassium
8100
mg/Kg - dry
365
5
02/08/21 21:19
JTR
6010D
Selenium
<3.65
mg/Kg - dry
3,65
1
02/06/21 03:16
JTR
6010D
Sodium
2540
mg/Kg - dry
182
1
02/06/21 03:16
JTR
6010D
Zinc
134
mg/Kg - dry
9.12
1
02/06/21 03:16
JTR
6010D
Sulfur
9270
mg/Kg - dry
73.0
1
02/06/21 03:16
JTR
6010D
Qualifiers/ DF Dilution Factor
Definitions MQL Method Quantitation Limit
L Limit Exceeded
Page 4 of 6

PAN
Mineralization
as decimal
ITotal dry
tonslyear
jAcres
Applied on
Rate
0.3
TKN
111000
NH3
3820
NO3
36.5
NO2
0
% Solids
0.137
PAN Surface
34100.5 mglkg
58.201 Ibsldry ton
0
1 lbs total PAN
#DIV101
jibs PAN/acre
PAN Injection
35010.5 mg/kg
72.021 lbs/dry ton
0
Ibs total PAN
#DIVl01
Ilbs PAN/acre
Dry Tons11000 gal.
0.57129
1st year PAN
Surface lbs.
0
1st year PAN
Injected lbs.
0
lbs.lacre
Surface
#DIVIOI
lbs./acre
Injected
#DIV/O.
MR(TKN-NH3)+ + .5(NH3)+NO3+NO2 =mglkg
mg/kg x .002 =Ibsldry ton
MR(TKN-NH3) + 1(NH3)+NO3+NO2=rnglkg
mg/kg x .002 =Ibsldry ton
1000 X 8.34 X %solids X sp. gravity
2000
"=dry tons11000gal."

SAR
Sodium Absorption Ratio
Na : Sodium (MgIL) Equivalent weight: 23
Ca : Calcium (MgIL) Equivalent weight: 20
Mg: Magnesium (MgIL) Equivalent weight: 12
Milli Equivalent = Mg1L / Equivalent weight
Na M !L Ca(M IL Mg MIL
347.98 1 1438.5 1 672.67
Na (ME) I Ca (MEN, I M9_„(ME.)
15.12957 71.925 56.05583
SAR= Na Milli Equivalentl[0.5 X (Ca Milli Equivalent + Mg Milli equivalent)]0.5 power
SAR= 1.891337 (From MgIL entered above)
SAR= 1,89125 (From ME entered below)
Na ME
Ca (ME)
M4 {ME)
15.13
1 71.9
1 56.1
The amour
amount of E
Permitting

Analytical Results'
N ' "i C ik
U.S. Biosolids Inc =FP
958 Hoots Road
Roaring River, NC 28669
Receive Date: 02/01/2021
Reported: 02/17/2021
For:
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
210201-15-01 TCLP Baxter See Attached as Noted 0210212021 PACE
Respectfully submitted,
Melissa Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Pagel of 31

ceAnapical
Intar.V�l�bt.sen
ANALYTICAL RESULTS
Project: TCLP
Pace Project No.: 92519773
Pape Analytical Servkill LLC
9600 Kincay Ave, Sulte 100
Huntersville, NC 28078
(704)875,9092
Sample: 210201.15.01 Lab ID: 92519773001 Collected: 02101121 11:30 Received: 02fD2121 14:uu matrix:. oiw
Results reported on a "dry weight' basis and are adjusted for percent moisture, sample size and any dilutions.
Parameters Results Units Report Limit OF Prepared Analyzed GAS No. Qual
Chlorinated Herb. (GC) 8151A Analytical Method: EPA 8151A Preparation Method: 8151A
Leachate Method/Date: 1311; 02/08121 09:31 Initial pH: 6.36; Final pH: 4.98
Pace National - Mt. Juliet
2,4,5-TP (Siivex) ND mglL 0.00200 1 02109121 11:21 0200121 1926 93-72-1
2 4-D ND mg1L a of 1 021D9121 11:21 02/10721 19:26 94-75.7
Surrogates
2,4-DCAA(S)
90.B %
14.0-158
1 0270912111:21 0211012119:26 19719-28-8
0081 TCLP Pesticides RVE
Analytical Method; EPA 8081B Preparation Method: EPA 3510C
Leachate MethodlDate: EPA 1311; 02103I21 15:47 Initial pH: 5.6; Final it 5
Pace Analytical Services - Charlotte
gamma-BHC (Lindane)
NO ugfL
0,50
1 02105I21 08:32 02108121 14',36 58.89-9
GNordane (Technical)
ND uglL
3.0
1 02105i21 08,32 02108/21 14:36 57-74-9
Endrin
NO ugfL
0.50
1 0210512108:32 02/0812l 14:36 72-20-8
Heptachlor
NO ugfL
0.50
1 0210512t 08,32 D2108121 14:36 76-44-8
Heptachlor epoxide
NO ugfL
0.50
1 02/05121 08:32 02100121 14:36 1024-57-3
Methoxychlor
NO uglL
1000
1 02f05121 08:32 02/08121 14:36 72-43-5
Toxaphene
NO ugfL
3.0
1 0210512108:32 021OB12114:36 8001-35.2
Surrogates
Decachlorobiphenyl(S)
66 %
10-154
1 02105121 08:32 02108121 14 36 2051-24-3
Tetrachloro-m-xylene (S)
65 %
10-184
1 02105i21 08:32 02108121 14:36 877-09-8
8082 GCS PCB
Analytical Method: EPA 8082A Preparation
Method'.
EPA 3546
PaceAnalytica) Services - Chadotle
PCB-1016 (Aroclor 1016)
NO ugikg
249
1 02103121 22:41 02/04121 10:51 12674.11-2
PCB-1221 (Aroclor 1221)
NO ugikg
249
1 02/03121 22:41 02/04121 10:51 11104-28-2
PCB-1232 (Aroclo( 1232)
NO ugikg
249
1 02103121 22 41 02f04121 10,51 11141-16-5
PCB-1242 (Aroclor 1242)
NO ugikg
249
1 02103/21 2241 021G4/21 10:51 53469-21-9
PCB-1248 (Al 1246)
NO ugikg
249
1 02103)21 22Al 02104/21 10:51 12672-29.6
PC8-1254 (Aroclor 1254)
ND ugtkg
249
1 02103f21 22:41 02104/21 10:51 11097-69-1
PCB-1260 (Aroclor 1260)
NO ugikg
249
1 02/03121 22:41 02104121 10:51 11096-82-5
Surrogates
Decachlorobiphenyl (S)
23 %
10-160
1 02/03/21 22:41 02104[21 10.51 2051-24-3
8082 TCLP PCSs RVE
Analytical Method' EPA 8082A Preparation Method: EPA 3510C
Leachate MethodlDate: EPA 1311: 02f03121 15A7 Initial pH- 5.6, Final pH 5
Pace Analytical Services - Charlotte
PCB-1016 (Aroclor 1016)
ND ugfL
1000
1 02108f21 09:06 02109/21 12:47 12674-11-2
PCB-1221 (Aroclor 1221)
ND ugfL
1000
1 02108121 09:06 02109f2112:47 11104-28-2
PCB-1232 (Aroclor 1232)
NO ugfL
1000
1 02YO8121 09:06 D2109121 12:47 11141-16-5
PCB-1242 {Aroclor 1242)
NO uglt
1000
1 02f08121 09:06 02109121 12;47 53469-21-9
PCB-1248 (Aroclor 1248)
ND ugfL
1000
1 02108121 0906 02109121 12A7 12672-29-6
PCB-1254 (Al 1254)
NO ugfL
1000
1 02108121 09:06 02/09121 12:47 11097-69.1
PC8-1280 (Aroclor 1260)
NO ug/L
1000
1 02108121 09:06 02f09121 12A7 11096,82-5
Surrogates
Decachlorobiphenyl (S)
103 %
10-181
1 02108f21 09:06 02109/21 12:47 2051-24-3
REPORT OF LABORATORY ANALYSIS
This report shall not be
reproduced.
except in lull,
Date: 0211612021 03:47 PM
without the wririen consent of Pace Analytical
Services_ LLC.
Page 5 or 28
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 8 of 31

aceAnalyiieale
en w.Owlillil re
ANALYTICAL RESULTS
Project, TCLP
Pace Project Na.: 92519773
Pace Analytical Services, LLC
9800 Kincey Ave. Suite 100
HunlersvNle, NC 28078
[phone]
Sample: 210204.15.01
Ril reported on a "dry
Parameters
Lab Ilk 925197730011 Collected: 02101121 11:30 Received: 02/02/21 14:00 Matrix: SOu(l
weight" basis and are adjusted for percent moisture, sample size and any dilutions.
Results Units Report Limit OF Prepared Analyzed CAS No. Qual
6010 MET ICP, TCLP
Analytical Method, EPA 6010D Preparation Method: EPA 3010A
Leachate MethodlDste'. EPA 1311, 02/03121 15:47 Initial pH: 5.81: Final pH: 2
Pace Analytical Services -Asheville
Arsenic
ND f ll. 0,050 1
02105121 01:25 02105121 12.05 7440-38-2
Barium
NO mglL 0,25 1
02(05121 01:25 02/05121 12:05 7440-39-3
Cadmium
ND mglL 0,0050 1
02105121 01:25 0=512l 12:05 7440-43-9
Chromium
NO mg1L 0.050 1
02105)2101.25 021'05/2112:05 7440-47-3
Lead
ND mg)L 0,025 1
0210512101:25 02105121 12:05 7439-92-1
Selenium
ND mglL 010 1
0210512101:25 02105/21 12:05 7782-49-2
Silver
NO irl 0,025 1
02105f2101:25 0210512112:05 7440-22-4
7470 Mercury, TCLP Analytical Method: EPA 7470A Preparation Method: EPA 7470A
Leachate Method/Date: EPA 1311; 02103/21 15:47 lnilial pH: 5-81; Final pH. 2
Pace Analytical Services - Asheville
Mercury NO mglL 0 D0020 1 02l05121 10:11 02/05121 14:15 7439-97-6
8270E TCLP RVE
Analytical Method: EPA 6270E Preparation Method, EPA 3510C
Leachate Method/bate: EPA 1311: 02103/21 15A7 Initial pH: 5.6: Final pH_ 5
Pace Analytical Services - Charlotte
1,4-0icNorobenzene
ND
uglL
60.0
1 0210512108:31 021061211510 106.46-7
2,4-Dint rotoluene
NO
ug1L
50.0
1 02105121 08:31 02/06/21 15:10 121-14-2
Hexachium-1.3-butadlene
NO
ug1L
50.0
1 02105/2108:31 0210612115:10 57-68-3
Hexachlarobeozene
NO
ug1L
50.0
1 0210512148:31 0210612115:10 118.74.1
Hexachloroethane
ND
uglL
50,0
1 02105121 08:31 0210612115:10 67-72-1
2-Methylphenol(o-Cresol)
NO
LglL
500
1 02105121 08:31 02106/21 15:10 95-48-7
X41-Methylphenol(m8p Cl
N❑
uglL
50.0
1 02/05121 0831 02/06/21 15:10 15631-10-4
Nitrobenzene
ND
uglL
50.0
1 0210512108:31 021061211510 98-95-3
Pentachlorophenol
ND
ug1L
100
1 02105?2t 08:31 0206121 15:10 87-86-5
Pyridine
ND
uglL
50,0
1 0210512108:31 0210612115:10 110.66-1
2.4,5-Trichlorophenol
ND
uglL
50.0
1 0210572108-31 021061211510 95-95-4
2,4,6-Tfichiorophenol
ND
uglL
50.0
1 0210512108:31 021061211510 88-06-2
surrogates
Nitrobenzene-d5 (S)
43
°/
10-144
1 02IW21 08:31 02/06/21 15:10 4165-60-0
2-Fluerobiphenyl (S)
30
%
10-130
1 02/05121 0831 02106121 15:10 321-60-8
Tefphenyi-d14 (S)
139
I
34-163
1 02105121 08:31 02r06121 15:10 11718.51-0
Phenol-d6 (S)
23
%
10-130
1 02105121 08.31 02106121 15:10 13127-88-3
2-Fluorophenol(S)
32
%
IG-130
1 02M5121 08:31 02106121 15:10 367-12-4
2,4,6-Tribromophenol (S)
55
%
10-144
1 02/05121 08:31 02/06121 15'10 118-79-6
8260D MSV TCLP
Analytical Method. EPA 8260D Leachate MethodlDate: EPA 1311. 02111121 13:15
Pace Analytical Services - Charlotte
Benzene
ND
l
100
20 02/13121 16:15 71-43-2
2-Butanone (MEK)
NO
ug1L
200
20 0203121 16:15 78-93-3
Caftion tetrachloride
ND
uglL
100
20 0211312l 16:15 56-23-5
Chlorobanzene
ND
uglL
100
20 021131211615 108-90-7
Chloroform
ND
uglL
100
20 0211312116:15 67-66-3
REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced.
except in iull,
Dale: D211612021 03:47 PM
without the written consent of Pace Analytical Services- LLC
Page 6 of 2$
PO Box 228 • Statesville, NC 28687 e 704/872/4697
Page 9 of 31

1U klf ykal
/�Zce
M1nr.PliWahi.cenl
f
ANALYTICAL RESULTS
Pace Analytical Services, LLC
9800 Kir,my Ave. Suite 100
Huntersvi0e, NC 28078
[phone]
Project. TCLP
Pace Project No.: 92519773
Sample: 210201.15.01
Lab ID: 92519773001 Collected: 02101121 11:30
Received: 02/02121 14:00 Matrix: Solid
Results reported ors a "dry weight"
basis and are adjusted for percent moisture, sample size and any dilutions.
Parameters
Results Units Report Limit DF
Prepared Analyzed CAS No. Qual
8260D MSV TCLP
Analytical Method: EPA8260D Leachale MeihodlDate:
EPA 1311; 02/11/21 13,15
Pace Analytical Services - Charlotte
1.4-Dichiorobenzene
ND Lg1L 100 20
0211312116:15 106-46-7
1.2-Dichloroethane
NO ug1L 100 20
0211312116:15 107-06-2
1.1-Dichloroethene
ND u9il. 100 20
011312116:15 75-35-4
Tetrachloroethene
ND uglL 100 20
0211312116:15 127-18-4
Trichloroethene
ND ugrL 100 20
02f1312116:15 79-01-6
Vinyl chtoride
ND uglL 100 20
02/13121 16:15 75-01-4
Surrogates
1,2-Dichloroethane-d4IS)
82 % 70-130 20
021131211615 17060-07-0
Toluene-d8 (S)
98 % 67-135 20
02113/21 16:15 2031-26-5
4-Bromofluorobenzane (S)
99 % 70-130 20
D2113121 16:15 460-M-4
Percent Moisture
Analytical Method: SW-846
Pace Analytical Services - Charlotte
Percent Moisture
86.5 % 0.10 1
02/02121 16:34 N2
1010 Flashpoint,Closed Cup
Analytical Melhod: EPA 1010A
Pace Analytical Services - Asheville
Flashpoint
>200 deg F 70.0 1
02114i21 15:35
9045 pH Soil
Analytical Method: EPA 9045D
Pace Analytical Services -Asheville
pH at 25 Degrees C
7.1 Std, Units 0.10 1
02115121 13:55 H6
9095 Paint filter Liquid Test
Analytical Method: EPA 9095E
Pace Analytical Services - Asheville
Free Liquids
Pass to 1
02!09121 12,30
733C S Reactive Cyanide
Anatytical Method: EPA9014 Preparation Method: SW-846
7.3.3.2
Pace Analytical Services - Greensburg
Cyanide. Reactive
ND mgikg 74 1
021051'21 19:51 02108/21 12:27
734S Reactive Sulfide
Analytical Method: SM 4500S2F-2011 Preparation Method:
SW-846 7.3.4.2
Pace Analytical Services - Greensburg
Sulfide, Reactive
ND Mg/kg 74.3 1
021'05121 19:51 02/05121 19:55
REPORT OF LABORATORY ANALYSIS
This report Shall not be raPMduced, except do hull,
Date. 0211612021 03:47 PM without the written consent of Pace Analytical Services. LLC- Page 7 of 28
PO Box 228 a Statesville, NC 28687 • 704/872/4697
Page 10 of 31

Receive Date: 01/23/2020
Reported: 01 /27/2020
For: BAXTER
Comments:
Sample Number
Parameter
Sample ID
Result
Unit
Method
Analyzed
Analyst
200123-32-01
Fecal Coliforms
B1
1811
MPNIg
SM92210E-2006
01/24/2020
WC
200123-32-01
Percent Solids
B1
12.7
%
SM2546B-2011
01/24/2020
WC
200123-32-02
Fecal Coliforms
B2
1870
MPNIg
SM92210E-2006
01/24/2020
WC
200123-32-02
Percent Sol -ids
B2
12.3
%
SM254OB-2011
01/24/2020
WC
200123-32-03
Fecal Coliforms
B3
1769
MPN/g
SM92210E-2006
01124/2020
WC
200123-32-03
Percent Solids
B3
13
%
SM2540B.2011
01124/2020
WC
200123-32-04
Fecal Coliforms
B4
1797
MPNIg
SM92210E-2006
01/24/2020
WC
200123-32-04
Percent Solids
B4
12.8
%
sM2540e-2011
01/24/2020
WC
200123-32-05
Fecal Coliforms
B5
1949
MPNIg
SM92210E-2006
01/24/2020
WC
200123-32-05
Percent Solids
B5
11.8
%
SM254OB-2011
01/24/2020
WC
200123-32-06
Fecal Coliforms
B6
1917
MPNIg
SM92210E-200s
01/24/2020
WC
200123-32-06
Percent Solids
B6
12
%
SM25400-2011
01/24/2020
WC
200123-32-07
Fecal Coliforms
B7
1825
MPNIg
SM92210E-2006
01/24/2020
WC
200123-32-07
Percent Solids
B7
12.6
%
SM25408-2011
01/24/2020
WC
Respectfully submitted,
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
PO Box 228 a Statesville, NC 28687 • 704/872/4697
Pagel of 4

Analytical Results
U.S. Biosolids Inc
958 Hoots Road
Roaring River, NC 28669
Receive Date: 03/19/2020
Reported: 04/27/2020
For: BAXTER
Comments:
`AN A LY i I C A L
e, 3
Sample Number Parameter Sample 1D Result Unit Method Analyzed Analyst
200319-21-01 30 Day Benchscaie BAXTER
Respectfully submitted..
Dena Myers
NC Cert #440,
NCDW Cert #37755,
EPA #NC00909
% eP.425.R-WYu 03/19/2020 WC
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page ' of 3

30 Day Bench Worksheet Sample ID # —) 31� "2{
WEEK I
Samples
Total Solids 1
Volatile Solids
% Volatile Fraction
I
2
Z
z
I .0
0. 58
3
,.
}. !
U127-7
Average:
1
02
WEEK 2
Samples 11
1
Total Solids
1
Volatile Solids
(
% Volatile Fraction
z
2
3
i LA
a _
U .21561
Average_
j , "T
002
Q,Q 24
Samples I Total Solids Volatile Solids TMevolatile
2
3
A
WEEK 4
Samples I
Total Solids
Volatile Solids
% Vora latile Fction
- -
-3
1.LAO
_
Aver"e:
I .
1
n. r5W53
WEEK 5
les
Total Solids
Volatile Solids
% Volatile Fraction
_Sam
sAvera
2Aj3
�__� �
e:
MCA
WEEK 6
Samples
Total Solids
Volatile Solid . % Vola le�Fraction
Z
i t
31
3
0 - D
Average:
I
_P1$
Van Kleeck Reduction: a %Val. Frac. Final %Vol. Fr . X 100 =
nitial °/u Vo3. ac. — ( Initial % Vol. Frac. X Final % Vol. Frac.)
FINAL RESU _ �- %

State of North Carolina
DWR
Department of Environmental Quality
Division of Water Resources
Division of Water Resources LAND APPLICATION SITE CERTIFICATION
INSTRUCTIONS FOR FORM: LASC 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more iglbrnration, visit the Woer Quality Perwitting Section's Non-Di.srharve Permittin z Unit
General — This certification provides detailed information of receiving sites for land application of Class B residuals (may include
water treatment plant or other type residuals) in accordance with 1 5A NCAC 021- .1100. Do not submit this certification for review
without a corresponding application form (FORM: RLAP 06-16 or FORM: SDR 06-16).
Unless otherwise noted. the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A. Land Application Site Certification (FORM: LASC 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: l_ASC 06-16) form. Please
do not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions. attachments
to the application may be made.. as long as the attachments are numbered to correspond to the section and item to which they
refer.
❑ For new or renewed permits, submit the requested information for all land application sites.
❑ For modified permits, submit the requested information for only those sites that are new. transferred or affected by the
proposed modification.
B. Land Application Site Information:
❑ The status of the land application site with respect to this residuals land application program must be provided in table 1. The
status categories and their corresponding codes are as follows:
♦ New (N) ♦ Renewed (R) ♦ Modified (M) ♦ Transferred (T) ♦ Deleted (D)
❑ Attach the following in accordance with each status code:
Status Code
Required Item
N
R
T
M
County Board
✓
Notif ication. doc
i
Land Owner
✓
✓
Agreement
(If applicable)
—
Setback Waiver
Agreement
An updated vicinity/setback map in accordance with the "Map Guidance
for Res idua,,Is... Pqfn, its-
-----
✓
✓
✓
A soils and agronomic evaluation in accordance with the "Soil Scientist
Evaluation Policy -
✓
INSTRUCTIONS FOR FORM: LASC 06-16 Page I of')

G
❑■
a
An updated accounting of the land application site's cumulative
pollutant loading rates CPLRs
Status Code
Required Item
-7
N
R
T
M
For previously permitted sites without a soil series name indicated in the
Attachment B, submit County Soil Survey Map (or equivalent) clearly
indicate the location of the land application site and in accordance with
the soil map requirements in the "Soil Scientist Evaluation Policy"
_
Acknowledgement of field transfer from Land Owner (Fields may not
✓
be permitted to multiple Permittees over the same time period)
* This item may be required for land application site with a status code "M". please contact the Division if you need assistant in
determining attachment requirements.
Crop Type should include the most likely crop types for the life of the permit (five years).
Predominant Soils Series Name must be either the name of the soil indicated in Attachment "B" of the existing permit, or
name of the soil series as provided by the licensed soil scientist.
Predominant Soil Mapping Unit or Representative Slope: Either the Soil Mapping Unit or the representative slope of each
site must be provided. The predominant soil -mapping unit must be consistent with the predominant soil series name. Please
note that the soil mapping units are variable between Counties, so care should be taken in properly identifying the correct
mapping unit. If a representative slope is provided, it must be determined accordingly:
❑ For sites previously permitted for use, but do not have an established soil mapping unit (the mapping unit provides
information on both the soil series name and the slope of the soil), the Applicant may determine the representative slope
by using the average slope provided in the County Soil Survey (or equivalent). A soil type with a slope range of 4 - 8%
would have a representative slope of6%.
❑ New Sites to be permitted must have slopes determined as part of the soils report prepared by a licensed soil scientist.
Acceptable methods for determining location coordinates (i.e., latitude and longitude) and their corresponding codes are as
follows:
• Address Matching (ADD)
• Aerial Photography with Ground Control (A ER)
• Cadastral Survey (SUR)
• Conversion from Coordinate Plane (CP)
• Conversion from Township -Section -Range (TSR)
• Conversion from Universal "Frans Mere (UTM)
• Map Interpretation by Digital or Manual Extraction (MAP)
C. Waterbody and Classifications Information: (new sites only)
• Digital or Raw Photo Extraction (EXT)
• Geodetic Quality GPS Survey (GEO)
• LORAN-C Navigation Device (LOR)
• Navigation Quality GPS (GPS)
• Remote Sensing (RS)
• Zip Code Centroid (ZIP)
❑ Use an 8.5 by l [-inch copy of the portion of a 7.5-minute USGS Topographic Map to identify the location where the
residuals program activities are planned to occur as well as the closest downslope surface waters as clearly as possible. Each
map portion must be labeled with the map name and number, the identified location, and be of clear and reproducible quality.
❑ Surface water body classifications information may be found at: http://deq.nc.goviabouti'divisions/water-
resources/planningr/classification -standards/class ifications
❑ Any questions concerning the waterbody and its classification, please contact the Division's regional offices.
❑ A list of the Division's regional offices, their county coverage. and their contact information may be downloaded at:
Itttp://deq. nc.gov/contact/regional-oft ices
❑ General Instructions: There are 17 river basins in North Carolina. Each basin has associated waterbodies with assigned
subbasins, location descriptions, stream index numbers and established classifications.
I. Identify the project area on a 7.5 minute USGS topographical map (an 8.5 x l ]-inch sheet showing the project area
should be submitted with the permit application regardless of whether a Stream classification was completed).
2. Determine the names of all the closest down slope surface waters from the project site. For unnamed tributaries, see
Table l : Unnamed Tributaries Entering Other States or for Specific Basin Areas. Label any unnamed tributaries as
"UT to slreant name" as the waterbody name.
Open the link http://deq.tic.g_ov/about/divisions/water-resources; planning/classification-standards/classifications.
❑ Stream Classification Process: One of the options below may be used depending on the known initial project information.
❑ KNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select proper basin from the List all Waterbodies in Basin sorted report. Sort hydrologically as this will provide
the proper location descriptions if multiple runs.
INSTRUCTIONS FOR FORM: LASC 06-16 Page 2 of;

2. Locate the name of the identified waterbody (from General Directions) on the I ist.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ KNOWN COUNTY WHERE CLOSEST DOWN SLOPE SURFACE WATER IS LOCATED
1. Select the proper county from the List all Waterbodies in county, hydrologically report.
2. Locate the name of the identified waterbody (from General Directions) on the list.
3. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
4. Record all Basins, Stream Index Numbers and Classifications applicable to the project.
❑ UNKNOWN BASIN WHERE CLOSEST DOWN SLOPE SURFACE WATER 1S LOCATED
1. Use the Clickable basin map to hydrologically sorted list report.
2. Click on the approximate project location to bring up the hydrologically sorted list.
3. Locate the name of the identified waterbody (from General Directions) on the list.
4. For multiple listings of the same waterbody name in the report, select and verify the location description. The term
"source" in the description means the beginning of the waterbody segment (most upstream point).
5. Record all Basins, Stream index Numbers and Classifications applicable to the project.
❑ Notes on index number and unnamed streams:
Unnamed Streams 15A NCAC 02B .0301(i).
❑ Any stream which is not named in the schedule of stream classifications carries the same classification as that assigned
to the stream segment to which it is tributary (at the point of envy) except:
(A) unnamed streams specifically described in the schedule ofclass itications-,
(B) unnamed freshwaters tributary to tidal saltwaters will be classified "C'% or
(C) after November 1, 1986, any newly created areas of tidal saltwater which are connected to Class SA waters by
approved dredging projects will be classified "SC" unless case -by -case reclassification proceedings are conducted.
❑ The following river basins have different policies for unnarned streams entering other states or for specific areas of the
basin:
Unnamed Tributaries Entering Other States or for Specific Basin Areas
Hiwassee River Basin Streams entering Georgia or Tennessee shall be classrtrcd "C Tr,"
Little Tennesse River Streams entering Georgia or 'l-ennessee shall be classified "C Tr." Such streams in the Savannah
Basin And Savannah River drainage area entering South Carolina shall be classified 'B Tr."
River Draina e Area
French Broad River Streams entering Tennessee will be classified "B."
Basin
Watauga River Basin
Streams entering the State of Tennessee are classified "C."
Broad River Basin
Streams entering South Carolina are classified "C."
Streams entering the State of Tennessee are classified "C."
Streams entering South Carolina are classified "C."
Streams entering Virginia are classified "C." and such streams entering South Carolina are
New River Basin
Catawba River Basin
Yadkin -Pee Dee River
Basin
classified "C."
Streams entering South Carolina are classified "C Sw."
Lumber River Basin
Streams entering Virginia are classified "C." Except that all backwaters of John H. Kerr
Reservoir and the North Carolina portion of streams tributary thereto not otherwise named or
Roanoke River Basin
described shall carry the classification "B," and all backwaters of Lake Gaston and the North
Carolina portion of streams tributary thereto not otherwise named or described shall carry the
classification "C and B."
Streams entering Virginia are classified "C._
All drainage canals not noted in the schedule are classified "C Sw." except the main drainage
Chowan River Basin
Tar -Pamlico River
Basin
canals to Pamlico Sound and its bays which shall be classified "SC."
All drainage canals not noted in the schedule are classified "C."
Pas uotank River Basin
INSTRUCTIONS FOR FORM: LASC 06-16 Page 3 of 3

LAND APPLICATION SITE CERTIFICATION
Applicant's name: Baxter Healthcare Corporation
Land application sites currently certified: 69.6 net acres and "Total to be certified: 69.6 net acres.
I. LAND APPLICATION SITE INFORMATION (See Instruction B):
I
Status
Code'
Site/Field
ID
Landowner(s)
R
DPI -A
Douglas Poplin
Douglas Poplin
R
DPI-B
R
DPI-C
Douglas Poplin
Douglas Poplin
R
DPI-D
R
DP2
Douglas Poplin
Douglas Poplin
R
DP,
R
DP4
Douglas Poplin
Douglas Poplin
R
DP5
Lessee(s) or Operator(s) I Net Acres � County
Crop(s)
U
5.5
Wilkes
Fescue
1.6
Wilkes
Fescue
3.0
Wilkes
Fescue
9.6
Wilkes
Corn
0.8
Wilkes
i Fescue/Corn
14.6
Wilkes
Fescue
8.7
Wilkes
Fescue
159
Wilkes
Fescue
•! �d
a Status Code fix land application sites are: ♦ N (New) • R (Renewed) ♦ M (Modified) ♦ 1 1 t ransicrrcd) ♦ D C ( Cie 1
n Soil Series Name (i.e. Appling- Cecil. etc.)
Mapping Unit must be consistent with those used in the County Sail Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is Ce132)
11. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
SitelField ID
Latitude
Longit"
f DPI -A
36.234860
80.944
-80.943
DPI-B
36.234860
DPI -C
36.236670
-80.945
DPI-D
36.236700
-80.945
DP2
36.236670
-80.947
DP3
36.242070
-80.941
DP4
36.240270
-80.938
DP5
36.236660
-80.941
de
Location
Location Method Code
Location Accuracy
Datum
360
NAD 83
ADD
Nearest Second
100
NAD 83
ADD
Nearest Second
470
NAD 83
ADD
Nearest Second
600
NAD 83
ADD
Nearest Second
690
NAD 83
ADD
Nearest Second
020
NAD 83
ADD
Nearest Second
790
NAD 83
ADD
Nearest Second
020
NAD 83
ADD
Nearest Second
Note: Please keep the site information (1.) and uaterhody information (11.) of the same field on the same page.
Predominant Soil
Series Name
Waterbody Subbasin and
Stream Index No.
Hughes Branch 12-50
Hughes Branch 12-50
Hughes Branch 12-50
Hughes Branch 12-50
Hughes Branch 12-50
Hughes Branch 12-50
Hughes Branch 12-50
Hughes Branch 12-50
Fairview
Fairview
Fairview
Fairview
Fairview
Fairview
Fairview
Fairview
Mapping Unit
or Rep. Slope'
FcC2
FcC2
FcC2
FcB2
FcB2
FcB2
FcC2
FcC2
Current and Proposed
Class
WS-lV
WS-1V
WS-1V
WS-IV
WS-1V
WS-1V
WS-1V
WS-IV
WS-IV
WS-IV
WS-lV
WS-1V
WS-IV
WS-1V
WS-lV
WS-IV
FORM: LASC 06-16 Page I

LAND APPLICATION SITE CERTIFICATION
Applicant's name: Baxter Healthcare Corporation
Land application sites currently certified: 69.6 net acres and Total to be certified: 69.6 net acres.
1. LAND APPLICATION SITE INFORMATION (See Instruction B):
Status
Code'
Site/Field
ID
Landowner(s)
Lessee(s) or Operator(s)
Net Acres
County
Crop(s)
Predominant Soil
Series Name 6
Mapping Unit
or Rep. Slope`
R
DP6
Douglas Poplin
5.5
Wilkes
Fescue
Fairview
FcC2
R
DP7
Douglas Poplin
4A
Wilkes
Fescue
Fairview
FcC2
N
N
N
I
,..
a Status Code for land application sites arc: ♦ N (New) ♦ K (Kene��,ed) • M (modttleo) • t t ransierrea) • u tucieLcut
h Soil Series Name (i.e. Appling, Cecil, etc.)
Mapping Unit must he consistent with those used in the County Soil Survey (i.e. for a 2-8% slope Cecil in Anson County the mapping unit is CeB2)
11. WATERBODY AND CLASSIFICATIONS INFORMATION (See Instruction C):
Site/Field ID
DP6
Latitude Longitude
36,238470"-80.9432400
Location
Datum
NAD 83
Location Method Code
ADD
Location Accuracy
Nearest Second
Waterbody Subbasin and
Stream Index No.
Hughes Branch 12-50
Current and Proposed
Class
WS-[V WS-IV
DP7 36.2402700 "
-80.94 3240°
NAD 83
ADD
Nearest Second
Hughes Branch 12-50
WS-IV
WS-IV
°
NAD 83
ADD
Nearest Second
NAD 83
ADD
Nearest Second
NAD 83
ADD
Nearest Second
° 11
o r 11
NAD 83
ADD
Nearest Second
NAD 83
ADD
Nearest Second
NAD 83
ADD
Nearest Second
Note: Please keep the site information (i.) and waterbody information (it.) of the same new on the same page.
FORM: LASC 06-16
Page I

� l �
Division of Water Resources
State of North Carolina
Department of Environmental Quality
Division of Water Resources
15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as a checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted, the Applicant shall submit one original and two copies of the application and
supporting documentation
For more information, visit the Water Qualii.v Permitting Section's Non -Discharge Permiuing Unit.
General - This document is an agreement between the Applicant and land owner(s) of residuals receiving sites for land application of
Class B residuals (may include water treatment plant or other type residuals) in accordance with 15A NCAC 02T .1 100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless other-wisc noted. the Applicant shall submit one on.-inal and two copies of the application and supporting documentation listed
below.
A. Land Owner Agreement (FORM: LOA 06-16):
❑ Submit the completed and appropriately executed Land Application Site Certification (FORM: LASC 06-16) form. Please do
not make any unauthorized content changes to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as lone as the attachments are numbered to correspond to the section and item to which they
refer.
❑ Prepare a separate agreement for each set of land application sites that arc owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGREEMENT FOR THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hereby permits:
Applicant's name: _ Baxter Healthcare Corporation
hereinafter referred to as the Permittee, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement.-
Lease
Land t:se or
Site/Field ID
(yes/no)
Cropping Patterns
DPI -A
Pasture
NO
DPI_B
NO
Pasture i
DPI-C i
NO
Pasture
DI'I-D
NO
Pasture
DP2
NO
Corn
DP3
NO
11a�
DP4
NO
Pasture
Intended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
Animal Feed
Animal Feed
Animal Feed
Animal Feed
Animal Feed
Animal Feed
Animal Feed
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewed each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as written notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: I.OA 00- 16 Page I of 3

State of North Carolina
Department of Environmental Quality
Division of Water Resources
Division of Water Resources 15A NCAC 02T .1100 — LAND OWNER AGREEMENT
FORM: LOA 06-16
Please use the following instructions as it checklist in order to ensure all required items are submitted. Adherence to these
instructions and checking the provided boxes will help produce a quicker review time and reduce the amount of additional
information requested. Failure to submit all of the required items will lead to additional processing and review time for the
permit application. Unless otherwise noted the Applicant shall submit one original and two copies of the application and
supporting documentation
!err more information, visit the Water CQualily Permitting Section's Nor?-Dischar e PermittingUnit.
General This document is an agreement bct%veen the Applicant and land owner(s) of residuals receiving sites for land application of
Class 13 rrsiduaIS (ma)' include water treatment plant or other tvpc residuals) in accordance with 15A NCAC 02T .1100. Do not submit
this agreement for review without a corresponding application form (FORM: RLAP 06-16).
Unless otherwise noted, the Applicant shall submit one original and two copies of the application and supporting documentation listed
below.
A, Land Owner Agreement (FORM: LOA 06-16):
❑ Subwit the completed and appropriately executed land Application Site Certification (FORM: 1,ASC 06-16) form. Please do
not make any Unauthorized content chances to this form. If necessary for clarity or due to space restrictions, attachments to
the application may be made, as lop-! as the attachments are numbered to correspond to the section and item to which they
retor.
❑ Prepare a separate agreement for each set of land application sites that are owned or operated by an entity other than the
Applicant.
❑ A copy of the completed and appropriately executed agreement must be provided to the landowner and the lessee/operator.
AGRFE1INIEN'r FOR. THE LAND APPLICATION OF RESIDUALS TO PRIVATELY OWNED LAND
The undersigned landowner or his representative hercb}permits:
Applicant's name: - _ Baxtci- ilealthcare_ _____
hereinafter referred to as the Permittec, to land apply residuals from the following facility(ies) onto the following land
application site(s) (i.e., see attached setback maps) in accordance with the stipulations and restrictions as given in this
Agreement:
Site/Field ID l..case Land t
(yeslno) Cropping PPaatterns i
1)PNO Pasture
DPG N'O Pasture
DP7 NO Pasture
ntended Use of Crops
Residuals Source
(optional)
Special note
(no-till/over-seed/
pasture)
Animal Feed
Animal Feed
Animal Feed
The landowner or his representative receives, in consideration, full use of the nutrient value of the applied residuals while the
Permittee receives, in consideration, the use of the land application site(s) described above for the disposal of the residuals.
This Agreement shall remain in effect for the length of the Division's permit for the residuals land application program and
shall be renewetl each time this permit is renewed.
The undersigned landowner or his representative and the Permittee agree to abide with the following restrictions and
stipulations until such time as �) ritten notification, given 30 calendar days in advance, modifies or cancels this Agreement.
FORM: I,OA 06-16 Page I of 3

STIPULATIONS:
I. The landowner or his represcriumve shall not ell(Cr into env additional residuals application contracts or agreements with another permitted
entity for the rims) specified by this Agrecmcnl.
2. Should the landowner or his representative Icasc or o(llcn%ise permit the use of the land application site(s) to a third party, the landowner shall
be responsihlc to ensure that the third party :ilt.rces and complies vkith the terms and conditions of this Agreement.
3. Hie lando« ncr or his representative shall adhere to the prov isions ofthis Agreement until all of the site restrictions (under Section 11) are met.
4. Notilict(lion ofcancellation ofthis Agreement shall he im'nediatcly forwarded to NCDf.NR-DWR. Non -Discharge Permitting Unit. 1617 Mail
Service ("enter. Raicie,h. NC 27699-1617.
5. The Permittee must request and obtain a permit modification from the Division prior to a transfer of the land application sites) to anew
landowner In addition. the cu1-1-c3rl landott ner steal[ Ltiae n n06CC to the new landowner that gives full details of the residuals applied at the land
application ;ims).
6. the Permittcc has provided the landowner or his represcW:i(kc with information and data concerning the residuals land application program.
includim, ar anah :,is of constituents orthc residuals. residuals application methods. schedules for typical cropping patterns. a description of the
cquipmenl used hN the Permittee.
7. The Pcrmit(ec +ill provide the landowner or his rcprescolutivc \kith a copy of the residuals permit prior to commencement of any residuals land
application cvcnl and a copy oflltc results ofeach soil analysis.
8. If the soil pl i of the land application site(s) is not maintained at 0 D or greater. sufficient amounts of lime shall be applied to achieve a final soil
pl I of at last 6.0. unless an agronomist prov ides inl'orm<stion indicating that the pH of the soil, residuals and lime mixture is suitable for the
specified er{gyp.
9. The landovt ner or his representative and the Permittee \kill agree on residuals application rates and schedules based on crop patterns, results of
soil samples. and the permitted npplicalion limits.
10. ']'he IandtM ner or his rcprescntaiit c will pro% idc the Permittcc +kith information regarding the amount and analv sis of other sources of nutrients
(C.g.. rerlihlCf. Lill rciurWed animal %\rite. cte ) that hamc hcen applied to the land application site(s).
1 1. the landowner or his represeuuive twill inform the Permittee orany revisions or modifications to the intended use and cropping patterns for
the land application site(s) priorto each plantint season to cmtblc the Permittee to amend this Agreement and schedule residuals land application
events at appropriate periods.
12. Spccilie residuals land application area houndarics shall he clearly marked on the land application site(s) by the Permittee. the landowner. or
his representative prior to and during a residuals land application event.
13. the Ianclow not- or his representative herchv aa(horiics the Permittee. local officials, and State officials or their representatives to; enter and
inspect a),N properly. premises- or place on or related to the land application sites) at any reasonable time for the purpose of determining
compliance %N i(h the permit: cslahlish monitorinv. Caciiitics on or near the land application sites) as required by the permit: copy any records
that mtrsi he kept undo the terms and conditions of (he permit: take necessary leaehatc. surface water. groundwater, or soil samples during the
term of. anti 1 -1 month: alter termination ol. thin As.rccnunt
II. RESTRICTIONS:
1. Appropriate measures must be taken by the Perntitlec amPor the landowner or his representative to control public access to the land application
site(s) during, active use and for the i 2-month period lollotcing a residuals land application event. Such controls may include the posting of
signs that indicate the activities being conducted at the land application site(s).
2. Animals shall not he grazed on the land application silc(s) for a 30-day period following a residuals land application event. Land application
sites that are to he used forgrazing. steal I haN c I'cncing- (pal +N i11 he -i ed to prevent access during these periods after such residuals land application
ev enis.
3. Food cn}I,s. 1"ecd crops. and fiber crops shall not he her\e,ted for a 30-day period following a residuals land application event.
d. Food crop, ty ith hary ested parts that touch the residuals; soil mixture and are totally above the land surface shall not be harvested for a 14-month
period follLM 1112 a residuals land application C%Col
5. Food crap, w ith hark ested parts helo«the an-facc o the land shall not he harvested for a 20-inonth period following a residuals land application
event when the residuals remain on the land stirlaec for tour months or longer prior to incorporation into the soil.
6. Food crops vN ltli hark ested parts below the surface of the land steal I not be harvested fora 38-month period following a residuals land application
event a hen the residuals remain on the land surface for less than lour months prior to incorporation into the soil.
7. "turf grow n on land vrhere residuals arc applied shalt not hr harvested for a 12-month period following a residuals land application event.
11LALTERNATI\ F:S FOR WATER SUPPLY "ELLS INSIDF. IIIE COMPLIANCE BOUNDARY: (please check one)
15A N('A( 0 11 0107Wd prohibits water supply w Clls w Rhin (hc compliance boundary. I lowcver. 15A NCAC 02T .0105(h) allows the compliance
bomufary to he placed closer to the waste dispo;nl area. such lhat the Neater supply well is situated outside of the compliance boundary provided
the ground\ wadi sutndards can be met at the nee\ I\-estahlishcd compliance boundary. Please mark one of the following;
❑ A re -defined compliance boundary is needed for licld(s) ID: -
(Please include the rationale for the requested re -location oflhc compliance boundary and attach a map showing the newly proposed compliance
boundar, to the application package)
® A re-delincki compliance houndar, is not needed for this site.
IV. ACKNOWLYW;F NIF.NT OF F1ELD TRANSf:F.12: (if needed)
❑ The land ;rphhcation held(,) ID: -. __ __ ___ . is currently permitted under another
residuals land application pro_�ran: Permit Nunihcr WO: _ _. the land owner hereby acknowledge that by signing this
agreement. he: she is requc ting that the iicld(s) he remo� ed from the previously permitted residuals land application program and transferred
into the nc�, program:
(Name of the new program)
FORM: LOA 06-16 Page 2 of 3

Laodowner's Certification:
I certify that I am a dceiW1 landowner of the abovr-referenced land application site(s) and am authorized to make decisions
regarding tine tisc of the laid application %ite(s) on bchalrorother deeded landowners QEj that 1 am otherwise authorized, through
a power of ituome+ or other Icgal delegation, io make decisions regarding the use of the land application site(s) on behalf of the
deeded landim,ners I certify that the above -referenced land application site(s) are not included in any waste disposal contractor
agreement %ith another municipality, contractor. or other permitted entity. Furthermore. I certify that I have read this Agreement,
understand the stipulations, restrictions. altcrnati4;es for water supply wells inside the compliance boundary, acknowledgement of
field transfer. and do hereby grant permission it) the f ermitice to land apply residuals to the land application site(s) as specified
herein.
I,andowner name: I�gtglas Poplin
Address: . 59, a -in I kile Min. Rd.
City: ^_ Rgnda ._� _ State: , ,. NC' Zip: 28670
Phone: 336-957-?-iS l -mail address:
Signature �lt.�� "......... Date:._
NOR I I I C AR01.INA, Wilke% COUNTY
I, the undcrsigned 1`igmy Public do hereby ceriifj that Doup has Po lid n _.........._...
personally appeared h,:ore me this day and acknowledged the due execution of the forgoing instrument.
WITNESS my hand and ollicial seal this the
day of fit V r► _ , . , ,1``,,�`A `� /•��'��
Signaurre and peal.
My cuminission crl. "':.
O � •+?'k
:�1,�
Lessee's/Operat or'sCertiftccation: ''r•'••iC'4R41rtN `����\
,',i:�lt14ti44
I certify that I have read tl:'s Agreement and do hercbt agree io abide by the stipulations and restrictions as specified herein.
Lessceloperator name. -
Address:
City.. — — State: --
Phone: F. mail address:
Signature:
Perm ittee's C ertificatiion:
Date. -
Zip: _.
I certify that I have read r', . Agreement and do hcrcb\ agree to abide by the stipulations and restrictions as specified herein.
Signing official name: _ _. S,- aTi J ' t�VGg.-ef f .I%
Signature: _.... �F _ Date:. .1-y 20*21
FORM: LOA 06-16 Page 3 of 3
., i

e
a

r
:hm:
pjo�,10;14

DP1-C
3.0 acres
;d
7
Poplin, Douglas: Site Evaluation Field Map
Field: DPI-C
Acres3.0 0
Wilkes County NC
36.23609-80.64623 North Carolina Stateutane. NADS3
Buffers
Perennial Stream (100')
House 00`
House 'Well (1�4'00
0 )
Property Boundary
Field Boundary G House
— USGS Stream s Well
Nc cin ® Unused Area
Board
125 250 500 Feet

A
12
;I
a
;.z

40
A
? i1 i1f 4.
_Ik_����
A
AA/
�A
:ti
• DP2
0.8 acres
Buffers j
Perennial Stream (100')
House 100')
House 400'
-- Well (1 0')
— Property Boundary
Field Boundary House
— USGS Stream Well
Woo ® Unused Area
Poplin, Douglas Site Evaluation Field Map
Field. DP2
Acres: 0.8 U 125 250 500 Feet
Nilkes COunty, NC I l I t I r 1
23 36 529 TO 94665 "North Carolina 5taleplane NAM

r 7 s
�W�'.W'
• J'
o
O
in
E o �
=
rvcj
U )00
_00-
O
c �S_
OJ
L OOyyQ1
m
{�
m
m m 43CD
0
sn
m
m
LL
O
N
Q
U
C
O
m
2
LLJ
CD
U
O
Z V
J
O
T�
tl
Q Z7 GJ
O mU
Yry

Olt
A.

14
7
-ford

1y4
DIU

t
� i
ti L
DPl
4.4 acres
f Buffers
r -
h Perennial Stream (100')
House 10
House Well (i�4000:))
0')
Property Boundary C
Field Boundary House
-- USGS Stream Well
r
NC ® Unused Area �
Board
Poplin, Douglas- Site Evaluation Field Map
Field: QP7 "
Acres7 4.4 125 250 500 Feet
Mikes County, NC {
ar ,Agpr -Rn Qd';IA North Caiohna Slaleplane, NAD83

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE.
A Ut'1' ed• 5 5
Facility Name: Baxter Healthcare Corporation WQ Permit 9: WQ0031725 Field #: IA cres i iz
Land Owner: Douglas Poplin Annual Dry Tons Applied: 10.7020 Site #t: DP Acres Permitted: 5_5
Operator: Douglas Poplin Predominant Soil Series: FcC2 Cation Exchange Capacity (non 503).
Crop I Name:
Fescue
Crop 1 Max.
PAN:
t 58
Crop 2
Name:
Crop
2 Max. PAN:
Volume
Precip.
>
'o_
z >
�- 9
Vulumc applied
Residual Sourccs
Soil
Card.
¢
3
Nitrate
PAN Applied
Name O'Crop Type
Receiving Residual
o =
(enter one) Solids;
°%o
Applied per
(NPI)EiS #. u't�k.
Pass 24
m =
_
I'KN
E
�M
and
; ]i,s/acre)
o
Li uid
Solids
Acre
Fen-. Animal
(pry'
Hn.
F
':
;1'
Nitrite
Application
pp
Qy
Cu. Yds Gallons
(DryTonsrAc)
Waste. etc
Wet.
Moist)
inches
-
^
nglkg
mglkg
mg/kg
Crop I
Crop 2
Crop t
Crop 2
8-2020
100.06
12.7
1.946
WQ0031725
do
0
s
0.5
0.3
86866
20107
66.9
117.326
NA
Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0,000
0.000
2000
0.000
0.000
0.000
0.000
0.000
0.0000.000
0.000
0.000
0.000
0.000
0.000
0.000
"00
0.000
U.000
0.000
Residuals Applications
totals
on FORM
FSF
sapp ( attach
FORM
FSF supp
to this form):
TOTALS: 1 100.061 0
As
Cd Cu
Cr
Pb
H.P,
Mo
Ni
I Se
Ln
P 1 t7.32t5 0.000
Lime
Applied
Annual lbs/acre
0.014
0.002 j 0.314
4#0994#
0.012
0.000
0.020
0.044
0.014
0.328
10.419
Date
I lbs/ac
o
Prior Years Cumulative lbslac
0.199
0.055 3 259
2.384
0.064
0.011
0.15
0.787
0.128
4.959
Current Cumulative Ibs/ac
0.213
0.057 3 573
##a####
0.076
0.011
0.170
0.831
0 142
5.287
Permitled C. P. L. R.****
36
34 1338
NA
267
t5
NA
374
89
1 2499
Permit PAN Limit Ist/2nd Crop
158
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance wiui a symum ucaaga- U 0--
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S - Surface, 1N - Injection, INC - incorporation
1-33-20••1 **Volatilization Rate: Surface -0.5, Injection/lncorpo ration- 1-0
r
Signature of Land Applier pate **R Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.. Cumulative Pollutant Loading Rate
DENR FORM FSF (1212006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
AND SUBMITTED FOR EACH FIELD APPLIED ON
PLEASE MAKE A COPY OF
THIS BLANK FORM TO BE COMPLETED
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE,
Facility Name: Baxter Healthcare Corporation
WQ Permit #: WQ0031725 Field #: I Acres Utilized: Lb
Land Owner: Douglas Poplin
Annual Dry Tons Applied: 3.1231 Site #: DP Acres Permitted: 1.G
Cation Exchange Capacity (non 503):
Operator: Douglas Poplin
Predominant Soil Series: FcC2
Crop 1 Name: Fescue
158 Crop 2 Name: Crop 2 Max. PAN:
Crop l Max. PAN: p
Volume applied
pp
Volume
Residual
Soil
Precip.
v
c
3
S
Z ' Nitrate Naine of Crop Type
- PAN Applied Receiving Residual
O
(enter one) Sulidsi
�/
Applied per
(NPI)CS i!. WQfI.
Cond.
(Dr
Pali 24
m
F
TKN
3 and (Ihslacre}
Application
Nitrite
;? 0
1,iyuid
Solids
Acre
Fert _ Animal
.
Wet.
Hrs.
s b
9 si
* o
N
„ ?
G
N
y
-'
m !k Ci0 1 Cr0 2 [:itl I Crop
p p p
Q
Cu. Yds
Gallons
{Dry TonsrAc)
Wastc, etc)
Moist}
hnC�Bs
�
_
mglkg
mglkg 9 9
66.9 11NA Fescue
5-2020
29.2
12.7
1.952
WQ0031725
dry 1
U
s
0 5
0.3
86866
2U107
a,000000 0,000
0,004
D.000 O.D00
0.000
0_000 0.000
D.000
0.000 0.000
0.000
0.000 0.000
0.000
0.000 0.000
0.000
0.000 0.000
0A00
0.000 0.000
0.000
0.000 0.000
0000
0.000 0.000
0.000
0.000 D.000
U.000
Residuals Applications totals on FORM FSF supp ( attach FORM
FSF supp
to this farm):
Cd
Cu
Cr Pb
H Mo Ni
Se Zn
P 117.695 D.000 Lime Applied
iOlALS,
29.2
o
As
0.002
0.315
'##004
0.012
o.000 0.020 0.044
U.014 U.329
10.451
0.014
Annuallbslacre
0,053
3.106
2.245
0.265
o.01 1 0.143 0.742
U.124 4.96
ZDate
Prior Years Cumulative lbs/ac
0.1611
96
Current Cumulative lbsrac
0.210
0.055
3.421
#######
0277
U.011 0,163 U.786
0.138 4.960
Permitted C. P. L. R.****
36
3�
1338
NA
267
l5 NA 37t
89 249B
158
Permit PAN Limit lsU2nd Crop
with a system designed to assure that
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance
for submitting false
and evaluated the information submitted. I am aware that there are significant penalties
qualified personnel properly gathered
information, including the possibility of fines and imprisonment for knowing violations."
"Application Method: S - Surface, 1N - Injection, INC - Incorporation
j - ��•?•� t **Volatilization Rate: Surface - 0.5, Injectionllncerporation - 1.0
*** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
Signature of Land Applier
Date aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loadinti Rate
DENR FORM FSF (12/2006)

Volume applied
Volume
Residual Sources
Soil
Cond.(enter
Precip.
>
S
A
z;
one) Sohcls?
%
Applied per
(NPI)ES N. WQ#.
Past 2d
=
=
a
TKN
R
co
Li uid
�€
Solids
Acre
Fem. Animal
Wet.
�
2
0
Cu. Yds Gallons
Ioy
Waste. etc)
MOO) OO)
inches
[l
0
s
s 1
�.
0.5
0.5
0 3
0.3
mgfkg
85866
86866
mglkg
20107
20107
5 2U20
45.3
12.7
1.615
WQ0031725
drt
6-2020
9.2
12.7
0.328
WQ0031725
dry
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "NIA" 1N A BLANK OR BOX WHEN NOT APPLICABLE.
]d p Acres utilized: 3
Facilitv Name: Baxter Healthcare Corporation WQ Permit #: WQ0031725 Fte • 1C _
Acres Permitted:
Land Owner: Douglas Poplin Annual Dry Tons Applied: 5.8291 Site #t: DP 3
Operator: Douglas Poplin Predominant Soil Series: FcC2 Cation Exchange Capacity (non 503): -
158 Crop 2 Name: Crop 2 Max. PAN:
Crop 1 Name: Fescue Crop ]Max. PAN: P -
Name ul' Crop IN•pe
Receiving Residual
Application
Crop 1 Crop 2
Fescue
Fescue
Nitrate
and
Ni:ritc
mglkg
PAN Applied
(Ihslacrcj
Crop l
Crop 2
06.9
97.381
NA
66.9
19.777
NA
0.0U0
0.000
0.000
0-000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0 Wu
0.000
0.000
0 000
0.00U
0.000
0.000
5 000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
H M Ni Se Zr P 117.158 0.000 Lime Applied
FOI'ALS:
>a.s
o
As
Cd
Cu
0.313
Cr
#######
Pb
U.012
�
O.U00
a
0.U20
0.0W43
10.g03
Date
ibslac
U.U14
4.002
Annuallb5lacre
v
Prior ears Cumulative Ibs/ac
1i-77R
0.067
3-79
'.634
-
0.317
0.013
0.168
U.812
2020
100U
Current Cumulative Ibs/ac
0.792
0.069
4.103
#######
0.329
0.013
o.188
0.9Permitted
C. P. L. R.***`
36
34
1338
N
267
15
NA
37
15$
Permit PAN Limit 1st/2nd Crop
in with a system designed to assure that
"1 certify, under penalty of law, that this document was prepared under my direction or supervision accordance
that there are significant penalties for submitting false
qualified personnel properly gathered and evaluated the information submitted.
1 atn aware
information, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
-Volatilization Rate: Surface - 0.5, Injection/incorporation - 1.0
*�* Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
Sigrsat re of Land Applier Date
aerobically digested -0.3, raw sludge -0.4
"***C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (1212006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE ,MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility :Name: Baxter Healthcare Corporation WQ Permit #: WQ0031725 Field #: 1D
Land Owner: Douglas Poplin Annual Dry Tons Applied: 17.8584 Site #: DP
Operator: Douglas Poplin
Cron 1 Name: Fescue
Predominant Soil Series: FcC2
Crop I Max. PAN: 158 Crop 2 Name:
Acres Utilized: 9.6
Acres Permitted: 9.6
Cation Exchange Capacity (non 503):
Crop 2 Max. PAN:
L
y{enter
❑
Volume applied
one) Solids/
Liquid
Cu. Yds Gallons
o:�
Solids
Volume
Applied per
Acre
(Dry Tonsrac)
Residual Sources
(NPDES 4. W #.
Feri.. Animal
Waste. CIO
Soli
CO31d
l�Wet'
Moist)
Prerip.
Past 24
Hrs.
inches
a
a
{ '9
�
f a
r `-`
-.'
TKN
o S
�.
mg/kg
Nitrate
and
Nitrite
'nBA9
PAN Applied
Name oi'Crop Type
Receiving Residual
Application
Crop I I
Crop 2
Crop I
Crop 2
5-2020
66.41
i 12.7
0.740
WQ01,i3) 725
dry
0
s
D.5
0.3
868b6
20107
6ti.9
44.613
AEA
Fescue
8-2020
100,56
12.7 ,
1.120
\VQ0031725
do
0
s
0.5
0.3
86966
20107
66.9
67.554
NA
Fescue
0.000
0.000
0.000
0.000
0.00o
0.000
i
0.000
0.000
0.000
E 0 0o0
0.000
0.000
I
0.000
0.000
0.000
0.000
0.000
0.000
i
0.000
0.000
0.000
0.000
0.000
D.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
16(.97
a
As
Cd
Cu
I Cr
Pb
H
Mo
Ni
I Se
Zn
P
112_f56
0.000
Lime Applied
Annual lbs/acre
0.014
0.002
0.300
#######
0 011
0.000
0.019
0.042
0.014
0.314
9A58
Date
I lbs/ac
Prior Years Cumulative Ibs/ac
0.192
().051
3.041
2.209
0 284
0.009
0.139
0 714
0.108
4,394
12-2020
2000
Current Cumulative )bs/ac
0,206
0.053
3.341
#######
0.295
0.009
0.158
0.756
0.122
4.708
Permitted C. P. L. R.****
36
34
1339
NA
267
1 15
NA
374
89
2498
Permit PAN Limit Ist/2nd Crop
15t3
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system cieslgnen to assure tnat
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S - Surface, 1N - Injection, INC - Incorporation
��i�r `rj� j-� •�D� 1 --Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (1212006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Baxter Healthcare Corporation WQ Permit #: WQ0031725 Field #: 3-Grass Acres Utilized: 6.983
Land Owner: Douglas Poplin Annual Dry Tons Applied: 21.7527 Site #: DP Acres Permitted: 6.983
Operator: Douglas Poplin Predominant Soil Series: FcB2 Cation Exchange Capacity (non 503):
Crnn 1 Nnme- Fescue Cron I Max. PAN: 194 Crop 2 Name. Crop 2 Max. PAN:
Volume applied
Volume
Residual Sources
ScuI
Precip-
>
<
3
Nitrate
PAN Applied
Name ot'Crop Type
L
p Y
,
(enter one) Solids!
q
Applied per
(NPDGS #. WQd.
Cond.
Past 24
-�
-
x w
m
x R
E ry
„
Tf1N
o 3
M c
and
; Ibs/acre)
Receiving Residual
_
o
Liquid
Solids
Acre
Feri.. Animal
(Dry.
Hrs.
_
N
m
a 3
G
Nitrite
Application
Crep !
Crop 2
Crop ]
C'rop 2
Cu. Yds Gallons
(Dry T9n51AC)
Waste. ctc)
Wet.
Moist)
"e^
�
_
-
C
'rg/k9
mWkg
M9lkg
2-2020
106.6
12.7
1.633
tA'Q0031725
dry
0
s
0.5
0.3
86866
20107
66.9
98.449
NA
Fescue
3-2020
26.13
12.7
0.400
W00031725
dry
0
s
0.5
0.3
86866
20107
66.9
24.132
NA
Fescue
11-20201
70.65
12.7
1.082
WQ0031725
dry
0
S
0.5
0.3
96866
20107
66.9
65 248
NA
Fescue
0.000
0.000
0.000
0.000
0.000
OAnO
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS: 203.381 D
AS
Cd
Cu
Cr
Pb
P. P,
Mo
Ni
Se
Zn
P 187.828 0.000
Lime Applied
Annuallbslacre
0.023
0.003
0.502
#######
0.019
0.001
0.031
0.070
0.023
0.525
13.91
14.435
2498
16.678
Date I lbsiac
Prior Years Cumulative lbsiac
0.451
0.138
7.668
5.441
0 657
0.023
0.323
', 1.656
0.617
t>
Current Cumulative lbsiac
0A74
0.141
8.170
######N
0.676
0.024
0.354
1.726
0.640
Permitted C. P. L. R.****
36
34
1338
NA
267
I5
NA
374
89
Permit PAN Limit Ist/2nd Crop
194
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accornanee wtIna system uesigucu tv aaau, r ivat
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
**Volatilization Rate: Surface-0.5, injection/lncorpo ration - 1.0
Signature of Land Applier Date*" Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loadine Rate
DENR FORM FSF (1212006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE. MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "N/A" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Baxter Healthcare Corporation
WQ Permit #: WQ0031725
Field 9: 3-Corn Acres Utilized: 5.887
Land Owner: Douglas Poplin
Annual Dry Tons Applied: 20.7634
Site #: DP Acres Permitted: 5.887
Operator. Douglas Poplin
Predominant Soil Series: FcB2
Cation Exchange Capacity (non 503):
Crop li Name:
Corn
Crop I Max. PAN: 214
Crop 2 Name: Crop 2 Max. PAN:
Volume
Residual Sources
,oil
Precip.
>
C
z
z a
Nitrate
Name of Crop "!"ype
PAN Applied
Receiving Residual
VOILIMC applil
-
(enter one) Sulid4r
�.o
Applied per
(NPDES #. WQO.
Conti.
tDn
Past 24
b
T
p _
�_ "
v
" -
TKN
c
+,c
and
Nitrite
(lbs/acre)
Application
v
Liquid
y
Solids
Acre
i
Fen- Animal
Wet.
Hrs.
o a
C o
�
_
v"
�
2 Crop 1
Crop 2
Cu. Yds
Gallons
;Dry Tons1Ac)
Waste. utc)
moist)
inches
mgtkg
mgkQ
mglkg
Crop 1
Crop
3 2020 i
194 13
12.7
3.527
WQ0031725
dry
1)
s
0.5
0.3
86866
20107
66.9
212,664
NA Corn
0.000
0.000
0.000
0.000
0.000
0.000
0.000
6.000
0.000
0.000
0.000
0.000
0.000
0-ow
o,ono
0.060
0.000
0.000
0.000
0 olio
0.000
0.000
0.000
0.000
0.000
0.000
Q-wo
0.00o
0.000
0.000
0.000
0.000
o.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
Cd
Cu Cr
Pb
H
Mo
Ni
Se
Zn P
212.664
o.Doo Lime Applied
As
Tc�Tnt.s:
l9a t3
o
0.004
0.569 ,440940
0.022
0.001
0.035
0.079
0.026
0.595 18.884
Date Ibslac
Annuallbs/acre
0,026
Prior Years Cumulative lbs/ac
0.456
0.133
2.236 5.43
0.657
0.023
0.311
1.644
0.602
13.848 12-2020 1000
Current Cumulative Ibslac
i 0.982
0.137
2.805
#4#4004
0."'
0.024
0.347
1.723
0.628
14.443
Permitted C. P. L. R.***«
36
34
1338
NA
267
15
NA
374
89
2498
214
Permit PAN Limit Ist/2nd Crop
in with a system designed to assure that
"I certify, under penally of law, that this document was prepared under my direction
or supervision accordance
I that there are significant penalties for submitting false
qualified personnel properly gathered and
evaluated the information submitted.
am aware
information, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
I
'"*VOlatifiZatiOn Rate: Surface - 0.5, Injection/Incorporation - 1.0
{** Mineralization Rates: Compost -0.1, anserobially digested -0.2,
Signature of Land
Applier
Date
aerobically digested -0.3, raw sludge -0.4
""C.P.L.R.: Cumulative Pollutant Loadine Rate
DENR FORM FSF (12/2006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OFTHIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE,
Facility Name: Baxter Healthcare Corporation WQ Permit #: WQ0031725 Field #: 4 Acres Utilized: 8.7
Land Owner. Douglas Poplin Annual Dry Tons Applied: 19.8617 Site #: DP Acres Permitted: 8.7
Operator: Douglas Poplin Predominant Soil Series: FeB2 Cation Exchange Capacity (non 503):
Cron I Name: Fescue Cron 1 Max. PAN: 194 Crop 2 Name: Crop 2 Max. PAN:
Volume applied
Volume
Residual Sources
Soil
Prccip.
�
<
�_
��
z >
�. �
Nitrate
PAN Applied
PP
Name of Crop Type
o
(enter one) Solids/
%
A Iced er
Pp P
(NPDES #. WQ#.
C onJ.
Peat 24
`
¢ =
a
TKN
o 3
and
t ]bs/acrc)
Receiving Residual
°3 0
Liquid
Solids
Acre
l,cri.. Animal
1Drq.
Hrs.
o
n �
w
Nitrite
Application
❑
Cu. Yds Gallons
(Dry TanslAc)
Waste. etc)
M wet.
inches
a ;
_
mglkg
mglkg
mglkg
Crop 1
Crop 2
Crop 1
Crop 2
1-2020
51.3
12 7
0.631
WQ0031725
dn'
0
s
0.5
0.3
86866
20107 1
66.9
38.027
NA
Fescue
2-2020
81.6
12.7
1.003
W00031725
do
0
s
0.5
0.3
86866
20107
66.9
60.488
NA
Fescue
9-2020
52.8
12.7
0.649
WQ0031725
dry
0
s
0.5
0.3
86866
2f)107
66.9
A139
NA
Fcscue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
ll.000
0.000
0.000
0.000
0.000
0.000
0 000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS:
185.71
0
As
Cd
Cu
Cr
Pb
H p,
Mo
Ni
I Se
Zn
I P
137-6541
0.000
Lime Applied
Annual lbs/acre
0.i,17
0.002
0.368
909i###
0.014
0.001
0.023
0.051
0.017
0.385
12.223
bate
Ibslac
Prior Years Cumulative Ibs/ac
0.344
0 1
5.579
4.083
0.469
0.017
0.238
1.335
0.179
10.096
0
Curreni Cumulative lbs/ac
0.361
0.102
5.947
4#0#04
0.483
0.018
0.261
1.386
0.196
10.481
Permitted C. P. L. R.****
36
34
1338
NA
1 267
1 15
NA
374
89
2498
Permit PAN Limit Ist/2nd Crop
Igo
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance witn a system aesigneu to assure inai
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
*Application Method: S - Surface, IN - Injection, INC - Incorporation
(.�,�•?h ;Z _ -Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
Signature of Land Applier Date *** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
aerobically digested -0.3, raw sludge -0.4
*'"**C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (1212006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Baxter Healthcare Corporation
WQ Permit t!: WQ0031725
Field #: S Acres Utilized: 15.9
Land Owner: Douglas Poplin
Annual Dry Tons Applied: 31.0076
Site #: DP Acres Permitted: 15.9
Cation Exchange Capacity (non 503):
Operator: Douglas Poplin
Predominant Soil Series: FcC2
Crop 1 Name: Fescue
Crop I Max. PAN: 158
Crop 2 Name: Crop 2 Max. PAN:
Soil
Precip.
<
D
'3
Nitrate
Name ot'CruP.IF`pe
PAN Applied
Volume applied
Vulume
Residual Sources
Cond.
,>
:d
R
TKN
^ 3
and
ReceivingResidual
t
C
(enter one) Solids/
%
Applied per
(NPDFS 4. WQ#.
(1)n.
Past 24
r _
=
W
-
R m
-
Nitrite
(]bslacre} A lication
Pp
O
Liquid
q
Soli&
Acre
Fen.. Animal
Wet.
44
*
mg/kg
Crop l
Crop 2 Crop t Crop
in
Cu. Yds
Gallons
(Day TonvAC)
Waste. etc)
Moist)
hncnes 1
°
mglllg
mglxg
NA Fescue
4-2(2U
116.32
12.7
0.796
Vr'0W3172�
dry
0
s
U.5
U.3
86866
20107
20107
66.9
66.9
47,991
30.136
NA Fescue
7-2020
74.3
12.7
0.500
W00031725
dry
0
s
0.5
0.5
0.3
0.3
86866
86866
20107
66.9
39,461
NA Fescue
I 1-2020
97.28
12.7
0.654
WOW31725
dry
U
s
U.Wo
0.000
0.00U
0.000
0,000
0.00D
0.000
0.000
0.000
0.01}t)
0.000
0.000
0.000
0.000
o.000
0.t}00
O.00U
0.000
0.000
O.000
0.000
0.000
O.OtfO
0,000
0.000
0.000
O.000
Residuals Applications
totals
on FORM
FSF supp ( attach FORM
FSF supp
to this form):
Cdi
Cu
Cr
Pb
H
Mo
Ni
Se Zn P
117.587
0.000 Lime Applied
As
ToTAI_ti_
2s9.9t
Oi
U.D02
U.314
#######
OAl2
U.004
0.020
0.044
0,014 0.329 10.440
Date lbslac
U.p14
Annual l bs/acre
0.288
0.083
4 589
3.222
0.405
0.01
0.195
1,097
0.135 8,499 12-2020 1000
Prior Years Cumulative Ibs/ac
Current Cumulative Ibsiac
0.302
0.085
4.903
#######
0.417
0.015
0.215
1.141
0.149 8.828
Permitted C. P. L. R.****
36
34
1338
NA
267
15
NA
374
89 2498
158
Permit PAN Limit 1st12nd Crop
in accordance with a system designed to assure that
"1 certify, under penalty of law,
that this document was prepared under my direction
or supervision
there are significant penalties for submitting false
qualified personnel properly gathered and
evaluated the information submitted.
1 am aware that
information, including the possibility
of fines and imprisonment for knowing violations."
*Application Method: S- Surface, 1N - Injection, INC- Incorporation
A7*12 2
-Volatilization Rate: Surface - 0.5, Injection/Incorporation - 1.0
•** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
Signature of�plier
Date
aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loadine Rate
DENR FORM FSF (1212006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE.
Facility Name: Raxter Healthcare Corporation WQ Permit #: WQ0031725 Field #: 6 Acres Utilized: 5.5
Land Owner: Douglas Poplin Annual Dry Tons Applied: 10.7598 Site tl: DP Acres Permitted: 5.5
Operator: Douglas Poplin Predominant Soil Series: FeC2 Cation Exchange Capacity (non 503):
C'rnn t Name: Fescue Cron I Max. PAN: 158 Crop 2 Name: Crop 2 Max. PAN:
Volume applied
Volume
Residual Sources
Soil
PrcriP.
D
<
e
=
7 v
-
Nilratr
Name of Crop Type
PAN Applied
c �_
(enter one) Solids/
9/0
Applied per
(Np:)1�:S #. WQ#,
Cawld.
Past 24
r, a
� =
m
F
TKN
a 3
�c o
and
Receiving Residual
( lbslacre)
a3 c
l.iyuid
Solids
Acre
Fen- Animal
(Dry.
firs,
T F,
c c
a -
i '^
: =
=
y
Nitrite
Application
�
�
Cu. Yds Gallons
IDry Tons/Ac) i
� ante. etc)
Moist)
,ncnes
�
�
�
mglkg
mglkg
nglkg
Crop l
Crop 2 Cnip 1
t:;rop 2
12-2020
100.6
12.7
1.956
WQ0031725
drN
0
s
0.5
0.3
86866 1
20107
66.9
117.959
NA Fescue
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0 000
0.000
0.000
0.000
a.000
0 ona
0.000
0.000
0.000
0.000
0.000
0 000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
Residuals Applications totals on FORM FSF supp ( attach FORM FSF supp to this form):
TOTALS
100.E
a
As
Cd
Cu
Cr
Pb
H
Mo
Ni
Se
Zn
P
117.959
0.000 Lime Applied
Annuallbsracre
0.014
0.002
0.315
##0#04#
0.012
0.000
0.020
0.044
0.014
0.330
10.472 Date
lbslac
0
Prior Years Cumulative lbslac
0.383
0A 1
6.222
4.500
0 566
0.017
0.253
1.26
0.153
11.627
Current Cumulative Ibs/ac
0.397
0.112
6.537
4#9##0#
0.578
0,017
0.273
1.304
0.167
11.957
Permitted C. P. L. R.****
36
34
1338
NA
267
15
NA
374
89
2498
Permit PAN Limit Istl2nd Crop
158
"I certify, under penalty of law, that this document was prepared under my direction or supervision in accordance with a system aestgneu iv assure ►uar
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
i•••
Signature of Land Applier
*Application Method: S - Surface, IN - Injection, INC - Incorporation
-14.7aij **Volatilization Rate: Surface -0.5, Injection/]ncorporation- LO
Date *** Mineralization Rates. Compost -0.1, anaerobially digested -0.2.
aerobically digested -9-3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (1212006)

ANNUAL LAND APPLICATION FIELD SUMMARY FORM
PLEASE MAKE A COPY OF THIS BLANK FORM TO BE COMPLETED AND SUBMITTED FOR EACH FIELD APPLIED ON
PLACE A "NIA" IN A BLANK OR BOX WHEN NOT APPLICABLE.
A U[•1' ed• 4 A
Facility Name: Baxter Healthcare Corporation WQ Permit #: WQ0031725 Field #: 7 cres t tz
Land Owner: Douglas Poplin Annual Dry Tons Applied: 6.0228 Site #: DP Acres Permitted: 4.4
Operator: Douglas Poplin Predominant Soil Series: FcC2 Cation Exchange Capacity (non 503):
N
Crop 1 Name:
Fescue
Crop I Max. PAN:
158
Crop 2 Name:
Crop 2 Max. PA .
Volume applied
Volume
Residua! Sources
Soil
Cond.
,
I rccip.
K
<
�
F n
Z
3
Nitrate
PAN Applied
Name of Crop Type
Receiving, Residual
(enter one) Solids,'
�;,
Applied per
(M)DES N. WQ#.
l7ry.
Past 24
?
T
a
:,
�;
CkN
�„
and
( Ibslacre)
Application
7
Liquid
Slide
Acre
Fert.. Animal
(
Wet_
llss.
a
�IE.
Nitritr
Cu. Yds
Gallons
{Dry TonsrAc)
Waste, etc)
oi511
noes
mglkg
mglkg
mglkg
Crop I
Crop 2
Crop 1
Crop 2
10-2020
49.91
12 7
1.213
WQ0031725
dry
o
s
0.5
0.3
86866
20107
66.9
73.153
NA
Fescue
11-2020
25.1
:2 7
0.610
WQ0031725
dry
0
s
0.5
0A
86866
20tO7
66.9
36.789
NA
Fescue
0.000
0.000
0.000
0.0oa
0.000
9 000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.000
0.00a
I 0.000
0.000
0.000
U.000
0.000
0.000
0.000
0.000
O.000
0.000
0.000
0.000
Residuals Applications
totals on FORM FSF supp ( attach
FORM FSF supp to this form):
75.011
0
As
Cd
Ctt
Cr
Pb
HL
Mo
Ni
I Se
Zn
I P
109.941
0.000
Lime A plied
TO'FAIS 1
Annual lbs/acre
0.013
0.002
0.294
0#04#
0.011
0.000
0.018
0.041
0.013
0.307
9.761)
J
Date
lbs/ac
Prior Years Cumulative lbs/ac
1 0.328
0 089
5.074
3.629
0.452
0 017
0 216
1.228
0.153
9.127
12-2020
1000
Current Cumulative lbs/a:
; 0.341
0.090
5.368
909999
0.463
0.017
0.234
1.269
0.166
9.434
Permitted C. P_ L. R.****
36
34
1338
NA
267
15
NA
374
89
2498
Permit PAN Limit lst/2nd Crop
158
+1,. 4
461 certify, under penalty of law, that this document was prepared under my atrecnon or superv,s,un -, ....,. a �.T . .. ,.. .6.. .-- ___ _
qualified personnel properly gathered and evaluated the information submitted. I am aware that there are significant penalties for submitting false
information, including the possibility of fines and imprisonment for knowing violations."
) *Application Method: S -Surface, IN - Injection, INC- Incorporation
�r ! "' • J&A **Volatilization Rate; Surface- 0.5, Injection/Incorporation - 1.0
' ** Mineralization Rates: Compost -0.1, anaerobially digested -0.2,
Signature of Land Applier Date aerobically digested -0.3, raw sludge -0.4
****C.P.L.R.: Cumulative Pollutant Loading Rate
DENR FORM FSF (12/2006)