NC0001899_Renewal (Application)_20210525

ROY COOPER
Governors
01
DIONNE DELLI-GATTI
Secretary
S.DANIEL SMITH NORTH CAROLINA
Director Environmental Quality
May 25, 2021
Moncure Holdings West, LLC.
Attn: Jason Kaplan, Manager
1150 Delaware Street-Ste 102
Denver, CO 80204
Subject: Permit Renewal
Application No. NC0001899
Moncure Holdings West WWTP
Chatham County
Dear Applicant:
The Water Quality Permitting Section acknowledges the May 25, 2021 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit.The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://dea.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Siincerrely,
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
cc: Benjamin Whitley,PE-WihersRavenel
ec: WQPS LaserFche File w/application
D E�.,,. North Carolina Department of Environmental Quality I Division of Water Resources
��/p Raleigh Regional Office 13600 Bartett Drive I Ralelgh.North Carolina 27609
z �\ 919.791.4200

el011
WithersRavenel
Our People. Your Success.
Mr. John Hennessy, Supervisor
Division of Water Resources
WQ Permitting Section — NPDES
1617 Main Service Center
Raleigh, NC 27699-1617
Subject: NPDES Permit Renewal Application
Moncure Holdings West, LLC
338 Pea Ridge Road
New Hill, Chatham County, North Carolina
Permit #NC0001899
Owner:
Moncure Holdings West, LLC
282 Century Place, Suite 2000
Louisville, CO 80027
Dear Mr. Hennessy,
Moncure Holdings West, LLC is requesting renewal of the above NPDES Permit per Federal Regulation 40
CFR 122.21 (f) and (f) (2). Closure of the WWTP was to estimated to be initiated within the 1st quarter of
this year (2021) in accordance with an approved lagoon closure plan approved by the NC Division of Water
Resources and result in the closure of the WWTP before the permit expiration date of July 31, 2021. The
initiation of the closure was delayed due to a shortfall in funding from which to conduct the closure.
Therefore, it is apparent now that the permit will need to be renewed. Funding has now been made
available to conduct the closure and the estimated construction schedule is now estimated with a
duration of 16 weeks. Renewal of this permit is needed to allow Moncure Holdings West LLC to continue
to operate the wastewater treatment facility at this location until closure of the WWTP facility has been
completed.
No operation which produces process wastewater such as the former OCPSF industrial effluent (which
ended in April 2015) or demolition activities (which ended in April 2017) continues at the site. Until such
time as closure of the WWTP is completed, the NPDES permit will need to remain active in order to
discharge effluent from the plant to Outfall 001. The effluent is essentially comprised of treated
stormwater which enters the collection system and open impoundments and the domestic waste for the
(2) employees retained on the site. Therefore, we are submitting Form 2C with this application.
If you have any questions regarding this Permit Renewal Application, please do not hesitate to contact
us at your convenience.
Regards,
CA_
1
Benjamin Whitley, PE " Chan Bryant, PE
Senior Project Manager
Senior Vice President
115 MacKenan Drive I Cary, NC 27511
t: 919 469.3340 I f: 919.467.6008 I www.withersravenel.com I License No C-0832
Cary I Greensboro 1 Pittsboro I Raleigh 1 Wilmington

Print All Pages
Print Form Only
United States
Environmental Protection Agency
Office of Water
Washington, D.C.
EPA Form 3510-1
Revised March 2019
Water Permits Division
aEPA Application Form 1
General Information
NPDES Permitting Program
Note: All applicants to the National Pollutant Discharge Elimination System (NPDES) permits
program, with the exception of publicly owned treatment works and other treatment works treating
domestic sewage, must complete Form 1. Additionally, all applicants must complete one or more of the
following forms: 2B, 2C, 2D, 2E, or 2F. To determine the specific forms you must complete, consult the
"General Instructions" for this form.

Paperwork Reduction Act Notice
The U.S. Environmental Protection Agency estimates the average burden to collect information
and complete Form 1 to be 2.9 hours for new applicants and 0.9 hours for applicants renewing
existing permits. This estimate includes time to review instructions, search existing data sources,
gather and maintain the needed data, and complete and review the collection of information.
New respondents must also prepare a topographic map. Send comments about the burden
estimate or any other aspect of this collection of information to the Chief, Information Policy
Branch (PM-223), U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue, NW,
Washington, DC 20460, and to the Office of Information and Regulatory Affairs, Office of
Management and Budget, 725 17th Street, NW, Washington, DC 20503, marked "Attention:
Desk Officer for EPA."

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
WWTP
Form Approved 03/05/19
OMB No. 2040-0004
Form
1
NPDES
V%EPA
U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
GENERAL INFORMATION
co
Activities Requiring an NPDES Permit o
0
1. ACTIVITIES
1.1
REQUIRING AN NPDES PERMIT (40 CFR 122.21(f) and (f)(1))
Applicants Not Required to Submit Form 1
1.1.1
Is the facility a new or existing publicly
treatment works?
If yes, STOP. Do NOT complete
Form 1. Complete Form 2A.
owned
1 1 2
Is the facility a new
treating domestic
If yes, STOP. Do NOT
complete Form 1.
Form 2S.
or existing treatment works
sewage?
✓ No
✓ No
Complete
1.2
Applicants Required to Submit Form 1
1.2.1
Is the facility a concentrated animal
operation or a concentrated aquatic
production facility?
Yes 4 Complete Form 1
and Form 2B.
feeding
animal
1.2.2
Is the facility an
commercial, mining,
currently discharging
existing manufacturing,
or silvicultural facility that is
process wastewater?
Form No
and Form 2C.
i No
✓ Yes 4 Complete
1
1.2.3
Is the facility a new manufacturing, commercial,
mining, or silvicultural facility that has
commenced to discharge?
Yes 4 Complete Form 1
and Form 2D.
not yet
1.2.4
Is the facility a new
commercial, mining,
discharges only nonprocess
❑ Yes 4 Complete
1 and
or existing manufacturing,
or silvicultural facility that
wastewater?
✓ No
Form ✓ No
Form 2E.
1.2.5
Is the facility a new or existing facility
discharge is composed entirely of stormwater
associated with industrial activity
discharge is composed of both stormwater
non-stormwater?
Yes 4 Complete Form 1
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x) or
b 15 .
whose
or whose
and
✓ No
Name, Mailing Address, and Location
2. NAME,
2.1
MAILING ADDRESS, AND LOCATION (40 CFR 122.21(f)(2))
Facility Name
Moncure Holdings West, LLC WWTP
2.2
EPA Identification Number
NCD053488409
2.3
Facility Contact
Name (first and last)
Jason Kaplan
Title
Owner / Manager
Phone number
303-516-3478
Email address
[e-mail]
2.4
Facility Mailing Address
Street or P.O. box
338 Pea Ridge Road
City or town
New Hill
State
NC
ZIP code
27562
EPA Form 3510-1 (revised 3-19)
Page 1

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
Form Approved 03/05/19
OMB No. 2040-0004
m m Name, Mailing Address,
Operator Information o SIC and NAILS Codes and Location Continued
0 0
2.5
Facility Location
Street, route number, or other specific identifier
338 Pea RidgeRoad
County name
Chatham
County code (if known)
019
City or town
New Hill
State
NC
ZIP code
27562
3. SIC
AND NAICS CODES (40 CFR 122.21(f)(3))
3.1
SIC Code(s)
Description (optional)
N/A
Facility production shutdown in Nov. 2014, site demo completion April 2017,
operating a WWTP processing / treating storm water from the site.
3.2
NAICS Code(s)
Description (optional)
N/A
Facility production shutdown in Nov. 2014, site demo completion April 2017,
operating a WWTP processing / treating storm water from the site.
4. OPERATOR
INFORMATION (40 CFR
122.21(f)(4))
4.1
Name of Operator
Jason Kaplan - Owner of Moncure Holdings West LLC
4.2
Is the
'
name you listed in Item 4.1 also the owner?
Yes ❑ No
4.3
Operator Status
❑ Public —federal ❑ Public —state ❑ Other public (specify)
❑ Private ❑ Other (specify)
Phone Number of Operator
4.4
303-516-3478
Indian m Operator Information
Land -I Continued
0
4.5
Operator Address
Street or P.O. Box
1150 Delaware Street - Suite 102
City or town
Denver
State
CO
ZIP code
80204
Email address of operator
[e-mail]
5. INDIAN
LAND (40 CFR 122.21(f)(5))
5.1
Is the facility
❑ Yes
located on Indian Land?
' No
EPA Form 3510-1 (revised 3-19)
Page 2

EPA Identification Number
NPDES Permit Number Facility Name
NCD053488409 NC0001899 Moncure Holdings West LLC
SECTION 6. EXISTING ENVIRONMENTAL PERMITS (40 CFR 122.21(f)(6))
Form Approved 03/05/19
OMB No. 2040-0004
6.1 Existing Environmental Permits (check all that apply and print or type the corresponding permit number for each)
❑✓ NPDES (discharges to surface
water)
NC0001899
❑ RCRA (hazardous wastes)
❑ UIC (underground injection of
fluids)
❑ PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
❑ Ocean dumping (MPRSA)
SECTION 7. MAP (40 CFR 122.21(f)(7))
❑ Dredge or fill (CWA Section 404)
❑ Other (specify)
7.1 Have you attached a topographic map containing all required information to this application? (See instructions for
specific requirements.)
❑ Yes ❑ No ❑ CAFO—Not Applicable (See requirements in Form 2B.)
SECTION 8. NATURE OF BUSINESS (40 CFR 122.21(f)(8))
Nature of Business
8.1 Describe the nature of your business.
Presently there are (2) employees at the site, an ORC and the Site Leader overseeing the operation of the WWTP
for the purpose of processing, monitoring, and treating site storm water which enters the collection system and
open impoundments along with a small amount of domestic wastewater (2 employees).
Manufacturing was shutdown November 2014 and Demolition of the manufacture facility was completed April
2017. The plant engaged in the manufacture of industrial synthetic polyester fiber and organic polyester resin.
Moncure Holdings West LLC, currently maintains and operates the wastewater treatment plant for the treatment
of storm water (storm water run-off from the old manufacturing area & other structures) and sanitary for (2)
employees, WW effluent discharges to Outfall 001. Storm water run-off and fire pond overflow discharges through
Outfall 002 to Shaddox Creek.
SECTION 9. COOLING WATER INTAKE STRUCTURES (40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
❑� Yes ❑ No 4 SKIP to Item 10.1.
9.2 Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r). Consult with your
NPDES permitting authority to determine what specific information needs to be submitted and when.)
SECTION 10. VARIANCE REQUESTS (40 CFR 122.21(f)(10))
Variance Requests
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)? (Check all that
apply. Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
❑ Fundamentally different factors (CWA ❑ Water quality related effluent limitations (CWA Section
Section 301(n)) 302(b)(2))
❑ Non -conventional pollutants (CWA ❑ Thermal discharges (CWA Section 316(a))
Section 301(c) and (g))
❑ Not applicable
EPA Form 3510-1 (revised 3-19) Page 3

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC +
Form Approved 03/05/19
OMB No. 2040-0004
0,
Checklist and Certification Statement c
0
11. CHECKLIST
11.1
AND
In Column 1 below,
For each section,
that not all applicants
CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
mark the sections of Form 1 that you have completed and are submitting with your application.
specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
are required to provide attachments.
Column 1
Column 2
1: Activities Requiring an NPDES Permit
❑ w/ attachments
✓ Section
2: Name, Mailing Address, and Location
❑ w/ attachments
✓ Section
3: SIC Codes
❑ w/ attachments
✓ Section
4: Operator Information
❑ w/ attachments
✓ Section
5: Indian Land
❑ w/ attachments
✓ Section
6: Existing Environmental Permits
❑ w/ attachments
✓ Section
7: Map
✓ Section
✓ map pographic
✓ w/ additional attachments
8: Nature of Business
❑ w/ attachments
✓ Section
9: Cooling Water Intake Structures
❑ w/ attachments
✓ Section
10: Variance Requests
❑ w/ attachments
✓ Section
11: Checklist and Certification Statement
❑ w/ attachments
✓ Section
11.2
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Name (print or type first and last name)
Jason Kaplan
Official title
Manager
Signature
91"...-- /411---
Date signed
EPA Form 3510-1 (revised 3-19)
Page 4

Print All Pages
Print Form Only
.w.EPA
United States
Environmental Protection Agency
Office of Water
Washington, D.C.
EPA Form 3510-2C
Revised March 2019
Water Permits Division
Application Form 2C
Existing Manufacturing,
Commercial, Mining, and
Silvicultural Operations
NPDES Permitting Program
Note: Complete this form and Form 1 if your facility is an existing manufacturing, commercial, mining,
or silvicultural facility that currently discharges process wastewater.

Paperwork Reduction Act Notice
The U.S. Environmental Protection Agency estimates the average burden to collect information and
complete Form 2C to be 32.5 hours. This estimate includes time for reviewing instructions, searching
existing data sources, gathering and maintaining the needed data, and completing and reviewing the
collection of information. Send comments about the burden estimate or any other aspect of this
collection of information to the Chief, Information Policy Branch (PM-223), U.S. Environmental
Protection Agency, 1200 Pennsylvania Avenue, NW, Washington, DC 20460, and to the Office of
Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street, NW,
Washington, DC 20503, marked "Attention: Desk Officer for EPA."

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
Form Approved 03/05/19
OMB No. 2040-0004
Form
2C
NPDES
%I,EP
U.S Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
EXISTING MANUFACTURING, COMMERCIAL, MINING, AND SILVICULTURE OPERATIONS
SECTION 1.OUTFALL LOCATION (40 CFR 122.21(g)(1))
1.1
Outfall Location
Provide infor
Outfall
Number
mation on each of the facility's outfalls in the table below.
Receiving Water Name
Latitude
Longitude
001
Haw River
35° 31' 1"
- 79° 3' 25'
002
Shaddox Creek
35° 37' 0"
- 79° 2' 36"
11
11
SECTION 2. LINE DRAWING (40 CFR 122.21(g)(2))
2.1
Have you attached a line drawing to this application that shows the water flow through your facility with a water
balance? (See instructions for drawing requirements. See Exhibit 2C-1 at end of instructions for example.)
❑✓ Yes ❑ No
SECTION 3. AVERAGE FLOWS AND TREATMENT (40 CFR 122.21(g)(3))
3.1
Average Flows and Treatment
For each outfall identified under Item 1.1, provide average flow and treatment information. Add additional sheets if
necessary.
**Outfall Number** 001
Operations Contributing to Flow
Operation
Average Flow
Sanitary - (2) Employees (estimated 10gal/day)
0.00001 mgd
Process
0 mgd
Stormwater (2018 - Feb 2021)
0.02176 mgd
mgd
Treatment Units
Description
(include size, flow rate through each treatment unit,
retention time, etc.)
Sanitary - Screening, Activated Sludge, Sedimentation,
Code from
Table 2C-1
1-T; 3-A; 1-U
Final Disposal of Solid or
Liquid Wastes Other Than
by Discharge
Process Water Treatment - Sedimentation
1-U
Storm Water: Screening, Activated Sludge, Sedimentation
1-T; 3-A; 1-U
EPA Form 3510-2C (Revised 3-19)
Page 1

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
Form Approved 03/05/19
OMB No. 2040-0004
Average Flows and Treatment Continued
3.1
cont.
**Outfall Number** 002
Operations Contributing
to Flow
Operation
Average Flow
Storm Water Run-off
0.016 mgd
mgd
mgd
mgd
Treatment
Units
Description
(include size, flow rate through each treatment unit,
retention time, etc.)
Code from
Table 2C-1
Final Disposal of Solid or
Liquid Wastes Other Than
by Discharge
Storm Water - Sedimentation,
1-U
**Outfall Number**
Operations Contributing
to Flow
Operation
Average Flow
mgd
mgd
mgd
Treatment
Description
(include size, flow rate through each treatment unit,
retention time, etc.)
Units
Code from
Table 2C-1
mgd
Final Disposal of Solid or
Liquid Wastes Other Than
by Discharge
System
Users
3.2
Are
0
you applying for an NPDES permit to operate a privately owned
Yes
•
treatment works?
No 4 SKIP to Section 4.
3.3
Have
0
you attached a list that identifies each user of the treatment
Yes
•
works?
No
EPA Form 3510-2C (Revised 3-19)
Page 2

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
Form Approved 03/05/19
OMB No. 2040-0004
SECTION 4. INTERMITTENT
FLOWS (40 CFR 122.21(g)(4))
c
Li
E
m
c
4.1
Except for storm runoff, leaks, or spills, are any discharges described
❑ Yes
✓
in Sections 1 and 3 intermittent or seasonal?
No 4 SKIP to Section 5.
4.2
Provide information on intermittent or seasonal flows for each applicable outfall. Attach additional pages, if necessary.
Frequency
Flow
Rate
Outfall
Number
Operation
(list)
Average
Days/Week
Average
MonthslYear
Long -Term
Average
Maximum
Daily
Duration
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
SECTION
5. PRODUCTION
(40
CFR 122.21(g)(5))
w
w
co
c>
n
a
5.1
Do
✓
any effluent
Yes
limitation guidelines (ELGs) promulgated by EPA under Section
❑ No 4
304 of the CWA apply to your facility?
SKIP to Section 6.
5.2
Provide the following information on applicable ELGs.
ELG Category
ELG Subcategory
Regulatory Citation
CPSS (DuraFiber - Shutdown 2014
astic Materials, Synthetic Resins, and Nonvulcanizable Elas
40 CFR 414
2824: Synthetic Organic Fibers, Except Cellulosic
40 CFR 414
Production -Based Limitations
5.3
Are any of the applicable ELGs expressed in terms of production
❑ Yes
✓
(or other measure of operation)?
No 4 SKIP to Section 6.
5.4
Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
Outfall
Number
Operation, Product, or Material
Quantity per Day
Unit of
Measure
EPA Form 3510-2C (Revised 3-19)
Page 3

EPA
NCD053488409
SECTION
06.2
d
E
oProject
E
as
as
d
C6
Q
Identification
6. IMPROVEMENTS
6.1
Number
Are you presently
upgrading, or
affect the discharges
❑ Yes
NPDES Permit Number
NC0001899
(40 CFR 122.21(g)(6))
required by any federal, state, or
operating wastewater treatment equipment
described in this application?
Moncure
local authority
or practices
Facility Name
Holdings West LLC
to meet an implementation
or any other environmental
Form Approved 03/05/19
OMB No. 2040-0004
schedule for constructing,
programs that could
6.3.
✓ No 4 SKIP to Item
Briefly identify each applicable project in the table below.
Brief Identification and Description of
Affected
Outfalls
(list outfall
number)
Source(s) of
Discharge
Final Compliance Dates
Required
Projected
6.3
Have you attached sheets describing any additional water pollution
that may affect your discharges) that you now have underway
❑ Yes ❑ No
control programs
or planned? (optional item)
(or other environmental projects
Not applicable
✓
SECTION
7. EFFLUENT AND INTAKE CHARACTERISTICS (40 CFR 122.21(g)(7))
0
y
'L
CD
CO
CCI
R
c
R
cu7.5
See the instructions to determine the pollutants and parameters you are required to monitor and, in turn, the tables you must
complete. Not all applicants need to complete each table.
Table A. Conventional and Non -Conventional Pollutants
7.1
Are you requesting
your outfalls?
a waiver from your NPDES permitting
authority for one or more of
the Table A pollutants for any of
7.3.
■ Yes
151 No 4 SKIP to Item
7.2
If yes, indicate
Outfall
the applicable outfalls below.
Number
Attach waiver request
Outfall Number
and other required
information to the application.
Outfall Number
7.3
Have you completed
requested and
monitoring for all Table A pollutants at
attached the results to this application package?
each of your outfalls for which
No; has been
a waiver has not been
requested from my NPDES
for all pollutants at all outfalls.
0 Yes
a waiver
•permitting
authority
Table B.
Toxic Metals, Cyanide, Total Phenols, and Organic Toxic Pollutants
7.4
Do any of the
listed in Exhibit
facility's processes that contribute wastewater
2C-3? (See end of instructions for exhibit.)
fall into one or more of the
primary industry categories
7.8.
0 Yes
• No 4 SKIP to Item
Have you checked
"Testing Required" for all toxic metals,
cyanide, and total phenols in
Section 1 of Table B?
0 Yes
• No
7.6
List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s) identified
in Exhibit 2C-3.
Primary Industry Category
Required GC/MS Fraction(s)
(Check applicable boxes.)
❑ Volatile 0 Acid 0 Base/Neutral 0 Pesticide
❑ Volatile 0 Acid 0 Base/Neutral 0 Pesticide
0 Volatile 0 Acid 0 Base/Neutral 0 Pesticide
EPA Form 3510-2C (Revised 3-19)
Page 4

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
Form Approved 03/05/19
OMB No. 2040-0004
0,
Used or Manufactured ° Toxics Effluent and Intake Characteristics Continued
0
7.7
Have you checked
GC/MS fractions
"Testing Required" for all required
checked in Item 7.6?
pollutants in Sections 2 through
5 of Table B for each of the
0 Yes
• No
7.8
Have you checked
where testing
"Believed Present" or "Believed
is not required?
Absent" for all pollutants listed in Sections
1 through 5 of Table B
4 Yes
• No
7.9
Have you provided
required or (2)
indicated are
(1) quantitative data for those
quantitative data or other required information
"Believed Present" in your discharge?
Section 1, Table B, pollutants for which
for those Section 1, Table
you have indicated testing is
B, pollutants that you have
0 Yes
■ No
7.10
Does the applicant
Yes +
qualify for a small business exemption
Note that qualify at the top of Table
then SKIP to Item 7.12.
under the criteria specified
B,
in the instructions?
•you
p No
7.11
Have you provided
determined testing
pollutants you
(1) quantitative data for those
is required or (2) quantitative data
have indicated are "Believed Present"
Sections 2 through 5, Table B, pollutants
or an explanation for those Sections
in your discharge?
for which you have
2 through 5, Table B,
0 Yes
• No
Table C. Certain Conventional and Non -Conventional Pollutants
7.12
Have you indicated
for all outfalls?
whether pollutants are "Believed Present" or "Believed Absent" for all pollutants listed on Table C
❑ No
✓ Yes
7.13
Have you completed
indirectly in an
"Believed Present"?
Table C by providing (1) quantitative data for those pollutants that are limited either directly or
ELG and/or (2) quantitative data or an explanation for those pollutants for which you have indicated
❑ No
✓ Yes
Table D. Certain Hazardous Substances and Asbestos
7.14
Have you indicated
all outfalls?
whether pollutants are "Believed Present" or "Believed Absent" for all pollutants listed in Table D for
❑ No
✓ Yes
7.15
Have you completed Table D by (1) describing the
and (2) by providing quantitative data, if available?
❑ Yes
reasons the applicable pollutants are
expected to be discharged
✓ No
Table E. 2,3,7,8-Tetrachlorodibenzo-p-Dioxin (2,3,7,8-TCDD)
7.16
Does the facility use or manufacture one or more
know or have reason to believe that TCDD is or may
❑ Yes 4 Complete Table E.
of the 2,3,7,8-TCDD congeners listed
be present in the effluent?
in the instructions, or do you
8.
✓ No 4 SKIP to Section
7.17
Have you completed
Table E by reporting qualitative data for TCDD?
❑ No
✓ Yes
8. USED
OR MANUFACTURED TOXICS (40 CFR 122.21(g)(9))
8.1
Is any pollutant listed in Table B a substance or a
an intermediate or final product or byproduct?
❑ Yes
component of a substance used or
manufactured at your facility as
9.
✓ No 4 SKIP to Section
8.2
List the pollutants below.
1. 4. 7.
2. 5. 8.
3. 6. 9.
EPA Form 3510-2C (Revised 3-19)
Page 5

EPA
NCD053488409
SECTION
tA
Identification
9. BIOLOGICAL
9.1
Number
Do
within
1
TOXICITY
you have
the last
Yes
NPDES Permit Number
NC0001899
TESTS (40 CFR 122.21(g)(11))
any knowledge or reason to believe that
three years on (1) any of your discharges
Facility Name
Moncure Holdings West LLC
any biological test for acute or chronic
or (2) on a receiving water in
❑ No 4 SKIP to Section
Form Approved 03/05/19
OMB No. 2040-0004
toxicity has been made
relation to your discharge?
10.
ta>
1-
9.2
Identify the tests and their
purposes below.
.0
o
Test(s)
Purpose of Test(s)
Submitted to NPDES
Permitting Authority?
Date Submitted
1—
Trs
Chronic Toxicity
(Ceriodaphnia @ 0.94%)
Permit Condition
✓
Yes ❑ No
02/02/2021
0
o
00
Acute Toxicity
Permit Condition
✓
Yes ❑ No
04/20/2000
❑ Yes ❑ No
SECTION
10. CONTRACT
ANALYSES (40 CFR
122.21(g)(12))
10.1
Were
✓
any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
Yes ❑ No 4 SKIP to Section 11.
10.2
Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1
Laboratory Number 2
Laboratory Number 3
V1
Name of laboratory/firm
Pace Analytical Services
LLC
d
>,
72
<
Q
0
c
R
L
Laboratory address
9800 Kincey Ave. Suite 100,
Huntersville, NC
0
o
Phone number
704-875-9092
Pollutant(s) analyzed
SECTION
11. ADDITIONAL
INFORMATION
(40 CFR 122.21(g)(13))
c
0
11.1
Has the NPDES permitting authority requested additional
❑ Yes
information?
✓
No 4 SKIP to Section 12.
15
L
O
c
o
11.2
List the information requested and attach it to this application.
1. 4.
c
0
15
2. 5.
Q
3. 6.
EPA Form 3510-2C (Revised 3-19)
Page 6

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
Form Approved 03/05/19
OMB No. 2040-0004
SECTION 12. CHECKLIST AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
Checklist and Certification Statement
12.1
In Column 1 below, mark the sections of Form 2C that you have completed and are submitting with your application.
For each section, specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to complete all sections or provide attachments.
Column 1
Column 2
1: Outfall Location
❑ w/ attachments
1 Section
2: Line Drawing
❑ wl line drawing
1 Section
✓ wl additional attachments
Section
3: Average Flows and
wl list of each user of
❑ wl attachments ❑ privately owned treatment
works
✓
Treatment
4: Intermittent Flows
❑ wl attachments
1 Section
5: Production
❑ wl attachments
1 Section
6: Improvements
w/ optional additional
❑ wl attachments ❑ sheets describing any
additional pollution control
plans
✓ Section
Section
7: Effluent and Intake
❑ wl request for a waiver and ❑ wl explanation for identical
supporting information outfalls
❑ wl small business exemption ❑ w/ other attachments
request
Table wl A w/ Table B
❑ ❑
❑ wl Table C ❑ w/ Table D
❑ wl Table E ❑ w/ analytical results as an
attachment
✓
Characteristics
Section
8: Used or Manufactured
❑ wl attachments
✓
Toxics
Section
9: Biological Toxicity
❑ wl attachments
✓
Tests
10: Contract Analyses
❑ wl attachments
✓ Section
11: Additional Information
❑ wl attachments
✓ Section
Section
12: Checklist and
Statement
❑ wl attachments
✓
Certification
12.2
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly
responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true,
accurate, and complete. I am aware that there are significant penalties for submitting false information, including the
possibility of fine and imprisonment for knowing violations.
Name (print or type first and last name)
Jason Kaplan
Official title
Owner/ Manager
Signature
signed
4—.—Date
ill --
EPA Form 3510-2C (Revised 3-19)
Page 7

This page intentionally left blank.

EPA Identification Number
NPDES Permit Number
Facility Name
0utfall Number
NCD053488409
NC0001899
Moncure Holdings West LLC
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
A. CONVENTIONAL AND NON
Pollutant
CONVENTIONAL
Waiver
Requested
(if applicable)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(iii))1
Effluent
Intake
(Optional)
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average Daily
Discharge
(if available)
Number of
Analyses
Long -Term
Average Value
Number of
Analyses
❑
Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
1
Biochemical oxygen demand
(BODs)
❑
Concentration
mg/L
9.3
6.0
1.724
48
Mass
lb./day
0.439
0.242
2'
Chemical oxygen demand
(COD)
❑
Concentration
Mass
3.
Total organic carbon (TOC)
❑
Concentration
Mass
4.
Total suspended solids (TSS)
❑
Concentration
mg/L
9.70
6.76
7.342
48
Mass
5.
Ammonia (as N)
❑
Concentration
mg/L
1.630
0.240
0.110
16
Mass
6.
Flow
❑
Rate
MGD
0.101
0.0264
0.032
164
7.
Temperature (winter)
❑
°C
°C
21.0
15.8
89
Temperature (summer)
❑
°C
°C
28.6
24.6
75
8.
pH (minimum)
❑
Standard units
S.U.
6.440
6.440
164
pH (maximum)
❑
Standard units
s.u.
8.470
8.470
164
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19)
Page 9

This page intentionally left blank.

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Dscharge
(required)
eq fi
Maximum
Monthly
Discharge
(red) if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
AverageValue
Number
of
Analyses
Check here if you qualify as a small business per the instructions to Form 2C and, therefore, do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table. Note, however, that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1. Toxic Metals, Cyanide, and Total Phenols
1.1
Antimony, total
(7440-36-0)
Concentration
✓
Mass
1.2
Arsenic, total
(7440-38-2)
Concentration
✓
Mass
1.3
Beryllium, total
(7440-41-7)
Concentration
✓
Mass
1.4
Cadmium, total
(7440-43-9)
�
Concentration
ug/I
0.008
0.008
0.004
36
✓
✓
Mass
1.5
Chromium, total
(7440-47-3)
Concentration
Mass
1.6
Copper, total
(7440-50-8)
Concentration
Mass
1.7
Lead, total
(7439-92-1)
�
Concentration
✓
Mass
1.8
Mercury, total
(7439-97-6)
Concentration
✓
Mass
1.9
Nickel, total
(7440-02-0)
�
�
Concentration
✓
Mass
1.10
Selenium, total
(7782-49-2)
Concentration
Mass
1.11
Silver, total
(7440-22-4)
Concentration
st
Mass
EPA Form 3510-2C (Revised 3-19)
Page 11

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
1.12
Thallium, total
(7440-28-0)
Concentration
Mass
1.13
Zinc,total
(7440-66-6)
Concentration
✓
✓
Mass
Lb/Day
31.40
31.40
2.763
12
1.14
Cyanide, total
(57-12-5)
Concentration
mg/L
0.008
0.008
0.003
12
✓
✓
Mass
1.15
Phenols, total
Concentration
i
Mass
Section 2. Organic Toxic Pollutants (GC/MS Fraction
—Volatile Compounds)
2.1
Acrolein
(107-02-8)
Concentration
Mass
2'2
Acrylonitrile
(107-13-1)
Concentration
Mass
2.3
Benzene
(71-43-2)
❑
❑
Concentration
✓
Mass
2.4
Bromoform
(75-25-2)
❑
❑
Concentration
✓
Mass
2.5
Carbon tetrachloride
(56-23-5)
❑
❑
Concentration
✓
Mass
2.6
Chlorobenzene
(108-90-7)
Concentration
Mass
2'7
Chlorodibromomethane
(124-48-1)
Concentration
Mass
2.8
Chloroethane
(75-00-3)
Concentration
st
Mass
EPA Form 3510-2C (Revised 3-19)
Page 12

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
2'9
2-chloroethylvinyl ether
(110-75-8)
Concentration
Mass
2.10
Chloroform (67-66-3)
Concentration
t
Mass
2.11
Dichlorobromomethane
(75-27-4)
Concentration
✓
Mass
•
212
1,1-dichloroethane
(75-34-3)
Concentration
Mass
2'13
1 2-dichloroethane
(107-06-2)
Concentration
Mass
2.14
11-dichloroethylene
(75-35-4)
❑
Concentration
Mass
2.15
1,2-dichloropropane
(78-87-5)
❑
Concentration
Mass
2.16
1,3-dichloropropylene
(542-75-6)
Concentration
✓
Mass
2'17
Ethylbenzene
(100-41-4)
Concentration
✓
Mass
2 18
Methyl bromide
(74-83-9)
Concentration
✓
Mass
2 19
Methyl chloride
(74-87-3)
Concentration
Mass
2 20
Methylene chloride
(75-09-2)
Concentration
Mass
2.21
1 1,2 2- tetrachloroethane
(79-34-5)
❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 13

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Units
(specify)
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
2'22
Tetrachloroethylene
(127-18-4)
Concentration
Mass
2.23
Toluene
(108-88-3)
❑
✓
Concentration
Mass
2'24
1,2-trans-dichloroethylene
(156-60-5)
Concentration
✓
Mass
•
2 25
1,1,1-trichloroethane
(71-55-6)
Concentration
Mass
2 26
•
1,1,2-trichloroethane
(79-00-5)
Concentration
Mass
2 27
Trichloroethylene
(79-01-6)
❑
Concentration
Mass
2 28
Vinyl chloride
(75-01-4)
Concentration
Mass
Section 3. Organic Toxic Pollutants (GC/MS Fraction
—Acid Compounds)
3'1
2-chlorophenol
(95-57-8)
✓
Concentration
Mass
3.2
2 4-dichlorophenol
(120-83-2)
✓
Concentration
Mass
3'3
2 4-dimethylphenol
(105-67-9)
✓
Concentration
Mass
3.4
4 6-dinitro-o-cresol
(534-52-1)
Concentration
Mass
3.5
2 4-dinitrophenol
(51-28-5)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 14

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
3.6
2-nitrophenol
(88-75-5)
Concentration
Mass
3.7
4-nitrophenol
(100-02-7)
❑
❑
Concentration
✓
Mass
3.8
p-chloro-m-cresol
(59-50-7)
❑
❑
Concentration
✓
Mass
3.9
Pentachlorophenol
(87-86-5)
❑
❑
Concentration
✓
Mass
3.10
Phenol
(108-95-2)
❑
❑
Concentration
Mass
3.11
2,4,6-trichlorophenol
(88-05-2)
❑
❑
Concentration
Mass
Section 4. Organic Toxic Pollutants (GC/MS Fraction
—Base /Neutral
Compounds)
4.1
Acenaphthene
(83-32-9)
Concentration
Mass
4.2
Acenaphthylene
(208-96-8)
❑
❑
Concentration
✓
Mass
4.3
Anthracene
(120-12-7)
❑
❑
Concentration
✓
Mass
4.4
Benzidine
(92-87-5)
❑
❑
Concentration
✓
Mass
4.5
Benzo (a) anthracene
(56-55-3)
Concentration
Mass
4.6
Benzo (a) pyrene
(50-32-8)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 15

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
4.7
3 4-benzofluoranthene
(205-99-2)
Concentration
Mass
4•8
Benzo (ghi) perylene
(191-24-2)
Concentration
✓
Mass
4.9
Benzo (k) fluoranthene
(207-08-9)
Concentration
✓
Mass
4.10
Bis (2-chloroethoxy) methane
(111-91-1)
Concentration
✓
Mass
4.11
Bis (2-chloroethyl) ether
(111-44-4)
Concentration
Mass
4.12
Bis (2-chloroisopropyl) ether
(102-80-1)
Concentration
Mass
4.13
Bis (2-ethylhexyl) phthalate
(117-81-7)
Concentration
✓
Mass
4.14
4-bromophenyl phenyl ether
(101-55-3)
Concentration
✓
Mass
4.15
Butyl benzyl phthalate
(85-68-7)
Concentration
✓
Mass
4.16
2-chloronaphthalene
(91-58-7)
Concentration
✓
Mass
4.17
4-chlorophenyl phenyl ether
(7005-72-3)
Concentration
Mass
4.18
Chrysene
(218-01-9)
Concentration
Mass
4.19
Dibenzo (a,h) anthracene
(53-70-3)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 16

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
4.20
12-dichlorobenzene
(95-50-1)
Concentration
Mass
4.21
1,3-dichlorobenzene
(541-73-1)
❑
Concentration
✓
Mass
4.22
1,4-dichlorobenzene
(106-46-7)
❑
Concentration
✓
Mass
4.23
3 3-dichlorobenzidine
(91-94-1)
Concentration
Mass
4.24
Diethyl phthalate
(84-66-2)
Concentration
Mass
4.25
Dimethyl phthalate
(131-11-3)
Concentration
Mass
4.26
Di-n-butyl phthalate
(84-74-2)
Concentration
✓
Mass
4.27
2,4-dinitrotoluene
(121-14-2)
❑
❑
Concentration
✓
Mass
4.28
2,6-dinitrotoluene
(606-20-2)
❑
❑
Concentration
✓
Mass
4.29
Di-n-octyl phthalate
(117-84-0)
Concentration
✓
Mass
4.30
1,2-Diphenylhydrazine
(as azobenzene) (122-66-7)
❑
Concentration
✓
Mass
4.31
Fluoranthene
(206-44-0)
Concentration
Mass
4.32
Fluorene
(86-73-7)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 17

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
4.33
Hexachlorobenzene
(118-74-1)
Concentration
Mass
4.34
Hexachlorobutadiene
(87-68-3)
Concentration
✓
Mass
4.35
Hexachlorocyclopentadiene
(77-47-4)
❑
Concentration
✓
Mass
4.36
Hexachloroethane
(67-72-1)
Concentration
✓
Mass
4.37
Indeno (1,2,3-cd) pyrene
(193-39-5)
Concentration
Mass
4.38
Isophorone
(78-59-1)
Concentration
st
Mass
4.39
Naphthalene
(91-20-3)
Concentration
Mass
4.40
Nitrobenzene
(98-95-3)
Concentration
✓
Mass
4.41
N-nitrosodimethylamine
(62-75-9)
Concentration
✓
Mass
4.42
N-nitrosodi-n-propylamine
(621-64-7)
Concentration
✓
Mass
4.43
N-nitrosodiphenylamine
(86-30-6)
Concentration
Mass
4.44
Phenanthrene
(85-01-8)
Concentration
Mass
4.45
Pyrene
(129-00-0)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 18

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
outfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
4'46
1 2 4-trichlorobenzene
(120'-82-1)
❑
❑
Concentration
✓
Mass
Section 5. Organic Toxic Pollutants (GC/MS Fraction
—Pesticides)
5.1
Aldrin
(309-00-2)
❑
❑
Concentration
Mass
5.2
a-BHC
(319-84-6)
❑
❑
Concentration
✓
Mass
5.3
p-BHC
(319-85-7)
❑
❑
Concentration
✓
Mass
5.4
y-BHC
(58-89-9)
❑
❑
Concentration
✓
Mass
5'5
6-BHC
(319-86-8)
Concentration
st
Mass
5'6
Chlordane
(57-74-9)
Concentration
Mass
5'7
4 4'-DDT
(50-29-3)
Concentration
Mass
5.8
4 4'-DDE
(72-55-9)
❑
❑
Concentration
✓
Mass
5.9
4,4'-DDD
(72-54-8)
❑
❑
Concentration
✓
Mass
5.10
Dieldrin
(60-57-1)
❑
❑
seConcentration
Mass
5.11
a-endosulfan
(115-29-7)
❑
❑
Concentration
✓
Mass
EPA Form 3510-2C (Revised 3-19)
Page 19

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Duiredscarge
(eq)
Maximum
Monthly
f available)
( )
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
AverageValue
Number
of
Analyses
5.12
R-endosuIfan
(115-29-7)
Concentration
Mass
5.13
Endosulfan sulfate
(1031-07-8)
❑
❑
Concentration
✓
Mass
5.14
Endrin
(72 20 8)
❑
❑
Concentration
✓
Mass
5.15
Endrin aldehyde
(7421-93-4)
❑
❑
Concentration
✓
Mass
5.16
Heptachlor
(76-44-8)
❑
❑
Concentration
Mass
5.17
Heptachlor epoxide
(1024-57-3)
❑
❑
Concentration
✓
Mass
5.18
PCB-1242
(53469-21-9)
❑
❑
Concentration
✓
Mass
5.19
PCB-1254
(11097-69-1)
❑
❑
Concentration
✓
Mass
5.20
PCB-1221
(11104-28-2)
❑
❑
Concentration
✓
Mass
5.21
PCB-1232
(11141-16-5)
❑
❑
Concentration
✓
Mass
5.22
PCB-1248
(12672-29-6)
❑
❑
Concentration
✓
Mass
5.23
PCB-1260
(11096-82-5)
❑
❑
Concentration
✓
Mass
5.24
PCB-1016
(12674-11-2)
❑
❑
Concentration
✓
Mass
EPA Form 3510-2C (Revised 3-19)
Page 20

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(opt onal)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
Toxaphene
5.25 (8001-35-2)
Concentration
st
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19)
Page 21

This page intentionally left blank.

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
Outfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE C. CERTAIN CONVENTIONAL
Pollutant
AND NON CONVENTIONAL
Presence or Absence
(check one)
POLLUTANTS
Units
(specify)
(40 CFR 122.21(g)(7)(vi))1
Effluent
Intake
(Optional)
Believed
Present
Believed
Absent
Maximum DailyLon
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average Daily
Discharge
(if available)
Number of
Analyses
-Term
Average
Value
Number of
Analyses
❑ Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall. You need not complete the "Presence or Absence" column of Table C for
each pollutant.
❑ Check here if you believe all pollutants on Table C to be absent in your discharge from the noted outfall. You need not complete the "Presence or Absence" column of Table C for
each pollutant.
1
Bromide
(24959-67-9)
❑
Concentration
Mass
2.
Chlorine, total
residual
Concentration
Mass
3.
Color
❑
Concentration
✓
Mass
4.
Fecal coliform
❑
Concentration
✓
Mass
5
Fluoride
(16984-48-8)
❑
Concentration
Mass
6
Nitrate -nitrite
❑
❑
Concentration
Mass
7
Nitrogen, total
organic (as N)
Concentration
mg/L
2.3
2.3
0.965
12
sr
Mass
Lb/Day
8.
Oil and grease
❑
Concentration
mg/L
✓
Mass
Lb/Day
0.0
0.0
0.0
48
9'
Phosphorus (as
P),sr total (7723-14-0)
❑
Concentration
mg/L
Mass
Lb/Day
.300
.300
0.045
12
10.
Sulfate (as SO4)
(14808-79-8)
❑
srConcentration
Mass
11.
Sulfide (as S)
❑
Concentration
✓
Mass
EPA Form 3510-2C (Revised 3-19)
Page 23

EPA Identification Number
NCD053488409
TABLE C. CERTAIN CONVENTIONAL
NPDES Permit Number
NC0001899
AND NON CONVENTIONAL POLLUTANTS
Facility Name
Moncure Holdings West LLC
(40 CFR 122.21(g)(7)(vi))1
Outfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
(check one)
Effluent
Intake
(Optional)
Pollutant
Believed
Present
Believed
Absent
Units
(specify)
Maximum DailyLon
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average Daily
Discharge
(if available)
Number of
Analyses
-Term
Average
Value
Number of
Analyses
Sulfite (as SO3)
✓
Concentration
12
(14265-45-3)
Mass
Concentration
13.
Surfactants
Mass
Aluminum, total
✓
Concentration
14.
(7429-90-5)
Mass
Barium, total
Concentration
15.
(7440-39-3)
Mass
Boron, total
Concentration
16.
(7440-42-8)
Mass
Cobalt, total
Concentration
1
(7440-48-4)
Mass
Iron, total
✓
Concentration
18
(7439-89-6)
Mass
Magnesium, total
Concentration
19
(7439-95-4)
❑
✓
Mass
Molybdenum,
Concentration
20.
total
(7439-98-7)
❑
✓
Mass
Manganese, total
❑
✓
Concentration
21
(7439-96-5)
Mass
Tin, total
✓
Concentration
22
(7440-31-5)
Mass
Titanium, total
Concentration
23
(7440-32-6)
Mass
EPA Form 3510-2C (Revised 3-19)
Page 24

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
outfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
C. CERTAIN CONVENTIONAL
Pollutant
AND NON CONVENTIONAL
Presence or Absence
(check one)
POLLUTANTS
Units
(specify)
(40 CFR 122.21(g)(7)(vi))1
Effluent
Intake
(Optional)
Believed
Present
Believed
Absent
Maximum Dail
Discharge y
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average Daily
Discharge
(if available)
Number of
Analyses
Long -Term
Average
Value
Number of
Analyses
24.
Radioactivity
Alpha, total
❑
Concentration
✓
Mass
Beta, total
❑
Concentration
Mass
Radium, total
❑
Concentration
✓
Mass
Radium 226, total
❑
Concentration
✓
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19)
Page 25

This page intentionally left blank.

TABLE
EPA Identification Number
NCD053488409
D. CERTAIN HAZARDOUS
Pollutant
NPDES
SUBSTANCES
Permit Number
NC0001899
AND ASBESTOS (40
Presence or Absence
(check one)
Moncure
CFR 122.21(g)(7)(vii))1
Facility Name
Holdings West LLC
Reason Pollutant
0utfall Number
001
Believed Present in Discharge
Form Approved 03/05/19
OMB No. 2040-0004
Available Quantitative Data
(specify units)
Believed
Present
Believed
Absent
1.
Asbestos
❑
✓
2.
Acetaldehyde
❑
✓
3.
Ally' alcohol
❑
✓
4.
Ally' chloride
❑
✓
5.
Amyl acetate
❑
✓
6.
Aniline
❑
✓
7.
Benzonitrile
❑
✓
8.
Benzyl chloride
❑
✓
9.
Butyl acetate
❑
✓
10.
Butylamine
❑
✓
11.
Captan
❑
✓
12.
Carbaryl
❑
✓
13.
Carbofuran
❑
✓
14.
Carbon disulfide
❑
✓
15.
Chlorpyrifos
❑
✓
16.
Coumaphos
❑
✓
17.
Cresol
❑
✓
18.
Crotonaldehyde
❑
✓
19.
Cyclohexane
❑
✓
EPA Form 3510-2C (Revised 3-19)
Page 27

TABLE
EPA Identification Number
NCD053488409
D. CERTAIN HAZARDOUS
Pollutant
NPDES
SUBSTANCES
Permit Number
NC0001899
AND ASBESTOS (40
Presence or Absence
(check one)
Moncure
CFR 122.21(g)(7)(vii))1
Facility Name
Holdings West LLC
Reason Pollutant
0utfall Number
001
Believed Present in Discharge
Form Approved 03/05/19
OMB No. 2040-0004
Available Quantitative Data
(specify units)
Believed
Present
Believed
Absent
20.
2,4-D (2,4-dichlorophenoxyacetic acid)
❑
✓
21.
Diazinon
❑
✓
22.
Dicamba
❑
✓
23.
Dichlobenil
❑
✓
24.
Dichlone
❑
✓
25.
2,2-dichloropropionic acid
❑
✓
26.
Dichlorvos
❑
✓
27.
Diethyl amine
❑
✓
28.
Dimethyl amine
❑
✓
29.
Dintrobenzene
❑
✓
30.
Diquat
❑
✓
31.
Disulfoton
❑
✓
32.
Diuron
❑
✓
33.
Epichlorohydrin
❑
✓
34.
Ethion
❑
✓
35.
Ethylene diamine
❑
✓
36.
Ethylene dibromide
❑
✓
37.
Formaldehyde
❑
✓
38.
Furfural
❑
✓
EPA Form 3510-2C (Revised 3-19)
Page 28

TABLE
EPA Identification Number
NCD053488409
D. CERTAIN HAZARDOUS
Pollutant
NPDES
SUBSTANCES
Permit Number
NC0001899
AND ASBESTOS (40
Presence or Absence
(check one)
Moncure
CFR 122.21(g)(7)(vii))1
Facility Name
Holdings West LLC
Reason Pollutant
0utfall Number
001
Believed Present in Discharge
Form Approved 03/05/19
OMB No. 2040-0004
Available Quantitative Data
(specify units)
Believed
Present
Believed
Absent
39.
Guthion
❑
✓
40.
Isoprene
❑
✓
41.
Isopropanolamine
❑
✓
42.
Kelthane
❑
✓
43.
Kepone
❑
✓
44.
Malathion
❑
✓
45.
Mercaptodimethur
❑
✓
46.
Methoxychlor
❑
✓
47.
Methyl mercaptan
❑
✓
48.
Methyl methacrylate
❑
✓
49.
Methyl parathion
❑
✓
50.
Mevinphos
❑
✓
51.
Mexacarbate
❑
✓
52.
Monoethyl amine
❑
✓
53.
Monomethyl amine
❑
✓
54.
Naled
❑
✓
55.
Naphthenic acid
❑
✓
56.
Nitrotoluene
❑
✓
57.
Parathion
❑
✓
EPA Form 3510-2C (Revised 3-19)
Page 29

TABLE
EPA Identification Number
NCD053488409
D. CERTAIN HAZARDOUS
Pollutant
NPDES
SUBSTANCES
Permit Number
NC0001899
AND ASBESTOS (40
Presence or Absence
(check one)
Moncure
CFR 122.21(g)(7)(vii))1
Facility Name
Holdings West LLC
Reason Pollutant
0utfall Number
001
Believed Present in Discharge
Form Approved 03/05/19
OMB No. 2040-0004
Available Quantitative Data
(specify units)
Believed
Present
Believed
Absent
58.
Phenolsulfonate
❑
✓
59.
Phosgene
❑
✓
60.
Propargite
❑
✓
61.
Propylene oxide
❑
✓
62.
Pyrethrins
❑
✓
63.
Quinoline
❑
✓
64.
Resorcinol
❑
✓
65.
Strontium
❑
✓
66.
Strychnine
❑
✓
67.
Styrene
❑
✓
68.
2,4 5-T (2,4,5-trichlorophenoxyacetic
acid)
69.
TDE (tetrachlorodiphenyl ethane)
❑
✓
70
2,4,5-TP [2-(2,4,5-trichlorophenoxy)
propanoic acid]
❑
✓
71.
Trichlorofon
❑
✓
72.
Triethanolamine
❑
✓
73.
Triethylamine
❑
✓
74.
Trimethylamine
❑
✓
75.
Uranium
❑
✓
76.
Vanadium
❑
✓
EPA Form 3510-2C (Revised 3-19)
Page 30

TABLE
EPA Identification Number
NCD053488409
D. CERTAIN HAZARDOUS
Pollutant
NPDES
SUBSTANCES
Permit Number
NC0001899
AND ASBESTOS (40
Presence or Absence
(check one)
Moncure
CFR 122.21(g)(7)(vii))1
Facility Name
Holdings West LLC
Reason Pollutant
0utfall Number
001
Believed Present in Discharge
Form Approved 03/05/19
OMB No. 2040-0004
Available Quantitative Data
(specify units)
Believed
Present
Believed
Absent
77.
Vinyl acetate
❑
✓
78.
Xylene
❑
✓
79.
Xylenol
❑
✓
80.
Zirconium
❑
✓
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19)
Page 31

This page intentionally left blank.

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
TABLE E. 2,3,7,8 TETRACHLORODIBENZO P DIOXIN (2,3,7,8 TCDD) (40 CFR 122.21(g)(7)(viii))
Pollutant
TCDD
Congeners
Used or
Manufactured
Presence or
Absence
(check one)
Believed Believed
Present Absent
0utfall Number
001
Results of Screening Procedure
Form Approved 03/05/19
OMB No. 2040-0004
2,3,7,8-TCDD
D
Click to go back to the beginning of Form
EPA Form 3510-2C (Revised 3-19)
Page 33

This page intentionally left blank.

EPA Identification Number
NPDES Permit Number
Facility Name
Outfall Number
NCD053488409
NC0001899
Moncure Holdings West LLC
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
A. CONVENTIONAL AND NON
Pollutant
CONVENTIONAL
Waiver
Requested
(if applicable)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(iii))1
Effluent
Intake
(Optional)
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average Daily
Discharge
(if available)
Number of
Analyses
Long -Term
Average Value
Number of
Analyses
❑
Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
1
Biochemical oxygen demand
(BOD5)
❑
Concentration
mg/L
9.3
6.0
1.724
48
Mass
lb./day
0.439
0.242
2'
Chemical oxygen demand
(COD)
❑
Concentration
Mass
3.
Total organic carbon (TOC)
❑
Concentration
Mass
4.
Total suspended solids (TSS)
❑
Concentration
mg/L
9.70
6.76
7.342
48
Mass
5.
Ammonia (as N)
❑
Concentration
mg/L
1.630
0.240
0.110
16
Mass
6.
Flow
❑
Rate
MGD
0.101
0.0264
0.032
164
7.
Temperature (winter)
❑
°C
°C
21.0
15.8
89
Temperature (summer)
❑
°C
°C
28.6
24.6
75
8.
pH (minimum)
❑
Standard units
S.U.
6.440
6.440
164
pH (maximum)
❑
Standard units
s.u.
8.470
8.470
164
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19)
Page 9

This page intentionally left blank.

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Dscharge
(required)
eq fi
Maximum
Monthly
Discharge
(red) if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
AverageValue
Number
of
Analyses
Check here if you qualify as a small business per the instructions to Form 2C and, therefore, do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table. Note, however, that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1. Toxic Metals, Cyanide, and Total Phenols
1.1
Antimony, total
(7440-36-0)
Concentration
✓
Mass
1.2
Arsenic, total
(7440-38-2)
Concentration
✓
Mass
1.3
Beryllium, total
(7440-41-7)
Concentration
✓
Mass
1.4
Cadmium, total
(7440-43-9)
�
Concentration
ug/I
0.008
0.008
0.004
36
✓
✓
Mass
1.5
Chromium, total
(7440-47-3)
Concentration
Mass
1.6
Copper, total
(7440-50-8)
Concentration
Mass
1.7
Lead, total
(7439-92-1)
�
Concentration
✓
Mass
1.8
Mercury, total
(7439-97-6)
Concentration
✓
Mass
1.9
Nickel, total
(7440-02-0)
�
�
Concentration
✓
Mass
1.10
Selenium, total
(7782-49-2)
Concentration
Mass
1.11
Silver, total
(7440-22-4)
Concentration
st
Mass
EPA Form 3510-2C (Revised 3-19)
Page 11

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
1.12
Thallium, total
(7440-28-0)
Concentration
Mass
1.13
Zinc,total
(7440-66-6)
Concentration
✓
✓
Mass
Lb/Day
31.40
31.40
2.763
12
1.14
Cyanide, total
(57-12-5)
Concentration
mg/L
0.008
0.008
0.003
12
✓
✓
Mass
1.15
Phenols, total
Concentration
i
Mass
Section 2. Organic Toxic Pollutants (GC/MS Fraction
—Volatile Compounds)
2.1
Acrolein
(107-02-8)
Concentration
Mass
2'2
Acrylonitrile
(107-13-1)
Concentration
Mass
2.3
Benzene
(71-43-2)
❑
❑
Concentration
✓
Mass
2.4
Bromoform
(75-25-2)
❑
❑
Concentration
✓
Mass
2.5
Carbon tetrachloride
(56-23-5)
❑
❑
Concentration
✓
Mass
2.6
Chlorobenzene
(108-90-7)
Concentration
Mass
2'7
Chlorodibromomethane
(124-48-1)
Concentration
Mass
2.8
Chloroethane
(75-00-3)
Concentration
st
Mass
EPA Form 3510-2C (Revised 3-19)
Page 12

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
2'9
2-chloroethylvinyl ether
(110-75-8)
Concentration
Mass
2.10
Chloroform (67-66-3)
Concentration
t
Mass
2.11
Dichlorobromomethane
(75-27-4)
Concentration
✓
Mass
•
212
1,1-dichloroethane
(75-34-3)
Concentration
Mass
2'13
1 2-dichloroethane
(107-06-2)
Concentration
Mass
2.14
11-dichloroethylene
(75-35-4)
❑
Concentration
Mass
2.15
1,2-dichloropropane
(78-87-5)
❑
Concentration
Mass
2.16
1,3-dichloropropylene
(542-75-6)
Concentration
✓
Mass
2'17
Ethylbenzene
(100-41-4)
Concentration
✓
Mass
2 18
Methyl bromide
(74-83-9)
Concentration
✓
Mass
2 19
Methyl chloride
(74-87-3)
Concentration
Mass
2 20
Methylene chloride
(75-09-2)
Concentration
Mass
2.21
1 1,2 2- tetrachloroethane
(79-34-5)
❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 13

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Units
(specify)
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
2'22
Tetrachloroethylene
(127-18-4)
Concentration
Mass
2.23
Toluene
(108-88-3)
❑
✓
Concentration
Mass
2'24
1,2-trans-dichloroethylene
(156-60-5)
Concentration
✓
Mass
•
2 25
1,1,1-trichloroethane
(71-55-6)
Concentration
Mass
2 26
•
1,1,2-trichloroethane
(79-00-5)
Concentration
Mass
2 27
Trichloroethylene
(79-01-6)
❑
Concentration
Mass
2 28
Vinyl chloride
(75-01-4)
Concentration
Mass
Section 3. Organic Toxic Pollutants (GC/MS Fraction
—Acid Compounds)
3'1
2-chlorophenol
(95-57-8)
✓
Concentration
Mass
3.2
2 4-dichlorophenol
(120-83-2)
✓
Concentration
Mass
3'3
2 4-dimethylphenol
(105-67-9)
✓
Concentration
Mass
3.4
4 6-dinitro-o-cresol
(534-52-1)
Concentration
Mass
3.5
2 4-dinitrophenol
(51-28-5)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 14

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
3.6
2-nitrophenol
(88-75-5)
Concentration
Mass
3.7
4-nitrophenol
(100-02-7)
❑
❑
Concentration
✓
Mass
3.8
p-chloro-m-cresol
(59-50-7)
❑
❑
Concentration
✓
Mass
3.9
Pentachlorophenol
(87-86-5)
❑
❑
Concentration
✓
Mass
3.10
Phenol
(108-95-2)
❑
❑
Concentration
Mass
3.11
2,4,6-trichlorophenol
(88-05-2)
❑
❑
Concentration
Mass
Section 4. Organic Toxic Pollutants (GC/MS Fraction
—Base /Neutral
Compounds)
4.1
Acenaphthene
(83-32-9)
Concentration
Mass
4.2
Acenaphthylene
(208-96-8)
❑
❑
Concentration
✓
Mass
4.3
Anthracene
(120-12-7)
❑
❑
Concentration
✓
Mass
4.4
Benzidine
(92-87-5)
❑
❑
Concentration
✓
Mass
4.5
Benzo (a) anthracene
(56-55-3)
Concentration
Mass
4.6
Benzo (a) pyrene
(50-32-8)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 15

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
4.7
3 4-benzofluoranthene
(205-99-2)
Concentration
Mass
4•8
Benzo (ghi) perylene
(191-24-2)
Concentration
✓
Mass
4.9
Benzo (k) fluoranthene
(207-08-9)
Concentration
✓
Mass
4.10
Bis (2-chloroethoxy) methane
(111-91-1)
Concentration
✓
Mass
4.11
Bis (2-chloroethyl) ether
(111-44-4)
Concentration
Mass
4.12
Bis (2-chloroisopropyl) ether
(102-80-1)
Concentration
Mass
4.13
Bis (2-ethylhexyl) phthalate
(117-81-7)
Concentration
✓
Mass
4.14
4-bromophenyl phenyl ether
(101-55-3)
Concentration
✓
Mass
4.15
Butyl benzyl phthalate
(85-68-7)
Concentration
✓
Mass
4.16
2-chloronaphthalene
(91-58-7)
Concentration
✓
Mass
4.17
4-chlorophenyl phenyl ether
(7005-72-3)
Concentration
Mass
4.18
Chrysene
(218-01-9)
Concentration
Mass
4.19
Dibenzo (a,h) anthracene
(53-70-3)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 16

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
4.20
12-dichlorobenzene
(95-50-1)
Concentration
Mass
4.21
1,3-dichlorobenzene
(541-73-1)
❑
Concentration
✓
Mass
4.22
1,4-dichlorobenzene
(106-46-7)
❑
Concentration
✓
Mass
4.23
3 3-dichlorobenzidine
(91-94-1)
Concentration
Mass
4.24
Diethyl phthalate
(84-66-2)
Concentration
Mass
4.25
Dimethyl phthalate
(131-11-3)
Concentration
Mass
4.26
Di-n-butyl phthalate
(84-74-2)
Concentration
✓
Mass
4.27
2,4-dinitrotoluene
(121-14-2)
❑
❑
Concentration
✓
Mass
4.28
2,6-dinitrotoluene
(606-20-2)
❑
❑
Concentration
✓
Mass
4.29
Di-n-octyl phthalate
(117-84-0)
Concentration
✓
Mass
4.30
1,2-Diphenylhydrazine
(as azobenzene) (122-66-7)
❑
Concentration
✓
Mass
4.31
Fluoranthene
(206-44-0)
Concentration
Mass
4.32
Fluorene
(86-73-7)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 17

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
4.33
Hexachlorobenzene
(118-74-1)
Concentration
Mass
4.34
Hexachlorobutadiene
(87-68-3)
Concentration
✓
Mass
4.35
Hexachlorocyclopentadiene
(77-47-4)
❑
Concentration
✓
Mass
4.36
Hexachloroethane
(67-72-1)
Concentration
✓
Mass
4.37
Indeno (1,2,3-cd) pyrene
(193-39-5)
Concentration
Mass
4.38
Isophorone
(78-59-1)
Concentration
st
Mass
4.39
Naphthalene
(91-20-3)
Concentration
Mass
4.40
Nitrobenzene
(98-95-3)
Concentration
✓
Mass
4.41
N-nitrosodimethylamine
(62-75-9)
Concentration
✓
Mass
4.42
N-nitrosodi-n-propylamine
(621-64-7)
Concentration
✓
Mass
4.43
N-nitrosodiphenylamine
(86-30-6)
Concentration
Mass
4.44
Phenanthrene
(85-01-8)
Concentration
Mass
4.45
Pyrene
(129-00-0)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 18

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
outfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
4'46
1 2 4-trichlorobenzene
(120'-82-1)
❑
❑
Concentration
✓
Mass
Section 5. Organic Toxic Pollutants (GC/MS Fraction
—Pesticides)
5.1
Aldrin
(309-00-2)
❑
❑
Concentration
Mass
5.2
a-BHC
(319-84-6)
❑
❑
Concentration
✓
Mass
5.3
p-BHC
(319-85-7)
❑
❑
Concentration
✓
Mass
5.4
y-BHC
(58-89-9)
❑
❑
Concentration
✓
Mass
5'5
6-BHC
(319-86-8)
Concentration
st
Mass
5'6
Chlordane
(57-74-9)
Concentration
Mass
5'7
4 4'-DDT
(50-29-3)
Concentration
Mass
5.8
4 4'-DDE
(72-55-9)
❑
❑
Concentration
✓
Mass
5.9
4,4'-DDD
(72-54-8)
❑
❑
Concentration
✓
Mass
5.10
Dieldrin
(60-57-1)
❑
❑
seConcentration
Mass
5.11
a-endosulfan
(115-29-7)
❑
❑
Concentration
✓
Mass
EPA Form 3510-2C (Revised 3-19)
Page 19

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Duiredscarge
(eq)
Maximum
Monthly
f available)
( )
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
AverageValue
Number
of
Analyses
5.12
R-endosuIfan
(115-29-7)
Concentration
Mass
5.13
Endosulfan sulfate
(1031-07-8)
❑
❑
Concentration
✓
Mass
5.14
Endrin
(72 20 8)
❑
❑
Concentration
✓
Mass
5.15
Endrin aldehyde
(7421-93-4)
❑
❑
Concentration
✓
Mass
5.16
Heptachlor
(76-44-8)
❑
❑
Concentration
Mass
5.17
Heptachlor epoxide
(1024-57-3)
❑
❑
Concentration
✓
Mass
5.18
PCB-1242
(53469-21-9)
❑
❑
Concentration
✓
Mass
5.19
PCB-1254
(11097-69-1)
❑
❑
Concentration
✓
Mass
5.20
PCB-1221
(11104-28-2)
❑
❑
Concentration
✓
Mass
5.21
PCB-1232
(11141-16-5)
❑
❑
Concentration
✓
Mass
5.22
PCB-1248
(12672-29-6)
❑
❑
Concentration
✓
Mass
5.23
PCB-1260
(11096-82-5)
❑
❑
Concentration
✓
Mass
5.24
PCB-1016
(12674-11-2)
❑
❑
Concentration
✓
Mass
EPA Form 3510-2C (Revised 3-19)
Page 20

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
0utfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(opt onal)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
Toxaphene
5.25 (8001-35-2)
Concentration
st
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19)
Page 21

This page intentionally left blank.

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
Outfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE C. CERTAIN CONVENTIONAL
Pollutant
AND NON CONVENTIONAL
Presence or Absence
(check one)
POLLUTANTS
Units
(specify)
(40 CFR 122.21(g)(7)(vi))1
Effluent
Intake
(Optional)
Believed
Present
Believed
Absent
Maximum DailyLon
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average Daily
Discharge
(if available)
Number of
Analyses
-Term
Average
Value
Number of
Analyses
❑ Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall. You need not complete the "Presence or Absence" column of Table C for
each pollutant.
❑ Check here if you believe all pollutants on Table C to be absent in your discharge from the noted outfall. You need not complete the "Presence or Absence" column of Table C for
each pollutant.
1
Bromide
(24959-67-9)
❑
Concentration
Mass
2.
Chlorine, total
residual
Concentration
Mass
3.
Color
❑
Concentration
✓
Mass
4.
Fecal coliform
❑
Concentration
✓
Mass
5
Fluoride
(16984-48-8)
❑
Concentration
Mass
6
Nitrate -nitrite
❑
❑
Concentration
Mass
7
Nitrogen, total
organic (as N)
Concentration
mg/L
2.3
2.3
0.965
12
sr
Mass
Lb/Day
8.
Oil and grease
❑
Concentration
mg/L
✓
Mass
Lb/Day
0.0
0.0
0.0
48
9'
Phosphorus (as
P),sr total (7723-14-0)
❑
Concentration
mg/L
Mass
Lb/Day
.300
.300
0.045
12
10.
Sulfate (as SO4)
(14808-79-8)
❑
srConcentration
Mass
11.
Sulfide (as S)
❑
Concentration
✓
Mass
EPA Form 3510-2C (Revised 3-19)
Page 23

EPA Identification Number
NCD053488409
TABLE C. CERTAIN CONVENTIONAL
NPDES Permit Number
NC0001899
AND NON CONVENTIONAL POLLUTANTS
Facility Name
Moncure Holdings West LLC
(40 CFR 122.21(g)(7)(vi))1
Outfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
Presence or Absence
(check one)
Effluent
Intake
(Optional)
Pollutant
Believed
Present
Believed
Absent
Units
(specify)
Maximum DailyLon
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average Daily
Discharge
(if available)
Number of
Analyses
-Term
Average
Value
Number of
Analyses
Sulfite (as SO3)
✓
Concentration
12
(14265-45-3)
Mass
Concentration
13.
Surfactants
Mass
Aluminum, total
✓
Concentration
14.
(7429-90-5)
Mass
Barium, total
Concentration
15.
(7440-39-3)
Mass
Boron, total
Concentration
16.
(7440-42-8)
Mass
Cobalt, total
Concentration
1
(7440-48-4)
Mass
Iron, total
✓
Concentration
18
(7439-89-6)
Mass
Magnesium, total
Concentration
19
(7439-95-4)
❑
✓
Mass
Molybdenum,
Concentration
20.
total
(7439-98-7)
❑
✓
Mass
Manganese, total
❑
✓
Concentration
21
(7439-96-5)
Mass
Tin, total
✓
Concentration
22
(7440-31-5)
Mass
Titanium, total
Concentration
23
(7440-32-6)
Mass
EPA Form 3510-2C (Revised 3-19)
Page 24

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
outfall Number
001
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
C. CERTAIN CONVENTIONAL
Pollutant
AND NON CONVENTIONAL
Presence or Absence
(check one)
POLLUTANTS
Units
(specify)
(40 CFR 122.21(g)(7)(vi))1
Effluent
Intake
(Optional)
Believed
Present
Believed
Absent
Maximum Dail
Discharge y
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average Daily
Discharge
(if available)
Number of
Analyses
Long -Term
Average
Value
Number of
Analyses
24.
Radioactivity
Alpha, total
❑
Concentration
✓
Mass
Beta, total
❑
Concentration
Mass
Radium, total
❑
Concentration
✓
Mass
Radium 226, total
❑
Concentration
✓
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19)
Page 25

This page intentionally left blank.

TABLE
EPA Identification Number
NCD053488409
D. CERTAIN HAZARDOUS
Pollutant
NPDES
SUBSTANCES
Permit Number
NC0001899
AND ASBESTOS (40
Presence or Absence
(check one)
Moncure
CFR 122.21(g)(7)(vii))1
Facility Name
Holdings West LLC
Reason Pollutant
0utfall Number
001
Believed Present in Discharge
Form Approved 03/05/19
OMB No. 2040-0004
Available Quantitative Data
(specify units)
Believed
Present
Believed
Absent
1.
Asbestos
❑
✓
2.
Acetaldehyde
❑
✓
3.
Ally' alcohol
❑
✓
4.
Ally' chloride
❑
✓
5.
Amyl acetate
❑
✓
6.
Aniline
❑
✓
7.
Benzonitrile
❑
✓
8.
Benzyl chloride
❑
✓
9.
Butyl acetate
❑
✓
10.
Butylamine
❑
✓
11.
Captan
❑
✓
12.
Carbaryl
❑
✓
13.
Carbofuran
❑
✓
14.
Carbon disulfide
❑
✓
15.
Chlorpyrifos
❑
✓
16.
Coumaphos
❑
✓
17.
Cresol
❑
✓
18.
Crotonaldehyde
❑
✓
19.
Cyclohexane
❑
✓
EPA Form 3510-2C (Revised 3-19)
Page 27

TABLE
EPA Identification Number
NCD053488409
D. CERTAIN HAZARDOUS
Pollutant
NPDES
SUBSTANCES
Permit Number
NC0001899
AND ASBESTOS (40
Presence or Absence
(check one)
Moncure
CFR 122.21(g)(7)(vii))1
Facility Name
Holdings West LLC
Reason Pollutant
0utfall Number
001
Believed Present in Discharge
Form Approved 03/05/19
OMB No. 2040-0004
Available Quantitative Data
(specify units)
Believed
Present
Believed
Absent
20.
2,4-D (2,4-dichlorophenoxyacetic acid)
❑
✓
21.
Diazinon
❑
✓
22.
Dicamba
❑
✓
23.
Dichlobenil
❑
✓
24.
Dichlone
❑
✓
25.
2,2-dichloropropionic acid
❑
✓
26.
Dichlorvos
❑
✓
27.
Diethyl amine
❑
✓
28.
Dimethyl amine
❑
✓
29.
Dintrobenzene
❑
✓
30.
Diquat
❑
✓
31.
Disulfoton
❑
✓
32.
Diuron
❑
✓
33.
Epichlorohydrin
❑
✓
34.
Ethion
❑
✓
35.
Ethylene diamine
❑
✓
36.
Ethylene dibromide
❑
✓
37.
Formaldehyde
❑
✓
38.
Furfural
❑
✓
EPA Form 3510-2C (Revised 3-19)
Page 28

TABLE
EPA Identification Number
NCD053488409
D. CERTAIN HAZARDOUS
Pollutant
NPDES
SUBSTANCES
Permit Number
NC0001899
AND ASBESTOS (40
Presence or Absence
(check one)
Moncure
CFR 122.21(g)(7)(vii))1
Facility Name
Holdings West LLC
Reason Pollutant
0utfall Number
001
Believed Present in Discharge
Form Approved 03/05/19
OMB No. 2040-0004
Available Quantitative Data
(specify units)
Believed
Present
Believed
Absent
39.
Guthion
❑
✓
40.
Isoprene
❑
✓
41.
Isopropanolamine
❑
✓
42.
Kelthane
❑
✓
43.
Kepone
❑
✓
44.
Malathion
❑
✓
45.
Mercaptodimethur
❑
✓
46.
Methoxychlor
❑
✓
47.
Methyl mercaptan
❑
✓
48.
Methyl methacrylate
❑
✓
49.
Methyl parathion
❑
✓
50.
Mevinphos
❑
✓
51.
Mexacarbate
❑
✓
52.
Monoethyl amine
❑
✓
53.
Monomethyl amine
❑
✓
54.
Naled
❑
✓
55.
Naphthenic acid
❑
✓
56.
Nitrotoluene
❑
✓
57.
Parathion
❑
✓
EPA Form 3510-2C (Revised 3-19)
Page 29

TABLE
EPA Identification Number
NCD053488409
D. CERTAIN HAZARDOUS
Pollutant
NPDES
SUBSTANCES
Permit Number
NC0001899
AND ASBESTOS (40
Presence or Absence
(check one)
Moncure
CFR 122.21(g)(7)(vii))1
Facility Name
Holdings West LLC
Reason Pollutant
0utfall Number
001
Believed Present in Discharge
Form Approved 03/05/19
OMB No. 2040-0004
Available Quantitative Data
(specify units)
Believed
Present
Believed
Absent
58.
Phenolsulfonate
❑
✓
59.
Phosgene
❑
✓
60.
Propargite
❑
✓
61.
Propylene oxide
❑
✓
62.
Pyrethrins
❑
✓
63.
Quinoline
❑
✓
64.
Resorcinol
❑
✓
65.
Strontium
❑
✓
66.
Strychnine
❑
✓
67.
Styrene
❑
✓
68.
2,4 5-T (2,4,5-trichlorophenoxyacetic
acid)
69.
TDE (tetrachlorodiphenyl ethane)
❑
✓
70
2,4,5-TP [2-(2,4,5-trichlorophenoxy)
propanoic acid]
❑
✓
71.
Trichlorofon
❑
✓
72.
Triethanolamine
❑
✓
73.
Triethylamine
❑
✓
74.
Trimethylamine
❑
✓
75.
Uranium
❑
✓
76.
Vanadium
❑
✓
EPA Form 3510-2C (Revised 3-19)
Page 30

TABLE
EPA Identification Number
NCD053488409
D. CERTAIN HAZARDOUS
Pollutant
NPDES
SUBSTANCES
Permit Number
NC0001899
AND ASBESTOS (40
Presence or Absence
(check one)
Moncure
CFR 122.21(g)(7)(vii))1
Facility Name
Holdings West LLC
Reason Pollutant
0utfall Number
001
Believed Present in Discharge
Form Approved 03/05/19
OMB No. 2040-0004
Available Quantitative Data
(specify units)
Believed
Present
Believed
Absent
77.
Vinyl acetate
❑
✓
78.
Xylene
❑
✓
79.
Xylenol
❑
✓
80.
Zirconium
❑
✓
1 Sampling shall be conducted according to sufficiently sensitive test procedures (i.e., methods) approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I, subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C (Revised 3-19)
Page 31

This page intentionally left blank.

EPA Identification Number
NCD053488409
NPDES Permit Number
NC0001899
Facility Name
Moncure Holdings West LLC
TABLE E. 2,3,7,8 TETRACHLORODIBENZO P DIOXIN (2,3,7,8 TCDD) (40 CFR 122.21(g)(7)(viii))
Pollutant
TCDD
Congeners
Used or
Manufactured
Presence or
Absence
(check one)
Believed Believed
Present Absent
0utfall Number
001
Results of Screening Procedure
Form Approved 03/05/19
OMB No. 2040-0004
2,3,7,8-TCDD
D
Click to go back to the beginning of Form
EPA Form 3510-2C (Revised 3-19)
Page 33

TO HAW
RIVER
)
ROADWAY SURFACES
ROOF TOP
LEGEND
- STORM DRAINAGE
PROCESS SEWER
— — SANITARY SEWER
FINISH OIL TREATMENT
POLYMER COOLING WATER SYSTEM
- - - - SPILL COLLECTION SYSTEM
♦10
NPOES OUTFALL 001
22
TO
STORMWATER OUTFALL 2 CREEKO%
CREEK
NPDES OUTFALL 002
•OTICr
o gswrt NIO9
:0 .0,10r401.100 1
. wr0w 0. 00 01010am
.Ia 0; 1.4.Z.000 0107,4.0.0 .cacao
7w AVFw AN. ww art 00.
REVISED FROM SK-940310-3 GARB WLB 11/06/95 6
ISSUED FOR NFORMAT10N GARB KB II/09/95 7
GENERAL REVISION GARB WIB 12/06/95 8
A00E0 NEW BORDER. GENERAL REV GARB *LB _ 03/02/00 9
ADDED 510RM wA1E9 10068S EAST OF wH GARB WIB 06/16/00
ADDEO HT-28 & GENERAL REVISION GARB WLB 10/02/02
REVISED NOTES 10 AND 25
ADD NEW BORDER, REM 35 & GENERAL REV
700E0 ROADWAY 8 ROOF TOP SWAM LEGD0
GENERAL REVISIONS
AFON
GARB WLB
GARB WLB
GARB CEP
TMK
MR5
/YIN
44.000
atl
63/01/N
I0/03/05
02 22/07
01 17/12
STORMWATER au/TALL 3
TO
S146D1X17
CREEK
STORMWATER
OUTFALL 4
L- _t .
TO
SHADDOX
CREEK
FOR DETAILS IN THIS AREA
SEE SHEET 2 OF 2
TO
4a-SHAODOX
CREEK
NOTES:
A -WAREHOUSE
8-FIBERS PROCESSING
C-MAINTENANCE/STORES
D-SPINNING
E-POLYMER
F-UTILITIES
G-QUALITY CONTROL
I. -ME' PONDS
J-STORM WATER RETENTION CHANNEL
K-DRAINAGE TRENCHES
L-WASTEWATER TREATMENT (AERATION BASIN)
M-SPCC EQUIPMENT BLDG (EMERGENCY VEHICLES)
N-SPILL COLLECTION BASIN
0-BEAM CLEµ1NG BUILDING
P-NOT USED
0-PROCESS WATER TREATMENT PLANT
R-M51 STORAGE BLDG
5-ADMINISTRATION BLDG
T-STORM WATER RETENTION POND
U-POLYMER AUXILURY SWITCHGEAR BUILDING
V-ENGINEERING BUILDING ANNEX
1-FUEL OIL TANK (AREA 1)(VT-45)
2-FUEL OIL TANKS (µEA 2)(VT-14.30.4k HT-8)
3-GLYCOL TANKS(VT-19,20,34)
4-OOWTHERM TANKS(HT-1.2.3)
5-DIESEL OIL TANKS(HT-22.23)
6-CAUSTIC TANKS(VT-235)
1-SPIN FINISH TREATMENT TANKS
8- DRUM STORAGE FACILRY
9-MARLEY TOWERS OW-2& 1W-3)
10-GASOLINE/DIESEL TANK5 (HT-'5,18,2')
11-DIRA TANK (VT -78)
12-TPA BINS(Vr-31,32.33)
I 3 -TRANSFORMERS TF-1.2.11.22
4-TRANSFORMERS TF-3,4,13,14
15-TRANSFORMERS TF-5,6,7,8,15,15,17,1 R,19.20,75,26
115-TRANSFORMER TF-9
17-TRANSFORMERS TF- 10.12
16-TRANSFOMERS TF-21,23,24
19-BLDG II CHEMICAL/UNNERSAL WASTE STORAGE
20-0C CHEMICAL STORAGE ROOM
21-EG TANKS (HT -10.11,25)
22-HAZARDOUS WASTE SATELLITE ACCUMULATION POINT
23-VT-97 FINISH 06_ TANK
24 -TV -5 & TV/ -5 COOLING TOWERS
25-MAIN PROPANE TANK (HT-
2
6-SMALL PROPANE TANKS
27-M51 GAS CYLINDER STORAGE
28-ENCLOSED FINISH STORAGE (DRUMS)
29-NITROGEN STORAGE TANK
30-TRANSFORMERS TF-27.28
31-OIL MIST AIR POLLUTION CONTROL (LIME)
32-PROPANE VAPORIZER (HE-555)
33-SFG RECOVERY BEDS
34-RAT-28
SAFETY FIRST
APPROVED FOR SAT ETV BY
W.L BOYER 71/09/95
PLOT 0 1-1 CAD DWG
w[f[107CC
vat1RELOW ONGRµ 077EE1 2 OF 2
OM NO
25-34-1009
KPR:.43
L. BOYER
art •IM loom 76
11/09/95 Aw1.4.
J MURPHY
11/09/95 wp N75
Performance° Fibe
MONCIII6 AANT
0E0 001. NC
WATERFLOW DIAGRAM
SHEET 1 OF 2
511O
,25-34-1008-9

(drainage from old manufacturing bldgs. slabs, surface run-off)
Process (no process water) Sanitary (2 employees)
1
Stormwater Low -Lift -Station
(Run-off west side of the site)
/
Process
1
Wastewater Treatment Plant
Sanitary
Mixing Chamber I- WWTP Spill Pond
\ 7
Aeration Basin
1
Clarifier
/ \
Contact Chamber
Outfall 001
Polishing
West Fire Pond East Fire Pond
(overflow) (overflow)
Stormwater ►
1
Stormwater Ditch
1
002 Containment Pond
Haw River
► Outfall002
1
Shaddox Creek