NC0037834_Renewal (Application)_20211228

Send the completed renewal package to:
Ms.Wren Thedford
NC DEQ/DWR /NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
[[e-mail]]
RECEIVED
DEC 2 8 2021
NCDEQ/DWR/NPDES

Winston-Salem/Forsyth County
tY
tor
Ititi I ities
Water•Wastewater•Solid Waste
Wastewater Division,2799 Griffith Road,Winston-Salem,NC 27103
0:336-727-8000,F:336-659-4320, cityofws.org/utilities
December 17, 2021 RECEIVED
Ms. Wren Thedford DEC 2 8 2021
NC DEQ/DWR/NPDES
1617 Mail Service Center NCDEQ/DWRINPDES
Raleigh,NC 27699-1617
RE: Archie Elledge WWTP NC0037834—Permit Renewal Request Application
Dear Ms. Thedford,
This letter is a formal request by the City of Winston Salem for a Permit Renewal at the Archie Elledge
WWTP NC0037834 facility. Please see additional information below regarding some of the enclosures
included with our application:
• Our Priority Pollutant Analysis was conducted in 2017,2019, and 2021. We received a letter
(Enclosure 1)dated December 6,2018 from Deborah Gore with NC DEQ requiring additional
metals(Co, Sb, Sn, Ti,V)for our Long Term Monitoring Plan,Table D. These additional metals
were reported in 2019 and 2021.In addition,it was discovered that Tin was originally reported as
<0.025 mg/L on both reports. The reports were revised.The updated results were both<0.01
mg/L.
• The April 2019 PPA had to be resampled for 624 volatile analysis due to foaming(Enclosure 2).
The resample took place in June of 2019.
• For Table E,a quarterly chronic TOX pass/fail was conducted in October 2021. The second
species sampling event took place the week of November 29,2021 and was approved by Cindy
Moore with NC DENR(Enclosure 3).
In addition to the above referenced enclosures,our Permit Renewal Application Package includes the
following attachments:
• EPA Application Form 2A-Sections 1 through 6
• Topographic Map/Flow Diagram/Narrative
• Completed and Attached Tables A&B
• Attached Data for Table C&D
• Completed Table D
• Attached Data for Table E
• Attached 2020 Pretreatment Annual Report for Table F
• Sludge Management Plan
City Council:Mayor Allen Joines;Denise D.Adams,Mayor Pro Tempore,North Ward;Barbara Hanes Burke,Northeast Ward;Robert C.Clark,West Ward;
John C.Larson,South Ward;Jeff Macintosh,Northwest Ward;Kevin Mundy,Southwest Ward;Annette Scippio,East Ward;James Taylor,Jr.,Southeast Ward;
City Manager:Lee D.Garrity
County Commissioners:David R.Plyler,Chair;Don Martin,Vice Chair;Fleming El-Amin;Ted Kaplan;Richard V.Linville;Tonya McDaniel;Gloria D.Whisenhunt;
Call 311 or 336-727-8000 County Manager:Dudley Watts,Jr.
Winston-Salem/Forsyth County Utility Commission:Randall S.Tuttle,Chair;L.Wesley Curtis,Jr.,Vice Chair;Harold E.Day;Tom Griffin;Yvonne H.Hines;
[e-mail] cityofws.org Duane Long;Hugh W.Jernigan;Chris Parker;Donald R.Stewart;Charles Wilson;Allan Younger

nerely,
o ney Dr v
Director of tili les
City of Winston Salem
P.O.Box 2511
Winston Salem,NC 27102
336.747.7315
[e-mail]
2

Enclosure 1

.yL W
•
/ K ^
ROY COOPER i
Governor ° I1
MICHAEL S.REGAN \�
Secretary 4 dw+r.*
LINDA CULPEPPER
Interim Director NORTH CAROLINA
Environmental Quality
December 6, 2018
Via email ([e-mail])
Joel Freeman,Senior Chemist/IWC Supervisor
City of Winston-Salem •
Mason Meads Complex
2799 Griffith Road
Winston-Salem, NC 27103
Subject: Long Term Monitoring Plan (LTMP) Updates
Program: City of Winston-Salem (NPDES No. NC0037834)
Archie Elledge WWTP (NC0037834) & Muddy Creek WWTP (NC0050342)
Forsyth County
Dear Mr. Freeman:
EPA defines pollutants of concern (POCs) as any pollutant which might reasonably be expected
to be discharged to the POTW in quantities which could pass through or interfere with the POTW,
contaminate the sludge, or jeopardize POTW worker safety and health. One of the criteria to
determine pollutants be included in the LTMP POCs list is if it is limited in significant industrial
user(SIU) permits.
In recent industrial user permit OUP) reviews, it came to the PERCS Unit's attention that certain
IUP-limited pollutants are not always included in the LTMP as they are not conventional
pollutants that are typically evaluated in the Headworks Analysis. For example, antimony,cobalt,
tin, titanium and vanadium are required to have limits in the Centralized Waste Treatment (40
CFR 437) categorical standard. Not all of them have water quality standards or are on the 126
priority pollutants scan list but they might have adverse impacts on the aquatic life or human
health like other emerging contaminants. After a discussion with the NPDES Complex Permitting
Unit, the decision has been made that these pollutants are required to be added to your LTMP
and monitored at least 3 times every 5 years along with the 126 priority pollutants scan only at
the effluent. If any pollutant is detected at the effluent using the following detection levels(DLs),
the influent should also be monitored.
II?41H f,,,:ll1. \ �/
OpMnerl N(�.'ma Id OydT la/
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh,North Carolina 27699-1617
919,707.9000

Metals DL Method Instrumentation
Co-cobalt 50 ug/L EPA Method 200.8 Rev5.4 ICPMS
Sb-antimony 10 ug/L EPA Method 200.8 Rev5.4 ICPMS
Sn-tin 10 ug/L EPA Method 200.8 Rev5.4 ICPMS
Ti-titanium 10 ug/L EPA Method 200.7 Rev4.4 ICP j
V-vanadium 10 ugh!. EPA Method 200.7 Rev4.4 ICP
Please add the metals from the table above to your monitoring plan based on the parameters
limited in any IUPs subject to 40 CFR 437 and submit your updated LTMP by January 31,2019. If
you have questions or comments, please contact Monti Hassan at 919-707-3626 [email:
[e-mail]] or Deborah Gore, Unit Supervisor at 919-707-3624 [email:
[e-mail]]. Thank you for your continued cooperation with the Pretreatment
Program.
Sincerely,
Deborah Gore,
PERCS Unit supervisor
E CV)
wo.vw,a a u,T,>M�.w uaut
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street 11617 Mail Service Center I Raleigh,North Carolina 27699-1617
919.707.9000

Enclosure 2

Enclosure 3

Bonnie McKee
From: Moore, Cindy <[e-mail]>
Sent: Thursday, October 28, 2021 10:42 AM
To: Bonnie McKee
Cc: Mike Reed;Thomas, Zachary T; Henning, Lorimar S
Subject: RE: [External] 2nd Species Elledge WWTP - Muddy Creek WWTP
*** CAUTION! EXTERNAL SENDER*** STOP.EVALUATE.VERIFY.Were you expecting this email?Does the content make
sense?Can you verify the sender? If the email is suspicious: Do not click links or open attachments.Click the Report
Message button in Outlook to notify Information Systems.
Performing your second species test in November will be fine for both plants.
From: Bonnie McKee <[e-mail]>
Sent:Thursday,October 28, 2021 10:32 AM
To: Moore, Cindy<[e-mail]>
Subject: [External] 2nd Species Elledge WWTP-Muddy Creek WWTP
Importance: High
CAUTION: External email. Do not click links or open attachments unless you verify.Send all suspicious email as an attachment to
Report Spam.
Good Morning,
The Cityof Winston Salem is gettingreadyto submitpermit renewals for Elledge
g
WWTP NC0037834 and MuddyCreek WWTP NC0050342. Both plants have
successfully completed all quarterly Chronic TOX Pass/Fail sampling events, however
both plants need 1 additional 211d Species event to complete their permit renewal
applications.
We would like to conduct this test in November if acceptable.
Bonnie McKee
Laboratory Utilities Plant Supervisor
i

Application Form 2A
2022 Permit Renewal

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge WWTP OMB No.2040-0004
Form U.S.Environmental Protection Agency
2A 41•EPA Application for NPDES Permit to Discharge Wastewater
NPDES NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
SECTION 1. BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
Archie Elledge Wastewater Treatment Plant
Mailing address(street or P.O. box)
P.O. Box 2511
City or town State ZIP code
0 Winston-Salem NC 27102
Contact name(first and last) Title Phone number Email address
0 Courtney Driver City/County Utilities Director [phone] [e-mail]
Location address(street,route number,or other specific identifier) ❑ Same as mailing address
2801 Griffith Rd
U-
City or town State ZIP code
Winston-Salem NC 27103
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission ❑✓ No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
❑ Yes ❑✓ No 4 SKIP to Item 1.4.
Applicant name
Applicant address(street or P.O. box)
0
City or town State ZIP code
0
Contact name(first and last) Title Phone number Email address
D-
1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
❑ Owner ❑ Operator ❑✓ Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
❑ Facility ❑ Applicant 0 Facility and applicant
(they are one and the same)
1.6 Indicate below any existing environmental permits. (Check all that apply and print or type the corresponding permit
number for each.)
Existing Environmental Permits
a.
✓❑ NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
water) control)
E NC0037834
o ❑✓ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
00817R9
cn
❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑✓ Other(specify)
404)
Stormwater NCG110000-Di
EPA Form 3510-2A(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge WWTP OMB No.2040-0004
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type Ownership Status
Served Served (indicate percentage)
Winston Salem 85,877 too %separate sanitary sewer 0 Own 0 Maintain
%combined storm and sanitary sewer 0 Own ❑ Maintain
d 0 Unknown 0 Own 0 Maintain
co
c Walkertown 4,064 too %separate sanitary sewer El Own 0 Maintain
o
%combined storm and sanitary sewer ❑ Own 0 Maintain
as
0 Unknown 0 Own ❑ Maintain
0.
a Unincorporated 2,027 too %separate sanitary sewer 0 Own 0 Maintain
a Forsyth %combined storm and sanitary sewer 0 Own ❑ Maintain
cu 0 Unknown 0 Own 0 Maintain
d %separate sanitary sewer 0 Own 0 Maintain
%combined storm and sanitary sewer El Own 0 Maintain
c 0 Unknown El Own ❑ Maintain
w Total
d Population 91,968
c� Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of sewer line(in miles) 100 o' %
�0
z' 1.8 Is the treatment works located in Indian Country?
o' ❑ Yes ❑✓ No
o
1.9 Does the facility discharge to a receiving water that flows through Indian Country?
c ❑ Yes ❑✓ No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
60 mgd
rzi
Annual Average Flow Rates(Actual)
1 Two Years Ago Last Year This Year
Co 19.25 mgd 21.27 mgd 21.91 mgd
Maximum Daily Flow Rates(Actual)
cu
O Two Years Ago Last Year This Year
23.9 mgd 26.8 mgd 26.7 mgd
ca 1.11 Provide the total number of effluent discharge points to waters of the United States by type.
o Total Number of Effluent Discharge Points by Type
n- o. Constructed
22• 1- Treated Effluent Untreated Effluent Combined Sewer Bypasses Emergency
Overflows Overflows
0
N
_
3 1 0 0 0 0
EPA Form 3510-2A(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge VWVTP OMB No.2040-0004
Outfalls Other Than to Waters of the United States
1.12 Does the POTW discharge wastewater to basins, ponds,or other surface impoundments that do not have outlets for
discharge to waters of the United States?
❑ Yes ❑✓ No 4 SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface (check one)
Impoundment
❑ Continuous
gpd ❑ Intermittent
O Continuous
gpd 0 Intermittent
•
❑ Continuous
gpd 0 Intermittent
w 1.14 Is wastewater applied to land?
❑ Yes ❑✓ No4SKIPtoItem1.16.
0 1.15 Provide the land application site and discharge data requested below.
N Land Application Site and Discharge Data
o Continuous or
o Average Daily Volume
Location Size Applied Intermittent
El (check one)
acresgpd 0 Continuous
o 0 Intermittent
acresgpd 0 Continuous
o ❑ Intermittent
acresgpd 0 Continuous
❑ Intermittent
7 1.16 Is effluent transported to another facility for treatment prior to discharge?
o ❑ Yes m No 4 SKIP to Item 1.21.
1.17 Describe the means by which the effluent is transported(e.g.,tank truck,pipe).
1.18 Is the effluent transported by a party other than the applicant?
❑ Yes ❑ No 4 SKIP to Item 1.20.
1.19 Provide information on the transporter below.
Transporter Data
Entity name Mailing address(street or P.O.box)
City or town State ZIP code
Contact name(first and last) Title
Phone number Email address
EPA Form 3510-2A(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge VVVVfP OMB No.2040-0004
1.20 In the table below,indicate the name, address,contact information, NPDES number,and average daily flow rate of the
receiving facility.
Receiving Facility Data
-0 Facility name Mailing address(street or P.O. box)
City or town State ZIP code
0
Contact name(first and last) Title
0
Phone number Email address
QNPDES number of receiving facility(if any) 0 None Average daily flow rate mgd
0 1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do not
have outlets to waters of the United States(e.g., underground percolation,underground injection)?
En
❑ Yes ❑✓ No 4 SKIP to Item 1.23.
0 1.22 Provide information in the table below on these other disposal methods.
CDInformation on Other Disposal Methods
o Disposal Location of Size of Annual Average Continuous or Intermittent
Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
acresgpd 0 Continuous
0 Intermittent
0 Continuous
acres gpd 0 Intermittent
acres gpd ❑ Continuous
❑ Intermittent
1.23 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)?(Check all that apply.
w y Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
3 ❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
cr
co cp Section 301(h)) 302(b)(2))
ElNot applicable
1.24 Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works
the responsibility of a contractor?
❑ Yes ❑✓ No+SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
o Contractor name
(company name)
Mailing address
(street or P.O. box)
City,state, and ZIP
code
0 Contact name(first and
c� last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
EPA Form 3510-2A(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge VWVfP OMB No.2040-0004
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
o Outfalls to Waters of the United States
= 2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
❑✓ Yes ❑ No 4 SKIP to Section 3.
c 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration. 4,300,000 gpd
c Indicate the steps the facility is taking to minimize inflow and infiltration.
m Collection System improvement project is underway with an Engineering firm.Lines annually cleared of roots and debris,
Jetted,and inspected on a routine basis.There are several rehabilitation projects underway to improve compliance and
capacity of the collections system.
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
0 specific requirements.)
rn-
0
0 ❑✓ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
c co (See instructions for specific requirements.)
LT_ co
o ❑✓ Yes ❑ No
2.5 Are improvements to the facility scheduled?
❑ Yes ✓❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
0
1.
E
0. 2.
E
0
3.
w
a�
co
4.
al 2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
Scheduled Begin End Begin
Outfalls Operational
0 Improvement Construction Construction Discharge
(from above) (list outfall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
as
CD
1.
CD
U 2
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No ❑ None required or applicable
Explanation:
EPA Form 3510-2A(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge'MNTP OMB No.2040-0004
SECTION 3.INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5))
3.1 Provide the following information for each outfall. (Attach additional sheets if you have more than three outfalls.)
Outfall Number 001 Outfall Number Outfall Number
State NC
N
m County Forsyth
'
0 City or town Winston Salem
o
c
O Distance from shore N/A ft. ft. ft.
w.
d Depth below surface N/A ft. ft. ft.
a
Average daily flow rate 21.27 mgd mgd mgd
Latitude 36° 1.0' 8.0" N 0 °
Longitude 80° 18' 868" W °
as
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
o ❑ Yes ❑✓ No 4 SKIP to Item 3.4.
N
I 3.3 If so, provide the following information for each applicable outfall.
N Outfall Number Outfall Number Outfall Number
0
15 Number of times per year
O discharge occurs
a Average duration of each
o` discharge(specify units)
To
Average flow of each
to discharge mgd mgd mgd
(13 Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑✓ Yes 0 No 4 SKIP to Item 3.6.
03.5 Briefly describe the diffuser type at each applicable outfall.
Outfall Number o01 Outfall Number Outfall Number
d
co perforated rubber sock with
oair provided by 3 blowers
o us 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
1,2 discharge points?
3• w ❑✓ Yes 0 No 4SKIP to Section 6.
EPA Form 3510-2A(Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge VWVfP OMB No.2040-0004
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number 001 Outfall Number Outfall Number
Receiving water name Salem Creek
Name of watershed, river,
c or stream system Yadkin River Basin
Q- U.S. Soil Conservation
-L
N Service 14-digit watershed None
o code
°' Name of state Yadkin
g management/river basin
co
U.S. Geological Survey
43 8-digit hydrologic 03040103
cc cataloging unit code
Critical low flow(acute) 15 cfs cfs cfs
Critical low flow(chronic) N/A cfs cfs cfs
Total hardness at critical mg/L of mg/L of mg/L of
low flow None Availed!
hA CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number ow Outfall Number Outfall Number
Highest Level of 0 Primary ❑ Primary ❑ Primary
Treatment(check all that ❑ Equivalent to ❑ Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
O Secondary ❑ Secondary 0 Secondary
❑ Advanced ❑ Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) ❑ Other(specify)
c
0
Design Removal Rates by
-. Outfall
u)
d
ci WE BOD5 or CBOD5 98
c
d
g
m TSS 97 To To ok
I—
VI Not applicable 0 Not applicable ❑ Not applicable
Phosphorus % % %
0 Not applicable ❑ Not applicable 0 Not applicable
Nitrogen % %
Other(specify) 0 Not applicable ❑ Not applicable 0 Not applicable
EPA Form 3510-2A(Revised 3-19) Page 7

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge VWVfP OMB No.2040-0004
3.9 Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season,describe below.
-a Chlorination using Sodium Hypochlorite,No seasonal variation
a)
0
0
Outfall Number 001 Outfall Number Outfall Number
0
0_ Disinfection type
Sodium Hypochlorite
M
CD
C
Seasons used N/A
CO
Dechlorination used? El Not applicable ❑ Not applicable ❑ Not applicable
❑✓ Yes ❑ Yes ❑ Yes
❑ No ❑ No El No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
✓❑ Yes ❑ No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑✓ Yes ❑ No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number 001 Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
Number of tests of discharge 17
water
Number of tests of receiving
water
3.13 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
❑✓ Yes ❑ No 4 SKIP to Item 3.16.
3.14 Does the POTW use chlorine for disinfection,use chlorine elsewhere in the treatment process,or otherwise have
cn
reasonable potential to discharge chlorine in its effluent?
El Yes 4 Complete Table B, including chlorine. ❑ No 4 Complete Table B,omitting chlorine.
c3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
CD
package?
w ❑✓ Yes ❑ No
3.16 Does one or more of the following conditions apply?
• The facility has a design flow greater than or equal to 1 mgd.
• The POTW has an approved pretreatment program or is required to develop such a program.
• The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C,must
sample other additional parameters(Table D),or submit the results of WET tests for acute or chronic toxicity for
each of its discharge outfalls(Table E).
❑ Yes Complete Tables C, D,and E as ❑ No 3 SKIP to Section 4.
applicable.
3.17 Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
✓❑ Yes ❑ No
3.18 Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
❑✓ Yes ❑ No additional sampling required by NPDES
permitting authority.
EPA Form 3510-2A(Revised 3-19) Page 8

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge WWfP OMB No.2040-0004
3.19 Has the POTW conducted either(1)minimum of four quarterly WET tests for one year preceding this permit application
or(2)at least four annual WET tests in the past 4.5 years?
El Yes ❑ No 4 Complete tests and Table E and SKIP to
Item 3.26.
3.20 Have you previously submitted the results of the above tests to your NPDES permitting authority?
ID Yes ❑ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21 Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of Results
(MM/DD/YYYY)
08/09/2021
m >96/Pass
c
.2
CO
3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
toxicity?
cr' ❑ Yes ❑✓ No 4 SKIP to Item 3.26.
3.23 Describe the cause(s)of the toxicity:
C
0,
w
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑ No 4 SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
El Yes Not applicable because previously submitted
information to the NPDES •ermittin• authori .
SECTION 4.INDUSTRIAL DISCHARGES AND HAZARDOUS WASTES(40 CFR 122.21(j)(6)and(7))
4.1 Does the POTW receive discharges from SIUs or NSCIUs?
❑✓ Yes ❑ No 4 SKIP to Item 4.7.
4.2 Indicate the number of SIUs and NSCIUs that discharge to the POTW.
Number of SIUs Number of NSCIUs
19 8
R
I 4.3 Does the POTW have an approved pretreatment program?
❑✓ Yes ❑ No
g 4.4 Have you submitted either of the following to the NPDES permitting authority that contains information substantially
identical to that required in Table F:(1)a pretreatment program annual report submitted within one year of the
application or(2)a pretreatment program?
❑✓ Yes ❑ No 4 SKIP to Item 4.6.
76 4.5 Identify the title and date of the annual report or pretreatment program referenced in Item 4.4.SKIP to Item 4.7.
PAR 2020 submitted February 22,2021.Approved on May 24,2021
— 4.6 Have you completed and attached Table F to this application package?
❑ Yes ❑ No
EPA Form 3510-2A(Revised 3.19) Page 9

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge WWTP OMB No.2040-0004
4.7 Does the POTW receive,or has it been notified that it will receive, by truck, rail,or dedicated pipe,any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
❑ Yes ❑✓ No 4 SKIP to Item 4.9.
4.8 If yes, provide the following information:
Annual
Hazardous Waste Waste Transport Method Amount of Units
Number (check all that apply) Waste
Received
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
0
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
0
N ❑ Truck ElRail
CO
❑ Dedicated pipe ❑ Other(specify)
CO
4.9 Does the POTW receive,or has it been notified that it will receive,wastewaters that originate from remedial activities,
0 including those undertaken pursuant to CERCLA and Sections 3004(7)or 3008(h)of RCRA?
❑ Yes ❑✓ No 4 SKIP to Section 5.
4.10 Does the POTW receive(or expect to receive)less than 15 kilograms per month of non-acute hazardous wastes as
specified in 40 CFR 261.30(d)and 261.33(e)?
❑ Yes 4 SKIP to Section 5. ❑ No
4.11 Have you reported the following information in an attachment to this application: identification and description of the
site(s)or facility(ies)at which the wastewater originates;the identities of the wastewater's hazardous constituents;and
the extent of treatment,if any,the wastewater receives or will receive before entering the POTW?
❑ Yes ❑ No
SECTION 5.COMBINED SEWER OVERFLOWS(40 CFR 122.216)(8))
5.1 Does the treatment works have a combined sewer system?
CO
❑ Yes ❑✓ No-SKIP to Section 6.
5.2 Have you attached a CSO system map to this application?(See instructions for map requirements.)
❑ Yes ❑ No
5.3 Have you attached a CSO system diagram to this application?(See instructions for diagram requirements.)
❑ Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 10

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge WVVTP OMB No.2040-0004
5.4 For each CSO outfall, provide the following information. (Attach additional sheets as necessary.)
CSO Outfall Number CSO Outfall Number CSO Outfall Number
= City or town
0
Y
State and ZIP code
tl
y
o County
4 o
3 Latitude °
0
0 °
cn Longitude °
0
Distance from shore ft. ft. ft.
Depth below surface ft. ft. ft.
5.5 Did the POTW monitor any of the following items in the past year for its CSO outfalls?
CSO Outfall Number CSO Outfall Number CSO Outfall Number
Rainfall ❑ Yes ❑ No ❑ Yes ❑ No 0 Yes ❑ No
a)
a
o CSO flow volume ❑ Yes ❑ No ❑ Yes 0 No ❑ Yes ❑ No
Y
c
CSO pollutant ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
o concentrations
cn
o Receiving water quality ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
CSO frequency ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes 0 No
Number of storm events ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
5.6 Provide the following information for each of your CSO outfalls.
CSO Outfall Number CSO Outfall Number CSO Outfall Number
} Number of CSO events in events events events
the past year
co
a
c Average duration per hours hours hours
d event ❑Actual or 0 Estimated ❑Actual or❑ Estimated ❑Actual or❑ Estimated
W million gallons million gallons million gallons
o Average volume per event
0 0 Actual or❑ Estimated 0 Actual or 0 Estimated ❑Actual or 0 Estimated
Minimum rainfall causing inches of rainfall inches of rainfall inches of rainfall
a CSO event in last year ❑Actual or 0 Estimated ❑Actual or 0 Estimated 0 Actual or 0 Estimated
EPA Form 3510-2A(Revised 3-19) Page 11
i

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge VWVTP OMB No.2040-0004
5.7 Provide the information in the table below for each of your CSO outfalls.
CSO Outfall Number CSO Outfall Number CSO Outfall Number
Receiving water name
Name of watershed/
'12 stream system
U.S.Soil Conservation 0 Unknown 0 Unknown ❑Unknown
Service 14-digit
watershed code
"> (if known)
Name of state
management/river basin
U.S.Geological Survey ❑Unknown 0 Unknown 0 Unknown
8-Digit Hydrologic Unit
Code(if known)
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
exam s les
SECTION 6.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
6.1 In Column 1 below,mark the sections of Form 2A 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 provide attachments.
Column 1 Column 2
• Section 1: Basic Application
Information for All Applicants ❑ w/variance request(s) ❑ w/additional attachments
❑ Section 2:Additional v❑ w/topographic map ✓❑ w/process flow diagram
Information ✓❑ w/additional attachments
✓❑ w/Table A ✓❑ w/Table D
❑ Section 3: Information on 0 w/Table B ✓❑ w/Table E
Effluent Discharges
✓❑ w/Table C ❑✓ w/additional attachments
Section 4: Industrial ❑ w/SIU and NSCIU attachments ❑✓ w/Table F
❑r Discharges and Hazardous
Wastes w/additional attachments
0 Section 5:Combined Sewer ❑ w/CSO map ❑ w/additional attachments
Overflows
❑ w/CSO system diagram
Section 6:Checklist and
❑ Certification Statement ❑ w/attachments
6.2 Certification Statement
/certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly responsible
for gathering the information,the information submitted is,to the best of my knowledge and belief,true,accurate,and
complete. I am aware that there are significant penalties for submitting false information,including the possibility of fine
and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Courtney Driver Utilities Director
S' n ture Date signed
01 I-1/QD-Q-A
EPA Form 3510-2A(Revised 3-19) Page 12

L'.
1TE
Hlr I
% ?`a; ENVIRONMENTAL LABORATORIES
A Division of Water Technology and Controls, Inc.
May 8, 2019
City of Winston-Salem
Attn: Bonnie McKee
2799 Griffith Road
Winston-Salem,NC 27103
RE: Volatile Data Detection Limits—April 2, 2019 Elledge PPA Effluent sample
Dear Ms. McKee:
Due to an excess foaming present in the above referenced sample we were unable to
achieve lower detection limits for volatile organic analysis. This sample required xl 0
dilution for volatile organic analysis.
If you have any questions concerning this matter,please give me a call. We appreciate
your business and look forward to working with you in the future.
Sincerely,
c, rcb Orcx C�
Amanda Hancock
Technical Services Supervisor
Meritech, Inc.
Ph: 336 342 4748
Fax: [phone]
642 Tamco Road • P.O. Box 27 • Reidsville, NC 27320
[phone] • [phone] Fax

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0037834 Archie Elledge WWfP 001 OMB No.2040-0004
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge 1 Average Daily Discharge Analytical ML or MDL
Pollutant Number of Methods include units
Value Units Value Units Samples ( )
Biochemical oxygen demand
El
I BOD5 or❑CBOD5 45 mg/L 9 mg/L 521 SM5210B-2011 2 m g/L ML
❑MDL
(report one)
Fecal coliform 2420 MPN/100 23 MPN/100 568 Colilert 18 1 #/100m1 E ML
0 MDL
Design flow rate 78.3 MGD 20.7 MGD 1096
pH(minimum) 6.2 S.U.
pH(maximum) 7.6 S.U,
Temperature(winter) 23 C 17 C 454
Temperature(summer) 29 C 24 C 642
Total suspended solids(TSS) 106 mg/L 8 mg/L 747 SM2540D-2011 2.5 mg/L o ML
❑MDL
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 3510-2A(Revised 3-19) Page 13

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0037834 Archie Elledge WVVTP on OMB No.2040-0004
TABLE B. EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Value Units Value Units Number of Method1 (include units)
Samples
Ammonia(as N) 7.8 mg/L 0.5 mg/L 651 SM 4500 D 2011 Variable ML
na ❑MDL
Chlorine 30 mg/L <20 mg/L 745 SM 4500 G 2011 20 mg/L o ML
(total residual,TROY
Dissolved Dissolved oxygen 10.1 mg/L 7.5 mg/L 1095 SM 4500 0 G 2011 NA o ML
❑MDL
Nitrate/nitrite 19.1 mg/L 11 mg/L 50 SM 4500 B&D 2011 0.1 mg/L ML
❑MDL
Kjeldahl nitrogen 44.4 mg/L 3.5 mg/L 49 SM 4500 C 2011 1 mg/L o ML
❑MDL
Oil and grease <5 mg/L <5 mg/L 2 EPA 1664B 5 mg/L o ML
❑MDL
Phosphorus 15.22 mg/L 1.98 mg/L 59 SM 4500 P E 2011 0.5 mg/L ML
❑MDL
Total dissolved solids 365 mg/L 326 mg/L 2 SM 2540 C 10 mg/L o ML
❑MDL
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).
2 Facilities that do not use chlorine for disinfection,do not use chlorine elsewhere in the treatment process,and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A(Revised 3-19) Page 15

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0037834 Archie HedgeWWTP 001 OMB No.2040-0004
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' (include units)
Value Units Value Units Samples
Metals,Cyanide,and Total Phenols
❑ML
Hardness(as CaCO3) ❑MDL
Antimony,total recoverable ❑ML
❑MDL
Arsenic,total recoverable ❑ML
❑MDL
Beryllium,total recoverable ❑ML
❑MDL
Cadmium,total recoverable ❑ML
❑MDL
Chromium,total recoverable 0 ML
❑MDL
Copper,total recoverable ❑ML
❑MDL
Lead,total recoverable ❑ML
❑MDL
Mercury,total recoverable ❑ML
❑MDL
Nickel,total recoverable ❑ML
❑MDL
Selenium,total recoverable ❑ML
❑MDL
Silver,total recoverable ❑ML
❑MDL
Thallium,total recoverable ❑ML
❑MDL
Zinc,total recoverable ❑ML
❑MDL
Cyanide ❑ML
❑MDL
Total phenolic compounds 0 ML
❑MDL
Volatile Organic Compounds
Acrolein ❑ML
❑MDL
Acrylonitrile ❑ML
❑MDL
Benzene ❑ML
❑MDL
Bromoform ❑ML
0 MDL
EPA Form 3510-2A(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0037834 Archie Elledge VVVVfP 001 0MB No.2040-0004
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant Analytical ML or MDL
Value Units Value Units Number of Methods (include units)
Samples
Carbon tetrachloride ❑ML
❑MDL
Chlorobenzene ❑ML
❑MDL
Chlorodibromomethane ❑ML
❑MDL
Chloroethane ❑ML
❑MDL
2-chloroethylvinyl ether ❑ML
❑MDL
Chloroform ❑ML
❑MDL
Dichlorobromomethane ❑ML
❑MDL
1,1-dichloroethane ❑ML
❑MDL
1,2-dichloroethane ❑ML
❑MDL
trans-1,2-dichloroethylene ❑ML
0 MDL
1,1-dichloroethylene o ML
❑MDL
1,2-dichloropropane ❑ML
❑MDL
1,3-dichloropropylene ❑ML
❑MDL
Ethylbenzene ❑ML
❑MDL
Methyl bromide ❑ML
❑MDL
Methyl chloride ❑ML
❑MDL
Methylene chloride ❑ML
❑MDL
1,1,2,2-tetrachloroethane ❑ML
❑MDL
Tetrachloroethylene ❑ML
❑MDL
Toluene ❑ML
❑MDL
1,1,1-trichloroethane ❑ML
❑MDL
1,1,2-trichloroethane ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0037834 Archie Elledge WWTP 001 OMB No.2040-0004
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant Analytical ML or MDL
Value Units Value Units Number of Method1 (include units)
Samples
Trichloroethylene ❑ML
❑MDL
Vinyl chloride ❑ML
❑MDL
Acid-Extractable Compounds
p-chloro-m-cresol ❑ML
❑MDL
2-chlorophenol ❑ML
❑MDL
2,4-dichlorophenol ❑ML
❑MDL
2,4-dimethylphenol ❑ML
❑MDL
4,6-dinitro-o-cresol ❑ML
❑MDL
2,4-dinitrophenol ❑ML
❑MDL
2-nitrophenol ❑ML
❑MDL
4-nitrophenol ❑ML
❑MDL
Pentachlorophenol ❑ML
❑MDL
Phenol ❑ML
❑MDL
2,4,6-trichlorophenol ❑ML
❑MDL
Base-Neutral Compounds
Acenaphthene ❑ML
_ ❑MDL
Acenaphthylene ❑ML
❑MDL
•
Anthracene ❑ML
❑MDL
Benzidine ❑ML
❑MDL
Benzo(a)anthracene ❑ML
❑MDL
Benzo(a)pyrene ❑ML
❑MDL
3,4-benzofluoranthene ❑ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0037834 Archie Elledge WWTP ow. OMB No.2040-0004
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
Benzo(ghi)perylene o ML
❑MDL
Benzo(k)fluoranthene ❑ML
❑MDL
Bis(2-chloroethoxy)methane ❑ML
❑MDL
Bis(2-chloroethyl)ether ❑ML
❑MDL
Bis(2-chloroisopropyl)ether ❑ML
❑MDL
Bis(2-ethylhexyl)phthalate ❑ML
❑MDL
4-bromophenyl phenyl ether ❑ML
❑MDL
Butyl benzyl phthalate ❑ML
❑MDL
2-chloronaphthalene ❑ML
❑MDL
4-chlorophenyl phenyl ether ❑ML
❑MDL
Chrysene ❑ML
❑MDL
di-n-butyl phthalate ID ML
❑MDL
di-n-octyl phthalate ❑ML
❑MDL
Dibenzo(a,h)anthracene ❑ML
❑MDL
1,2-dichlorobenzene ❑ML
❑MDL
1,3-dichlorobenzene ❑ML
❑MDL
1,4-dichlorobenzene ❑ML
❑MDL
3,3-dichlorobenzidine ❑ML
❑MDL
Diethyl phthalate ❑ML
❑MDL
Dimethyl phthalate ❑ML
❑MDL
2,4-dinitrotoluene ❑ML
❑MDL
2,6-dinitrotoluene 0 ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0037834 Archie Elledge WWfP 001 0MB No.2040-0004
TABLE C. EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant Analytical ML or MDL
Value Units Value Units Number of Method' (include units)
Samples
1,2-diphenylhydrazine ❑ML
0 MDL
Fluoranthene ❑ML
0 MDL
Fluorene ❑ML
❑MDL
Hexachlorobenzene ❑ML
❑MDL
Hexachlorobutadiene ❑ML
0 MDL
❑ML
Hexachlorocyclo-pentadiene 0 MDL
Hexachloroethane ❑ML
0 MDL
Indeno(1,2,3-cd)pyrene ❑ML
0 MDL
Isophorone ❑ML
0 MDL
Naphthalene ❑ML
0 MDL
Nitrobenzene ❑ML
o MDL
N-nitrosodi-n-propylamine ❑ML
0 MDL
N-nitrosodimethylamine ❑ML
0 MDL
N-nitrosodiphenylamine ❑ML
0 MDL
Phenanthrene ❑ML
❑MDL
Pyrene ❑ML
❑MDL
1,2,4-trichlorobenzene 0 ML
o MDL
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 3510-2A(Revised 3-19) Page 21

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0037834 Archie Elledge WWfP 001 OMB No.2040-0004
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum Daily Discharge Average Daily Dischar e
Pollutant Analytical ML or MDL
(list) Value Units Value Units Number of Method1 (include units)
Samples
E✓ No additional sampling is required by NPDES permitting authority.
Co-Cobalt <0.002 mg/L <0.002 mg/L 2 EPA 200.8 0.002 ML
0 MDL
Sb-Antimony 0.0015 mg/L 0.0014 mg/L 2 EPA 200.8 0.0005 ©ML
❑MDL
❑ML
Sn-Tin* <0.01 mg/L <0.01 mg/L 2 EPA 200.7 0.025 MDL
Ti-Titanium <0.005 mg/L <0.005 mg/L 2 EPA 200.8 0.005 ❑O ML
❑MDL
V-Vanadium <0.005 mg/L <0.005 mg/L 2 EPA 200.8 0.005 0 ML
0 MDL
❑ML
❑MDL
*Estimate ❑ML
0 MDL
❑ML
❑MDL
0 ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
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 3510-2A(Revised 3-19) Page 23

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0037834 Archie Elledge WWTP 001 OMB No.2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Information
Test Number Test Number Test Number
Test species
Age at initiation of test
Outfall number
Date sample collected
Date test started
Duration
Toxicity Test Methods
Test method number
Manual title
Edition number and year of publication
Page number(s)
Sample Type
Check one: El Grab ❑ Grab ❑ Grab
❑ 24-hour composite ❑ 24-hour composite ❑ 24-hour composite
Sample Location
Check one: ❑ Before Disinfection ❑ Before Disinfection ❑ Before disinfection
❑After Disinfection ❑After Disinfection ❑After disinfection
❑ After Dechlorination ❑ After Dechlorination ❑ After dechlorination
Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each
test.
Toxicity Type
Indicate for each test whether the test was ❑Acute ❑Acute ❑Acute
performed to asses acute or chronic toxicity,
or both.(Check one response.) ❑ Chronic ❑ Chronic CI Chronic
❑ Both ❑ Both ❑ Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0037834 Archie Elledge WWTP 001 OMB No.2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number Test Number Test Number
Test Type
Indicate the type of test performed.(Check one ❑ Static 0 Static ❑ Static
response.)
❑ Static-renewal ❑ Static-renewal 0 Static-renewal
❑ Flow-through 0 Flow-through 0 Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check ❑ Laboratory water 0 Laboratory water ❑ Laboratory water
one response.)
❑ Receiving water 0 Receiving water 0 Receiving water
If laboratory water,specify type.
If receiving water, specify source.
Type of Dilution Water
Indicate the type of dilution water. If salt ❑ Fresh water ❑ Fresh water ❑ Fresh water
water, specify"natural"or type of artificial 0 Salt water(specify) ❑ Salt water(specify) ❑ Salt water(specify)
sea salts or brine used.
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series.
Parameters Tested
Check the parameters tested. 0 pH 0 Ammonia ❑ pH ❑ Ammonia ❑ pH ❑ Ammonia
❑ Salinity 0 Dissolved oxygen 0 Salinity ❑ Dissolved oxygen 0 Salinity ❑ Dissolved oxygen
❑ Temperature 0 Temperature 0 Temperature
Acute Test Results
Percent survival in 100%effluent % % %
LC5o
95%confidence interval % % %
Control percent survival % %
EPA Form 3510-2A(Revised 3-19) Page 26

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0037834 Archie Elledge VVVVTP 001 OMB No.2040-0004
TABLE E. EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample. Copy the table to report additional test results.
Test Number Test Number Test Number
Acute Test Results Continued
Other(describe)
Chronic Test Results
NOEC
I C25 0/0
•
Control percent survival % %
Other(describe)
Quality ControllQuality Assurance
Is reference toxicant data available? ❑ Yes ❑ No ❑ Yes 0 No ❑ Yes 0 No
Was reference toxicant test within
acceptable bounds? ❑ Yes ❑ No ❑ Yes ElNo ❑ Yes ❑ No
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(describe)
EPA Form 3510-2A(Revised 3-19) Page 27

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EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge V VVfP OMB No.2040-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three Sills.Copy the table to report information for additional Sills.
SIU SIU SIU
Name of SIU Not Applicable Not Applicable Not Applicable
Mailing address(street or P.O.box) Not Applicable Not Applicable Not Applicable
City,state,and ZIP code Not Applicable Not Applicable Not Applicable
Description of all industrial processes that affect Not Applicable Not Applicable Not Applicable
or contribute to the discharge.
List the principal products and raw materials that Not Applicable Not Applicable Not Applicable
affect or contribute to the SIU's discharge.
Indicate the average daily volume of wastewater
discharged by the SIU. gpd gpd gpd
How much of the average daily volume is
attributable to process flow? gpd gpd gpd
How much of the average daily volume is
attributable to non-process flow? gpd gpd gpd
Is the SIU subject to local limits?
❑ Yes El No El Yes El No ❑ Yes El No
Is the SIU subject to categorical standards?
El Yes El No El Yes El No El Yes El No
EPA Form 3510-2A(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0037834 Archie Elledge VWVTP OMB No.2040-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SlUs. Copy the table to report information for additional Sills.
SIU SIU SIU
Under what categories and subcategories is the Not Applicable Not Applicable Not Applicable
SIU subject?
Has the POTW experienced problems(e.g.,
upsets,pass-through interferences)in the past 4.5 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
years that are attributable to the SIU?
If yes,describe. Not Applicable Not Applicable Not Applicable
EPA Form 3510-2A(Revised 3-19) Page 30

Topographic Map
Flow Diagram
Narrative

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City of Winston-Salem R
Archie Elledge WWTP N 1p,�att AilifIVO�,e �d
NPDES Permit NC0037834 A �Ir����d��90��grI✓:i�,®Winoo���--Nr�
Facility Location 411 5®��14�
Receiving Stream:Salem Creek Stream Class:C �� �
44
Stream Segment:12-94-12-{4) Sub-Basin#:03-07-04 scale not shown ,�1
n River Basin:Yadkin Pee-Dee HUC:0304010113 SCALE o
36.028889 -80.315000°
120,00o
County:Forsyth USGS Quad:Winston-Salem West

Day Tanks(2)
South Fork
0.48 MGD
Scr-ens(3) O 0 40 0 Chlorine
Salem Sl Aeration Basins Contact/
► Influent Primary Clarifiers(4) Secondary Clarifiers(6) Post Aeration
Interceptor 1&2(Inactive) _______
10.8 MGD Grit Removal(2) Pumps(6)� 1 1 r ;I E I _______
KimelL ► PE 11.1111111.111
sE
Interceptor I�/II/ill\►�7�
0.73 MGD Kl FE
Aeration
Screenings Basins 3-6 O
to Landfill ♦ ® oo °w :lc:**
to Landfill
OD To Salem Creek
v 21.57 MGD
PS RAS
CIPS Transfer Pumps
RWW
Force Main from Le, VP
Muddy Creek WAS Thickeners(3)
8.44 MGD ■�
RCY Rcv Sample Legend
ID Type* Parameters
- 1 C SS,VSS,NH3-N,COD,TKN,BOD
3 C/G SS,VSS,NH3-N,COD,BOD,Alkalinity
Anaerobic 16 G SS,VS
Digesters(6) ® 1
6 G Alkalinity
1 C
17 G SS,VSS,TKN
7 C/G SS,VSS,NH3-N,COD,TKN, BOD
Digested Sludge to 4 _ oS 20 C
Regional Biosolids Drying Facility pT 21 C
22 C
Three Backup Generators 2500 KW Each SI C
KI C
DT C
*C-Composite,G-Grab
WINSTON-SALEM/FORSYTH COUNTY
UTILITIES COMMISSION
Elf BLACK&VEATCH ARCHIE ELLEDGE WWTP
PROCESS FLOW DIAGRAM WITH SAMPLING LOCATIONS
195964.6100-lb PFD ADI 01-08-18

Archie Elledge WWTP Flow Narrative
NPDES Permit NC0037834
Archie Elledge Wastewater Treatment Plant effluent flow average is 21.91 MGD with a design flow rate
of 60 MGD, and max effluent flow of 100 MGD. There are three bar screens rated for 50 MGD each and
two grit classifiers also rated 50 MGD each. Once the flow has been screened and grit removal
completed, the flow would now travel through any of the 6 influent pumps. Flow is pumped, into two
EQ tanks to balance the flow into the plant. A portion of this flow is received from the Muddy Creek
WWTP daily based on their plant conditions. The wastewater then flows by gravity through the
remaining plant process. This flow will travel through four primary clarifiers, and then into four aeration
basins. Once the settling/biological process is complete it flows into six secondary clarifiers. The effluent
flow is then treated with hypochlorite for disinfection followed up by Sodium Bisulfite for dechlorination
before discharging into Salem Creek. All settled solids from the primary basins and waste activated
sludge is pumped into six Anaerobic digesters and methane gas is captured for beneficial reuse. Once
digestion is complete, biosolids are pumped to the dryer where solids are dried into class "A" pellets for
distribution to agricultural operations.
Archie Elledge has three diesel generators as a backup power source
3 x MTU 2500 kW Generators

Table A

Archie Elledge WWTP NC0037834 Effluent Results
Permit Renewal 2022
Table A
BOD BOD BOD Fecal Fecal Fecal Flow Flow Flow pH pH Temp Temp Temp TSS TSS TSS
mg/I mg/I mg/I #/100m1 #/100m1 #/100m1 MGD MGD MGD SU SU C deg C deg C mg/I mg/I mg/I
Max Ave #Samples Max Ave #Samples Max Ave #Samples Max Min Max Ave #Samples Max Ave #Samples
September-18 15 7 15 71 17 14 47.1 18.69 30 7.4 6.5 28 27 30 24 8 18
October-18 35 7 17 27 12 18 38.74 19.02 31 7.4 6.6 28 24 31 26 4 23
November-18 17 6 15 117 34 15 35.51 21.08 30 7.2 6.6 23 20 30 14 6 19
December-18 31 12 14 24 7 15 38.8 21.71 31 7.3 6.5 20 16 31 11 6 19
January-19 12 8 17 185 28 18 31.26 20.82 31 7.2 6.4 18 16 31 11 7 21
February-19 20 12 16 88 15 16 43.85 22.59 28 7.2 6.6 18 16 28 17 11 20
March-19 22 11 15 66 22 16 25.87 20.67 31 7.2 6.7 18 16 31 13 10 21
April-19 17 11 16 58 19 17 25.14 20.18 30 7.4 6.6 24 20 30 20 11 21
May-19 19 6 18 64 24 17 21.63 18.01 31 7.4 6.8 25 24 31 26 9 22
June-19 14 6 16 74 18 16 34.94 20.52 30 7.4 6.9 27 25 30 10 6 20
July-19 12 5 17 400 32 18 22.17 16.57 31 7.5 7 29 27 31 5 3 22
August-19 7 4 14 153 19 16 19.47 16.03 31 7.6 7.1 28 28 31 6 4 22
September-19 12 6 14 63 11 14 17.59 15.54 30 7.5 7 29 27 30 6 4 20
October-19 8 5 14 49 12 16 40.27 18.9 31 7.4 6.8 28 25 31 8 4 23
November-19 13 8 14 23 9 13 28.41 20.19 30 7.3 6.7 23 21 30 12 6 19
December-19 14 9 10 124 27 15 38.75 21.28 31 7.1 6.4 20 18 31 14 11 21
January-20 32 14 15 206 45 16 27.4 22.02 31 7.1 6.5 19 18 31 17 12 21
February-20 45 13 16 155 43 16 78.29 27.5 29 7 6.5 19 16 29 106 18 20
March-20 28 15 14 47 21 17 32.52 20.4 31 7.1 6.6 20 18 31 22 17 22
April-20 11.2 7 9 387 57 15 33.62 19.03 30 7.2 6.7 22 20 30 17 11 21
May-20 12.2 6 8 28 8 12 45.18 21.85 31 7.1 6.4 23 21 31 15 7 20
June-20 15 7 13 53 12 16 22.43 19.29 30 7.5 6.6 26 24 30 11 7 22
July-20 13 5 15 236 29 13 25.13 18.92 31 7.6 6.8 28 27 31 7 4 22
August-20 20 7 15 2,420 163 17 41.31 21.58 31 7.5 6.8 29 27 31 34 6 21
September-20 9 5 13 276 31 16 24.22 18.79 30 7.5 6.7 29 26 30 8 5 21
October-20 14 7 15 46 8 16 36.58 20.32 31 7.4 6.7 26 24 31 10 6 22
November-20 30 7 11 55 9 14 70 22.74 30 7.3 6.5 23 21 29 54 8 18
December-20 24 11 17 20 9 17 33.7 23.04 31 7.2 6.5 20 18 31 11 7 21
January-21 30 10 12 39 10 15 30.7 21.72 31 7.1 6.2 18 16 31 15 8 19
February-21 33 18 14 41 12 15 38.71 27.49 28 7.1 6.4 17 15 28 20 15 19
March-21 16 10 16 135 22 18 40.54 23.51 31 7.2 6.5 17 16 31 14 9 23
April-21 13 8 17 53 13 16 28.58 21.79 30 7.1 6.5 20 19 30 25 11 20
May-21 12 10 14 5 3 16 25.68 20.07 31 7.1 6.4 24 21 31 25 15 20
June-21 12 7 15 21 7 16 22.16 19.44 30 7.3 6.5 26 24 30 14 7 21
July-21 36 10 15 19 6 15 35.89 21.4 31 7.1 6.5 27 26 31 10 5 21
August-21 17 6 15 206 30 18 29.24 21.28 31 7.3 6.3 27 27 31 6 5 22
45 9 521 2420 23 568 78.3 20.7 1096 7.6 6.2 29 22 1095 106 8 747
Temp-Max Summer 29 Temp-Ave Summer 24 Temp-Max Winter 23 Temp-Ave Winter 17

Table B

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D 3 v m m n ID 01 m rt n m a 3 r g m m n
w c 3 o a w w Q v Q v°0 c` 3 a w m w v v 0- Q o0 v w 01 v cr v v
m < m m m < 'm s m m m m < m =' ', m
Y N IVf.L1FIJ N N N N N N N NIVN N 11.
O O O O O O O O O O O O lD t0 tD O 0 30 O 00 tD lD tp CC m CO CO
J O 0 0 0 N o 0 0 0 0 0 0 0 0 o O W O N O 0 0 o O 0 o F+ O V F+ F+ o F+ o W z
OD tr m in in in " V in to to in in in in N N in I-+ In t0 a in in in in in to io to W A V in W in
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 F+ 0 0 0 0 0 C!A z
IA in W U to in to V in N N A in in A A F+ F+ N tD in J in in W in in to in in in in m V in to in N W
A
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se
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v
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F+ m 9 O
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a
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9
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a C1
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oo
▪ W OO 0,, N oW A 311 W• W A W A A 01 m m 0 in io A, W N A I++ W m 3V0 A A N OWO m CO N A m t0 J X
F+ A o 0 m F+ 0 0 0 0 0 N N O W F+ 0 0 N O o 0 0 N F+ UI A O m 0 0 F+ V O O o J D 3
W W V O ya N m W W W A J t0 V A A V m m W i_, W in i, Co in to V t0 m V c
01 N CO m W N W A A A m m m m W co In to V m J V lD In N 0 N J A
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m
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▪ to

Table C & D
Priority Pollutant Analysis

October 2017

1 Annual Monitoring and Pollutant Scan
Facility Name: Elledge WWTP/NC0037834/Pipe 01 ORC: Jon Southern
Date of sampling: October 2-3, 2017 Phone: [phone]
Analytical Laboratory: Meritech, Inc. 1 / AEWWTP 2 / Prism 3
Parameter Sample Analytical Quantitation Sample Units of
Parameter Code Type Method Level Result Measurement
Ammonia (as N) 1 C0610 Composite EPA 350.1 0.02 0.02 mg/L
Chlorine (total residual,TRC) 2 50060 Grab Hach 10014 20 <20 mg/L
Dissolved Oxygen 2 00300 Grab SM 45000 G 7.2 mg/L
Nitrite plus Nitrate Total (as N) 1 00630 Composite EPA 353.2 0.1 13.7 mg/L
Total Kjeldahl Nitrogen i 00625 Composite EPA 351.1 0.2 1.2 mg/L
Oil and Grease 1 00556 Grab EPA 1664B 5 <5 mg/L
Total Phosphorus 1 C0665 Composite EPA 200.7 0.02 3.76 mg/L
Total Dissolved Solids 1 70295 Composite SM 2540C 10 527 mg/L
Hardness 1 00900 Composite SM 2340C 1 56 mg/L
Metals (total recoverable), cyanide and total phenols 1
Antimony 01097 Composite EPA 200.8 0.0005 0.001 mg/L
Arsenic 01002 Composite EPA 200.8 0.002 <0.002 mg/L
Beryllium 01012 Composite EPA 200.8 0.0005 <0.0005 mg/L
Cadmium 01027 Composite EPA 200.8 0.00015 <0.00015 mg/L
Chromium 01034 Composite EPA 200.8 0.002 0.004 mg/L
Copper 01042 Composite EPA 200.8 0.002 0.003 mg/L
Lead 01051 Composite EPA 200.8 0.0005 <0.0005 mg/L
Mercury(Method 1631E) 3 COMER Composite EPA 1631 1 <1.0 ng/L
Nickel 01067 Composite EPA 200.8 0.0005 0.0044 mg/L
Selenium 01147 Composite EPA 200.8 0.002 <0.002 mg/L
Silver 01077 Composite EPA 200.8 0.0005 <0.0005 mg/L
Thallium 01059 Composite EPA 200.8 0.0005 <0.0005 mg/L
Zinc 01092 Composite EPA 200.8 0.005 0.055 mg/L
Cyanide 00720 Grab EPA 335.4 0.005 0.005 mg/L
Total phenolic compounds 32730 Grab EPA 420.1 0.01 0.011 mg/L
Volatile organic compounds 1
Acrolein 34210 Grab EPA 624 50 <50 ug/L
Acrylonitrile 34215 Grab EPA 624 10 <10 ug/L
Benzene 34030 Grab EPA 624 1 <1 ug/L
Bromoform 32104 Grab EPA 624 1 <1 ug/L
Carbon Tetrachloride 32102 Grab EPA 624 1 <1 ug/L
Chlorobenzene 34301 Grab EPA 624 1 <1 ug/L
Chlorodibromomethane 34306 Grab EPA 624 1 6.86 ug/L
Chloroethane 85811 Grab EPA 624 5 <5 ug/L
2-chloroethyl vinyl ether 34576 Grab EPA 624 5 <5 ug/L
Chloroform 32106 Grab EPA 624 1 20.3 ug/L
Dichlorobromomethane 32101 Grab EPA 624 1 17.9 ug/L
1,1-dichloroethane 34496 Grab EPA 624 1 <1 ug/L
1,2-dichloroethane 32103 Grab EPA 624 1 <1 ug/L
Form - DMR- PPA-1 Page 1
1t

r Annual Monitoring and Pollutant Scan
Parameter Sample Analytical Quantitation Sample Units of
Parameter Code Type Method Level Result Measurement
Trans-1,2-dichloroethylene 34546 Grab EPA 624 1 <1 ug/L
1,1-dichloroethylene 34501 Grab EPA 624 1 <1 ug/L
1,2-dichloropropane 34541 Grab EPA 624 1
<1 ug/L
1,3-dichloropropylene 77163 Grab EPA 624 2 <2 ug/L
Ethylbenzene 34371 Grab EPA 624 1 <1 ug/L
Methyl Bromide 34413 Grab EPA 624 5 <5 ug/L
Methyl Chloride 34418 Grab EPA 624 5 <5 ug/L
Methylene Chloride 34423 Grab EPA 624 1 <1 ug/L
1,1,2,2-tetrachloroethane 81549 Grab EPA 624 1 <1 ug/L
Tetrachloroethylene 34475 Grab EPA 624 1 <1 ug/L
Toluene 34010 Grab EPA 624 1 <1 ug/L
1,1,1-trichloroethane 34506 Grab EPA 624 1 <1 ug/L
1,1,2-trichloroethane 34511 Grab EPA 624 1 <1 ug/L
Trichloroethylene 39180 Grab EPA 624 1 <1 ug/L
Vinyl Chloride 39175 Grab EPA 624 5 <5 ug/L
Acid-extractable compounds 1
P-chloro-m-creso 34452 Grab EPA 625 10 <10 ug/L
2-chlorophenol 34586 Grab EPA 625 10 <10 ug/L
2,4-dichlorophenol 34601 Grab EPA 625 10 <10 ug/L
2,4-dimethylphenol 34606 Grab EPA 625 10 <10 ug/L
4,6-dinitro-o-cresol 34657 Grab EPA 625 50 <50 ug/L
2,4-dinitrophenol 34616 Grab EPA 625 50 <50 ug/L
2-nitrophenol 34591 Grab EPA 625 10 <10 ug/L
4-nitrophenol 34646 Grab EPA 625 50 <50 ug/L
Pentachlorophenol 39032 Grab EPA 625 50 <50 ug/L
Phenol 34694 Grab EPA 625 10 <10 ug/L
2,4,6-trichlorophenol 34621 Grab EPA 625 10 <10 ug/L
Base-neutral compounds 1
Acenaphthene 34205 Grab EPA 625 10 <10 ug/L
Acenaphthylene 34200 Grab EPA 625 10 <10 ug/L
Anthracene CO220 Grab EPA 625 10 <10 ug/L
Benzidine 39120 Grab EPA 625 50 <50 ug/L
Benzo(a)anthracene 34526 Grab EPA 625 10 <10 ug/L
Benzo(a)pyrene 34247 Grab EPA 625 10 <10 ug/L
3,4 benzofluoranthene 34230 Grab EPA 625 10 <10 ug/L
Benzo(ghi)perylene 34521 Grab EPA 625 10 <10 ug/L
Benzo(k)fluoranthene 34242 Grab EPA 625 10 <10 ug/L
Bis (2-chloroethoxy) methane 34278 Grab EPA 625 10 <10 ug/L
Bis (2-chloroethyl) ether 34273 Grab EPA 625 10 <10 ug/L
Bis (2-chloroisopropyl) ether 34283 Grab EPA 625 10 <10 ug/L
Bis (2-ethylhexyl) phthalate 39100 Grab EPA 625 10 <10 ug/L
4-bromophenyl phenyl ether 34636 Grab EPA 625 10 <10 ug/L
Butyl benzyl phthalate 34292 Grab EPA 625 10 <10 ug/L
2-chloronaphthalene 34581 Grab EPA 625 10 <10 ug/L
4-chlorophenyl phenyl ether 34641 Grab EPA 625 10 <10 ug/L
Form - DMR- PPA-1 Page 2

Annual Monitoring and Pollutant Scan
I
Parameter Sample Analytical Quantitation Sample Units of
Parameter Code Type Method Level Result Measurement
Chrysene 34320 Grab EPA 625 10 <10 ug/L
Di-n-butyl phthalate 39110 Grab EPA 625 10 <10 ug/L
Di-n-octyl phthalate 34596 Grab EPA 625 10
<10 ug/L
Dibenzo(a,h)anthracene 34556 Grab EPA 625 10
<10 ug/L
1,2-dichlorobenzene 34536 Grab EPA 625 10 <10 ug/L
1,3-dichlorobenzene 34566 Grab EPA 625 10 <10 ug/L
1,4-dichlorobenzene 34571 Grab EPA 625 10 <10 ug/L
3,3-dichlorobenzidine 34631 Grab EPA 625 50 <50 ug/L
Diethyl phthalate 34336 Grab EPA 625 10 <10 ug/L
Dimethyl phthalate 34341 Grab EPA 625 10 <10 ug/L
2,4-dinitrotoluene 34611 Grab EPA 625 10 <10 ug/L
2,6-dinitrotoluene C0626 Grab EPA 625 10 <10 ug/L
1,2-diphenylhydrazine 34346 Grab EPA 625 10
<10 ug/L
Fluoranthene C0376 Grab EPA 625 10 <10 ug/L
Fluorene 34381 Grab EPA 625 10 <10 ug/L
Hexachlorobenzene C0700 Grab EPA 625 10 <10 ug/L
Hexachlorobutadiene 39702 Grab EPA 625 10 <10 ug/L
Hexachlorocyclo-pentadiene 34386 Grab EPA 625 50 <50 ug/L
Hexachloroethane 34396 Grab EPA 625 10 <10 ug/L
Indeno(1,2,3-cd)pyrene 34403 Grab EPA 625 10 <10 ug/L
Isophorone 34408 Grab EPA 625 10 <10 ug/L
Naphthalene 34696 Grab EPA 625 10
<10 ug/L
Nitrobenzene 34447 Grab EPA 625 10 <10 ug/L
N-nitrosodi-n-propylamine 34428 Grab EPA 625 10 <10 ug/L
N-nitrosodimethylamine 34438 Grab EPA 625 10 <10 ug/L
N-nitrosodiphenylamine 34433 Grab EPA 625 10 <10 ug/L
Phenanthrene 34461 Grab EPA 625 10 <10 ug/L
Pyrene 34469 Grab EPA 625 10 <10 ug/L
1,2,4,-trichlorobenzene 34551 Grab EPA 625 10 <10 ug/L
"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 managed 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 fines and imprisonment for knowing violations."
Auth', ized Repr ative e
/IF 44
ature
Date
1 Anaylzed by Meritech
2 Analyzed by Archie Elledge Wastewater Treatment Plant
3 Analyzed by Prism
Form - DMR- PPA-1 Page 3

April 2019

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
50050 00010 00400 50060 C0310 C0530 31616 00300 C0600
I 21. E. .5 a
iz _ O
E _ Continuous 5 X week 5 X week 5 X week 2 X week 2 X week 2 X week 5 X week Monthly
E
T.
0 8 a Recorder Grab Grab Grab Composite Composite Grab Grab Composite
a E m E 0 C of
'A3 [= O O O Z FLOW TEMP-C pll CHLORINE BOD-Cone TSS-Conc FCOLI BR DO TOTAL N-
2400 clock Hrs 2400 clock Hrs Y/B/N mgd deg c su ug/1 mg/I mg/I mpn/100m1 mg/I mg/I
1 0600 24 0800 24 Y 21.24 16 6.6 <20 4 8 7.5
2 0600 24 0800 24 Y 21.17 17 6.9 <20 14 9 16 7.4
3 0600 24 0800 24 Y 20.84 17 7.1 <20 8 10 14 7.1 13.4
4 0600 24 0800 24 Y 20.41 18 7.2 <20 17 14 8 8.5
5 0600 24 0800 24 Y 23.08 18 7.2 <20 12 14 7.5
6 0600 24 0800 24 B 20.6 18 7.6
7 0600 24 0800 24 B 18.85 19 7.6
8 0600 24 0800 24 Y 20.67 20 6.8 <20 10 2 7.5
9 0600 24 0800 24 Y 25.14 20 7.1 <20 8 12 58 7.9
10 0600 24 0800 24 Y 21.3 19 7.3 <20 14 ]3 12 8.6
II 0600 24 0800 24 Y 20.48 21 7.4 <20 10 12 9 8
12 0600 24 0800 24 Y 21.15 20 7.2 <20 14 I I 7.2
13 0600 24 0800 24 B 22.34 20 7.7
14 0600 24 0800 24 B 21.76 20 7.9
15 0600 24 0800 24 Y 20.66 20 7 <20 8 8 7.4
16 0600 24 0800 24 Y 21.88 20 7 I <20 6 8 39 7.1
17 0600 24 0800 24 Y 16.47 20 7.2 <20 7 9 48 8.6
18 0600 24 0800 24 Y 22.48 20 7.2 <20 I 1 13 7.8 9.3
19 0600 24 0800 24 B 18.21 21 H H H H II 7.7
20 0600 24 0800 24 B 18.56 20 7.6
21 0600 24 0800 24 B 18.58 20 8.5
22 0600 24 0800 24 Y 20.34 19 6.9 <20 9 15 7.7
23 0600 24 0800 24 Y 21.24 20 7.1 <20 9 10 22 7.6
24 0600 24 0800 24 Y 16.61 24 7.1 <20 11 10 18 7.6
25 0600 24 0800 24 Y 21.88 21 7.1 <20 14 10 8 8.6
26 0600 24 0800 24 Y 15.69 21 7.1 <20 10 I1 7.5
27 0600 24 0800 24 B 19.4 21 7.3
28 0600 24 0800 24 B 17.86 20 7.8
29 0600 24 0800 24 Y 17.5 19 6.8 <20 12 13 7.6
30 0600 24 0800 24 Y 18.97 20 6.9 <20 Is 20 23 6.9
Monthly Average Limit: 30 21 30 200
Monthly Average: 20.178667 19.633333 0 10.9375 10.904762 14.187218 7.71 11.35
Daily Maximum: 25.14 24 7.4 _0 17 20 58 8.6 13.4
`
Daily Minimum: 15.69 16 6.6 0 6 4 2 6.9 9.3
•••*No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday
Discharge Monitoring Report-Copy Of Record(COR NC0037834_Ver_3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
C0665 01027 34306 THP3B 00094 00720 32101 00900 TGP3B 0109E NC01
E E a
F 0 A. PF m
E - -
— Monthly Quarterly _Quarterly Monthly Monthly Quarterly Quarterly Quarterly Quarterly Quarterly Annually
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w E a k t: U z`
G U (= O O O z TOTAL P- CADMIUM CLRDBIIME CER7DCHV CNDUCTVY CN-TOT DICLBR.MT TOT HARD CERI7DPF ZINC ANN POL
2400 clock Hrs 2400 clock Hrs Y/B/N mg/I ug/I ug/1 percent umhos/cm ug/I ug/I mg/I pass/fail ug/I yes=1 no=0
1 0600 24 0800 24 Y 493 1
2 0600 24 0800 24 Y <0.15 <I <20 <I 44 P 68
3 0600 24 0800 24 Y 0.71 <0.15 52 92
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y
9 0600 24 0800 24 Y
10 0600 24 0800 24 Y
II 0600 24 0800 24 Y 0.98
12 0600 24 0800 24 Y
13 0600 24 0800 24 B
14 0600 24 0800 24 B
IS 0600 24 0800 24 Y
16 0600 24 0800 24 Y .
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 B H
20 0600 24 0800 24 B
21 0600 24 0800 24 B
22 0600 24 0800 24 Y _
23 0600 24 0800 24 Y
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y
30 0600 24 0800 24 Y
Monthly Average Limit:
Monthly Average: 0.845 0 0 493 0 0 48 80 1
Daily Maximum: 0.98 0 0 493 0 0 52 92 1
Daily Minimum: 0.71 0 0 493 0 0 44 68 I
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver 3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
C0610 34506 34511 34496 34501 34551 34536 32103 34541 34346 34546
E E I
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C U 2 O O O z NH3-N- Ill-ICE 112-TCE 1,1-DCE I,I-DCEY 124-TCB 1,2-DCB t,2-DCE 1,2-DCP I2DIPHEN 1-I2DCE1'
2400 clock Hrs 2400 clock Hrs Y/B/N mg/1 ug/I ug/I ug/I ug,'I ug/I ug/1 ug/I ug/I ug/I ug/I
1 0600 24 0800 24 Y <0.5
2 0600 24 0800 24 Y <0.5 <10 <10 <10 <10 <10 <10 <10
3 0600 24 0800 24 Y <0.5 <10 <10 <10
4 0600 24 0800 24 Y <0.5
5 0600 24 0800 24 Y <0.5
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y <0.5
9 0600 24 0800 24 Y <0.5
10 0600 24 0800 24 Y <0.5
I I 0600 24 0800 24 Y <0.5
12 0600 24 0800 24 Y <0.5
13 0600 24 0800 24 B
-
14 0600 24 0800 24 B
15 0600 24 0800 24 Y <0.5
16 0600 24 0800 24 Y <0.5
17 0600 24 0800 24 Y <0.5
18 0600 24 0800 24 Y <0.5
19 0600 24 0800 24 B H
20 0600 24 0800 24 B
21 0600 24 0800 24 B
22 0600 24 0800 24 Y <0.5
23 0600 24 0800 24 Y <0.5
24 0600 24 0800 24 Y <0.5
25 0600 24 0800 24 Y 1.9
26 0600 24 0800 24 Y 1.1
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y <0.5
311 0600 24 0800 24 Y <0.5
Monthly Average Limit:
Monthly Average: 0.142857 0 0 0 0 0 0 0 0 0 0
Daily Sla:imum. 1.9 0 0 0 0 0 0 0 0 0 0
Daily Minimum: 0 0 0 0 0 0 0 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
77163 34566 34571 34621 34601 34606 34616 34611 C0626 34576 34581
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A' d t° O o o % I,3-DCPE 1,3-DC13 1,4-DCB 246-TCPH 2,4-DCPH 2,4-DMPH 2,4-DNPH 2,4-DNT 26DINITR- 2-CEVE 2-CLRNAP
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/I ug/I ug/I ug/I ug/I ugh ug/I ug! ug/I
1 0600 24 0800 24 Y
2 0600 24 0800 24 Y <20 <50
3 0600 24 0800 24 Y <10 <10 <10 <10 <10 <50 <10 <10 <10
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y
9 0600 24 0800 24 Y
10 0600 24 0800 24 Y
11 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 B
14 0600 24 0800 24 B
15 0600 24 0800 24 Y
16 0600 24 0800 24 Y
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 B
28 0600 24 0800 24 B
21 0600 24 0800 24 B
22 0600 24 0800 24 Y
23 0600 24 0800 24 Y
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y
30 0600 24 0800 24 Y
Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0 0 0 0 0
Daily Maximum: 0 0 0 0 0 0 0 0 0 0 0
Daily Minimum: 0 0 0 0 0 0 0 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver 3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
34586 34591 34631 34657 34636 701112 34641 34646 34205 34200 34210
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G V [= 8` O z 2CPHENOL 2NPHENOL 3,31-DCB 46DN-o-C 4-BPPETH 4CL3MPHL 4-CPPETH 4NPHENOL ACENAPEN ACENAPYL ACROLEIN
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/I ug/I ug/I Ibs/day ug/I ug/I ug/I ug/I ug9
1 0600 24 0800 24 Y
2 0600 24 0800 24 Y <500
3 0600 24 0800 24 Y <l0 <10 <50 <50 <10 <10 <50 <10 <10
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y
9 0600 24 0800 24 Y
10 0600 24 0800 24 Y
11 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 B
14 0600 24 0800 24 B
15 0600 24 0800 24 Y
16 0600 24 0800 24 Y
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 B
20 0600 24 0800 24 B
21 0600 24 0800 24 B
22 0600 24 0800 24 Y
23 0600 24 0800 24 Y
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y
30 0600 24 0800 24 Y
•
Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0 0 0 0
+
Daily Maximum: 0 0 0 0 0 0 0 0 0 0
Daily Minimum: 0 0 0 0 0 0 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
34215 00410 01105 CO220 01097 111002 34030 39120 34526 34247 34230
E11
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O i ACRYLONI ALKLN,T ALUMINUM ANTHRACE ANTIMONY As-TOTAL BENZENE BENZIDIN BNZO-A-A BNZO-A-P BNZO-B-F
2400 dock Hrs 2400 clock Hrs Y/B/N ug/I mg/I mg/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I
1 0600 24 0800 24 Y -
2 0600 24 0800 24 Y <100 <10
3 0600 24 0800 24 Y <10 I <2 <50 <10 <10 <10
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y
9 0600 24 0800 24 Y
10 0600 24 0800 24 Y
II 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 B
14 0600 24 0800 24 B
I5 0600 24 0800 24 Y
16 0600 24 0800 24 Y
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 B
20 0600 24 0800 24 B
21 0600 24 0800 24 B
22 0600 24 0800 24 Y
23 0600 24 0800 24 Y
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y
30 0600 24 0800 24 Y
Monthly Average limit:
Monthly Average: 0 _ 0 1 0 0 0 0 0 0
l
Daily Maximum: 0 0 I 0 0 0 0 0 0
Daily Minimum: 0 0 I 0 0 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
34521 34242 01012 34278 34273 34283 39100 81010 32104 34292 32102
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2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/I ug/I ug/1 ug/I ug/I percent ug/I ug/I ug/I
1 0600 24 0800 24 Y
2 0600 24 0800 24 Y <10 <10
3 0600 24 0800 24 Y <10 <10 <0.5 <10 <10 <10 <10 <10
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y
9 0600 24 0800 24 Y
10 0600 24 0800 24 Y
II 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 B
14 0600 24 0800 24 B
15 0600 24 0800 24 Y
16 0600 24 0800 24 Y
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 B
20 0600 24 0800 24 B
21 0600 24 0800 24 B
22 0600 24 0800 24 Y
23 0600 24 0800 24 Y
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y
30 0600 24 0800 24 Y 97.8
Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0 97.8 0 0 0
Daily Maximum: 0 0 0 0 0 0 0 97.8 0 0 0
Daily Minimum: 0 0 0 0 0 0 0 97.8 0 0 0
s"'No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_3.0_4_2019.pd0

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
34301 85811 32106 01034 34320 THP6C 01037 01042 34556 34336 34341
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C t 'Fef2 O O O z CHLROBNZ CLROETHA CHLRFORM Cr-TOTAL CHRYSENE FTH7DCHV COBALT COPPER DBNZO-ah DIETY-PH DIMET-PH
2400 clock Hrs 2400 clock Hrs Y/B/N ug/1 ug/I ug/I mg/1 ug/I percent mg/1 mg/1 ug/I ug/I ug/I
I 0600 24 0800 24 Y
2 0600 24 0800 24 Y <10 <50 11.5
3 0600 24 0800 24 Y <2 <10 <0.002 4 <10 <10 <10
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y
9 0600 24 0800 24 Y
10 0600 24 0800 24 Y
II 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 B
14 0600 24 0800 24 B
15 0600 24 0800 24 Y
16 0600 24 0800 24 Y
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 B
20
0600 24 0800 24 B
21 0600 24 0800 24 B
22 0600 24 0800 24 Y
23 0600 24 0800 24 Y
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y
30 0600 24 0800 24 Y
Monthly Average Limit:
Monthly Average: 0 0 11.5 0 0 0 4 0 0 0
Daily Maximum: 0 0 11.5 0 0 _ 0 4 0 0 0
Daily Minimum: 0 0 11.5 0 0 0 4 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
39110 34596 34371 C0376 34381 00951 C0700 39702 34386 34396 34403
i
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G U 2 O O O z DNB PHTH D-n-OCPH ETHYLBEN FLUORANT FLUORENE F-TOTAL HCB-Cons HEXCLBD HCCP VICE I123CDPY
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/I ug/I ug/1 ug/I ug/I ug/I ug/I ug/I ug/I
1 0600 24 0800 24 Y
2 0600 24 0800 24 Y <10
3 0600 24 0800 24 Y <10 <10 <10 <10 <10 <I 0 <50 <10 <10
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y
9 0600 24 0800 24 Y
10 0600 24 0800 24 Y
11 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 B
14 0600 24 0800 24 B
IS 0600 24 0800 24 Y
16 0600 24 0800 24 Y
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 B
20 0600 24 0800 24 B
21 0600 24 0800 24 B
22 0600 24 0800 24 Y
23 0600 24 0800 24 Y
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y
30 0600 24 0800 24 Y
r Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0 0 0 0
Daily Maximum: 0 0 0 0 0 0 0 0 0 0
Daily Minimum: 0 0 0 0 0 0 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
01045 34408 01051 01055 COMER 34413 34418 34423 01062 34696 01067
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d E a u e
a, U F= O `O O z IRON ISPHRONE LEAD MANGNESE MERCURY- METHYLBR METHYLCH MECL2 MOLY NAPTHALE NICKEL
2400 clock Hrs 2400 clock Hrs Y/B/N mg/I ug/1 mg/I mg/1 ug/l ug/I ug/I ug/I ug/I ug/I mg/1
I 0600 24 0800 24 Y
2 0600 24 0800 24 Y 0.00196 <50 <50 <10
3 0600 24 0800 24 Y <10 <0.5 <10 2.1
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 B
7 0600 24 0800 24 B I
8 0600 24 0800 24 Y
9 0600 24 0800 24 Y
10 0600 24 0800 24 Y
It 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 B
14 0600 24 0800 24 B
15 0600 24 0800 24 Y
16 0600 24 0800 24 Y
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 B
20 0600 24 0800 24 B
21 0600 24 0800 24 B
22 0600 24 0800 24 Y
23 0600 24 0800 24 Y
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y
38 0600 24 0800 24 Y
Monthly Average Limit:
Monthly Average: 0 0 0.00196 0 0 0 0 2.1
Daily Maximum: 0 0 0.00196 0 0 0 0 2.1
Daily Minimum: 0 0 0.00196 0 0 0 0 2.1
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver 3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
00630 34447 00625 00620 00615 34438 34428 34433 00556 34452 39032
B 6
F E. m
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d E 5 0 0 U a
G c. 12. O O O z NO2&NO3 NITROBEN TOT KJEL NO3-N NO2-N NDMA NDnPA NDPA OIL-GRSE pCLRmCR PCP
2400 clock Hrs 2400 clock Hrs Y/B/N mg/I ug/I mg/I mg/I mg/I ug/I ug/I ug/I mg/I ug/I ug/I
1 0600 24 0800 24 Y 15
2 0600 24 0800 24 Y 14.8
3 0600 24 0800 24 Y 10.4 <10 3.03 9.3 <10 <10 <10 <5 <10 <50
4 0600 24 0800 24 Y <5
5 0600 24 0800 24 Y <5
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y 13.7
9 0600 24 0800 24 Y 14.4
10 0600 24 0800 24 Y 5.6
II 0600 24 0800 24 Y <5
12 0600 24 0800 24 Y 6.8
13 0600 24 0800 24 B
14 0600 24 0800 24 B
15 0600 24 0800 24 Y 10.3
16 0600 24 0800 24 Y 10.2
17 0600 24 0800 24 Y 5.9
18 0600 24 0800 24 Y 4.2 <5 0.07
19 0600 24 0800 24 B H
20 0600 24 0800 24 B
21 0600 24 0800 24 B
22 0600 24 0800 24 Y 11.1
23 0600 24 0800 24 Y 14.6
24 0600 24 0800 24 Y 10.5
25 0600 24 0800 24 Y 6.5
26 0600 24 0800 24 Y 7.9
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y 15.4
30 0600 24 0800 24 Y 16.2
Monthly Average Limit:
Monthly Average: 10.4 0 3.615 8.961905 0.07 0 0 0 0 0 0
Daily Maximum: 10.4 0 4.2 16.2 0.07 0 0 0 0 0 0
Daily Minimum: 10.4 0 3.03 0 0.07 0 0 0 0 0 0
-
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_3.0_4_2019.pdt)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
34461 34694 32730 34469 01147 01077 70295 81011 00945 81549 34475
I
I
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C U F O O O z PHENANTH PHENOL PHEN,TR PYRENE Se-TOTAL SILVER RES/DISS TSS-%R SULFATE TETCLETH TETCLETY
2400 clock Hrs 2400 clock Hrs Y/I3/N ug/I ug/1 mg/I ug/1 mg/I mg/I mg/I percent mg/I ug/I ug/I
I 0600 24 0800 24 Y
2 0600 24 0800 24 Y <0.01 <10 <10
3 0600 24 0800 24 Y <10 <10 <10 <I <0.5 365
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y
9 0600 24 0800 24 Y
10 0600 24 0800 24 Y
11 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 B
14 0600 24 0800 24 B
15 0600 24 0800 24 Y
16 0600 24 0800 24 Y
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 B
20 0600 24 0800 24 B
21 0600 24 0800 24 B
22 0600 24 0800 24 Y
23 0600 24 0800 24 Y
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y
30 0600 24 0800 24 Y 97.1
Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 365 97.1 0 0
Daily Maximum: 0 0 0 0 0 0 365 97.1 0 0
Daily Minimum: 0 0 0 0 0 0 365 97.1 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=NoVisitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
01059 01102 01152 34010 39180 01087 39175
I 12
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t%G J O O O z THALLIUM TIN TITANIUM TOLUENE TCETHYLE VANADIUM VINYLCHL
2400 clock Hrs 2400 clock Hrs Y/D/N mg/1 mg/I mg/I ug/1 ugh! mg/1 ugh!
1 0600 24 0800 24 Y
2 0600 24 0800 24 Y <10 <10 <50
3 0600 24 0800 24 Y <0.5 <0.01 <0.005 <0.005
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y
9 0600 24 0800 24 Y
10 0600 24 0800 24 Y
II 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 B
14 0600 24 0800 24 B
15 0600 24 0800 24 Y
16 0600 24 0800 24 Y
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 B
20 0600 24 0800 24 B
21 0600 24 0800 24 B
22 0600 24 0800 24 Y
23 0600 24 0800 24 Y
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y
30 0600 24 0800 24 Y
Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0
Daily Maximum: 0 0 0 0 0 0 0
Daily Minimum: 0 0 0 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_3.0_4_2019.pd0

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: INFLUENT DISCHARGE NO.: 001
C0310 C0530 50050 00010 00400 50060 C0610 00300
E
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E. 2 X week 2 X week
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d 0 : C`
U t= Z BOD-Cone TSS-Cone FLOW TEMP-C pH CHLORINE NH3-N-Cone DO
2400 Hrs mg./1 mg/1 mgd deg c su ugh mg/I mg/I
1 0600 24 280
2 0600 24 497 380
3 0600 24 448 320
4 0600 24 443 288
5 0600 24 461 285
6 0600 24
7 0600 24
8 0600 24 272
9 0600 24 514 408
10 0600 24 458 325
11 0600 24 412 340
12 0600 24 443 315
13 0600 24
14 0600 24
15 0600 24 272
16 0600 24 464 325
17 0600 24 604 392
18 0600 24 459 340
19 0600 24 H H
20 0600 24
21 0600 24
22 0600 24 324
23 0600 24 459 404
24 0600 24 475 487
25 0600 24 642 567
26 0600 24 628 320
27 0600 24
28 0600 24
29 0600 24 404
30 0600 24 596 844
Monthly Average Limit:
Monthly Average: 500.1875 375.809524
Daily Maximum: 642 844
Daily Minimum: 412 272
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; EN V WTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April2019) VERSION:3.0 STATUS:Submitted
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE: 12/06/2021
Electronically Certified by Matthew Richard Lavigne on 2021-12-02 06:59:11.926
ORC/Certifier Signature :Matthew Richard Lavigne Phone # : [phone] Date
I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.The written submission shall be made as required by part II.E.6 of the
NPDES permit.
Electronically Signed by James F Crump on 2021-12-06 08:03:09.239
Permittee/Submitter Signature: * * *James F Crump Phone #:[phone] Date
Permittee Address:2801 Griffith Rd Winston Salem NC 271036417 Permit Expiration Date:06/30/2022
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 managed 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 fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME:Archie Elledge WWTP
CERTIFIED LAB#:#69
PERSON(s)COLLECTING SAMPLES:Jon Southern
PARAMETER CODES
Parameter Code assistance may be obtained by visiting https://deq.nc.gov/about/divisions/water-resources/edmr/user-documentation.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:YES indicates that No Flow/Discharge occurred and,as a result,no data is reported for any parameter on the DMR for the
entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).
Discharge Monitoring Report-Copy Of Record(COR NC0037834_Ver 3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
Report Comments:
On April 3 Total Phosphorus was run in house and by Meritech. The results were 0.67 mg/L and 0.75 respectively.The two results were averaged and reported.
The 4/3/19 Tin sample was originally analyzed and reported as<0.025 mg/L.The data was re-evaluated and then reported as<0.01 mg/L.The analyte exceeded the lower
calibration range of the analytical method/instrument.The reported value should be considered an estimate.
On April 18,2019 The Effluent total nitrogen result is an estimate. The nitrate results were not obtained by running a Low Level curve.
April 19,2019 was a Holiday.
Revision 2.0 contains PPA parameters.
Due to foaming the volatiles analysis for PPA was re-sampled and reported in June 2019.
Revision 3.0 was revised to update the Tin results on 12/2/21.

June 2019

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
ii
50050 00010 00400 50060 0)310 C0530 31616 00300 C0600
ii
E E
P E F- T-.
Continuous 5 X week 5 X week 5 X week 2 X week 2 X week 2 X week 5 X week Monthly
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o' U t° C '3' O z° FLOW TEMP-C pH CHLORINE BOD-Cooe TSS-Cone FCOLt BR DO TOTAL N-
2400 clock Hrs 2400 clock Ilia Y/B/N mgd degc su ug/1 mg/1 mg/1 mpn/100m1 mg/1 mg/1
1 0600 24 0800 24 B 15.84 24 8.2
2 0600 24 0800 24 B 15.32 25 7.3
3 0600 24 0800 24 Y 16.17 25 7.2 <20 6 8 7.4
4 0600 24 0800 24 Y 18.28 24 7.1 <20 7 10 14 7.4
5 0600 24 0800 24 Y 17.92 25 7.4 <20 4 7 10 7
6 0600 24 0800 24 Y 17.59 25 7.3 <20 4 6 10 6.7
7 0600 24 0800 24 B 18.99 26 7.2 <20 5 6 7
8 0600 24 0800 24 B 32.8 26 7.1
9 0600 24 0800 24 B 31.37 24 7.6
10 0600 24 0800 24 Y 23.92 24 6.9 <20 7 45 7.4
II 0600 24 0800 24 Y 18.45 24 Zl <20 4 8 26 7.4
12 0600 24 0800 24 Y 19.17 24 7.2 <20 4 6 26 7.2
13 0600 24 0800 24 Y 24.93 24 7.3 <20 14 7 74 7.1
14 0600 24 0800 24 Y 21.36 24 7.2 <20 IO 9 6.8
15 0600 24 0800 24 B 16.68 24 7.6
16 0600 24 0800 24 B 15.6 24 7.9
17 0600 24 0800 24 Y 18.04 25 7.1 <20 5 9 7.5
18 0600 24 0800 24 Y 34.94 25 7.2 <20 9 7 10 7.8 14.6
19 0600 24 0800 24 Y 30 25 7.1 <20 9 9 12 7.1
20 0600 24 0800 24 Y 21.49 26 7 <20 7 6 28 7.4
21 0600 24 0800 24 Y 21.75 25 7.1 <20 4 5 7.5
22 0600 24 0800 24 B 19.51 25 7.6
�3 0600 24 0800 24 B 22.26 24 7.2
24 0600 24 0800 24 Y 20.74 25 6.9 <20 7 2 7.2
25 0600 24 0800 24 Y 17.81 25 7.2 <20 2 4 3 6.9
26 0600 24 0800 24 Y 18.66 25 7.3 <20 3 3 2 7.2
27 0600 24 0800 24 Y 17.71 26 7.4 <20 3 4 7 7.6
28 0600 24 0800 24 Y 16.08 27 7.3 <20 5 4 7.4
29 0600 24 0800 24 B 16.07 26 7.2
38 0600 24 0800 24 B 16.01 27 7.4
Monthly Avenge Limit: 30 21 30 200
Monthly Avenge: 20.515333 24.933333 0 5.875 6.3 11.230637 7.336667 14.6
Daily Mnuboom: 34.94 27 -4 0 14 10 74 8.2 14.6
Daily Minimum: 15.32 24 6.9 0 2 3 2 6.7 14.6
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENV WTHR=No Visitation-Adverse Weather, NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
•
C0665 01027 34306 THP3B 00094 00720 32101 00900 01092 NC01 C0610
u
- _ Monthly Quarterly Quarterly Monthly Monthly Quarterly Quarterly Quarterly Quarterly Annually
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a to F= O O O z` TOTAL P- CADMIUM CLRDBRME CER7DCHV CNDUCTVY CN-TOT DICLBRMT TOT HARD ZINC ANN POL NH3-N-
2400 clock Hee 2400 clock Ars Y/B/N mg/I ug/1 ug/I percent umhos/cm ug/I ug/1 mg/I ug/I yes=1 no-3 mg/1
I 0600 24 0800 24 B ,I
2 0600 24 0800 24 B
3 0600 24 0800 24 Y 752 <0.5
4 0600 24 0800 24 Y <0.5
5 0600 24 0800 24 Y <0.5
6 0600 24 0800 24 Y <0.5
7 0600 24 0800 24 B 1.54 0.5
8 0600 24 0800 24 B
9 0600 24 0800 24 B
IO 0600 24 0800 24 Y <0.5
It 0600 24 0800 24 Y 5.66 14 <0.5
12 0600 24 0800 24 Y <0.5
13 0600 24 0800 24 Y <0.5
14 0600 24 0800 24 Y <0.5
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 Y <0.5
18 0600 24 0800 24 Y <0.5
19 0600 24 0800 24 Y <0.5
20 0600 24 0800 24 Y <0.5
21 0600 24 0800 24 Y <0.5
22 0600 24 0800 24 B
23 0600 24 0800 24 B
24 0600 24 0800 24 Y <0.5
25 0600 24 0800 24 Y <0.5
26 0600 24 0800 24 Y <0.5
27 0600 24 0800 24 Y 0.39 <0.5
28 0600 24 0800 24 Y <0.5
29 0600 24 0800 24 B
30 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 0.965 5.66 752 14 I 0.025
Daily Maximum: 1.54 5.66 752 14 I 0.5
Daily Minimum: 0.39 5.66 752 14 I 0
"'■'No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
34506 34511 34496 34501 32103 34541 34546 77163 34576 34210 34215
E E P.
1.: E 1: 7,u - O m
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c U F O O O 2 111-TCE 112-TCE 1,1-DCE 1,1-DCEY 12-DCE 1,2-DCP t-I2DCEY 13-DCPE 2-CEVE ACROLEIN ACRYLONI
2400 Block H. 2400 clock Hrs Y/B/N ug/1 ug/1 ug/1 ug/1 ug/1 ug/1 ug/1 ug/1 ug/1 ug/1 ug/1
1 0600 24 0800 24 B
2 0600 24 0800 24 B
3 0600 24 0800 24 Y
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 Y
7 0600 24 0800 24 B
8 0600 24 0800 24 B
9 0600 24 0800 24 B
10 0600 24 0800 24 Y
u 0600 24 0800 24 Y ' I <I al <I <I <1 I <2 <5 <50 <Ill
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y
14 0600 24 0800 24 Y
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
II 0600 24 0800 24 Y
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y
22 0600 24 0800 24 B
23 0600 24 0800 24 B
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 B
30 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0 0 0 0 0
Doily Maximum: 0 0 0 0 0 0 0 0 0 0 0
Dolly Minimum: 0 0 0 0 0 0 0 0 0 0 0
•*•'No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather, NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
•
00410 01105 01097 01002 34030 01012 81010 32104 32102 34301 85811
is E E
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C V E2 O '0'. O Z ALKLN,T ALUMINUM ANTIMONY As-TOTAL BENZENE BERYLIUM BODS-VaR BROMOFR CARBNTET CHLROBNZ CLROETHA
2400 clock lire 2400 clock lire Y/B/N mg/I mg/1 ug/l ug/1 ug/1 ug/1 percent ug/l ug/1 ug/1 ug/I
1 0600 24 0800 24 B
2 0600 24 0800 24 B
3 0600 24 0800 24 Y
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 Y
7 0600 24 0800 24 B
-
8 0600 24 0800 24 B
9 0600 24 0800 24 B
10 0600 24 0800 24 Y
11 0600 24 0800 24 Y <I <I <I <I <5
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y
14 0600 24 0800 24 Y
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y
22 0600 24 0800 24 B
23 0600 24 0800 24 B
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 B
30 0600 24 0800 24 B 98.4
Monthly Average Limit:
-
Monthly Average: 0 98.4 0 0 0 0
Daily Maximum: 0 98.4 0 0 0 0
Daily Mlolmum: 0 98.4 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=NoVisitation—AdverseWeather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
32106 01034 THP6C 01042 34371 00951 01045 01051 01055 COMER 34413
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2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ugh percent ug/I ug/I ug/I mg/1 ug/I ug/I ugh ugh
I 0600 24 0800 24 B
2 0600 24 0800 24 B
3 0600 24 0800 24 Y
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 Y
7 0600 24 0800 24 B
8 0600 24 0800 24 B
9 0600 24 0800 24 B
10 0600 24 0800 24 Y
11 0600 24 0800 24 Y 15.8 <I <5
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y
14 0600 24 0800 24 Y
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y
22 0600 24 0800 24 B
23 0600 24 0800 24 B
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 B
30 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 15.8 0 0
Daily Maximum: 15.8 0 0
Daily Minimum: 15.8 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
34418 34423 01062 01067 00630 00625 00620 00615 00556 TGP3B 01147
I 612 t
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aETHYLCH MECL2 MOLY NICKEL No2&NO3 TOT KJEL NO3-N Not-N Ott.GRSE CERI7DPF Se-TOTAL
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2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/I ug/1 mg/1 mg/I mg/1 mg/I <Jl pass/fail ug/I
1 0600 24 0800 24 B
2 0600 24 0800 24 B
3 0600 24 0800 24 Y
4 0600 24 0800 24 Y ,13
5 0600 24 0800 24 Y 11.5
6 0600 24 0800 24 Y 7.7
7 0600 24 0800 24 B
8 0600 24 0800 24 B
9 0600 24 0800 24 B
10 0600 24 0800 24 Y 8.4
11 0600 24 0800 24 Y 3 - I 10.3
12 0600 24 0800 24 Y 10.4
13 0600 24 0800 24 Y 9.5
14 0600 24 0800 24 Y <5
15 0600 24 0800 24 B
16 0600 24 0800 24 B 1
17 0600 24 0800 24 Y 8.7 Ili
18 0600 24 0800 24 Y 4.3 10.1 <0.05
19 0600 24 0800 24 Y 7.6
20 0600 24 0800 24 Y 8.9
21 0600 24 0800 24 Y 10.3
22 0600 24 0800 24 B 1
23 0600 24 0800 24 B
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y 10
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y 7.4
28 0600 24 0800 24 Y 8.4
29 0600 24 0800 24 13
30 0600 24 0800 24 B
Monthly Average Llmit:
Monthly Average: 0 0 4.5 8.8875 0
Daily Maximum: 0 0 4.5 13 0
Daily Minimum: 0 0 4.5 0 O
*00*No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
01077 70295 81011 00945 81549 34475 01059 34010 39180 39175
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U F' O O O ,'e' SILVER RES/DISS TSS-VoR SULFATE TETCLETH TETCLETY THALLIUM TOLUENE TCETHYLE VINYLCHL
2400 clock Hrs 2400 clock Hrs Y/B/N ugh mg/I percent mg/I ug/I ug/1 ug/I ug/1 ug/I ug/1
I 0600 24 0800 24 B
2 0600 24 0800 24 B
3 0600 24 0800 24 Y
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y
6 0600 24 0800 24 Y
7 0600 24 0800 24 B
8 0600 24 0800 24 B
9 0600 24 0800 24 B
IS 0600 24 0800 24 Y
II 0600 24 0800 24 Y <I <I I <I <5
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y
14 0600 24 0800 24 Y
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 Y
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800. 24 Y
22 0600 24 0800 24 B
23 0600 24 0800 24 B
24 0600 24 0800 24 Y
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 B
30 0600 24 0800 24 B 98.1
Monthly Average Limit:
Monthly Average: 98.1 0 0 0 0 0
Daily Maximum: 98.1 0 0 0 0 0
Daily Minimum: 98.1 0 0 0 0 0
*•aa No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: INFLUENT DISCHARGE NO.: 001
• C0310 C0530 50050 00010 00400 50060 C0610 00300
E •
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2 X week 2X week
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U 2 i BOD-Cone TSS-Cone FLOW TEMP-C pH CHLORINE NH3-N-Coon DO
2400 Hrs mg/1 mg/1 mgd deg c su ug/I mg/1 #/100m1
1 0600 24
0600 24
3 0600 24 396
a 0600 24 384 328
0600 24 425 330
6 0600 24 414 290
7 0600 24 432 368
8 0600 24
0 0600 24
lu 0600 24 212
II 0600 24 348 284
12 0600 24 357 324
13 0600 24 418 340
14 0600 24 388 292
15 0600 24
16 0600 24
17 0600 24 224
18 0600 24 424 480
19 0600 24 242 416
20 0600 24 270 248
21 0600 24 341 284
22 0600 24
23 0600 24
24 0600 24 264
25 0600 24 347 276
26 0600 24 335 285
27 0600 24 361 416
28 0600 24 402 415
29 0600 24
30 0600 24
Monthly Average Limit:
Monthly Average: 368 323.E
Daily Maximum: 432 480
Daily Minimum: 242 212
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
1

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Submitted
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE:10/09/2019
4 ' cfa„,4` 10/08/2019
ORC/Certifi Signature: Jon M Southern E-Mail:[e-mail] Phone #:[phone] Date
By this signature,I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.
If the facility is noncompliant,please attach a list of corrective actions being taken and a time-table for improvements to be made as required by part II.E.6 of
the NPDES permit.
10/09/2019
Permittee/Submitter Signature:*** James rump E-Mail:[e-mail] Phone #:[phone] Date
Permittee Address:2801 Griffith Rd Winston Salem NC 271036417 Permit Expiration Date:06/30/2022
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 managed 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 fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME:AEWWTP Laboratory
CERTIFIED LAB#:#69
PERSON(s)COLLECTING SAMPLES:Operators
PARAMETER CODES
Parameter Code assistance may be obtained by calling the NPDES Unit(919)807-6300 or by visiting http://portal.ncdenr.org/web/wq/swp/ps/npdes/forms.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:Check this box if no discharge occurs and,as a result,there are no data to be entered for all of the parameters on the DMR
for entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Jon Madison Southern ORC CERT NUMBER:986488
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:06-2019(June 2019) VERSION:2.0 STATUS:Submitted
Report Comments:
Other Laboratory used:Meritech#165
6/5/19#7G pH results are 7.3 and 7.4
6/18/19 Elledge Effluent#7 received at 6.3 degree C.
Revision 2.0 includes PPA parameters.

January 2021

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021(January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO
50050 00010 00400 50060 C0310 C0610 C0530 31616 00300
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O u 2 O o O Z FLOW TEMP-C pH CHLORINE BOD-Cone NH3-N-Cone TSS-Cone FCOLI BR 1)O
2400 clock Hn 2400 clock Hrs Y/B/N mgd deg c su ugh mg/1 mg/1 mg/1 #/100m1 mg/1
1 0600 24 0800 24 B HOLIDAY
2 0600 24 0800 24 B 21.23 17 8.5
3 0600 24 0800 24 B 21.86 18 7.4
4 0600 24 0800 24 Y 23.48 17 6.2 <20 <0.5 7 <1 7.3
5 0600 24 0800 24 Y 24.1 16 6.8 <20 5 <0.5 7 8 7.2
6 0600 24 0800 24 Y 21.9 16 6.9 <20 <0.1 8 34 7.6
7 0600 24 0800 24 Y 20.74 16 7 <20 9 <0.5 8 39 7.2
8 0600 24 0800 24 Y 21.15 17 6.9 <20 <0.5 7 7.2
9 0600 24 0800 24 20.61 16 7.8
10 0600 24 0800 24 20.3 16 8.1
11 0600 24 0800 24 Y 21.26 16 6.7 <20 <0.5 5 _ 8.1
12 0600 24 0800 24 Y 21.55 16 6.9 <20 <0.5 6 5 7.8
13 0600 24 0800 24 Y 19.66 16 7.1 <20 7 <0.2 5 8 7.8
14 0600 24 0800 24 Y 20.72 17 7.1 <20 <0.5 5 11 7.8
15 0600 24 0800 24 Y 21.68 17 7 <20 8 <0.5 7 7.6
16 0600 24 0800 24 B 21.9 17 7.5
17 0600 24 0800 24 Y 17.72 16 8.2
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y 20.41 16 7 <20 II <0.5 7 2 7.3
20 0600 24 0800 24 Y 19.76 16 7.1 <20 6 <0.5 7 3 7.7
21 0600 24 0800 24 Y 19.28 17 7.1 <20 8 <0.5 7 I 8.2
22 0600 24 0800 24 Y 19.24 17 7.I <20 7 <0.5 7 8.3
23 0600 24 0800 24 18.31 16 8.5
24 0600 24 0800 24 18.5 16 8.5
25 0600 24 0800 24 Y 21.82 16 6A 20 0.5 9 8
26 0600 24 0800 24 Y 27.17 16 7 <20 10 <0.5 13 3 7.4
27 0600 24 0800 24 Y 24.18 16 7 <20 10 <0.5 15 6 8
28 0600 24 0800 24 Y 30.7 16 7 <20 11 <0.5 13 21 7.4
29 0600 24 0800 24 Y 20.74 15 7.1 <20 30 <0.5 14 8.2
30 0600 24 0800 24 B 23.67 15 7.7
31 0600 24 0800 24 B 27.49 15 7.9
Monthly Avenge Limit: 30 30 2.4 30 200
Monthly Average: 21.763103 16.241379 0 10.166667 0 8.263158 5.110373 7.8
Dairy Maximum: 30.7 18 7.1 0 30 0 15 39 8.5
Daily Minimum: 17.72 IS 6.2 0 5 0 5 0 7.2
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021(January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
C0600 C0665 01027 34306 THP3B 00094 00720 32101 00900 TGP3B 01092
E
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q U 4O O O Z TOTAL N- TOTAL P- CADMIUM CLRDBRME CER7DCHV CNDUCTVY CN-TOT DICLBRMT TOT HARD CERI7DPF ZINC
2400 clock Hrs 2400 clock Hrs Y/B/N mg/I mg/I mg/1 ug/1 percent umhos/cm ug/1 ug/1 mg/1 pass/fail mg/1
1 0600 24 0800 24 B HOLIDAY
2 0600 24 0800 24 B
3 0600 24 0800 24 B
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y <0.00015 1.94 476 <20 6.95 26 0.064
6 0600 24 0800 24 Y 15.1 0.9 <0.00015 PASS <20 60 0.054
7 0600 24 0800 24 Y I
8 0600 24 0800 24 Y
9 0600 24 0800 24
10 0600 24 0800 24
11 0600 24 0800 24 Y
12 0600 24 0800 24 Y <20
13 0600 24 0800 24 Y 12.1 0.4 <0.000 I 5 0 051
14 0600 24 0800 24 Y
15 0600 24 0800 24 Y
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y
22 0600 24 0800 24 Y
23 0600 24 0800 24
24 0600 24 0800 24
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y 0.6
28 0600 24 0800 24 Y
29 0600 24 0800 24 Y
30 0600 24 0800 24 B
31 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 13.6 0.633333 0 1.94 476 0 6.95 43 0.056333
Daily Maximum: 15.1 0.9 0 1.94 476 0 6.95 60 0.064
Daily Minimum: 12.1 0.4 0 1.94 476 0 6.95 26 0.051
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834 Ver 2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021(January2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
NC01 34506 34511 34496 34501 34551 34536 32103 34541 34346 34546
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2400 dock Hrs 2400 dock Hrs Y/B/N yes=1 no=0 ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/1 ug/I ug/I
1 0600 24 0800 24 B HOLIDAY
2 0600 24 0800 24 B
3 0600 24 0800 24 B
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y I <I <I <I <I <10 <10 <I <I <10 <I
6 0600 24 0800 24 Y
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24
10 0600 24 0800 24
II 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y
14 0600 24 0800 24 Y
15 0600 24 0800 24 Y
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
I 21 0600 24 0800 24 Y
22 0600 24 0800 24 Y
23 0600 24 0800 24
24 0600 24 0800 24
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 Y
30 0600 24 0800 24 B
31 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: I 0 0 0 0 0 0 0 0 0 0
Daily Maximum: 1 0 0 0 0 0 0 0 0 0 0
Daily Minimum: I 0 0 0 0 0 0 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_2.0_1_2021.pdf)
1

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021 (January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
77163 34566 34571 34621 34601 34606 34616 34611 C0626 34576 34581
F F P
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2. ! 5 u o`
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O 2 I,3-DCPE 1,3-DCB I,4-DCB 246-TCPH 2,4-DCPH 2,4-DMPH 2,4-DNPH 2,4-DNT 26DINITR- 2-CEVE 2-CLRNAP
2400 clock Firs 2400 dock Hrs Y/B/N ug/I ug/1 ug/1 ug/1 ug/I ug/I ug/1 ug/I ug/1 ug/I ug/I
1 0600 24 0800 24 B HOLIDAY
2 0600 24 0800 24 B
3 0600 24 0800 24 B
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y <1 <10 <10 <10 <10 <10 <50 <10 <10 <5 <10
6 0600 24 0800 24 Y
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24
10 0600 24 0800 24
11 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y
14 0600 24 0800 24 Y
15 0600 24 0800 24 Y
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y
22 0600 24 0800 24 Y
23 0600 24 0800 24
24 0600 24 0800 24 I
1
25 0600 24 0800 24 Y II
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 Y
38 0600 24 0800 24 B
31 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0 0 0 0 0
Daily Maximum: 0 0 0 0 0 0 0 0 0 0 0
Daily Minimum: 0 0 0 0 0 0 0 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021 (January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
34586 34591 34631 34657 34636 34641 34646 34205 34200 34210 34215
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a e t U
C U [= O O O e< 2CPHENOL 2NPHENOL 3,3'-DCB 46DN-o-C 4-BPPETH 4-CPPETH 4NPHENOL ACENAPEN ACENAPYL ACROLEIN ACRYLONI
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/l ug/I ug/I ug/I
1 0600 24 0800 24 B HOLIDAY
2 0600 24 0800 24 B
3 0600 24 0800 24 B
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y <10 <10 <50 <50 <10 <10 <50 <10 <I <50 <10
6 0600 24 0800 24 Y
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24
10 0600 24 0800 24
II 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y
14 0600 24 0800 24 Y
15 0600 24 0800 24 Y
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y
22 0600 24 0800 24 Y
23 0600 24 0800 24
24 0600 24 0800 24
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 Y
30 0600 24 0800 24 B
31 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0 0 0 0 0
Daily Maximum: 0 0 0 0 0 0 0 0 0 0 0
Daily Minimum: 0 0 0 0 0 0 0 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver 2.0_1_2021.pdt)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021 (January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
CO220 01097 01002 34030 39120 34526 34247 34230 34521 3424E 01012
I
t— E F a[- O
I ce
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E :
_u'E O . Grab Composite Composite Grab Grab Grab Grab Grab Grab Grab Composite
t z e
G U E2 O O O z ANTHRACE ANTIMONY As-TOTAL BENZENE BENZIDIN BNZO-A-A BNZO-A-P BNZO-B-F BNZO-ghi BNZO-K-F BERYLIUMI
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I mg/I mg/1 ug/I ug/I ug/I ug/I ug/1 ug/I ug/I mg/I
I 0600 24 0800 24 B HOLIDAY
2 0600 24 0800 24 B
3 0600 24 0800 24 B
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y <10 <1 <50 <10 <10 <10 <I0 <10
6 0600 24 0800 24 Y 0.0015 <0.002 <0.005
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24
10 0600 24 0800 24
II 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y <0.002
14 0600 24 0800 24 Y
15 0600 24 0800 24 Y
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y
22 0600 24 0800 24 Y
23 0600 24 0800 24
24 0600 24 0800 24
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 Y
30 0600 24 0800 24 B
31 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 0 0.0015 0 0 0 0 0 0 0 0 0
Daily Maximum: 0 0.0015 0 0 0 0 0 0 0 0 0
Daily Minimum: 0 0.0015 0 0 0 0 0 0 0 0 0
' ****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021 (January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
34278 34273 34283 39100 32104 34292 32102 34301 85811 32106 01034
E Ea
t- E .i 18
m E _ O 4
E - x
01 E a ° IE -_
O i. Grab Grab Grab Grab Grab Grab Grab Grab Grab Grab Composite
2 E A `u C C
G U 4 O O O 2 BIS2CXMT BIS2CYET BIS2CIET B2E PHTH BROMOFR BU-BZ-PH CARBNTET CHLROBNZ CLROETHA CHLRFORNI Cr-TOTAL
2400 clock firs 2400 clock Hrs Y/B/N ug/I ug/1 ug/l ug/1 ug/1 ug/I ug/l ug/I ug/I ug/I mg/I
1 0600 24 0800 24 B HOLIDAY
2 0600 24 0800 24 B
3 0600 24 0800 24 B
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y <10 <10 <10 <10 <1 <10 <1 <1 <5 10.4
6 0600 24 0800 24 Y <0.002
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24
10 0600 24 0800 24
11 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y <0.002
14 0600 24 0800 24 Y
19 0600 24 0800 24 Y
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y
-
22 0600 24 0800 24 Y
23 0600 24 0800 24
24 0600 24 0800 24
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 Y
30 0600 24 0800 24 B
31 0600 24 0800 24 B
'Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0 0 0 10.4 0
Daily Maximum: 0 0 0 0 0 0 0 0 0 10.4 0
Daily Minimum: 0 0 0 0 0 0 0 0 0 10.4 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_2.0_1_2021.pd0

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021 (January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
34320 01037 01042 34556 34336 34341 39110 34596 34371 C0376 34381
I E
1: E F- a
E F -4O
III E P.
1= In- Ti
u g
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d E '7. 8 a e
G U [= O O O z CHRYSENE COBALT COPPER DBNZO-ah DIETY-PH DIMET-PH DNB PHTH D-n-OCPH ETIIYLBEN FLUORANT FLUORENE
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I mg/I mg/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I kg/day
1 0600 24 0800 24 B HOLIDAY
2 0600 24 0800 24 B '
3 0600 24 0800 24 B
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y <I 0 <10 <I 0 <10 <10 <10 <1 <10 <10
6 0600 24 0800 24 Y <0.002 0.003
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24
10 0600 24 0800 24
II 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y 0.002
14 0600 24 0800 24 Y
15 0600 24 0800 24 Y
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800 24 iY
22 0600 24 0800 24 IIY
23 0600 24 0800 24
24 0600 24 0800 24
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 Y
30 0600 24 0800 24 B
31 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 0 0 0.0025 0 0 0 0 0 0 0 0
Daily Maximum: 0 0 0.003 0 0 0 0 0 0 0 0
Daily Minimum: 0 0 0.002 0 0 0 0 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; EN V WTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
1 eDMR PERIOD:01-2021(January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
00951 C0700 39702 34386 34396 34403 34408 01051 01055 COMER 34413
E
F E F- v
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a b
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R 0 u e
G u F 8 O O c F-TOTAL HCB-Cone HEXCLBD HCCP HCE Il23CDPY ISPHRONE LEAD MANGNESE MERCURY- METHYLBR
2400 clock Hrs 2400 dock Hrs Y/B/N mg/I ug/1 ug/1 ug/1 ug/I ug/I ug/I mg/I mg/1 ng/t ug/I
I 0600 24 0800 24 B HOLIDAY
•
2 0600 24 0800 24 B
3 0600 24 0800 24 B
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y <10 <10 <50 <10 <10 <10 <5
6 0600 24 0800 24 Y 0.0007
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y 1.18
9 0600 24 0800 24
10 0600 24 0800 24
II 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y 0.6 <0.0005 0.012
14 0600 24 0800 24 Y
15 0600 24 0800 24 Y
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y
22 0600 24 0800 24 Y
23 0600 24 0800 24
24 0600 24 0800 24
25 0600 24 0800 24 Y _
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 Y
30 0600 24 0800 24 B
31 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 0.6 0 0 0 0 0 0 0.00035 0.012 1.18 0
Daily Maximum: 0.6 0 0 0 0 0 0 0.0007 0.012 1.18 0
Daily Minimum: 0.6 0 0 0 0 0 0 0 0.012 1.18 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021(January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
a 34418 34423 01062 34696 01067 00630 34447 00625 00620 34438 34428
i- t F C
Ei.
c C F y
O Grab Grab Calculated Grab Composite Composite Grab Composite Calculated Grab Grab
d E a ?
5 C a'',A cf. [= O O O Z METHYLCH MECL2 MOLY NAPTHALE NICKEL NO2&NO3 NITROBEN TOT KJEL NO3-N NDMA NDnPA
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I mg/I ug/I mg/I mg/I ug/I mg/I mg/I ug/I ug/I
I 0600 24 0800 24 B HOLIDAY
2 0600 24 0800 24 B
3 0600 24 0800 24 B
4 0600 24 0800 24 Y 12.9
5 0600 24 0800 24 Y <5 <I <10 <10 13.2 <10 <10
6 0600 24 0800 24 Y 0.0018 13.9 1.2 10.5
7 0600 24 0800 24 Y 9.2
8 0600 24 0800 24 Y
9 0600 24 0800 24
10 0600 24 0800 24
11 0600 24 0800 24 Y 14
12 0600 24 0800 24 Y 15.6
13 0600 24 0800 24 Y <0.002 0.0017 10 2.1
14 0600 24 0800 24 Y 6.1
15 0600 24 0800 24 Y 10.8
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y 17.2
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y 13.8
22 0600 24 0800 24 Y 14.2
23 0600 24 0800 24
24 0600 24 0800 24
25 0600 24 0800 24 Y 14.1
26 0600 24 0800 24 Y 13.8
27 0600 24 0800 24 Y 12
28 0600 24 0800 24 Y 10.2
29 0600 24 0800 24 Y 9.8
30 0600 24 0800 24 B
31 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 0 0 0 0 0.00175 11.95 0 1.65 12.3375 0 0
Daily Maximum: 0 0 0 0 0.0018 13.9 0 2.1 17.2 0 0
Daily Minimum: 0 0 0 0 0.0017 10 0 1.2 6.1 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_2.0_1_2021.pd0
I

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021 (January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
34433 00556 34452 39032 34461 34694 32730 34469 01147 01077 70295
E 11
E F — O3.
E. z`
E 6 i = g.
-
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E o e
G U F2 O O O z NDPA OIL-GRSE pCLRmCR PCP PHENANTH PHENOL PHEN,TR PYRENE Se-TOTAL SILVER RES/DISS
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I mg/I ug/I ug/I ug/I ug/I mg/I ug/I mg/I mg/I mg/I
I 0600 24 0800 24 B HOLIDAY
2 0600 24 0800 24 B
3 0600 24 0800 24 B
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y <10 <5 <10 <50 <10 <10 0.074 <10
6 0600 24 0800 24 Y <0.001 <0.0005 287
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24
Io 0600 24 0800 24
It 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y <0.001 <0.0005
14 0600 24 0800 24 Y
15 0600 24 0800 24 Y
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
IS 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y
22 0600 24 0800 24 Y
23 0600 24 0800 24
24 0600 24 0800 24
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 Y
30 0600 24 0800 24 B
31 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0.074 0 0 0 287
Daily Maximum: 0 0 0 0 0 0 0.074 0 0 0 287
Daily Minimum: 0 0 0 0 0 0 0.074 0 0 0 287
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR NC0037834_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021 (January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
81549 34475 01059 01102 01152 34010 39180 01087 39175
I. E
F E F n
' O I
2.1
E F.
u O 2. Grab Grab Composite Composite Composite Grab Grab Composite Grab
a 21a a a a' B
C U 4 O O O 7 TETCLETH TETCLETY THALLIUM TIN TITANIUM TOLUENE TCETHYLE VANADIUM VINYLCHL
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I mg/I mg/I mg/I ug/I ug/l mg/I ug/I
I 0600 24 0800 24 B HOLIDAY
2 0600 24 0800 24 B
3 0600 24 0800 24 B
4 0600 24 0800 24 Y
5 0600 24 0800 24 Y <I <I <I <1 <5
6 0600 24 0800 24 Y <0.0005 <0.01 <0.005 <0.005
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24
10 0600 24 0800 24
II 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y
14 0600 24 0800 24 Y
15 0600 24 0800 24 Y
16 0600 24 0800 24 B
17 0600 24 0800 24 Y
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y
22 0600 24 0800 24 Y
23 0600 24 0800 24
24 0600 24 0800 24
25 0600 24 0800 24 Y
26 0600 24 0800 24 Y
27 0600 24 0800 24 Y
28 0600 24 0800 24 Y
29 0600 24 0800 24 Y
30 0600 24 0800 24 B
31 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0 0 0
Daily Maximum: 0 0 0 0 0 0 0 0 0
Daily Minimum: 0 0 0 0 0 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_2.0_1_2021.pd0

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021(January2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: INFLUENT DISCHARGE NO.: 001
C0310 C0530 50050 00010 00400 50060 ('0610 00300
E
F E
E = C
2 X week 2 X week
E
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e H
U g Z HOD-Cone TSS-Cone FLOW TEMP-C pH CHLORINE NH3-N-Cone DO
2400 Hrs mg/1 mg/1 mgd deg c su ugh mg/1 mg/1
i 0600 24 HOLIDAY
2 0600 24
3 0600 24
4 0600 24 191
0600 24 303 247
6 0600 24 200
7 0600 24 352 236
8 0600 24 256
9 0600 24
l0 0600 24
ii 0600 24 184
12 0600 24 243
13 0600 24 458 247
14 0600 24 273
15 0600 24 366 320
16 0600 24
17 0600 24
18 0600 24 HOLIDAY
19 0600 24 290 243
20 0600 24 218 268
2i 0600 24 360 348
22 0600 24 316 296
223 0600 24
24 0600 24
25 0600 24 257
26 0600 24 349 315
27 0600 24 265 250
28 0600 24 269 283
29 0600 24 172 210
30 0600 24
31 0600 24
Monthly Average Limit:
Monthly Average: 309.833333 256.157895
Daily Maximum: 458 348
Daily Minimum: 172 184
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENVWTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0037834_Ver_2.0_1_2021.pdt)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021(January2021) VERSION:2.0 STATUS:Submitted
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE: 12/06/2021
Electronically Certified by Matthew Richard Lavigne on 2021-12-02 06:58:18.465
ORC/Certifier Signature :Matthew Richard Lavigne Phone #: [phone] Date
I certify that this report is accurate and complete to the best of my knowledge.
The permittee shall report to the Director or the appropriate Regional Office any noncompliance that potentially threatens public health or the environment.
Any information shall be provided orally within 24 hours from the time the permittee became aware of the circumstances.A written submission shall also be
provided within 5 days of the time the permittee becomes aware of the circumstances.The written submission shall be made as required by part II.E.6 of the
NPDES permit.
Electronically Signed by James F Crump on 2021-12-06 08:02:28.312
Permittee/Submitter Signature: * * *James F Crump Phone #:[phone] Date
Permittee Address:2801 Griffith Rd Winston Salem NC 271036417 Permit Expiration Date:06/30/2022
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 managed 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 fines and imprisonment for
knowing violations.
CERTIFIED LABORATORIES
LAB NAME:Archie Elledge WWTP
CERTIFIED LAB#:#69
PERSON(s)COLLECTING SAMPLES:Operators
PARAMETER CODES
Parameter Code assistance may be obtained by visiting https://deq.nc.gov/about/divisions/water-resources/edmr/user-documentation.
FOOTNOTES
Use only units of measurement designated in the reporting facility's NPDES permit for reporting data.
*No Flow/Discharge From Site:YES indicates that No Flow/Discharge occurred and,as a result,no data is reported for any parameter on the DMR for the
entire monitoring period.
**ORC on Site?:ORC must visit facility and document visitation of facility as required per 15A NCAC 8G.0204.
***Signature of Permittee:If signed by other than the permittee,then delegation of the signatory authority must be on file with the state per 15A NCAC 2B
.0506(b)(2)(D).
Discharge Monitoring Report-Copy Of Record(COR NC0037834 Ver 2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0037834 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Archie Elledge WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Matthew Richard Lavigne ORC CERT NUMBER:997822
GRADE:WW-4 ORC HAS CHANGED:No
eDMR PERIOD:01-2021(January 2021) VERSION:2.0 STATUS:Submitted
Report Comments:
Subout Laboratory=Meritech#165
Subout Laboratory=Waypoint Analytical#402
January 1st was a Holiday.
The 1/5/21 Effluent was analyzed twice for Dichlorobromomethane with results of 6.88 ug/1 and 6.95 ug/1.
The 1/5/21 Effluent was analyzed twice for Chlorodibromomethane with results of 1.76 ug/1 and 1.94 ug/1.
The 1/5/21 Effluent was analyzed for 1,2-DCB,1,3-DCB and 1,4-DCB by methods 624 and 625. All three compounds were<lug/L by method 624 and all three compounds
were<10 ug/L by method 625.
The 1/6/21 Effluent ammonia sample was run in house with a result of<0.5mg/l. It was also analyzed by Meritech with a result of<0.1mg/l.
The 1/6/21 Tin sample was originally analyzed and reported as<0.025 mg/L.The data was re-evaluated and then reported as<0.01 mg/L.The analyte exceeded the lower
calibration range of the analytical method/instrument.The reported value should be considered an estimate.
On 1/11/21 the analyst failed to record the slope for pH on the datasheet. The analyst said it was in QC but could not remember the exact result.
On 1/12/21 the analyst failed to record the read-out time for the 1/11/21 fecal sample.This analyst generally reads the fecals 1st thing upon arriving at work which would have
been within QC.There are at least two other non-consecutive results for the week available.
On 1/15/21 the Nitrate 25mg/1 Calibration Check Standard failed QC at 30.4mg/1.The Spike and Spike Duplicate failed QC at 152%and 149%respectively.The analyst suspects
something in the Muddy Creek Effluent might be"Shocking"the electrode. The nitrate run,calibration,and slope all look good up until the MC Effluent is analyzed.Analyst is
going to increase the amount of interference suppressor that is used to see if that helps.
January 18th was a Holiday.
On 1/19/21 the Nitrate spike duplicate%recovery was outside of QC at 126%.
On 1/20/21 on the BOD run the sample/sample duplicate failed QC because the final DO on the sample duplicate was<I.0mg/L. The Influent and Effluent samples collected
1/19/21 and 1/20/21 were affected.
Version 2.0 revised to update the Tin results on 12/2/21.

Table E
Chronic Toxicity

Efflu€snt Toxicity Report Form-Chronic Fathead Minnow Multi-Concentration Test Date:4/20/2018
r ,
Facility: Winston Salem-Elledge Creek NPDES#NC00 37834 Pipe#: 001 County: Forsyth
Labor tory: Meritech,` Ind Comments)
x '
Sign re of Opera or in Rasp Bible C.lrge
X 2 e_tzer
Signature of Laboratory Supervisor
MAIL ORIGINAL TO: Water Sciences Section
Aquatic Toxicoloby Branch
Division of Water Resources
1621 Mail Service Center
Raleigh,NC 27699-1621
rest Initiation Date/Time 4/10/2018 4:16 PM Avg Wt/Surv.Control 0.884 Test Organisms
%Eff. Repl. 1 2 3 4 r Cultured In-House
Control Surviving# 10 10 10 10 %Survival 100.0 Outside Supplier
Original# 10 10 10 10
Wt/original(mg) 0.821 0.955 0.899 0.860 Avg Wt(mg) 0.884 Hatch Date: 4/9/18
38 Surviving# 10 10 9 10 %Survival 97.5 Hatch Time: 3:00 pm CT
Original# 10 10 10 10
Wt/original(mg) 0.930 0.831 0.750 0.893 Avg Wt(mg) 0.851
48 Surviving# 10 10 10 10 %Survival 100.0
Original# 10 10 10 10
Wt/original(mg) 0.850 0.846 0.917 0.871 Avg Wt(mg) 0.871
76 Surviving# 10 10 10 10 %Survival 100.0
Original# 10 10 10 10
Wt/original(mg) 0.807 0.869 0.827 0.852 Avg Wt(mg) 0.839
86 Surviving# 9 10 10 10 %Survival 97.5
Original# 10 10 10 10
Wt/original(mg) 0.898 0.859 0.823 0.856 Avg Wt(mg) 0.859
96 Surviving# 10 10 10 10 %Survival 100.0
Original# 10 10 10 10
Wt/original(mg) 0.698 0.925 0.742 0.783 Avg Wt(mg) 0.787
Vater Quality Data Day
Control 0 1 2 3 4 5 6
pH(SU)Init/Fin 8.04 / 7.77 8.12 / 7.82 7.99 / 7.88 8.17 / 7.89 8.20 17.73 8.22 17.87 8.23 17.77
DO(mg/L) Init/Fin 7.75 16.91 8.00 / 7.16 7.98 / 6.94 7.85 / 7.31 8.01 / 6.26 7.48 / 6.87 7.71 / 6.90
Temp(C)!nit/Fin 25.6 / 24.6 24.5 / 24.4 25.3 / 24.4 24.4 / 24.6 24.6 / 25.0 25.4 / 24.2 25.6 / 24.9
High Concentration o 1 2 3 4 5 6
pH(SU)!nit/Fin 7.19 17.66 7.37 / 7.68 7.48 / 7.98 7.56 / 7.89 7.68 / 7.97 7.43 / 8.02 7.72 17.97
DO(mg/L) Init/Fin 8.11 / 7.04 7.89 / 7.12 8.13 / 6.92 7.85 / 6.74 7.67 / 6.58 7.78 / 7.13 7.68 16.57
Temp(C)Init/Fin 25.3 / 24.7 25.5 124.3 25.0 / 24.5 25.2 / 24.3 25.0 / 25.1 25.8 124.9 25.1 / 24.9
Sample 1 2 3 Survival Growth Overall Result
Collection Start Date 4/9/2018 4/11/2018 4/12/2018 Normal ri‘ Ffi ChV >96
Grab Hom.Var. In:` l
Composite(Duration) 24.0 24.0 24.0 NOEC 96 96
Hardness(mg/L) 50 58 52 LOEC >96 >96
Alkalinity(mg/L) 58 85 97 ChV >96 >96
;onductivity(umhos/cm) 761 771 742 Method Steel's Dunnett's
Chlorine(mg/L) <0.1 <0.1 <0.1
Temp.at Receipt(°C) 1.3 1.7 0.7 Stats Survival Growth
Conc. Critical Calculated Critical Calculated
Dilution H2O Batch# 1255 1256 1257 1258 1259 38 10 16 2.41 0.7668
Hardness(mg/L) 44 44 44 44 46 48 10 18 2.41 0.2985
Alkalinity(mg/L) 52 54 52 51 54 76 10 18 2.41 1.0536
;onductivity(umhos/cm) , 209 210 207 213 224 86 10 16 2.41 0.5795
96 10 18 2.41 2.2653
DWQ Form AT-5(1/04)

Effluent Toxicity Report Form - Chronic Pass/Fail and ;Acute,LC50 Date: 04/19/18
Facility: WIN rTON SALEM - ELLEDGE WWTP NPDES#: NC0037834 Pipe#: 001 County: FORSYTH
Labora ory Performin Test: MERITECH LABS, INC.
-A„ ��J� Comments:
/Q(X
Si ature Operator in Respo ible Charge
Signature of Laboratory Supe 'issor * PASSED: -2.75% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -0.685
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -2.75
% Mortality Avg.Reprod.
# Young Produced 25 28 24 28 22 22 25 24 27 23 23 20
0.00 24.25
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 24.92
Treatment 2 Treatment 2
Effluent %: 76%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
10.272% PASS FAIL
# Young Produced 25 25 26 23 27 25 28 26 26 25 19 24 % control orgs X
producing 3rd
brood Check One
Adult (L) ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 04/11/18
Control 8.06 8.00 8.16 8.12 7.95 8.12 Collection (Start) Date
Sample 1: 04/09/18 Sample 2: 04/11/18
Treatment 2 7.33 7.99 7.47 8.30 7.93 8.26 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24 hrs L A A
r d r d r d U M M
t t t Sample 2 X 24 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness(mg/1) 42
Control 7.83 7.81 7.86 7.48 7.83 7.61
Spec. Cond. (pmhos) 180 761 771
Treatment 2 8.37 7.85 8.27 7.45 8.00 7.57
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.3 1.7
(Mortality expressed as %, combining replicates) 1
Note: Please
0 % % o 0 0 0 % % % Concentration Complete This
Section Also
% o % 0 o 0 0 o a o a Mortality
% %
start/end start/end
LC50 = % Method of Determination Control
'95% Confidence Limits Moving Average Probit _
-- % Spearman Karber - Other High
Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs') :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

fluent Toxicity Report Form-Chronic Fathead Minnow Multi-Concentration Test Date:7/19/2019
Facility: Winston Salem-Elledge Creek NPDES#NCOO 37834 Pipe#: 001 County: Forsyth
Laboratory: Meritech, Inc. Comments'
Signat/of Operator in Res onsible Ch e
x
Signature of Laboratory Supervisor
MAIL ORIGINAL TO: Water Sciences Section
Aquatic Toxicoloby Branch
Division of Water Resources
1621 Mail Service Center
Raleigh,NC 27699-1621
Test Initiation Date/Time 7/9/2019 5:40 PM Avg Wt/Surv.Control 0.528 Test Organisms
Y.Eff. Repl. 1 2 3 4 r Cultured In-House
Control Surviving# 10 10 10 10 %Survival 100.0 rx Outside Supplier
Original# 10 10 10 10
Wt/original(mg) 0.546 0.463 0.527 0.574 Avg Wt(mg) 0.528 Hatch Date: 7/8/19
38 Surviving# 10 10 10 10 %Survival 100.0 Hatch Time: 3:00 pm CT
Original# 10 10 10 10
Wt/original(mg) 0.577 0.531 0.522 0.558 Avg Wt(mg) 0.547
48 Surviving# 10 10 10 10 %Survival 100.0
Original# 10 10 10 10
Wt/original(mg) 0.523 0.647 0.593 0.664 Avg Wt(mg) 0.607
76 Surviving# 10 9 10 10 %Survival 97.5
Original# 10 10 10 10
Wt/original(mg) 0.608 0.589 0.605 0.527 Avg Wt(mg) 0.582
86 Surviving# 9 10 10 10 %Survival 97.5
Original# 10 10 10 10
Wt/original(mg) 0.534 0.533 0.651 0.561 Avg Wt(mg) 0.570
96 Surviving# 10 9 10 10 %Survival 97.5
Original# 10 10 10 10
Wt/original(mg) 0.542 0.533 0.621 0.555 Avg Wt(mg) 0.563
Water Quality Data Day
Control 0 1 2 3 4 5 6
pH(SU)'nit/Fin 8.05 / 7.98 8.10 / 8.09 8.13 / 7.88 8.20 / 8.02 8.15 / 8.04 8.19 / 8.02 8.20 / 7.78
DO(mg/L) Init/Fin 7.90 / 7.87 7.98 17.68 7.74 / 7.26 7.78 17.57 7.83 / 8.01 8.02 / 7.90 8.04 / 7.28
Temp(C)Init/Fin 24.3 / 24.1 24.8 / 24.6 24.2 / 24.0 24.8 / 24.1 24.1 / 24.7 24.4 / 24.0 24.4 / 24.0
High Concentration o 1 2 3 4 5 6
pH(SU)Init/Fin 7.21 / 7.82 7.61 / 7.90 7.60 / 7.97 7.68 / 8.18 8.05 / 8.17 8.18 / 8.18 7.84 / 8.35
DO(mg/L) Init/Fin 8.22 / 7.83 7.89 / 7.78 8.06 / 7.17 7.97 / 7.45 7.99 / 7.98 8.06 / 7.70 7.97 / 8.03
Temp(C)Init/Fin 25.4 / 24.8 24.9 / 24.3 24.3 / 24.0 24.7 / 24.1 25.0 / 24.7 24.6 / 24.5 24.9 / 24.1
Sample 1 2 3 Survival Growth Overall Result
Collection Start Date 7/8/2019 7/10/2019 7/11/2019 Normal 111 Fl ChV >96
Grab Horn.Var. fl (.
Composite(Duration) 24.0 24.0 24.0 NOEC 96 96
Hardness(mg/L) 46 54 54 LOEC >96 >96
Alkalinity(mg/L) 54 91 98 ChV >96 >96
Conductivity(umhoslcm) 751 762 764 Method Steel's Dunnett's
Chlorine(mg/L) <0.1 <0.1 <0.1
Temp.at Receipt(°C) 3.4 1.7 1.3 Stats Survival Growth
Conc. Critical Calculated Critical Calculated
Dilution H2O Batch# 1413 1414 1415 1416 38 10 18 2.41 -0.5923
Hardness(mg/L) 44 42 44 42 48 10 18 2.41 -2.4071
Alkalinity(mg/L) 55 53 53 52 76 10 16 2.41 -1.6630
Conductivity(umhos/cm) 198 203 199 190 86 10 16 2.41 -1.2833
96 10 16 2.41 -1.0707
DWQ Form AT-5(1/04)

Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 07/17/19
Facility: WINSTON SALEM - ELLEDGE WWTP NPDES#: NC0037834 Pipe#: 001 County: FORSYTH
Labora ory Performing Test: MERITECH LABS, INC.
Comments:
X
Si nature off era r in Responsible Charge
Signature of Laboratory Supervisor * PASSED: -2.35% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -0.485
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -2.35
% Mortality Avg.Reprod.
# Young Produced 20 23 21 22 14 18 19 25 26 23 23 21
0.00 21.25
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L . L
0.00 21.75
Treatment 2 Treatment 2
Effluent %: 76%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
15.298% PASS FAIL
# Young Produced 25 21 19 23 20 22 22 21 22 22 22 22 % control orgs X
producing 3rd
brood Check One
Adult (L)ive (D)ead L L L L L L L L L L L L 91.7%
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 07/10/19
Control 8.01 7.99 8.04 8.08 7.91 7.90 Collection (Start) Date
Sample 1: 07/08/19 Sample 2: 07/10/19
Treatment 2 7.44 8.03 7.70 8.37 7.98 8.15 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 24 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness(mg/1) 44
Control 7.95 7.58 7.89 7.63 7.83 7.77
Spec. Cond. (jimhos) 154 751 762
Treatment 2 8.02 7.60 8.11 7.78 7.99 7.79
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 3.4 1.7
(Mortality expressed as %, combining replicates) I
Note: Please
% % % %
% Concentration Complete This
o % % % % %
Section Also
% % % Mortality
% % a% %o % % %
start/end start/end
LC50 = % Method of Determination Control
95% Confidence Limits Moving Average _ Probit
% -- % Spearman Karber Other High
Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

o a d
Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 10/15/20
Facility: WINSTON SALEM - ELLEDGE WWTP NPDES#: NC0037834 Pipe#: 001 County: FORSYTH
Laboratory Performing Test: MERITECH LABS, INC. Comments:
ba-"
X
Signa ure of Op r or in Responsible Charge
X a7'�
Signature of aboratory Supervisor * PASSED: -0.99% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia Chronic Test Results
Chronic Pass/Fail Reproduction Toxicity Test Calculated t = -0.221
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 i % Reduction = -0.99
% Mortality Avg.Reprod.
# Young Produced 24 27 27 26 30 27 22 27 24 23 27 18 0.00 25.17
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L 0.00 25.42
Treatment 2 Treatment 2
Effluent %: 76%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Cnrol t CV rol%o PASS FAIL
# Young Produced 26 28 26 22 25 22 28 27 25 28 22 26 % control orgs X
producing 3rd
brood Check One
Adult (L)ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 10/07/20
Control 8.03 8 .00 7.87 7.92 7.94 7.85 Collection: Date
110/05/20 Sample 2: 10/07/20
Treatment 2 7.69 7.96 7.89 8.04 7.81 8.10 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.0 hrs L MA A
A
✓ d r d r d
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample D.O. Hardness(mg/1) 44
Control 7.91 7.69 8.15 7.42 7.78 7.60 Spec. Cond. (pmhos) 155 628 720
Treatment 2 8.02 7.72 7.87 7.63 7.57 7.86 Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.9 0.9
(Mortality expressed as %, combining replicates) Note: (Please
% % % o % o % % % % Concentration Complete This
Section Also
Mortality
start/end start/end
LC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit High
% -- % Spearman Karber _ Other g
Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Effluent Toxicity Report Form-Chronic Fathead Minnow Multi-Concentration Test Date:10/19/2020
Facility: Winston Salem-Elledge Creek NPDES#NC00 37834 Pipe#: 001 County: Forsyth
La ttory: Mer't/ech,Inc. Comments I
x
Signature of Operator Res 7?"C ar
x 1�f�/
Signature of Laboratory Supervisor
MAIL ORIGINAL TO: Water Sciences Section
Aquatic Toxicoloby Branch
Division of Water Resources
1621 Mail Service Center
Raleigh,NC 27699-1621
'est Initiation Date/Time 10/6/2020 4:25 PM Avg Wt/Surv.Control 0.768 Test Organisms
%Eff. Repl. 1 2 3 4 fi Cultured In-House
Control Surviving# 10 10 10 9 %Survival 97.5 f_" Outside Supplier
Original# 10 10 10 10
Wt/original(mg) 0.700 0.809 0.695 0.781 Avg Wt(mg) 0.746 Hatch Date: 10/5/20
38 Surviving# 10 10 8 10 %Survival 95.0 Hatch Time: 3:00 pm CT
Original# 10 10 10 10
Wt/original(mg) 0.744 0.779 0.668 0.704 Avg Wt(mg) 0.724
48 Surviving# 10 10 9 10 %Survival 97.5
Original# 10 10 10 10
Wt/original(mg) 0.682 0.750 0.748 0.760 Avg Wt(mg) 0.735
76 Surviving# 10 10 9 10 %Survival 97.5
Original* 10 10 10 10
Wt/original(mg) 0.716 0.715 0.575 0.773 Avg Wt(mg) 0.695
86 Surviving# 9 10 10 10 %Survival 97.5
Original# 10 10 10 10
Wt/original(mg) 0.673 0.683 0.739 0.713 Avg Wt(mg) 0.702
96 Surviving# 10 10 10 10 %Survival 100.0
Original# 10 10 10 10
Wt/original(mg) 0.718 0.757 0.823 0.757 Avg Wt(mg) 0.764
later Quality Data Day
Control 0 1 2 3 4 5 6
pH(SU)!nit/Fin 7.78 / 7.70 7.79 / 7.61 7.80 / 7.48 7.70 / 7.53 7.78 / 7.62 7.79 / 7.76 7.61 / 7.44
DO(mg/L) Init/Fin 8.08 / 7.23 7.79 17.32 7.77 / 6.69 7.76 / 6.78 7.91 / 7.31 7.87 / 7.42 7.77 / 6.57
Temp(C)Init/Fin 24.5 / 24.7 24.0 / 25.0 24.6 / 25.2 24.1 / 24.6 24.1 / 24.4 24.3 / 24.6 24.1 / 24.2
High Concentration o 1 2 3 4 5 6
pH(SU)Init/Fin 7.48 / 7.75 7.52 / 7.88 7.49 / 7.64 7.49 / 7.69 7.50 / 7.88 7.78 / 7.79 7.53 / 7.66
DO(mg/L) !nit/Fin 8.22 / 6.89 8.13 / 7.33 7.87 / 6.34 7.55 / 6.61 7.79 / 7.26 7.60 / 7.08 7.68 / 6.54
Temp(C)Init/Fin 24.6 / 25.3 24.2 / 25.2 24.3 / 24.9 24.4 / 24.9 25.6 / 24.2 24.9 / 24.1 24.8 124.9
Sample 1 2 3 Survival Growth Overall Result
Collection Start Date 10/5/2020 10/7/2020 10/8/2020 Normal f i. J E ChV >96
Grab Horn.Var. f F['
Composite(Duration) 24.0 24.0 24.0 NOEC 96 96 •
Hardness(mg/L) 48 54 52 LOEC >96 >96
Alkalinity(mg/L) 55 62 58 ChV >96 >96
onductivity(umhos/cm) 628 720 704 Method Steers Dunnett's
Chlorine(mg/L) <0.1 <0.1 <0.1
Temp.at Receipt(°C) 1.9 0.9 0.9 Stats Survival Growth
Conc. Critical Calculated Critical Calculated
Dilution H2O Batch# 1509 1510 38 10 17.5 2.41 0.6013
Hardness(mg/L) 46 44 48 10 18 2.41 0.3006
Alkalinity(mg/L) 32 29 76 10 18 2.41 1.3762
onductivity(umhos/cm) 170 157 86 10 18 2.41 1.1825
96 10 20 2.41 -0.4677
DWQ Form AT-5(1/04)

' Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 10/14/21
Facility: WINSTON SALEM - ELLEDGE WWTP NPDES#: NC0037834 Pipe#: 001 County: FORSYTH
Laboratory Performing Test: MERITECH LABS, INC.
e-7 Comments:
Signature of Opera r in Responsible Charge
1 j
X f/®�� "f_
Signatur'e�oof L. •or ry Supervisor * PASSED: -6.71% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t =
Tabular t =
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -6.71
% Mortality Avg.Reprod.
# Young Produced 22 22 23 25 25 25 25 22 23 25 24 22
0.00 23 .58
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 25.17
Treatment 2 Treatment 2
Effluent %: 76%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
5.847% PASS FAIL
## Young Produced 26 27 28 26 25 19 25 24 26 23 27 26 % control orgs X
producing 3rd
brood Check One
Adult (L)ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 10/06/21
Control 8.03 7.90 8.06 7.94 7.99 7.88 Collection (Start) Date
Sample 1: 10/04/21 Sample 2: 10/06/21
Treatment 2 7.32 8.18 7.78 8.40 7.86 7.93 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.0 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness (mg/1) 46
Control 7.98 7.22 7.64 7.60 8.57 7.29 I
Spec. Cond. (pmhos) 152 532 606 1
Treatment 2 8.32 7.40 7.88 7.88 8.60 7.16 I
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.2 1.0
(Mortality expressed as %, combining replicates) I
Note: Please
% o % % %
a % % Concentration Complete This
% %
Section Also
% % % % % % % % % % Mortality
start/end start/end
LC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit _
% -- % Spearman Karber _ Other High
Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Effluent Toxicity Report Form-Chronic Fathead Minnow Multi-Concentration Test Date:12/8/2021
Facility: Winston Salem-Elledge Creek NPDES#NC00 37834 Pipe#: 001 County: Forsyth
Laboratory: Meritech,Inc. �/ �7 Comments'
x /L(c..t /`Wf,.Y'w1-6?0e. Te L t,,,, �LOs.c....... 33 391-ticO
Res
pons'
Signature of Operato le Charge/ ail/Phone Number
x 2771 1
Signature of Laboratory Supervisor
MAIL ORIGINAL TO: Water Sciences Section
Aquatic Toxicoloby Branch
Division of Water Resources
1621 Mail Service Center
Raleigh,NC 27699-1621
Test Initiation Date/Time 11/30/2021 3:45 PM Avg Wt/Surv.Control 0.516 Test Organisms
%Eff. Repl. 1 2 3 4 [ Cultured In-House
Control Surviving# 9 10 10 9 %Survival 95.0 I_ Outside Supplier
Original# 10 10 10 10
Wt/original(mg) 0.466 0.430 0.585 0.479 Avg Wt(mg) 0.490 Hatch Date: 11/29/21
38 Surviving# 10 10 10 10 %Survival 100.0 Hatch Time: 4:00-5:00 pm
Original# 10 10 10 10
Wt/original(mg) 0.453 0.479 0.512 0.472 Avg Wt(mg) 0.479
48 Surviving# 10 9 9 9 %Survival 92.5
Original# 10 10 10 10
Wt/original(mg) 0.496 0.482 0.494 0.400 Avg Wt(mg) 0.468
76 Surviving# 9 10 10 8 %Survival 92.5
Original# 10 10 10 10
Wt/original(mg) 0.500 0.514 0.506 0.559 Avg Wt(mg) 0.520
86 Surviving# 9 10 10 10 %Survival 97.5
Original# 10 10 10 10
Wt/original(mg) 0.592 0.447 0.587 0.516 Avg Wt(mg) 0.536
96 Surviving# 9 10 10 10 %Survival 97.5
Original# 10 10 10 10 1
Wt/original(mg) 0.470 0.490 0.488 0.511 Avg Wt(mg) 0.490
Water Quality Data Day
Control 0 1 2 3 4 5 6 1
pH(SU)Init/Fin 7.53 / 7.74 7.89 / 7.61 7.83 / 7.77 7.90 / 7.67 7.87 / 7.90 7.94 / 7.61 7.88 / 7.63
DO(mg/L) Init/Fin 7.91 / 7.53 8.12 / 7.46 7.89 / 7.57 8.00 r 7.53 7.87 18.08 8.17 / 7.32 8.01 / 7.29
Temp(C)Init/Fin 24.9 125.0 24.8 / 25.5 25.8 / 25.2 24.9 124.6 24.5 / 24.9 24.8 / 24.6 24.4 / 25.4
High Concentration 0 1 2 3 4 5 6
pH(SU)!nit/Fin 7.97 / 7.74 7.37 17.64 7.34 / 7.90 7.60 / 7.92 7.41 / 8.05 7.93 / 7.68 7.52 17.71
DO(mg/L) Init/Fin 8.08 / 7.36 8.30 / 7.11 8.27 / 7.29 8.36 / 7.54 8.19 / 8.06 8.12 16.81 8.04 17.07
Temp(C)Init/Fin 25.1 / 24.6 25.0 / 25.3 25.6 124,6 25.1 / 24.9 25.0 125.2 25.1 / 25.0 25.6 124.6
Sample 1 2 3 Survival Growth Overall Result
Collection Start Date 11/29/2021 12/1/2021 12/2/2021 Normal Fl Fl ChV >96
Grab Horn.Var. ri rl
Composite(Duration) 24.0 24.0 24.0 NOEC 96 96
Hardness(mg/L) 56 54 50 LOEC >96 >96
Alkalinity(mg/L) 47 79 70 ChV >96 >96
Conductivity(umhos/cm) 528 551 545 Method Steel's Dunnett's
Chlorine(mg/L) <0.1 <0.1 <0.1
Temp.at Receipt(°C) 0.7 2.9 0.9 Stats Survival Growth
Conc. Critical Calculated Critical Calculated
Dilution H2O Batch# 1617 1618 1619 38 10 22 2.41 0.3365
Hardness(mg/L) 44 46 42 48 10 16 2.41 0.6730
Alkalinity(mg/L) 31 32 29 76 10 17 2.41 -0.9101
Conductivity(umhos/cm) 159 178 166 86 10 20 2.41 -1.3919
96 10 20 2.41 0.0076

Table F
Pretreatment Annual Report 2020

Winston-Salem/Forsyth County
Utilities
Water•Wastewater•Solid Waste
Wastewater Division,2799 Griffith Road,Winston-Salem,NC 27103
0:336-727-8000,F:336-659-4320, cityofws.org/utilities
February 22, 2021
Michael J. Montebello
Department of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
•
Dear Mr. Montebello
The City of Winston-Salem's Industrial Pretreatment Program is submitting its pretreatment annual report
for 2020. This submittal will comply with NPDES Permits NC0037834 and NC0050342 Part IV, Section
D (10). Enclosed are the following:
• Narrative
• Public Notice
• Pretreatment Program Summary(PPS)
• Significant Non-Compliance Report(SNCR)
• Sills In SNC Historical Report
• Industrial Data Summary Forms(IDSF)
• Allocation Tables for Permits NC0037834 and NC0050342
• SIU's Inspection Summary
Sincerely,
(.,1:1 ..-/....-.rsn.---"
Joel Freeman
Industrial Waste Control Supervisor
mmEmCity Council:Mayor Allen Joiner;Denise D.Adams,Mayor Pro Tempore,North Ward;Barbara Hanes Burke,Northeast Ward;Robert C.Clark,West Ward;
John C.Larson,South Ward;Jeff Macintosh,Northwest Ward;Kevin Mundy,Southwest Ward;Annette Scippio,East Ward;James Taylor,Jr.,Southeast Ward;
City Manager:Lee D.Garrity
County Commissioners:David R.Plyler,Chair;Don Martin,Vice Chair;Fleming El-Amin;Ted Kaplan;Richard V.Linville;Tonya McDaniel;Gloria D.Whisenhunt;
Call 311 or 336-727-8000 County Manager:Dudley Watts,Jr.
Winston-Salem/Forsyth County Utility Commission:Randall S.Tuttle,Chair;L.Wesley Curtis,Jr.,Vice Chair;Harold E.Day;Tom Griffin;Yvonne H.Hines;
citylink(q)cityofws.or0 Duane Long;Hugh W.Jernigan;Chris Parker;Donald R.Stewart;Charles Wilson;Allan Younger

Winston-Salem/Forsyth County
Utilities
Water•Wastewater•Solid Waste
2020 Annual Pretreatment Report
NPDES Permit Holder: City of Winston-Salem
Period Covered: January 1, 2020 to December 31, 2020
NPDES Permits: Archie Elledge WWTP NC0037834
Muddy Creek WWTP NC0050342
Sludge Permit: Class A—Thermal Dryer
Distribution and Marketing/Surface Disposal
WQ0029804
Person to contact concerning information contained in this report:
Joel Freeman
Utility Plant Supervisor/IWC
Winston-Salem/Forsyth County Utilities
2799 Griffith Road
Winston-Salem,NC 27107
[phone]
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.
The information submitted is,to the best of my knowledge, and belief,true,
accurate and complete based upon my inquiry of the person or persons who
manage the system, or those persons directly responsible for gathering the
information. I am aware that there are significant penalties for submitting false
information, including the possibility of assessment of fines and/or imprisonment
for knowing violations.
F A• t 4Z ..fie/
oel Freeman Date
1

NARRATIVE
GENERAL PROGRAM INFORMATION
Michael Gearren was hired as the new Chemist for the Pretreatment Program. His duties
are to monitor all Food Service Establishments for compliance.
GENERAL PERMIT INFORMATION
Winston-Salem/Forsyth County Utilities operates the Industrial Waste Control(IWC)
Pretreatment program under the guidance of Joel Freeman in compliance with 15A NCAC
02H.0908(f). [15ANCAC 02.0908(f); 40 CFR 403.12(o)]. In 2020 there were SIU permit
modifications. The program has 28 Significant Industrial Users with 10 of the users being
Categorical. All inspections and sampling were completed in 2020. All violations were
addressed to the industries. IWC continues to use LINKO as its server to track,monitor, and
log industrial data.
Renewals: There were no IUP renewals in 2020
New Permits: There were no new IUP issued in 2020
Modifications:
Permit Company Permit State Approval
Name Information Date
#1044 Clarios (Johnson Name change March 3, 2020
Controls)
#2001 Herbalife Nutrition Limits change August 25,2020
#3102 Lantal Textiles Limits change August 25,2020
#3051 Pepsi Limits change October 28,2020
#2010 Tex-Tech Coatings Name change March 4,2020
AUTHORIZATION TO CONSTRUCT
No authorization to constructs were issued in 2020
2

SPECIAL SIU COMMENTS
Industrial Waste Control is continuing to find ways to decrease BOD and silver in the SIU's.
SIGNIFICANT NON-COMPLIANCE (SNC)
Clarios#1044, 1/6 months for lead violations.
Suiza Dairy Group#1189, 1/6 months for BOD violations
Environmental Relief Technology,#3054, 1/6 months pH violations
Environmental Relief Technology,#3054, 2/6 months pH violations
Progress Rail, #1038, 2/6 months Zinc violations
***Public notice enclosed.
SIGNIFICANT INDUSTRIAL USER INFORMATION
The following S1U had a change in Authorized Representative for report monitoring and
Submittal
• Ardagh#3010
• Bekaert#2018
• Clarios#1044
• Grass America#2103
• Sonoco Display&Packaging#1042
• Suiza Dairy Group#1189
• UniFirst#2015
3

PUBLIC NOTICE
Winston-Salem/Forsyth County Util-
ities, in accordance.with Federal and
State regulations, is hereby giving
public notice of industrial user sig-
nificant non-compliance with pre-
treatment regulations. Listed below
are the industrial users that were in
significant non-compliance with fed-
eral pretreatment regulations (40
CFR Part 403), state pretreatment
regulations (15NCAC 2H .0900),
and/or local pretreatment regula-
tions at any time during the calendar
year 2020.
Clarios, IUP#1044 was in significant
non-compliance for Lead violations
for the period of January through
June of 2020. Clarios returned to
compliance during the reporting pe-
riod of June through December of
2020. Suiza Dairy Group, IUP#1189
was in significant non-compliance
for Biochemical Oxygen Demand vio-
lations for period of January through
June of 2020. Suiza Dairy Group re-
turned to compliance during the re-
porting period of June through De-
cember of 2020. Environmental Re-
lief Technology, IUP#3054 was in
significant non-compliance for pH vi-
olations for the period of January
through June of 2020. Environmental
Relief Technology, IUP#3054 was in
significant non-compliance for pH vi-
olations for the period of July
through December of 2020. Progress
Rail, IUP#1038 was in significant
non-compliance for Zinc violations
for the period of July through De-
cember of 2020.
WSJ: February 3,2021,

. ..................... ..
Notice
Details for Notice
17 hrs ago
PUBLIC NOTICE Winston-Salem/Forsyth County Utilities, in accordance with Federal and State
regulations, is hereby giving public notice of industrial user significant non-compliance with
pretreatment regulations. Listed below are the industrial users that were in significant non-compliance
with federal pretreatment regulations (40 CFR Part 403), state pretreatment regulations (15NCAC
2H .0900), and/or local pretreatment regulations at any time during the calendar year 2020. Clarios,
IUP#1044 was in significant non-compliance for Lead violations for the period of January through June
of 2020. Clarios returned to compliance during the reporting period of June through December of 2020.
Suiza Dairy Group, lUP#1189 was in significant non-compliance for Biochemical Oxygen Demand
violations for period of January through June of 2020. Suiza Dairy Group returned to compliance during
the reporting period of June through December of 2020. Environmental Relief Technology, IUP#3054
was in significant non-compliance for pH violations for the period of January through June of 2020.
Environmental Relief Technology, IUP#3054 was in significant non-compliance for pH violations for the
period of July through December of 2020. Progress Rail, IUP#1038 was in significant non-compliance for
Zinc violations for the period of July through December of 2020. WSJ: February 3, 2021.
.. .. ............................_....
. ..........................

Chapter 9, PAR Guidance
Pretreatment Performance Summary (PPS)
1. Pretreatment Town Name: City of Winston-Salen
2. "Primary" NPDES Number NCO() 37834
or Non Discharge Permit# if applicable=>
3. PAR Begin Date, please enter 01/01/yyyy 3.=> 1/1/2020
4. PAR End Date, please enter 12/31/yyyy 4.=> 12/31/2020
5. Total number of SIUs, includes CIUs 5.=> 19
6. Number of CIUs 6.> 8
•
7. Number of SIUs with no IUP, or with an expired IUP 7.=> 0
8. Number of SIUs not inspected by POTW 8.=> 0
9. Number of SIUs not sampled by POTW 9.=> 0
10. Number of SIUs in SNC due to IUP Limit violations 10.=> 4
11. Number of SIUs in SNC due to Reporting violations 11._> 0
12. Number of SIUs in SNC due to violation of a Compliance Schedule,CO,AO or similar 12.=> 0
13. Number of CIUs in SNC 13.=> 2
14. Number of SIUs included in Public Notice 14.=> 4
15 Total number of SIUs on a compliance schedule, CO, AO or similar 15.=> 0
16. Number of NOVs,NNCs or similar assesed to SIUs 16._> 161
17. Number of Civil Penalties assessed to SIUs 17.=> 8
18. Number of Criminal Penalties assessed to SIUs 18.=> 0
19. Total Amount of Civil Penalties Collected 19.=> $ 38,500
20. Number of IUs from which penalties collected 20.-> 2
Foot Notes: AO Administrative Order IUP Industrial User Pretreatment Permit POTW Publicly Owned Treatment Works
CIU Categorical Industrial User NNC Notice of Non-Compliance SIU Significant Industrial User
CO Consent Order NOV Notice of Violation SNC Significant Non-Compliance
IU Industrial User PAR Pretreatment Annual Report
revised 1/2018: PAR PPS 2018
L - -

Chapter 9, PAR Guidance
Pretreatment Performance Summary (PPS)
1. Pretreatment Town Name: City of Winston-Salen
2. "Primary" NPDES Number NC00 50342
or Non Discharge Permit# if applicable=>
3. PAR Begin Date,please enter 01/01/yyyy 3.=> 1/1/2020
4. PAR End Date, please enter 12/3 l/yyyy 4.=> 12/31/2020
5. Total number of SIUs, includes CIUs 5.=> 9
6. Number of CIUs 6.=> 2
7. Number of SIUs with no IUP, or with an expired IUP 7._> 0
8. Number of SIUs not inspected by POTW g.=> 0
9. Number of SIUs not sampled by POTW 9._> 0
10. Number of SIUs in SNC due to IUP Limit violations 10._> 0
11. Number of SIUs in SNC due to Reporting violations 11._> 0
12. Number of SIUs in SNC due to violation of a Compliance Schedule,CO,AO or similar 12.=> 0
13. Number of CIUs in SNC 13._> 0
14. Number of SIUs included in Public Notice 14.=> 0
15 Total number of SIUs on a compliance schedule, CO,AO or similar 15._> 0
16. Number of NOVs,NNCs or similar assesed to STUB 16._> 13
17. Number of Civil Penalties assessed to SIUs 17.=> 0
18. Number of Criminal Penalties assessed to SIUs 18.=> 0
19. Total Amount of Civil Penalties Collected I9._> $ 0
20. Number of IUs from which penalties collected 20.=> 0
Foot Notes: AO Administrative Order IUP Industrial User Pretreatment Permit POTW Publicly Owned Treatment Works
CIU Categorical Industrial User NNC Notice of Non-Compliance SIU Significant Industrial User
CO Consent Order NOV Notice of Violation SNC Significant Non-Compliance
IU Industrial User PAR Pretreatment Annual Report
revised 1/2018: PAR PPS_2018

Pretreatment Annual Report (PAR) PAR covers this calendar year=> 2020
Significant Non-Compliance Report Control Authority=Program=Town Name => City of Winston-Salem
WWTP=Wastewater Treatment Plant, use separate form for each WWTP. WWTP Name => Muddy Creek
SILT= Significant Industrial User NPDES # _> NC0050342
SNC = Significant Non-Compliance
A SNCR Form must be submitted with every PAR, please write "None " if you had No SIUs in SNC during calendar year
SNC ? (Yes /No )
IUP Pipe Industry Name Parameter for each 6-month period.
# # or "Reporting" Jan. -June July- Dec.
None
Attach a copy of the Division's "SIUs in SNC Historical Report" for your POTW's SIUs behind this page .
Is the database correct ? Notify the Division of any errors ! Database indicates SNC history for previous years.
EVERY SNC MUST be explained in the Narrative, How was, is, or will it be resolved?
REPEAT SNCs axe serious matters that MUST be explained in the Narrative.
Form name: PA.R,SNCR,2401
Date Revised: 1/4/2001

Pretreatment Annual Report (PAR) PAR covers this calendar year=> 2020
Significant Non-Compliance Report Control Authority=Program=TownName => City of Winston-Salem
WWTP =Wastewater Treatment Plant,use separate form for each WWTP. WWTP Name => Archie Elledge
SIU= Significant Industrial User NPDES # => NC0037834
SNC = Significant Non-Compliance
A SNCR Form must be submitted with every PAR, please write "None" if you had No SIUs in SNC during calendar year
SNC ? (Yes/No )
IUP Pipe Industry Name Parameter for each 6-month period.
# # or "Reporting" Jan. -June July- Dec.
1044 1 Clarios Zinc yes no
1189 1 Suiza Dairy BOD yes no
3 054 1 ERT pH yes yes
1038 1 Prgress Rail Zinc no yes
Attach a copy of the Division's "SIUs in SNC Historical Report" for your POTW's SIUs behind this page .
Is the database correct? Notify the Division of any errors ! Database indicates SNC history for previous years.
EVERY SNC MUST be explained in the Narrative, How was, is, or will it be resolved?
REPEAT SNCs are serious matters that MUST be explained in the Narrative.
Form name: PAR,SNCR,2001
Date Revised: 1/4/2001

[St11
IIVV REPORT
Winston-Salem
2013 2014 2015 2016 2017 2018 2019
1st half I 2nd half 1st half[2nd half 1st half 1 2nd half 1st half I 2nd half 1st half I 2nd half 1st half I 2nd half 1st half[2nd half
Sonoco Display& Packaging PreviousNames: Sonoco CorrFlex,LLC
IUP# 1042 Pipe# 01 CorrFlex Display SIU Word Description:
Chesapeak Display&Pack. paper,corrugated displays,packaging
IUP Status:Active
Reporting I I XI I I I I
Grass America Inc. PreviousNames:
IUP# 2103 Pipe# 01 SlU Word Description:
metals
IUP Status:Active
Cyanide I I I IX I I I
Tex-Tech Coatings PreviousNames: Highland industries Inc.
IUP# 2010 Pipe# 01 SIU Word Description:
textile
IUP Status:Active
EPA 624 IX I IX I I I I
HOH Corporation PreviousNames:
IUP# 1998 Pipe# 01 SIU Word Description:
CWr-ww/sludge trtrnt
lUP Status:Active
Arsenic I . I I XI I I I
Titanium I I I XIX I I XI
Vanadium I I I I I I XI
Zinc I I I IX I I XI
Clarios PreviousNames: Johnson Controls Battery Group •
IUP# 1044 Pipe# 01 SIU Word Description:
metals,battery-461.34C
IUP Status:Active
Lead IX I I I I l I
An'X'in a semi-annual period indicates snc for the period for the respective parameter.
This information is compiled from manysources,and has not been verified. PAGE 77
PRINTED ON:12/16/2020 p
Contact the local pretreatment coordinator or state pretreatment staff if errors are noted.

htstarkg
REPORT
Stratford Metal Finishing PreviousNames:
IUP# 1152 Pipe* 01 SIU word Description:
metals,Job Electroplating shop
IUP Status:Active
Cyanide I I I I I I XI
•
An'X'in a semi-annual period indicates snc for the period for the respective parameter.
PRINTED ON:12/16/2020 This information is compiled from many sources,and has not been verified. PAGE 78
Contact the local pretreatment coordinator or state pretreatment staff if errors are noted.

ateat out P)rog an Info Djatai ase printed on: 12/22/2020
for Program Name Winston-Salem / Stream Information IWc%at 7010 75.59
WWTP Name Archie Elledge
Program Approval Date 06/15/1983 7Q10 Flow cfs/mgd 15 / 9.69
1Q10 Flow cfs/mgd 12.41 / 8.02
Pretreatment Status
Full Stream Classification C
Region WSRO Basin Number YADO4
County Forsyth ... Receiving Stream Name SALEM CREEK J
NPDES Number NC0037834
Last PAR Rec 02/24/2020 PAR Due Date 03/01/2021 mercury
NPDES Effective Date 08/01/2017 1631
NPDES Expire Date Current Fiscal 06/14/2019 required
P 06/30/2022 Year PCI Done
POTW is Primary WWTP
TRUE Last Audit on 05/09/2018 Audit Year Next22/23 yes
Design Flow mgd 30.0000 %Design mgd is SIU permitted 9.92 Permitted SIU flow(mgd)[Pt_SIU) 2.975
WWTP SIU's 20 Program Sills 28 .�.—
WWTP CIU'S 8 Program CIUs 10 HWA LTMP IWS SUO ERP
date Inactive Date Next Due 110/01/2022 1 I 07/01/2021 I
Date Received by DWR 110/02/2017 112/20/2018 j [ 07/01/2016 I 01/13/2012 01/13/2020
Date Approved 1 02/28/2018 1 I 03/05/2019 1109/02/2016 I 02/09/2012 02/05/2020
Adopt Date Required
Date Adopted 11/14/2011
Info in this Box from Pt Contacts Date Date Date
PT_Pro Attended Attended Attended
Formal Name g.Prime Phenol ext Fax HWA Wksp IUP Wksp PAR Wksp
Mr.Joel Freeman 'Prim 11(336)-397-7621 1336-659-4320 II 1/30/2008 16/11/2012 11/24/2012
[e-mail] Industrial Waste Control Supervisor Manson Meads
Complex 27103
Mr.Olu Browne I 11(336)-397-7621 1 1336-659-4320 II I I I
[e-mail] Senior Chemist 2799 Griffith Road 27103
Mr.Michael Gearren I 11(336)-397-7620 I 1336-659-4320 II I I I
[e-mail] Chemist Manson Meads Complex 27103
Pretreatment Related NOVs from DWQ DWR Central Office Contact Monti Hassan
DWR Regional Contact Jim Gonsiewski

Pretreatment Program Iff f Dilaataba$e printed on: 12/22/2020
for Program Name Winston-Salem IWC%at 7Q10 5.54
W.NTP Name Muddy Creek Stream information
7Q10 Flow cfs/mgd 554 1357.88
Program Approval Date 06/15/1983 446.82 / 288.78
1Q10 Flow cfs/mgd
Pretreatment Status Full Stream Classification WS-IV
Region WSRO Basin Number YADO4
County Forsyth Receiving Stream Name YADKIN RIVER
NPDES Number NC0050342
Last PAR Rec 02/24/2020 PAR Due Date 03/01/2021 mercury
NPDES Effective Date 09/01/2017 1631
Current Fiscal 06/14/2019 required
NPDES Expire Date 06/30/2022 Year PCI Done
POT is Primary WTP
FALSE Last Audit on 05/09/2018 Audit Year Next22/23 Yes
W W
Design Flow mgd 21.0000 %Design mgd is SIU permitted I 10.08 Permitted SIU flow(mgd)[Pt_SIU) 2.116
WWTP SIU's 8 Program Sills 28
WWTP CIU's 2 Program CIUs 10 HWA LTMP IWS SUO ERP
date Inactive Date Next Due j 10/01/2022 i I 1107/01/2021
Date Received by DWR 10/02/2017 12/20/2018 1 ( 07/01/2016 01/13/2012 01/13/2020
Date Approved 102/28/2018 03/05/2019 j 109/02/2016 j 02/09/2012 02/05/2020
Adopt Date Required
Date Adopted 11/14/2011
Info in this Box from Pt Contacts Date Date Date
PT_Pro Attended Attended Attended
Formal Name g.Prime Phonel ext Fax HWA Wksp IUP Wksp PAR Wksp
Mr.Joel Freeman (Prim II(336)-397-7621 il 1336-659-4320 II 1/30/2008 ( 6/11/2012 ( 1/24/2012 I
Industrial rial Waste Control Supervisor Manson Meads Complex 27103
Mr.Olu Browne I II(336)-397-7621 1 1336-659-4320 II I I
[e-mail] Senior Chemist 2799 Griffith Road 27103
Mr.Michael Gearren I II(336)-397-7620 I 1336-659-4320 II I I
[e-mail] Chemist Manson Meads Complex 27103
Pretreatment Related NOVs from DWQ DWR Central Office Contact Monti Hassan
DWR Regional Contact Jim Gonsiewski
i

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Adele Knits
Use separate forms for each industry/pipe DTP Name=> Archie�;1ledge IUP# 2020
Enter BDL values as < (value) NPDES#=> NC;UU37834 Pipe# 1
1st 6 months, dates=> 1/1/2020 6/30/2020
2nd 6 months, dates=> 7/1/2020 12/31/2020
:Flow, mgd tsOD iIsb Ammonia
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months -2nd 6 months
Total#of samples=> 6 6 7 6 8 6 2 2
* Maximum (mg/1)_>
*- or Maximum (lb/d)_>
* or_6 Average(mg/1)_> 0.0863 0.0944 182 171 18 21 3.3 6
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic ' Cadmium 'Chromium COD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 1 2nd 6 months
Total#of samples=> 2 2 2 2 2 2
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or Average(mg/1)=> <0.01 <0.01 <0.002 <0.002 <0.036 0.203 N/A N/A
* or Average Loading(Ib/d)_> .
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A
Copper er Cyanide anide - Lead - Mercury 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months -
2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 2 3 2 2 2 2 2
* Maximum (mg/I)_>
* or Maximum (1b/d)_>
* or Average(mg/1)_> 0.008 0.0055 <0.0185 0.34 <0.046 <0.006 0.0000266 <0.0002
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these 1UP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PAR02QEdhehs e\Gis.iidefi aftt ,tsl�ct B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Adele Knits
Industrial Data Summary Form (1DSF) 1TJP# 2020
Use separate forms for each industry/pipe Pipe# 1
picket belenlum �llver Lane
1st1st 6 months tnd 6 months 1st 6 months 2nd 6 months lst 6 months 12nd.b months 1st.6 months 2nd 6 months
Total#of samples=> 2 2 2 2 2 2 2 2
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/I)_> <0.01 <0.01 <0.01 <0.01 <0.005 <0.005 0.2485 0.2135
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33%)_> N/A N/A N/A N/A N/A N/A N/A N/A
p11 Total Phosphorus1 l li tN k+'luorlre
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st T months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 8 6 2 2 2 2
* Maximum=> 9.2 8.7
* or Minimum=>
* or Average(mg/I)=> 0.398 0.69 7.47 20 N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A
Manganese Molybdenum
1st 6 months 2nd 6 months 1st 6 months'2nd 6 months 1st 6 months 12nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 2 2 2
* Maximum (mg/1)=>
* or Maximum (Ib/d)=>
* or Average(mg/I)_> 0.0075 0.01 <0.005 <0.005
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)=> 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A
BM—>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these TUP=>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PAllotf@$dhahsitelCfsiix ellaff afli $tslecl iB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each RIP pipe-Page 7 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF), Town Name=> City of Winston-Salem Name Ardagh
Use separate forms for each industry/pipe WWTP Name=> Archie Elledge IUP# 3010
Enter BDL values as < (value) NPDES#=> NC 0037834 Pipe# 1
1st 6 months, dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
1 r tow, mgci JiUJ) i S Ammonia
1st b months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st b months 2nd b months
Total#of samples=> 6 6 4 4 2
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* • or_6 Average(mg/1)=> 0.1427 0.117 N/A 140 N/A 71 N/A <0.286
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic Cadmium Chromium CUD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months I st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 10 6 10 6 16 12
* Maximum (mg/1)=>
* or Maximum (1b/d)_>
* or Average(mg/1)=> <1.45 <0.01 <0.002 <0.002 <0.0091 <0.0062 N/A N/A
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper - Cyanide Lead Mercury
1st 6 months 2nd 6 months 1st 6 months "2nd 6 months 1st 6 months 2nd 6 months 1st 6 months-2nd 6 months
Total#of samples=> 16 12 5 2 10 6 4
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.0148 0.0129 <0.005 <0.005 <0.01 <0.01 N/A <0.0002
* or Average Loading(1b/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these TIP=>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PABoi111)>fisdEs eNraibde¢ a¢t *ct 1B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Ardagh
Industrial Data Summary Form (IDSF) IUp# 3010
Use separate forms for each industry/pipe Pipe# 1
rIf 1CKel belenium - -bllver Line
1st 6 months 2nd 6 months 1st b months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 10 6 10 6 10 6 16 12
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/I)_> 0.0336 0.0182 <0.0117 <0.013 <0.005 <0.005 0.0779 0.0372
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A N/A
pH 1 I luoride Manganese l otal Phosphorus
1st 6 months I 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 15 11 9 7 16 12 6 8
* Maximum=> 9.7 10
* or Minimum=>
* or Average(mg/I)_> 13.7 16 0.172 0.0622 0.0925 <0.0644
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
Molybdenum U & ((Hexane) U & (Hydro C'arb Ik.N
1st 6 months'2nd 6 months'1st 6 months- 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 10 6 10 10 2
* Maximum (mg/1)=>
* or Maximum (Ib/d)_>
* or Average(mg/1)_> 0.0199 0.0202 N/A N/A <5.0 <5.0 N/A 8.7
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>—66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these ICTP=>Industrial User Permit lb/d>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL.1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PAPog misi3eNCiinbdEli hafthgats1�ct9IB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each RIP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Bekaert
Use separate forms for each industry/pipe WWTP Name=> Archie Elledge IUP# 2018
Enter BDL values as < (value) NPDES#—> NC;UU i"/i334 Pipe# I
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
r iow, mgd DUD -1 Ammonia
1st 6 months 2nd 6 months 1st 6 months 7inc(6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 8 6 8 6 1
* Maximum (mg/1)_>
* or Maximum (Ib/d)_>
* or 6_Average(mg/1)_> 0.0101 0.0149 955 869 334 751 N/A 94
* or Average Loading(1b/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A . N/A N/A
Arsenic Cadmium Chromium COD
1st 6 months 2nd 6 months 1st 6 months 2na 6 months. 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 8 6 8 6 8 6
* Maximum (mg/1)_>
* or Maximum (Ib/d)_>
* or Average(mg/1)=> <0.01 <0.01 <0.002 <0.002 <0.005 <0.0067 N/A N/A .
* or Average Loading(1b/d)=>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A
Copper Cyanide Lead 1Vlercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months - 2nd 6 months 1st 6 months '2nd 6 months
Total#of samples=> 8 6 1 8 6 3
* Maximum (mg/1)_>
* or Maximum (1b/d)=> ,
* or Average(mg/1)_> 0.1371 0.111 N/A 0.01 <0.01 <0.01 N/A <0.0002
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33%)=> N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PA>Pontl> exile iaieli2tlhafttesatslyct$B4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page . 1 of 7

Pretreatment Annual Report (PAR) Industry Name Bekaert
Industrial Data Summary Form (1DSF) 1UP# 2018
Use separate forms for each industry/pipe Pipe# 1
'Nickel {,eienium -diver vane
1st 6 months 2nd b months 1st 6 months '2nd 6 months 1st 6 months 2nd 6 months st 6 months -2nd 6 months
Total#of samples=> 8 3 8 3 8 3 8 6
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)=> <0.01 <0.010 <0.01 <0.01 <0.005 <0.005 1.153 1.470
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH Monde -lvlanganese Molybdenum
1st 6 months 2nd 6 months 1st 6 months '2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 8 6 8 6 8 6
* Maximum=> 7.2 7.5
* or Minimum=>
* or Average(mg/1)_> N/A N/A 0.0363 0.0768 <0.005 <0.005
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 . . 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
Total.I' osphorus 11Sd'
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months- 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1
* Maximum (mg/1)=> ,
* or Maximum (Ib/d)_>
* or Average(mg/1)_> N/A 68 N/A 113
* or Average Loading(1b/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
"` POTW must enter at least one of these '1UP=>Industrial User Permit lb/d=>pounds per day
four rows, PIease indicate bow averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP—>wastewater treatment plant
Chapter: PAR Guidance File name: PPIP r S 1 ileN isiide¢etha¢test& slycili iB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Clarios
WWTP Name=> Archie Eliedge IUP# 1044
Use separate forms for each industry/pipe
EnterNPDES#_> NC;UU37834 Pipe# 1
BDL values as< (value)
1st 6 months, dates=> 1/1/2020 6/3 0/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
11+low, mgd 15VI) 1 'Ammonia
i st 6 months 2nd 6 months 1st 6 months 2nd b months 1st 6 months 2nd 6 months 1st 6 months `2nd 6 months
Total#of samples=> 6 6 2 2 1
* Maximum (mg/1)=>
* or Maximum (1b/d)_>
* or 6_Average(mg/1)_> 0.0378 0.0085 N/A 41 N/A 6.0 N/A 4.4
* or Average Loading(lb/d)=> •
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic Cadmium Chromium CUD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 16 6 16 6 16 6 N/A N/A
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.01 <0.01 <0.002 <0.002 <0.005 <0.005
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33%)=> N/A N/A N/A N/A N/A N/A
I Copper Cyanide I Lead Mercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 55 17 1 55 • 17 3
* Maximum (mg/I)=>
* or Maximum (1b/d)_>
* or Average(mg/1)_> <0.0058 <0.005 N/A <0.005 1.5043 0.3201 N/A <0.0002
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 76 N/A 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A 71 N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PARTBiliallirnizsitelifeiiid20AlthafttigattaRkill3,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1. of 2

Pretreatment Annual Report (PAR) Industry Name Clarios
Industrial Data Summary Form (IDSF) IUP# 1044
Use separate forms for each industry/pipe Pipe# 1
INIcKei eienium 1 Silver - L1nC
1st 6 months btnd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months '2nd 6 months
Total#of samples=> 16 6 16 6 16 6 16 6
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/I)_> <0.01 <0.01 <0.01 <0.01 <0.005 <0.005 <0.01 <0.01
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33%)=> N/A N/A N/A N/A N/A N/A N/A N/A
PH hluoride lvlanganese I otal Phosphorus
1st 6 months 2nd 6 months J 1st 6 months 2nd 6 months 1st 6 months .2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 195 188 16 6 1
* Maximum=> 8.8 8.5
* or Minimum=>
* or Average(mg/1)_> N/A N/A <0.005 <0.005 N/A 0.069
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)=> 0 0 0 • 0 0 0
%TRC violations,(SNC is>=33%)_> N/A N/A N/A N/A N/A N/A N/A
Molybdenum 'I KIN
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months' 1st 6 months 2nd 6 months
Total#of samples=> 16 6 1
* Maximum (mg/1)=>
* or Maximum. (lb/d)=>
* or Average(mg/1)=> <0.005 <0.005 N/A 24.0
* or Average Loading(Ib/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0
%TRC violations, (SNC is>=33 %)=> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per Iiter
* POTW must enter at least one of these RIP—>Industrial User Permit ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>miIlion gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PPCRodiMfheie;Keeii } aftt s'gci B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Crothall
Use separate forms for each industry/pipe WWTP Name=> Muddy Creek IUP# 3100
Enter BDL values as < (value) NPDES#=> NC0050342 Pipe# 1
1st 6 months, dates=> 1/1/2020 6/30/2020
2nd 6 months, dates=> 7/1/2020 12/31/2020
1+low, mga ism) 1 -Ammonia
1st 6 months 2nd 6 months i st b months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 4 6 4 6 1
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or_6 Average(mg/I)_> 0.0102 0.0143 145 140 33 27 N/A <0.5
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic Cadmium Chromium COD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 1 1 1
* Maximum (mg/1)_>
* or Maximum (1b/d)=>
* or Average(mg/1)_> <0.01 <0.01 <0.002 <0.002 <0.005 <0.005 N/A N/A
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A • N/A
Copper Cyanide Lead Mercury
1st 6 months 2nd 6 months 1st 6 months 2nci 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 1 1 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/1)_> 0.006 0.008 <0.005 <0.005 <0.01 <0.01 <0.0002 <0.0002
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A
BDL=>BeIow Detection Limit mg/1=>milIigrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PliPorTigelluthsitieldeibledallhalitga,tscliifi413,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

•
Pretreatment Annual Report (PAR) Industry Name Crothall
Industrial Data Summary Form (1DSF) IUP# 3100
Use separate forms for each industry/pipe Pipe# I
'1r1CKe1 �eienium `Jfiver IL1i1C
L 1st 6 months nd 6 months 1st 6 months .2nd 6 months 1st 6 months I2nd 6 months Ir 1st b months '.2nd 6 months
Total#of samples=> 1 1 1 1 1 1 1 1
* Maximum (mg/I)_>
* or Maximum (lb/d)=>
* or Average(mg/1)_> <0.01 <0.01 <0.0I <0.01 <0.085 <0.005 0.241 0.216
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH Ji luoru!e Nlolybuenum 1"otla Phosphorus
1st 6 months 2nd 6 months 1st 6 months -2nd 6 months 1st 6 months-2nd 6 months) 1st 6 months 2nd 6 months
Total#of samples=> 4 6 1 1 1 1
* Maximum=> 10.4 10.4
* or Minimum=>
* or Average(mg/1)_> N/A N/A <0.005 0.011 5.13 0.63
* or Average Loading(Ib/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
1'.K.N -Manganese
f 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 I
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> N/A 4 <0.005 <0.005
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per Iiter
* POTW must enter at least one of these TOP=>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>miIIion gallons per day
Avg period could be month,Qtr,or s-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: P?IPodl3S ,ddaslite idie4 t iaptzgl$#* B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each TOP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Deere-Hitachi
Use separate forms for each industry/pipe 'TP Name=> Archie Elledge lUP# 2014
Enter BDL values as < (value) NPDES#_> NC 0037834 Pipe# I
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
t low, mga -BUD I !Ammonia
1st 6 months 2nd 6 months 1st 6 months Ind 6 months 1st 6 months '2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> _ 6 6 1 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/1)_> 0.0024 0.0028 N/A 694 N/A 12 <0.1 <0.1
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic ! Cadmium Chromium CUD
1st 6 months 2nd 6 months 1st 6 months J 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 8 3 10 8 13 N/A N/A
* Maximum (mg/I)_>
* or Maximum (lb/d)=>
* or Average(mg/1)_> <0.01 <0.0590 <0.002 <0.0076 0.0655 0.061
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33%)=> N/A N/A N/A N/A N/A N/A
Copper Cyanide - Lead - 1Vlercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2na 6 months
Total#of samples=> 8 14 3 7 3 9 2
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or Average(mg/1)_> 0.0418 0.0308 <0.005 <0.005 <0.0075 <0.0069 N/A <0.0002
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33%)_> N/A N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PRPodipEattisiteVadixledafifialktegLattctIN4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 9

•
Pretreatment Annual Report (PAR) Industry Name Deere-Hitachi
Industrial Data Summary Form (IDSF) IUP# 2014
Use separate forms for each industry/pipe Pipe# 1
r1sitcneilu ��-setenm 1 nver Line
t 6 months 2nd 6 months 1st 6 months 2nd 6 months I st 6 months 2nd 6 months 1st 6 months lnd 6 months
Total#of samples=> 8 14 2 8 3 9 8 14 V
* Maximum (mg/I)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.0388 <0.0095 <0.01 <0.01 <0.005 <0.005 0.0433 <0.025
* or Average Loading(1b/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33%)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH Monde -Manganese Total Phosphorus I
1st 6 months 2nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 8 15 1 2 8 1 1
* Maximum=> 8.58 8.7
* or Minimum=>
* or Average(mg/I)_> 0.92 N/A 0.194 0.1060 2990 3,660.000
* or Average Loading(1b/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A• N/A N/A N/A N/A N/A
Molybdenum IKN
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months l 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 7 1 1
* Maximum (mg/1)=>
* .or Maximum (Ib/d)_> ,
* or Average(mg/1)=> 0.036 0.0423 6.53 14.2
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these 1UP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: Pf z eisitelGkiate¢ a¢t slycl B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 7 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Deere-Hitachi
WWTP Name=> Archie Elledge IUP# 2014
Use separate forms for each industry/pipe NPDES#_> NC0037834 Pipe# 2
Enter BDL values as < (value) 1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
IMow, mga BUD 1 Ammonia
1st 6 months 2nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months -2nd 6 months
Total#of samples=> N/A N/A N/A N/A N/A N/A N/A N/A
* Maximum (mg/I)_>
* or Maximum (Ib/d)_> _
* or Average(mg/1)=>
* or Average Loading(1b/d)=>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic - Cadmium- Chromium' COD -
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=>
* Maximum (mg/I)=>
* or Maximum (lb/d)=>
* or Average(mg/1)=> N/A N/A N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)=> .N/A N/A N/A N/A N/A N/A
1 Copper Cyanide Lead 11Vlercury
1st 6 months 2nd 6 months f st 6 montTas-2nd 6 months 1st 6 months 2nd 6 months 1st 6 months ' 2nd 6 months
Total#of samples=>
• * Maximum (mg/1)=>
* or Maximum (Ib/d)_>
* or Average(mg/1)=> N/A N/A N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)=> ,
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
Vo TRC violations, (SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/l=>milligrams per Iiter
* POTW must enter at least one of these IUP=>Industrial User Permit Ibid=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr.or 6-month&if BDL,1/2BDL,or zero values used. TRC—>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PARoiffiallidEsElieIlltdidrclailhafttegalsctRikilB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Deere-Hitachi
Industrial Data Summary Form (IDSF) TUP# 2014
Use separate forms for each industry/pipe Pipe# 2
nicKei Selenium Sliver Line
I st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=>
* Maximum (mg/1)=>
* or Maximum (Ib/d)_>
* or Average(ing/1)_> N/A N/A N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A •
pH .Fluoride Manganese l otal Phosphorus
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=>
* Maximum=> N/A N/A
* or Minimum=>
* or Average(mg/1)_> N/A N/A N/A N/A N/A. N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
Molybdenum "1'KINl
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=>
* Maximum (mg/1)_>
* or Maximum (Ib/d)_> _
* or Average(mg/1)_> N/A N/A N/A N/A
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0
%TRC violations, (SNC is>=33%)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these . IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr.or 6-month&if BDL,I/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PA oifliAliedesRelti'sitde¢ahaftt #slyctii9r3B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 7

Pretreatment Annual Report (PAR) Control Authority, Industry
Town Name=> City of Winston-Salem Name Environmental Relief Tech
Industrial Data Summary Form (IDSF)
WWTP Name=> Archie Elledge IUP# 3054
Use separate forms for each industry/pipe
NPDES#=>NCUU37834 Pipe# 1
Enter BDL values as < (value)
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months, dates=> 7/1/2020 12/31/2020
i+low, mgui -BUD -I Ammonia
1st b months 2nd 6 months 1st 6 months 2nd 6 months 1st b months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 - 6 12 11 14 11
* Maximum (mg/I)=>
* or Maximum (1b/d)_>
* or6 Average(mg/1)=> 0.0157 0.019 4608 3,123 646 507 N/A N/A
* or Average Loading(Ib/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A • N/A N/A N/A N/A N/A N/A
Arsenic " Cadmium Chromium COD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=>
* Maximum (mg/1)_> _
* or Maximum (Ib/d)_>
* or Average(mg/I)_> N/A N/A N/A N/A N/A N/A N/A N/A
* or Average Loading(1b/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper - Cyanide - Lead - Mercury
1st 6 months 2nd 6 months 1st 6 months end 6 months 1st 6 months -2nd 6 months 1st 6 months -2nd 6 months
Total#of samples=>
* Maximum (mg/I)=>
* or Maximum (1b/d)_>
* or Average(mg/1)_> N/A N/A N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per Iiter
* POTW must enter at least one of these IUP=>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: P?PorBpSihmisRe‘Gaib a is t tcli B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) industry Name Environmental Relief Technology
Industrial Data Summary Form (IDSF) luP# 3054
Use separate forms for each industry/pipe Pipe# 1
V1cKe1 16eienlum - -�ll>lver I L1RC
1st 6 months 2nd 6 months 1st 6 months 2nd b months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months J{
Total#of samples=>
* Maximum (mg/1)_>
* or Maximum (Ib/d)_>
* or Average(mg/1)=> N/A N/A N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH Jiluorlde &Ply'bdenum l'otla Phosphorus
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months I 2nd 6 months- 1st 6 months 2nd 6 months
Total#of samples=> 62 23
* Maximum=> 12.06 12.6
* or Minimum=>
* or Average(mg/1)_> N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 70 72 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A
[KIN Manganese ltats,O11 ZSi Urease
• 1st 6 months 2nd 6 months- 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 16 14
* Maximum (mg/1)=>
* or Maximum (Ib/d)=>
* or Average(mg/1)=> N/A N/A N/A N/A 163 67
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL, 1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: P,N3?oahf dsRelaiah,¢a aOta sl ct 1B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 9

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (1DSF) Town Name=> City of Winston-Salem Name Grass
Use separate forms for each industry/pipe WWTP Name=> Archie Elledge IUP# 2103
EnterNPDES#_> NC:UU37x34 Pipe# 1
BDL values as< (value)
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
Iti IOW, mga 11iU13 1�1 Ammonia
1st b months lnd b months 1st b months -2nd b months 1st b months 2nd.b months 1st b months lnd 6 months
Total#of samples=> 1
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or_6 Average(mg/1)_> 0.0025 N/A N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
IArsenic CadmiumCrhromlumj CUD -
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6/months 2nd 6 months 1st 6 months 2nc{6 months
Total#of samples=> 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.014 N/A 0.004 N/A <0.005 N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper Cyanide - Lead Mercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.004 N/A <0.005 N/A <0.01 N/A N/A N/A
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A . N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/l=>milligrams per liter
* POTW must enter at least one of these IUP-->Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria wwrp=>wastewater treatment plant
Chapter: PAR Guidance File name: Pieodif Sdhad>sideN.i'aiefrci a¢t> s�c1R4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Grass
Industrial Data Summary Form (1DSF) 1UP# 2103
Use separate forms for each industry/pipe Pipe# 1
IiNicxei ' -selenium raver Line I
1st b months 2nd b months 1st 6 months 2nd b months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 1
* Maximum (mg/1)_> _
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.018 N/A 0.089 N/A <0.005 N/A 0.012 N/A
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
pH .F luoride Manganese 1 otal Phosphorus
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months `2nd 6 months 1st 6 months -2nd 6 months
Total#of samples=> 1 1
* Maximum=> 6.7 N/A
* or Minimum=>
* or Average(mg/1)_> N/A N/A 0.212 N/A N/A N/A
* or Average Loading(1b/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
•
Molybdenum 'I'KIN I
1st 6 months 2nd 6 months 1st 6 months 2nd months 1st 6 months 2nd 6 months 1st 6 months '2nd 6 months
Total#of samples=> 1 .
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or Average(mg/1)_> 0.032 N/A N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these 1UP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PA odi3f aisideViiiiiiir¢ afttgLWs1�c1.1 i13,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each RIP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Hanes Dye
WWTP Name=> Archie Elledge IUP# 1155
Use separate forms for each industry/pipe NPDES.#=> NC0037834 Pipe# 1
Enter BDL values as< (value) 1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months, dates=> 7/1/2020 12/31/2020
Iflow, mga inn/ (I s Ammonia
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months list 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 4 5 4 5 1
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or_6 Average(mg/1)=> 0.2364 0.2537 1820 983 258 217 N/A 3
* or Average Loading(Ib/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic Cadmium Chromium CUD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 NA NA
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> N/A <0.01 N/A <0.002 N/A <0.005
* or Average Loading(Ib/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Copper ' Cyanide Lead Mercury
1st 6 months 2nd 6 months 1st 6 months- 2ncf 6 months 1st 6 months 2nd 6 months l 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> N/A <0.005 N/A <0.005 N/A <0.01 N/A <0.0002
* or Average Loading(Ib/d)=>
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these RIP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PARo t teisiE3esain:ted t�lha¢t sect 1B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name HanesDye
Industrial Data Summary Form (IDSF) IUP# 1155
Use separate forms for each industry/pipe Pipe# 1
ivlcxel eienium ( uver I Laic
1st 6 months 2nd 6 months 1st 6 months lnd 6 months 1st 6 months lnd 6 months 1st 6 months .2nd 6 months
Total#of samples=> 1 1 2 1
* Maximum (mg/1)_>
* or Maximum (1b/d)=>
* or Average(mg/1)_> N/A <0.01 N/A <0.01 N/A <0.005 N/A 0.239
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A N/A
IpH 1 K_NManganese Molybdenum
1st 6 months 2nd 6 months l st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 4 5 1 1 1
* Maximum=> 9.7 7
* or Minimum=>
* or Average(mg/1)_> N/A 36 N/A 0.025 N/A <0.005
* or Average Loading(1b/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A
'total Phosphorus -
1 st 6 months .ncd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or Average(mg/1)_> N/A 2
* or Average Loading(1b/d)_>
%violations,(chronic SNC is>=66%)=>
%TRC violations, (SNC is>=33 %)=>
BDL=>Below Detection Limit mg/1=>miIligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Pcuuit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PAPodpEelhsisiteN ixted aft cl B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each RIP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form {fDSI=} Town Name=> City of Winston-Salem Name Herb9Iife
WWTP Name—> Archie Elledge IUP# 2001
Use separate forms for each industry/pipe
EnterNPDES#=> NC:UO37�34 Pipe# 1
BDL values as < (value)
1st 6 months,dates=> 1/17ZU20 6/30/2020
2nd 6 months, dates=> 7/1/2020 12/31/2020
1 riow, mga Ji3U1u iSS Ammonia
1st 6 months 2nd 6 months 1st 6 months "2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 4 5 4 5 1
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or_6_Average(mg/1)_> 0.0112 0.0235 675 748 1011 1,101 N/A 123
•
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
Arsenic 1 Cadmium Chromium CUD l
1st 6 months 2nd 6 montfis 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 N/A N/A
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)—> N/A <0.01 N/A <0.002 N/A 0.007
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)=> 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A
Copper Cyanide Lead - Mercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months - 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
_. * - or Average(mg/I)_> N/A 0.125 N/A <0.005 N/A 0.045 N/A <0.0002
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)=> 0 0
%TRC violations, (SNC is>=33%)=> N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these ]UP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PAPor'Hlf ieisReiatiirlegl iaQtez.Qts cla 4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP.pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Herbalife
Industrial Data Summary Form (IDSF) IUP# 2001
Use separate forms for each industry/pipe Pipe# 1
lNicKe1 Selenium 1nd 6 months Silver - Line
1st 6 months 2nd 6 months 1st 6 months 1st 6 months 2nd 6 months 1st 6 months .nd 6 months
Total#of samples=> I 1 1 1
• * Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/1)_> N/A <0.01 N/A <0.01 N/A <0.005 N/A 0.475
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A
pH Total Phosphorus Manganese Molybdenum
1st 6 months 12nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 5 101 1 1 1
* Maximum=> 9.9 11
* _ or Minimum=>
* or Average(mg/1)_> N/A 21 N/A 0.063 N/A <0.005
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A
lxiv
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1
* Maximum (mg/1)=>
* or Maximum (Ib/d)_>
* or Average(mg/I)=> N/A 188
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0
%TRC violations, (SNC is>=33 %)_> N/A
BDL=>Below Detection Limit mg/I_>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PliPoiBpSfht>Tside io d T ta¢tr t*ct 4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each fUP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name HOH
WWTP Name=> Archie Elledge IUP# 1998
Use separate forms for each industry/pipe NPDES#=> N(;UU37834 Pipe# 1
Enter BDL values as < (value) 1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months, dates=> 7/1/2020 12/31/2020
' 1(low, mga Jim/ 11 Ammonia
1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 3 6 2 5 1 2
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or_6_Average(mg/1)_> 0.0516 0.0456 264 69 358 195 33 132.0
* or Average Loading(Ib/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 - 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
1 Arsenic ! Cadmium JChromluml CW I Certification
1st 6 months Il 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months /nd 6 months- 1st 6 months 2nd 6 months
Total#of samples=> 14 23 14 23 14 23
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or_6_Average(mg/1)=> <0.016 <0.0561 <0.002 <0.0063 <0.0288 <0.052 Certification
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper Cyanide Lead Mercury
1st 6 months 2nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 14 23 6 10 14 23 9 14
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or 6_Average(mg/I)_> 0.0474 <0.094 <0.005 <0.0885 <0.0107 <0.3475 <0.0002 <0.0002
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
*. POTW must enter at least one of these nip=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PACRodgehisisitelfaiidtdalThatitgifkltc1914B,pages 12,13,14 Blank IDSP Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 4

Pretreatment Annual Report (PAR)
Industry Name HOH
Industrial Data Summary Form (1DSF) l'UP# 1998
Use separate forms for each industry/pipe Pipe# 1
Enter BDL values as < (value)
Antimony Cobalt 1m - 'titanium
1st 6 months -2nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 9 18 5 18 5 18 9 23
* Maximum (mg/1)_>
* or Maximum (Ib/d)_>
* or Average(mg/1)=> <0.107 <0.025 <0.0092 <0.016 <0.025 <0.025 <0.0222 <0.5861
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A 57 N/A
Vanadium 2,4,6-Tricholrophenol 13i(2-ethylhexlphthalate Carbazole
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 5 19 2 4 2 4 2 3
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.04 <0.0463 <0.075 0.0758 <0.075 <0.01 <0.075 <0.005
* or Average Loading(Ib/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A
o-Cresol p-Cresol n-1.)ecane 1r'luoranthene
1st 6 months -2nd 6 months 1st 6 months 2nd 6 months J 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 3 2 3 2 3 2 3
* Maximum (mg/1)_>
* or Maximum (Ib/d)_>
* or Average(mg/1)_> <0.075 <0.005 <0.075 <0.01 <0.075 <0.01 <0.075 <0.005
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=>
%TRC violations,(SNC is>=33 %)=>
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP—>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: Pf IBofifff efsiteNfiaiir el32t sa¢t *ctl 4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each RIP pipe-Page 7 of 4

Pretreatment Annual Report (PAR) Industry Name HOH
Industrial Data Summary Form (IDSF) 1UP# 1998
Use separate forms for each industry/pipe Pipe# 1
I1v lcxel selenium sliver JL lnc
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months "lnd 6 montSs
Total#of samples=> 14 23 8 17 14 23 14 23
•
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or Average(mg/1)=> <0.0402 <0.0523 <0.01 <0.01 <0.005 <0.005 0.1284 0.295
* or Average Loading(Ib/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A 40 N/A
pH Fluoride
luode Manganese 'l ofal Yhosphorus
11st 6 months 2nd 6 months 1st 6 months 12nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 137 143 8 10 1 2
* Maximum=> 10.3 10.3 _
* or Minimum=> •
* or Average(mg/1)_> N/A N/A 0.2939 0.379 0.822 3.2
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A
Molybdenum LEA 62,4 L+YA bLS MIN
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months I st 6 months - 2nd 6 months
Total#of samples=> 8 10 2 3 2 1 1 2
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or_6 mo_Average(mg/1)_> <0.0221 <0.0500 <0.01 0.014 <0.1 <0.5 39 154
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %}=> N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, PIease indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PPRofiffi htabsifeNGaiofie l aittrsl�ct lB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 3 of 4

•
Pretreatment Annual Report (PAR) Industry Name HOH
Industrial Data Summary Form (IDSF) IL.1P# 1998
Use separate forms for each industry/pipe Pipe# 1
Enter BDL values as < (value)
'n-Vctaclecane
1st 6 months 2nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months -2nd 6 months
Total#of samples=> 2 3
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.075 <0.01
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_>
%TRC violations, (SNC is>=33 %)_>
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months I 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=>
* Maximum (mg/I)_>
* or Maximum (lb/d)=>
* or Average(mg/1)=>
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_>
%TRC violations, (SNC is>=33 %)_>
1st?months 2nd 6 months *1st 6 months 2nd 6 months 11st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=>
* Maximum (mg/1)_>
* or Maximum (1b/d)_> .
* or Average(mg/1)_>
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=>
%TRC violations, (SNC is>=33 %)_>
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these NP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL, 1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PASoili usisRev:iisiidmd ia¢tegtB#*t8&r4B,pages 12,I3,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 4 of 4

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Ingredion
Use separate forms for each industry/pipe WWTP Name=> Archie h;lledge lUP# 1191
Enter BDL values as< (value) NPDES#_> NC UU37$34 Pipe# 1
1st 6 months, dates=>. 1/1/2020 6/30/2020
2nd 6 months, dates=> 7/1/2020 12/31/2020
r iow, mgd Iiu.0 -1 Ammonia
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd b months
Total#of samples=> 6 6 138 131 189 194 2
* Maximum (mg/1)_>
* or Maximum (1b/d)=>
* or 6_Average(mg/1)_> 0.7557 0.8707 1622 1,547 473 397 11 N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic Cadmium -C.'hromium CUD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months J 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 7 2 7 2 7 N/A N/A
* Maximum (mg/1)—>
* or Maximum (1b/d)_>
* or Average(mg/1)_> <0.01 <0.01 <0.002 0.002 0.009 <0.008
* or Average Loading(Ib/d)_>
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper Cyanide Lead Mercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 7 2 2 7 2 4
* Maximum (mg/1)_> .
* or Maximum (1b/d)_>
* or Average(mg/1)_> 0.019 0.0151 <0.005 N/A <0.01 <0.01 <0.0002 <0.0002
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these. IUP=>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,I/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: P?llbdlpf iteNCieiidesl a¢tgQtslyct1 4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR)
Industry Name Ingedion
Industrial Data Summary Form (IDSF) IUP# 1191
Use separate forms for each industry/pipe - Pipe# 1
AicKel - jl eienlum 1 silver Lim
I st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd b months 1 st s months 2nd 6 months
Total#of samples=> 2 7 2 7 2 7 4 9
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.01 <0.01 <0.01 <0.012 <0.005 <0.005 0.5028 0.3297
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33%)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH fluoride Manganese Total Phosphorus
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
. Total#of samples=> 8 14 2 7 2
* Maximum=> 10.7 10.4
* or Minimum=>
* or Average(mg/1)=> N/A N/A 0.124 0.0661 21 N/A
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations, (SNC is>=33%)_> N/A N/A N/A N/A N/A N/A N/A
Molybdenum MIN
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months-2nd 6 months
Total#of samples=> 2 7 2
* Maximum (mg/1)=>
*
or Maximum (lb/d)=>
* or Average(mg/1)_> 0.006 <0.0051 51 N/A
* or Average Loading(1b/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: RafPoliffk salitesiaiixEed a¢t sl;ct B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page ? of 2

f
Pretreatment Annual Report (PAR)
Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Lantal
Use separate forms for each industry/pipe WWTP Name=> Muddy Creek IUP# 3102
Enter BDL values as < (value) NPDES#=> NC0030342 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
r low, mga DUD 1 SS Ammonia
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 3 6 3 6 1
* Maximum (mg/I)=>
* or Maximum (lb/d)=>
* or_6_Average(mg/1)_> 0.0356 0.0231 92 126 11 45.0 N/A 20
* or Average Loading(Ib/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Arsenic Cadmium Chromium CUD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 3 1 3 1 3 1 N/A N/A
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/1)_> <0.01 <0.01 <0.002 <0.002 <0.0119 <0.005
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A
1Copper Cyanide Lead Mercury
1st 6 months - 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 3 1 1 3 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/1)=>
* or Average Loading(lb/d)=> 0.0353 0.0100 N/A <0.005 <0.01 <0.01 N/A <0.0002
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: P?Clioffli rsiEsReNeaiaie¢ aftttgatslect B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR)
Industry
Industrial Data Summary Form (IDSF) r# Lantal
3102
Use separate forms for each industry/pipe Pipe# 1
picKe1 -Selenium ( -siiver Line
t b months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
• Total#of samples=> 3 1 3 1 3 1 3 1
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/1)=> <0.01 <0.01 <0.01 <0.01 <0.005 <0.005 0.2767 0.055
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
1ph Fluoride iManganese Molybdenum
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 11 1st 6 months j 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 3 7 3 1 3 1
* Maximum=> 7.6 8.7
* or Minimum=>
* or Average(mg/1)_> N/A N/A 0.017 0.0220 <0.005 <0.005
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 • 0
%TRC violations, (SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A
1'Kt' 1 otal_Phosphorus
1st 6 months 2nd 6 months- 1st 6 months;2nd 6 months 1st 6-months 2nd 6 months 1st 6 months- 2nd 6 months
Total#of samples=> 1 1
* Maximum (mg/1)_>
* or Maximum (Ib/d)_>
* or Average(mg/1)_> N/A 47 N/A 1.5
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 ' 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb!d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PACRodifIEdfurisiiteVaiidnahlialitcgatsctik914B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Liquid Environmental
Use separate forms for each industry/pipeT1'Name=> Archle lledge IUP# 2020
Enter BDL values as< (value) NPDES#=> NC0037834 Pipe# 1
• 1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months, dates=> 7/1/2020 12/31/2020
r low, mgn BUD 1 NS Ammonia
1st b months 2nd 6 months 1st b months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 8 6 8 6 2
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or_6_Average(mg/1)_> 0.0389 0.0396 4591 4,306 530 192 N/A 30
* or Average Loading(Ib/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic - Cadmium Chromium CUD -
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 2 2
* Maximum (mg/1)=>
* or Maximum (1b/d)_>
* or Average(mg/I)_> N/A <0.01 N/A <0.002 N/A <0.005 N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper I Cyanide -i Lead lvlercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 2 2 2
* Maximum (mg/1)=>
* or Maximum (1b/d)=> _
* or Average(mg/1)_> N/A 0.035 N/A <0.005 N/A <0.01 N/A <0.002
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per Iiter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria W WTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PAPorfg Reirisiis e¢dhaftt glgctii B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each RIP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Liquid Environmental
industrial Data Summary Form (IDSF) luP# 2020
Use separate forms for each industry/pipe Pipe# 1
INIICKel I 1selenium i1ver - Line
1st 6 months 2nd 6 months J i st b months 2nd 6 months 1st 6 months 2nd b months 1st 6 months Ilnd 6 months
Total#of samples=> 2 2 2 2
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> N/A 0.047 N/A 0.028 N/A <0.005 N/A 0.297
* or Average Loading(lb/d)=> .
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH Fluoride Manganese I otal Phosphorus
1st 6 months 2nd 6 months 1st 6 months I 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 140 136 2 2
* Maximum=> 7.6 7.6
* or Minimum=>
* or Average(mg/1)_> N/A N/A N/A 0.2165 N/A 10.4
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A
Molybdenum U & U(Hexane) IAN
1st 6 months 2nd 6 months 1st 6 months 12nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 13 12 2
* Maximum (mg/1)_>
* or Maximum ()b/d)_>
* or Average(mg/1)_> N/A <0.005 <25 <16 N/A 86
* or Average Loading(Ib/d)_> _
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr.or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PABotfip idsidelGaioiecl a¢t slect IB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each RIP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Pepsi
WWTP Name=> Archie Elledge IUP# 1036
Use separate forms for each industry/pipe NPDES#_> NC0037834 Pipe# I
Enter BDL values as < (value) 1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months, dates=> 7/1/2020 12/31/2020
now, mga BUD 1].SS Ammonia
1st 6 months 2nd 6 months 1st 6 months -2nd 6 months II 1st 6 months 2nd 6 months i st 6 months 2nd 6 months
Total#of samples=> 6 6 4 6 4 6 1
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or_6_Average(mg/1)=> 0.1456 0.1687 2259 2,493 56 131 0.505 N/A
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
1 Arsenic Cadmium Chromium I Cull
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)=> .
* or Average(mg/1)_> <0.01 N/A <0.002 N/A <0.005 N/A N/A N/A
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Copper ! Cyanide - Lead I Mercury
1st 6 months 2nd 6 months 1st 6 months "2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)=> 0.015 N/A <0.005 N/A <0.01 N/A <0.0002 N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per Liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/23DL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: Pt odipEdhshs3tesaiaie¢ afingatsgct lB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page I of 2

Pretreatment Annual Report (PAR) Industry Name Pepsi
Industrial Data Summary Form (IDSF) IUP# 1036
Use separate forms for each industry/pipe Pipe# 1
1VlcKe1 Iselenium �Illver Line
1st 6 months 2nd 6 months 1st b months 2nd 6 months 1st 6 months 2nd 6 months 1st b months 2nd 6 months
Total#of samples=> 1 1 1 1
* Maximum (mg/1)=>
* or Maximum (Ib/d)_>
* or Average(mg/1)=> <0.010 N/A <0.01 N/A <0.005 N/A 0.328 N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> . 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
PH ` _Fluoride Manganese 1 otal Phosphorus
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 186 190 N/A N/A 1 N/A 1
* Maximum=> 11.5 11.3
* or Minimum=>
* or Average(mg/1)_> 0.005 21 N/A
* or Average Loading(1b/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Molybdenum 1 'I'M - 1
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months It 1st 6 months 2nd 6 months
Total#of samples=> 1 1
* Maximum (mg/1)_>
* or Maximum (1b/d)_>
* or Average(mg/1)_> <0.005 N/A 2.88 N/A
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 ,
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these [UP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: Poi l ai a hiided ante s ct lB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Pepsi 02 WOW
Use separate forms for each industry/pipe WWTP Name=> Archie E hedge IUP# 3051
Enter BDL values as < (value) NPDES#=> NZ UU37834 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months, dates=> 7/1/2020 12/31/2020
x low, mga -tail) t NN Ammonia
1st 6 months 2nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 2 6 2 5
* Maximum (mg/1)=>
* or Maximum (Ib/d)_>
* or_6_Average(mg/1)_> 0.0332 0.0374 8 124 <2.5 <2.5 N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33%)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic Cadmium- Chromium I CUD --
1st 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> N/A N/A
* Maximum (mg/I)=>
* or Maximum (1b/d)_>
* " or Average(mg/1)_> N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
ICopper Cyanide I Lead Mercury
1st 6 months 2nd 6 months I st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=>
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/1)_> N/A N/A N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNCis>=66%)=> 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria W WTP=>wastewater treatment plant
Chapter PAR Guidance File name: PAIDoffigdhictsitedi$iodetl a¢tig s'�ctBQrlB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Pepsi 02 WOW
Industrial Data Summary Form (IDSF) IUP# 3051
Use separate forms for each industry/pipe Pipe# 1
INICKe! Selenium Silver - LinC
1st 6 months 2nd 6 months 1st 6 months 2nd b months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=>
* Maximum (mg/1)_>
* or Maximum (1b/d)_>
* or Average(mg/1)_> N/A N/A N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH ti luoride Manganese "total Phosphorus
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 179 190
* Maximum=> 78 11.7
* or Minimum=>
* or Average(mg/1)_> N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Molybdenum '1 KIN
1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> ,
* Maximum (mg/I)_>
* or Maximum (lb/d)_>
* or Average(mg/1)=> N/A N/A N/A N/A
* ' or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A
BDL=>Below Detection Limit mg/1=>miIIigrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PARmErpathealsRe\Ctelidedailhatitegiktsctiliii4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each 1UP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Progress Rail
WWTP Name=> Archie Elledge IUP# 1038
Use separate forms for each industry/pipe NPDES#_> NC0037834 Pipe# 1
Enter BDL values as < (value) 1st 6 months, dates=> 1/1/2020 6/30/2020
2nd 6 months, dates=> 7/1/2020 12/31/2020
.ti low, mgo. JiUJJ J. Ammonia
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st b months "2nd b months 1st 6 months 2nd 6 months
Total#of samples=> 4 5
* Maximum (mg/1)=> ,
* or Maximum (lb/d)_>
* or_6_Average(mg/1)_> 0.0323 0.306 N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
•
Arsenic Cadmium Chromium CUD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st b months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 6 4 13 4 13 N/A N/A
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.01 <0.01 0.0044 <0.0046 0.0585 0.0741
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper - Cyanide • Lead Mercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 4 13 3 13 4 13 1 5
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.1668 0.2845 <0.007 <0.0021 <0.0029 <0.0059 <0.0002 <0.0002
* or Average Loading(1b/d)=>
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d—>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BOL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: P tITOd imtisite�i ibdu¢ aftte *cl. 1B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each RIP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Progress Rail
Industrial Data Summary Form (IDSF) 1UP# 1038
Use separate forms for each industry/pipe Pipe# 1
INleKel �eienlum ` bllver Glnc
'1st b months Ind 6 months 1st 6 months .2nd.6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 4 13 1 6 2 13 4 13
* Maximum (mg/I)=>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.0903 0.165 <0.01 <0.01 <0.005 <0.00025 1.13 1.782
* or Average Loading(Ib/d)_>
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0 0 N/A
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A 40
PH Fluoride -Manganese 'Total Phosphorus
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months- 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 7 1 6
* Maximum=> 9.8 9.8
* or Minimum=>
* or Average(mg/I)=> • N/A N/A 0.446 1.078 N/A N/A
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)=> 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A
Molybdenum - I±I'A 624 EPA 625 1 10
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 6 1 1
* Maximum (mg/1)_> .
* or Maximum (Ib/d)_>
* or 6 mo Average(mg/I)=> 0.064 0.750 N/A N/A N/A N/A 0.0038 <0.002
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PFYBorffiEd{ie ReNG3.iudea iaimg* ct 4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each 1UP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (l F) Town Name=> City of Winston-Salem Name RJR Tobaccoville
Use separate forms for each industry/pipe WWTP Name=> Muddy Creek IUP# 3001
NPDES#=> NC0050342 Pipe# 1
Enter BDL values as< (value)
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
Ii iow, mga Buy 1 ss r Ammonia
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months '2nd 6 months 1st 6 months 2nd 6 months
Total*of samples=> 6 6 4 6 4 6 1 1
* Maximum (mg/1)_> .
* or Maximum (lb/d)=>
* or_6^Average(mg/1)_> 0.1923 0.187 941 630 635 446 7 6
* or Average Loading(Ib/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic - Cadmium I Chromium - CUD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 2 1 2 1 2 N/A N/A
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/I)_> <0.01 <0.1 <0.002 <0.002 0.016 <0.0053
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A
111 Copper Lyanide Lead Mercury
1st 6 months 2n'6 months 1st 6 months 12nd 6 months 1st 6 months 2nd 6 months 1st 6 months - 2nd 6 months
Total#of samples=> 1 2 1 1 1 2 1 1
* Maximum (mg/1)=>
* or Maximum (Ib/d)_>
* or Average(mg/1)_> 0.181 0.123 <0.005 <0.005 0.012 <0.01 <0.0002 <0.0002
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
BDL>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month.Qtr.or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PABot b iteNesiale}dhafst sl�cii B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name RJRTobaccoville
Industrial Data Summary Form (IDSF) IUP# 3001
Use separate forms for each industry/pipe Pipe#
1
ricite-1 - 1selenlum , silver Valle
1st b months 2nd b months 1st 6 months 2nd 6 months 1st 6 months 2nd b months 1st 6 months 2nd 6 months
Total#of samples=> 1 2 1 2 1 2 1 2
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or Average(mg/1)_> 0.012 <0.01 <0.01 <0.01 <0.005 <0.005 0.574 0.223
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Pit f x'luoricie -Manganese Molybdenum
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months J 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 4 6 1 2 1 2
* Maximum=> 6.7 7
* or Minimum=>
* or Average(mg/1)_> N/A N/A 0.324 <0.005 0.006 <0.005
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
Total Phosphorus '1'KIN
1st 6 months 2nd 6 months 1st 6 months /nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 1
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or Average(mg/1)=> 3.7 3.47 34 24
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL.1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PAPottiNtrhslisilelea si afttg$,tsleeklif B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each TUP pipe-Page 2 of 2

Pretreatment Annual Report(PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name RJR Whitaker Park
T1'Name=> Muddy Creek MP# 3014
Use separate forms for each industry/pipe
Enter BDL values as< (value) NPDES#_> NC0050342 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
I low, mgci -I5UU 1 S Ammonia
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 8 6 9 6 1 2 1
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or 6 Average(mg/1)_> 0.3102 0.275 1505 1,508 1436 2,307 12 11.4
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic Cadmium Chromium - CUD
1st 6 months 2nd 6 months 11st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 12nd 6 months
Total#of samples=> 2 2 2 2 2 2 N/A N/A
* Maximum (mg/I)=>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.01 <0.01 0.0055 0.0055 0.0095 0.0155
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper Cyanide - Lead Mercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months I 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 2 1 2 2 2 1 2
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)=> 0.071 0.075 <0.005 <0.005 , <0.0125 <0.01 <0.0002 <0.0002
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit Ibid=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PARofdialliedsiteVaiidedalthaOtegilktsctafigB,pages I2,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each RIP pipe-Page 1 of 2

Pretreatment Annual Report (PAR)p ` Industry Name RJR Whitaker Park
Industrial Data Summary Form (IDSF) IUP# 3014
Use separate forms for each industry/pipe Pipe#
1
rImo 1 selenium silver Limet b months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months -2nd 6 months
Total#of samples=> 2 2 2 2 2 2 2 2
1 * Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.0125 0.0220 <0.01 <0.01 <0.005 <0.005 0.5865 0.368
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH Fluoride llvlanganese lvlolybden.um
1st 6 months ) 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 9 6 2 2 2 2
* Maximum=> 6.9 7
* or Minimum=>
* ' or Average(mg/1)_> N/A N/A 0.88 0.725 <0.005 <0.005
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33%)_> N/A N/A N/A N/A N/A N/A N/A
total Phosphorus l'-'
1st 6 months 2nd'"months l 1st 6 months end 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 2 1 2
* Maximum (mg/I)=>
* or Maximum (lb/d)=>
* or Average(mg/1)_> 28 10.30 ' 182 76
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 _
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL.1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PAPorlipf liekxReCtaia liaha¢tr slyct B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 2

Pretreatment Annual Report(PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Siemens
WWTP Name=> Muddy Creek IUP# 3026
Use separate forms for each industry/pipe
NPDES#=> NC0050342 Pipe# 1
Enter BDL values as < (value)
1st 6 months, dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
IMow, raga Buy I�5 Ammonia
1 st b months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1
Total#of samples=> 6 6 1 1 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or 6 Average(mg/1)_> 0.0015 0.0021 5 2 8 6 1.5 N/A
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic - Cadmium Chromium CUD
I
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 11st 6 months 2nd 6 months l 1st 6 months 2nd 6 months
Total#of samples=> 3 6 10 12 10 12 N/A N/A
* Maximum (mg/1)_>
* or Maximum (Ibid.)=>
* or Average(mg/1)=> <0.01 <0.1 <0.005 <0.005 <1.74 <0.4976
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
ICopper Cyanide Lead Mercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 10 12 7 10 10 12 1 2
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.0195 <0.034 <0.0213 <0.0093 <0.0343 <0.025 <0.0002 <0.002
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit Ib/d>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL.or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PABorIfiNidhaissRetliiudtrti rafltrg sctilfh4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Siemens
Industrial Data Summary Form (IDSF) IUP# 3026
Use separate forms for each industry/pipe Pipe# 1
INIcKei Jeienlum 61lVer Line
"1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months lnd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 10 12 3 6 10 12 10 12
* Maximum (mg/1)_>
* ' or Maximum (lb/d)=>
* or Average(mg/I)_> 2.3114 0.1523 <0.012 <0.1 <0.05 <0.05 <0.1 <0.1
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A
pH - r'luorlde Manganese Molybdenum
'1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st b months 2nd 6 months
Total#of samples=> 3 5 3 4 3 6
* Maximum=> 5.7 9.1
* or Minimum=>
* or Average(mg/1)_> N/A N/A 0.007 <0.05 4.13 1.770
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A
Total Phosphorus 11(N
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months j 1st 6 months-2nd 6 months
Total#of samples=> 1 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/1)_> 0.317 0.714 7.8 6.7
* or Average Loading(1b/d)_>
%violations, (chronic SNC is>=66%)=> 0 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PPCRotifpF misitelaikdmd aftt> *1i+9B,pages 12,13,14 Blank 1DSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 7

Pretreatment Annual Report(PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Sonoco
Use separate forms for each industry/pipe WWTP Name=> Archie Elledge IUP# 1042
Enter BDL values as< (value) NPDES#_> NC UU371f34 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
rlow, mgu DUD! I S `Ammonia
1st 6 months 2nd 6 months 1st 6 months 2nd b months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 9 12 9 12 1 2
* Maximum (mg/I)_>
* or Maximum (lb/d)_>
* or_6_Average(mg/1)_> 0.0156 0.0159 199 696 306 808 6.97 5.6
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic i Cadmium- -(i(iromlum um)
1st 6 months 2nd 6 months 1 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st months 2nd 6 months
Total#of samples=> 1 2 1 2 1 2 N/A N/A
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/1)_> <0.01 <0.01 <0.002 <0.002 <0.005 <0.005
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper - Cyanide Lead 'Ytercury
1st 6 months=2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 7 8 1 2 1 2 1 2
* Maximum (mg/1)_>
* or Maximum (Ib/d)=>
* or Average(mg/1)_> 0.0291 0.047 <0.005 <0.005 <0.01 <0.01 <0.0002 <0.0002
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC>Technical Review Criteria WWTP=>wastewater treatment plant
1 2
Chapter: PAR Guidance File name: PA��E�rs��evC>kiudEli�raPt�s�c1B,pages 12,13,14 Blank IDSP Form,Copy and use in your PAR Number each set for each IUP pipe-Page of

Pretreatment Annual Report (PAR) Industry Name Sonoco
Industrial Data Summary Form (IDSF) IVP# 1042
Use separate forms for each industry/pipe Pipe# 1
1Q 1cKel 'selenium Silver Lane
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 2 1 2 1 2 1 2
* Maximum (mg/1)_> .
* or Maximum (Ib/d)_>
* or Average(mg/1)_> <0.01 <0.01 <0.01 <0.01 <0.005 <0.005 0.27 0.30
* or Average Loading(lb/d)_> •
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH fluoride Manganese Molybdenum
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months- 1st 6 months 2nd 6 months
Total#of samples=> 3 6 1 2 1 2
* Maximum=> 8.2 9.7
* or Minimum=>
* or Average(mg/1)_> N/A N/A 0.013 0.022 0.053 <0.005
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
Total Phosphorus •1'K.1`I
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months-2nd 6 months
Total#of samples=> 1 2 1 2
* Maximum (mg/I)_>
* or Maximum (lb/d)_>
* or Average(mg/1)=> 2.08 2.8 15.7 12.0
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 .
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these 11JP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>miIlion gallons per day
Avg period could be month.Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: Pf rfige.HiaisRedt$iode¢alTha¢t slgclBf34B,pages 12,13,14 BIank 1DSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page _2 of 2

,
Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Stratford Metals
W
Use separate forms for each industry/pipeWWTP Name=> Archie 1✓lledge IUP# 1152
EnterNPDES#_> NC0037834 Pipe# I
BDL values as < (value}
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
r low, mga .iuli -1 Ammonia
1st 6 months 2nd 6 months 1st 6 months -2nd b months 1st 6 months 2nd 6 months 1st b months 2nd 6 months
Total#of samples=> 2 9
* Maximum (mg/1)_>
* or Maximum (1b/d)=>
* or 6 Average(mg/1)_> 0.02 0.02 N/A N/A N/A N/A N/A N/A
* or Average Loading(Ib/d)=>
%violations,(chronic SNC is>=66%)_> 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A
' Arsenic - Cadmium t Chromium ' CUP -
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 11st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 3 6 7 6 7 N/A N/A
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.01 <0.01 <0.0052 0.0227 <0.0138 <0.2121
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A
Copper Cyanide - Lead Nlercury '
' 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months ,2nd 6 months 1st 6 months -2nd 6 months
Total#of samples=> 6 7 7 15 6 7 3
* Maximum (mg/1)_>
* or Maximum (lb/d)_> .
* or Average(mg/1)_> 0.0123 0.4870 <0.005 <0.005 <0.01 <0.01 N/A <0.0002
* or Average Loading(1b/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A 33 N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used, TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter; PAR Guidance File name: PPf&br$gIt£dfiaitsiiteGii tedaltialit is cti B,pages 12,13,14 BIank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Stratford Metals
Industrial Data Summary Form (IDSF) 1UP# 1152
Use separate forms for each industry/pipe Pipe# 1
1N 1cKel �elenlum 1,llver Grc
1st b months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st b months 2nd 6 months
Total#of samples=> 6 7 2 3 6 7 6 7
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/I)_> 0.1678 0.3794 <0.009 <0.012 <0.005 0.06760 0.2253 0.2694
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations, (SNC is>=33%)_> N/A N/A N/A N/A N/A N/A
pH Fluoride Manganese 1`otal Phosphorus
1st 6 months `2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 4 9 6 3
* Maximum=> 10.2 9.7
* or Minimum=> _
* or Average(mg/1)_> N/A N/A <0.01 0.0053 N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0
%TRC violations, (SNC is>=33 %)_> N/A N/A
Molybdenum
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 3
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/1)=> 0.0475 0.069
* or Average Loading(1b/d)=>
%violations, (chronic SNC is>=66%)_> 0
%TRC violations,(SNC is>=33 %)_> N/A
BDL=>Below Detection Limit mg/I—>milligrams per liter
* POTW must enter at least one of these lUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PABodig sisitelikiaied aftt *ci B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Suiza Dairy Group
WWTP Name=> Archie Blledge IUP# 1189
Use separate forms for each industry/pipe NPDES#=> NC0O37834 Pipe# 1
Enter BDL values as< (value) 1st 6 months, dates=> 1/1/2O20 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
, riow, mgd. 'DUD 1Sa Ammonia
1st b months -2nd b months 1st b months lnd 6 months 1st 6 months -2nd b months 1st b months 2nd b months
Total#of samples=> 6 6 7 14 9 14 1 _ 1
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or_6 Average(mg/1)=> 0.2016 0.2164 6154 4,769 1480 1,225 46 5
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 86 N/A 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic Cadmium- Chromium" CUD
• 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 I 1 1 1 1 N/A N/A
* Maximum (mg/1)=>
* or Maximum (Ib/d)_>
* or Average(mg/1)_> <0.01 <0.01 <0.002 <0.002 0.008 0.009
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A
Copper - Cyanide Lead - Mercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 1 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.028 0.0230 0.019 0.007 <0.01 <0.01 N/A <0.0002
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these JUP=>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter; PAR Guidance File name: PfrBorripf mitsi3elalislE¢ailhaiStg sT�cl lB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Suiza Dairy Group
Industrial Data Summary Form (IDSF) rup# 1189
Use separate forms for each industry/pipe Pipe# 1
1v iCKe1 Selenium Sliver (Line
1st 6 months t2nu 6 months 1st 6 months 2nd 6 months 1st b months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 1 1 1 1 1
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.01 <0.01 <0.01 0.016 <0.005 <0.005 0.455 0.4200
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A
pH I luoricle Manganese 1 otal Phosphorus
1st 6 months-2nd months 1st 6 months 2nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6-months
Total#of samples=> 191 162 1 1 1 1
* Maximum=> 11.2 11
* or Minimum=>
* or Average(mg/1)_> N/A N/A 0.02 0.0160 28 36
* or Average Loading(Ib/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
Molybdenum TIS.N
- 1st 6 months -2nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.005 <0.005 160 125
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit Ib/d=>pounds per day
four rows, PIease indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month.Qtr.or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: P.Kl3i 8 ellsitetif§inde¢ aftt *ctl B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each RIP pipe-Page 2 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Superior
Use separate forms for each industry/pipe WWTP Name=> Muddy Creek IUP# 3101
EnterNPDES#=> NC�U5O342 Pipe# 1
BDL values as < (value)
1st 6 months, dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
I I low, mga 13OI) 1�S Ammonia
1st 6 months 2nd 6 months I st 6 months Ind 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 4
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or_6^Average(mg/1)_> 0.0023 0.009 N/A N/A • N/A N/A N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
-- Arsenic Cadmium 'Chromium (2013
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 4 1 4 1 4 N/A N/A
* —
Maxunum {mg/1) _
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.01 <0.01 <0.002 <0.002 0.023 0.0158
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper Cyanide Lead Mercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 4 1 4 1 4 2
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
-
* or Average(mg/1)_> 0.003 0.0078 0.027 0.060 <0.01 0.016 N/A <0.0002
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP m>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month.Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria W WIP=>wastewater treatment plant
Chapter: PAR Guidance File name: PARorlli£dhaisiaeVaiodcc32t taNa slyci B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each II3P pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Superior
Industrial Data Summary Form (IDSF) IUP# 3101
Use separate forms for each industry/pipe Pipe# 1
'ivlcKel - selenium -Sliver Ginc
I st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 4 1 4 1 4 3 9
* Maximum (mg/I)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.017 <0.01 <0.01 <0.01 <0.005 <0.005 0.4493 0.166
* or Average Loading(Ib/d)=>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH .Fluoride Molybdenum Total_Phosphorus
1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 4 1 4
* Maximum=> 9.9 10.5
* or Minimum=>
* or Average(mg/1)_> N/A N/A 0.029 <0.016 N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
'1 KN -ivlanganese
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months Ind 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 4
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/1)=> N/A N/A 0.011 <0.0115
* or Average Loading(1b/d)=>
%violations, (chronic SNC is>=66%)=> 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PFTorYlgamisi3e ibleglaf@taQt *c1 B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 9 of 7

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Tex-Tech
WWTP
separate forms for each industry/pipe Name=> Archie1~;iledge IUP# 2010
1
Enter BDL values as< (value). NPDES#_> NC;0037�34 Pipe#
1st 6 months, dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
r low, raga BUD -I IAmmonia
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 3 1 3 1
* Maximum (mg/1)_>
* or Maximum (Ib/d)_>
* or 6 _Average(mg/I)=> 0.013 0.0141 N/A 195 54 80 N/A 1.8
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic ' Cadmium Chromium - CUD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 3 3 3 3 3 3
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.01 <0.01 <0.002 <0.002 <0.005 <0.005 N/A N/A
* or Average Loading(Ib/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A
Copper Cyanide Lead Mercury 1
1st 6 months 2nd 6 months 1st 6 mon& 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 3 3 1 1 3 3 • 1 1
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/I)_> 0.2697 0.1033 <0.005 <0.005 <0.01 <0.01 <0.002 <0.0002
* or Average Loading(1b/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name; PA33odipEdhanisiteNaiizteliaShafittglIktsctRei4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each RIP pipe-Page 1 of 2

r
Pretreatment Annual Report (PAR) Industry Name Tex-Tech
Industrial Data Summary Form (1DSF) rurn# 2010
Use separate forms for each industry/pipe Pipe# 1
IvlcKel peienlum -�uver 'Lmc
'1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 3 3 3 3 3 3 3 3
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/I)=> <0.01 <0.01 <0.01 <0.01 <0.005 <0.005 0.3323 0.231
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33%)_> N/A N/A N/A N/A N/A N/A N/A
pH Fluoride Manganese 'Total Yhosphorus
1st 6 months 2nd 6 months 1st'months 2nd 6 months 1st 6 months 2nd 6 months 1st 4 months '2nd 6 months
Total#of samples=> 2 5 3 3 1
* Maximum=> 6.6 11.6 .
* or Minimum=>
* or Average(mg/1)=> N/A N/A 0.0123 0.017 N/A 0.668
* or Average Loading(lb/d)=> - 0
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
Molybdenum -:YA 624 KVA 62� '.1KN
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months -2nd 6 months
Total#of samples=> 3 3 2 3 N/A N/A 1
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or_6 mo Average(mg/1)_> <0.0059 <0.0059 0.3145 0.288 N/A 11.4
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)=> 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A — N/A , N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lbld=>pounds per day
four rows, PIease indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PABoilipkiiheriisitefibinte0allhatangik,tskcilifii413,pages 12,13,I4 Blank IDSF Form,Copy and use in your PAR Number each set for each 1UP pipe-Page 9 of 7

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name UniFirst
WWTP Name=> Archie E1ledge ItJP# 2015
Use separate forms for each industry/pipe
Enter BDL values as < (value) NPDES#_> NCUU37i334 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
1+low, mga Lill 1 Ammonia
1st 6 months I2nd 6 months 1st 6 months 2nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 4 9 4 9 1 1
* Maximum (mg/I)=>
* or Maximum (lb/d)=>
* . or_6_Average(mg/1)_> 0.0379 0.377 1699 1,748 715 657 2.3 0.57
* or Average Loading(Ib/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic - Cadmium Chromium CUD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months i 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 7 1 7 1 7 N/A N/A
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.01 <0.01 0.066 0.0206 0.048 0.038
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper Cyanide I Lead Mercury
1st 6 months 12nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 7 1 1 1 7 2
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/I)=> 0.489 0.280 <0.005 0.006 0.095 0.052 N/A <0.0002
* or Average Loading(lb/d)=>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PATorlt)FadsfteNGaibiesidfdialitcgat sciiilfh4B,pages 12,13,14 BIank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name UniFirst
Industrial Data Summary Form (IDSF) IUP# 2015
Use separate forms for each industry/pipe Pipe# 1
'1N1cXei 1selen1um silver - Lime
1st b months 2nd 6 months 1st 6 months 2nd b months 1st 6 months 2nd 6 months 1st 6 months -2nd 6 months
Total#of samples=> 1 7 1 7 1 7 I 7
* Maximum (mg/I)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.104 0.061 <0.01 <0.01 <0.005 <0.005 2.03 1.4
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH I*luorlcie -Manganese Molybdenum
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 4 9 I 7 1 7
* Maximum=> 9.7 10.5
* or Minimum=>
* or Average(mg/1)_> N/A N/A 0.175 0.132 0.074 0.051
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
Total Phosphorus - '1'Ki'
1st 6 months 2nd 6 months 1st 6 months 12nd 6 months 1 at 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 I 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/1)=> 3.52 2.9 32 24
* or Average Loading(lb/d)_> ,
%violations, (chronic SNC is>=66%)_> 0 0 0 0
%TRC violations, (SNC is>—33 %)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PAPorTiPalficalsilelatiideddlhaistaNctilik4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 9 of 2

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name WestRock01
WWTP Name=> Muddy Creek IiJP# 3041
Use separate forms for each industry/pipe
Enter BDE.values as < (value) NPDES#_> NC0050342 Pipe# 1
1st 6 months, dates=> 1/172020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
III low, mgd -BUD 1 Ammonia
1st 6 months 2nd b months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st b months 2nd 6 months
Total#of samples=> 6 6 10 12 10 12 1
* Maximum (mg/1)=>
* or Maximum (Ib/d)_>
* or 6 Average(mg/I)_> 0.0113 0.0119 674 635 184 1,495 N/A 22.0
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic Cadmium Chromium, COD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 4 1 4 1 4 N/A N/A
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/I)_> <0.01 <0.01 <0.002 <0.002 0.009 <0.005
* or Average Loading(lb/d)=>
violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper Cyanide Lead Mercury
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months` 1st 6 months -2nd 6 months, 1st 6 months 2nd 6 months
Total#of samples=> 8 10 1 2 1 4 I 1
* Maximum (mg/I)=>
* or Maximum (lb/d)=>
* or Average(mg/1)_> 0.6668 0.548 <0.005 <0.0153 <0.01 <0.01 <0.0002 <0.0002
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
BDL=>Below Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>miIIion gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PPE.orlTPf>:Thasilxidevfrhicde} a ts�eLiB,pages 12, 13,14 BIank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name WestRock01
Industrial Data Summary Form (1DSF) IUP# 3041
Use separate forms for each industry/pipe Pipe# 1
i1N1cxel 6eienium -aiiver Lane
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months '2nd 6 months
Total#of samples=> 1 4 1 4 1 4 7 10
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.01 <0.01 <0.01 <0.01 <0.005 <0.005 6784 0.332
* or Average Loading(Ib/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH t luoride Manganese Molybdenum
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 11 12 1 4 1 4
* Maximum=> 9.6 9.8
* or Minimum=>
* or Average(mg/1)=> N/A N/A 0.051 0.04 <0.005 <0.005
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)=> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
Total Phosphorus I •IK.N f
1st 6 months 2nd 6 months 1st 6 months -2nd 6 months f 1st 6-months 12nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/1)_> N/A 12.00 N/A 33.0
* or Average Loading(lb/d)=> -
%violations, (chronic SNC is>=66%)=> 0 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these RIP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used.. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PPIlbrfliSsfirtheA aio daThaftte #tcli lB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 2 -

Pretreatment Annual Report (PAR) Control Authority, Industry
•
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name WestRock02 Display
Use separate forms for each industry/pipe WWTP Name=> Muddy Creek IiJP# 3052
Enter BDL values as< (value) NPDES#_> NC0030342 Pipe# 1
1st 6 months, dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
r low, mga Ian) ' t SS ammonia
1st 6 months 2nd 6 months l 1st 6 months 2nd b months 1st 6 months 2nd 6 months 1st 6 months '2nd 6 months
Total#of samples=> 6 6 4 3 3 6 2
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or_6_Average(mg/I)_> 0.0194 0.0077 448 275 339 403 186 N/A
* or Average Loading(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
Arsenic - Cadmium -Chromium' C01)
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 3 3 3 N/A N/A
* Maximum (mg/1)_>
* or Maximum (Ib/d)_>
* or Average(mg/1)_> <0.01 N/A <0.002 N/A <0.008 N/A
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A
Copper - Cyanide Lead - Mercury
1st 6 months 2nd 6 months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 3 2 3 1
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.0237 N/A <0.005 N/A <0.01 N/A <0.0002 N/A
* or Average Loading(1b/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
BDL->BeIow Detection Limit mg/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PARorIff)SdhaltditeiSaiidtgialhatdcgd4gge1924B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 7

Pretreatment Annual Report (PAR) Industry Name WestRock02 Display
Industrial Data Summary Form (1DSF) IUP# 3052
Use separate forms for each industry/pipe Pipe# 1
1N1cKe1 1 belenzum bfiver Lane
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months -2nd 6 months
Total#of samples=> 3 3 3 3
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.01 N/A <0.01 N/A <0.005 N/A 0.4413 N/A
* or Average Loading(Ib/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
' pH - fluoride 1Vlanganese Molybdenum
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 3 6 3 3
* Maximum=> 8 7.7
* or Minimum=>
* or Average(mg/1)_> N/A N/A 0.0463 N/A 0.4643 N/A
* or Average Loading(1b/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations, (SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A
Total l'liosphorus 1 KiNl -
1 st 6 months 2nd 6 months 1st 6 months `2nd 6 months J 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 2 2
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> I4 N/A 211 N/A
* or Average Loading(lb/d)_>
%violations, (chronic SNC is>=66%)_> 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A
BDL=>Below Detection Limit mg/1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
•
Chapter: PAR Guidance File name: PARotlfg eirsReseaibrlad atit sWc14B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 2

SIU's at Elledge POTW
Permit Industrial User SIU Status Inspection Date
Number
2019 Adele Knits >25,000 October 20, 2020
2018 Bekaert >25,000, Potential to Impact October 23,2020
2014 Deere-IIitachi 433 Metal Finishing November 3,2020
3054 Environmental >25,000, Potential to Impact December 2, 2020
Relief Technology
2103 Grass America 433 Metal Finishing November 12,2020
1155 Hanes Dye & > 25,000, Potential to Impact November 20,2020
Finishing
2001 Herbalife >25,000, Potential to Impact July 22, 2020
2010 Tex-Tech Coatings Potential to Impact November 12, 2020
1998 HOFI 437 Centralized Waste November 4, 2020
1191 Ingredion >25,000, Potential to Impact November 4, 2020
1044 Clarios 461 Battery Mfg March 3, 2020
2020 Liquid 403 Grease Facility October 28, 2020
Environmental Pretreatment Standards
Services
1036 Pepsi Bottling >25,000, Potential to Impact March 11, 2020
3051 Pepsi WOW Plant >1=25,000 March 10, 2020
1038 Progress Rail 433 Metal Finishing November 10, 2020
1042 Sonoco Display & >25,000,Potential to Impact December 2, 2020
Packaging
1152 Stratford Metals 433 Metal Finishing December 10, 2020
1189 Suiza Dairy Group >25,000, Potential to Impact October 14, 2020
2015 UniFirst >25,000, Potential to Impact November 12,2020
Yellow highlighted are categorical SIU's

SIU's at Muddy POTW
Permit Industrial User SIU Status Inspection
Number Date
3010 Ardagh Group 465 Coil Coating October 28, 2020
3100 Crothall Laundry >25,000,Potential to Impact November 5, 2020
3102 Lantal Textiles >25,000, Potential to Impact October 19, 2020
3001 RJR Tobaccoville > 25,000,Potential to Impact November 19,2020
3014 RJR Tobacco WPSN > 25,000, Potential to Impact November 19, 2020
3026 Siemens Energy 433 Metal Finishing— June 25, 2020
Existing
3101 Superior Manufacturing 433 Metal Finishing— December 2, 2020
Existing
3041 WestRock Packaging > 25,000, Potential to Impact November 5,2020
3052 WestRock Display > 25,000, Potential to Impact November 30, 2020

Sludge Management Plan

Biosolids Disposal Strategy 2021-2025
Winston-Salem/Forsyth County Utility Commission
Archie Elledge WWTP (NPDES Permit NC0037834)
Muddy Creek WWTP (NPDES Permit NC0050342)
Sludges from the Utility Commission's two wastewater treatment plants are anaerobically
digested. Stabilized biosolids from the anaerobic digestion process at Muddy Creek are
now being pumped 5.2 miles into two blending tanks at Archie Elledge WWTP. Three 8"
HDPE pipe lines are utilized to pump biosolids between each facility. One line is for
biosolids from the Muddy Creek plant to the Elledge plant,the second line brings
centrate from Elledge Plant centrifuges back to Muddy Creek Lagoons, and the third is a
spare line. The Muddy Creek digested biosolids are pumped into the blending tanks along
with the biosolids from Archie Elledge's anaerobic digesters. The blend of biosolids is
then centrifuged into cake biosolids of approximately 22% solids. Cake biosolids from
the centrifuges are fed into the Andritz Rotary Drum Dryer to produce a 90-93% solids
dry pellet. This produces Class"A", "EQ"biosolids and is disposed of by land
application through a contractor or may be disposed of by other approved methods. The
North Carolina Division of Water Quality permit number for this facility is WQ0029804.
In summary,there are several biosolids disposal options for Winston-Salem. The
preferred method is distribution of class A pelletized biosolids. The least likely method
would be to landfill cake or pelletized biosolids. There are also existing lagoons at
Muddy Creek and Archie Elledge WWTP that are utilized to hold centrifuge/dryer
centrate for further processing in each plant and or biosolids storage.
S n erely,
Co neyD r
Utilities Di 'sion Director
CC: Frank Crump, Superintendent
Keith Jones, MCWWTP Supervisor
Matt Lavigne, AEWWTP Supervisor