NC0050342_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
ItJti 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
RECEIVED
Ms. Wren Thedford DEC 2 8 2021
NC DEQ/DWR/NPDES
1617 Mail Service Center NCDEQ/DWR/NPDES
Raleigh,NC 27699-1617
RE: Muddy Creek NC0050342—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 Muddy Creek
NC0050342 facility. Please see additional information below regarding some of the enclosures included
with our application:
• Enclosed is a copy of our formal request addressed to Mr.Mike Montebello(Enclosure 1)for a
reduction of monitoring frequency of specific conductivity. A summary of our minimum and
maximum specific conductivity results for three years is also enclosed(Enclosure 2).
• Our Priority Pollutant Analysis was conducted in 2017,2019, and 2021. We received a letter
(Enclosure 3)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 4).
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 5).
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
• Completed Tables A&B
• Attached Data for Table C
• Completed Table D
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;
ie2=1)
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] Duane Long;Hugh W.Jernigan;Chris Parker;Donald R.Stewart;Charles Wilson;Allan Younger

• Attached Data for Table E
• Attached 2020 Pretreatment Annual Report for Table F
• Sludge Management Plan?
• cerely,
Courtney Dri er .E.
Director of Utilities
City of Winston Salem
P.O.Box 2511
Winston Salem,NC 27102
336.747.7315
[e-mail]
2

Enclosure 1

Winston-Salem/Forsyth County •
Jt1I1tieS
Water•Wastewater•Solid Waste
Wastewater Division,2799 Griffith Road,Winston-Salem,NC 27103
0:336-727-8000,F:336-659-4320,cityofws.org/utilities
November 1, 2021
Mike Montebello
NC DEQ /DWR/NPDES Municipal Permitting
1617 Mail Service Center
Raleigh,NC 27699-1617
RE: Muddy Creek NC0050342-Reduction of Monitoring Frequency Request
Dear Mr. Montebello,
This letter is a formal request by the City of Winston Salem for a reduction in monitoring frequency of
Conductivity for the Muddy Creek WWTP Permit#NC0050342.
Our Muddy Creek facility has not had any permit limit violation for Conductivity in the past three years
and there have been no criminal violations of the Clean Water Act in the previous five years. The facility
is not currently under an SOC for Conductivity nor is it listed on EPA's Quarterly Noncompliance Report.
The City of Winston Salem is requesting this reduction in monitoring frequency to reduce overall
operating costs at our facilities.
Please see the attached table showing a three-year span of results for Conductivity at our Muddy Creek
Facility.
Sincerely,
•
te0MYLLifte-f4L.
Bonnie McKee
Laboratory Utilities Plant Supervisor
Manson Meads Complex/Archie Elledge WWTP
2799 Griffith Rd.
Winston Salem, NC 27103
336.765.0130
[e-mail]
•
--"cc:-Frank'Crump,-Chris Shame!,Matthew Lavigne Keith Jones— - — --
City Council:MayorAllenJolnes;Denise D.Adams,Mayor Pro Tempare,North Ward;Barbara Hanes Burke,Northeast Ward;Robert C.Clark,West Ward;
City Li n k 311 John C.Larson,South Ward;Jeff Macintosh,Northwest Ward;Kevin Mundy,Southwest Ward;Annette Sclpplo,East Ward;James Taylor,Jr.,Southeast Ward;
i ;, City Manager:Lee D.Garrity
County Commissioners:David R.Plyler,Chair;Don Marlin,Vice Chair;Fleming El-Amin;Ted Kaplan;Richard V.Linville;Tonya McDaniel;Gloria D.Whtsenhunt;
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]0 Duane Long;Hugh W.Jernigan;Chris Parker;Donald R.Stewart;Charies Wilson;Allan Younger

Enclosure 2

Muddy Creek NC 0050342
Reduced Permit Monitoring Request
Conductivity
Sp Conductivity Sp Conductivity Sp Conductivity
SM 2510 B 2011 SM 2510 B 2011 SM 2510 B 2011
umho/cm umho/cm umho/cm
Minimum Maximum Average
9/18/2018 303 9/14/2018 660 570
10/22/2018* 2 10/30/2018 1,044 539
11/16/2018 290 11/9/2018 585 482
12/17/2018 426 12/14/2018 745 542
1/25/2019 419 1/18/2019 689 531
2/25/2019 300 2/8/2019 531 463
3/5/2019 394 3/15/2019 542 485
4/15/2019 429 4/5/2019 563 491
5/14/2019 471 5/28/2019 599 538
6/19/2019 342 6/7/2019 667 503
7/24/2019 472 7/31/2019 666 579
8/26/2019 549 8/13/2019 665 616
9/10/2019 585 9/27/2019 668 611
10/31/2019 455 10/2/2019 639 572
11/1/2019 372 11/15/2019 571 512
12/2/2019 340 12/26/2019 544 484
1/15/2020 398 1/31/2020 535 475
2/14/2020 335 2/6/2020 523 447
3/2/2020 416 3/30/2020 574 508
4/14/2020 430 4/3/2020 611 527
5/29/2020 343 5/15/2020 533 475
6/1/2020 430 6/24/2020 555 510
7/2/2020 503 7/30/2020 686 585
8/24/2020 444 8/10/2020 651 540
9/10/2020 470 9/2/2020 619 557
10/12/2020 305 10/21/2020 713 583
11/16/2020 430 11/9/2020 755 661
12/1/2020 361 12/11/2020 693 588
1/29/2021 502 1/8/2021 742 667
2/17/2021 409 2/5/2021 723 574
3/29/2021 495 3/18/2021 695 600
4/1/2021 525 4/23/2021 1,008 658
5/4/2021 535 5/25/2021 793 717
6/9/2021 720 6/28/2021 935 804
7/26/2021 694 7/7/2021 993 801
2 1044 566
*The minimum Conductivity on 10/22/2018 was an anomaly.The Muddy Creek facility experienced a large
rain event prior to this sampling event. This sample was duplicated and the results confirm.

Enclosure 3

ROY COOPER i, e I
Governor
MICHAEL S.REGAN ` e ".
Secretary ***mows.*
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 (LIMP) 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 (IUP) 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.
•
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
V-vanadium 10 ug/L 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
•DEQ)
North Carolina Department of Environmental Quality I Division of Water Resources
512 North Salisbury Street l 1617 Mail Service Center I Raleigh,North Carolina 27699-1617
919.707.9000

Enclosure 4

_ •
,, .; IT
3 .3 M' IN.
45 /73c0,,
?`a' °i 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 xl0
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,
Amanda Hancock
Technical Services Supervisor
Meritech, Inc.
Ph: 336 342 4748
Fax: [phone]
642 Tamco Road P.O. Box 27 o Reidsville, NC 27320
[phone] • [phone] Fax

Enclosure 5

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 City of Winston Salem is getting ready to submit permit renewals for Elledge
WWTP NC0037834 and Muddy Creek WWTP NC0050342. Both plants have
successfully completed all quarterly Chronic TOX Pass/Fail sampling events, however
both plants need 1 additional 2nd Species event to complete their permit renewal
applications.
We would like to conduct this test in November if acceptable.
NAP! d ';t4' EMt
Agar
r
r
art
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
NC0050342 Muddy Creek Wastewater OMB No.2040-0004
Form U.S.Environmental Protection Agency
2A .SEPA 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
Muddy Creek Wastewater Treatment Plant
Mailing address(street or P.O.box)
P.O.Box 2511
City or town State ZIP code
0 Winston-Salem North Carolina 27102
Contact name(first and last) Title Phone number Email address
Courtney Driver,P.E. Director of Utilities [phone] [e-mail]
Location address(street,route number,or other specific identifier) ❑ Same as mailing address
U-
4561 Cooper Road
City or town State ZIP code
Winston-Salem North Carolina 27127
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
oCity or town State ZIP code
as
Contact name(first and last) Title Phone number Email address
0.
0.
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
w number for each.)
Existing Environmental Permits
41,
a.
❑ NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
water) control)
;= NC0050342
•
❑✓ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
No.00878R11
(1) ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ✓❑ Other(specify)
w 404)
Stormwater NCG110133/D
EPA Form 3510-2A(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0050342 Muddy Creek Wastewater 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)
100 %separate sanitary sewer 0 Own 0 Maintain
v WS/Clemmons/ 126,473/15,888/
a) %combined storm and sanitary sewer 0 Own 0 Maintain
Kernersville 21,291 0 Unknown 0 Own 0 Maintain
c 100 %separate sanitary sewer 0 Own 0 Maintain
o King/Lewisville/ 690/1,972/139 %combined storm and sanitary sewer 0 Own 0 Maintain
f° Tobaccoville
0 Unknown ❑ Own 0 Maintain
a100 %separate sanitary sewer 0 Own 0 Maintain
c Rural Hall/ 3,400/7,209 %combined storm and sanitary sewer 0 Own 0 Maintain
m Forsyth County 0 Unknown 0 Own 0 Maintain
E
100 %separate sanitary sewer 0 Own 0 Maintain
No Davidson 11,560/2,675 %combined storm and sanitary sewer 0 Own 0 Maintain
Co./Davie Co. 0 Unknown 0 Own 0 Maintain
8 Total
°' Population 191,297
ci Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of o 0
sewer line(in miles) 100 /0 0 /0
1.8 Is the treatment works located in Indian Country?
•
0
❑ Yes ✓❑ No
U
c 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
43.0 mgd
N Annual Average Flow Rates(Actual)
a Two Years Ago Last Year This Year
c
c 0 16.77 mgd 17.60 mgd 15.12 mgd
Maximum Daily Flow Rates(Actual)
cm Two Years Ago Last Year This Year
21.91 mgd 23.41 mgd 21.04 mgd
0) 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
° Q- Constructed
a,, Combined Sewer
s .o Treated Effluent Untreated Effluent Overflows Bypasses Emergency
Overflows
cn
in 2 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
NC0050342 Muddy Creek Wastewater 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 0 Intermittent
O Continuous
gpd ❑ Intermittent
❑ Continuous
gpd ❑ Intermittent
2 1.14 Is wastewater applied to land?
❑ Yes ❑✓ No 4 SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
a. Land Application Site and Discharge Data
o Continuous or
o Average Daily Volume
Location Size A lied Intermittent
pp (check one)
acres d 0 Continuous
o gp 0 Intermittent
acres d 0 Continuous
o gp 0 Intermittent
-0 0 Continuous
acres gpd 0 Intermittent
1.16 Is effluent transported to another facility for treatment prior to discharge?
o ❑ Yes ❑✓ 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
NC0050342 Muddy Creek Wastewater 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
g NPDES number of receiving facility(if any) ❑ None Average daily flow rate mgd
ta
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
d have outlets to waters of the United States(e.g.,underground percolation,underground injection)?
s ❑ Yes ❑✓ No 4 SKIP to Item 1.23.
N 1.22 Provide information in the table below on these other disposal methods.
0
Information 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
0 Continuous
acres gpd ❑ Intermittent
❑ Continuous
acres gpd ❑ Intermittent
acresgpd ❑ 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.
a) u) Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
c ❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
ta Section 301(h)) 302(b)(2))
❑ Not 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
0
Contractor name
(company name)
Mailing address
(street or P.O.box)
City,state,and ZIP
code
0 Contact name(first and
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
OMB No.2040-0004
NC0050342 Muddy Creek Wastewater
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
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?
o ❑✓ Yes ❑ No 4 SKIP to Section 3.
2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration
and infiltration.
6,300,000 gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
a
Currently working with engineer group to preform rehabilitation of sewer lines.Utilities Field Operations currently have
3 a sewer lines P/M program to check lines monthly to clear out roots and debris.
0
2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
0
0 specific requirements.)
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 E (See instructions for specific requirements.)
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.
1.
E
2.
E
0 0
3.
a
iU
n 4.
co 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
o Improvement Construction Construction Discharge
(from above) (list outfall (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY) Level
number) (MM/DD/YYYY)
a
1.
a
co
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
NC0050342 Muddy Creek Wastewater 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 002 Outfall Number
State North Carolina North Carolina
County Davidson County Davidson County
City or town Davidson Davidson
0
Distance from shore N/A ft. N/A ft. ft.
Q
d Depth below surface N/A ft. N/A ft. ft.
Average daily flow rate 15.23 mgd 0.00 mgd mgd
Latitude 35° 55' 52.9" N 35° 58' 36.1" N
Longitude 80° 22' 08.3" W 80° 20' 19.9" W
co
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.
a)
3.3 If so,provide the following information for each applicable outfall.
N Outfall Number Outfall Number Outfall Number
a Number of times per year
o discharge occurs
a Average duration of each
discharge(specify units)
o Average flow of each mgd o.00 mgd mgd
discharge
ma' Months in which discharge
occurs
3.4 Are any of the outfalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑✓ No 4 SKIP to Item 3.6.
CL, 3.5 Briefly describe the diffuser type at each applicable outfall.
CI
Outfall Number Outfall Number Outfall Number
d
y
o co' 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
discharge points?
❑ 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
NC0050342 Muddy Creek Wastewater OMB No.2040-0004
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number 001 Outfall Number 002 Outfall Number
Receiving water name Yadkin River Muddy Creek River
Name of watershed,river,
0
Or stream system Yadkin River Basin Yadkin River Basin
9- U.S.Soil Conservation
N Service 14-digit watershed
o code
L
r; Name of state
�° management/river basin Yadkin River Basin Yadkin River Basin
rn
•- U.S.Geological Survey
0) 8-digit hydrologic 03040103 03040103
ce cataloging unit code
Critical low flow(acute) 644 cfs 55 cfs cfs
Critical low flow(chronic) N/A cfs N/A cfs cfs
Total hardness at critical mg/L of N/A mg/L of mg/L of
low flow N/A CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number 001 Outfall Number 002 Outfall Number
Highest Level of t] Primary 0 Primary 0 Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
El Secondary 0 Secondary 0 Secondary
❑ Advanced ❑ Advanced 0 Advanced
❑ Other(specify) 0 Other(specify) 0 Other(specify)
c
0
'a Design Removal Rates by
u Outfall
N
N
n BOD5 or CBOD5 93 % 93
c
d
E
m TSS 95 % 95
H
0 Not applicable 0 Not applicable 0 Not applicable
Phosphorus % o
/o 0/a
0 Not applicable 0 Not applicable 0 Not applicable
Nitrogen
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
°/a % %
EPA Form 3510-2A(Revised 3-19) Page 7

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0050342 Muddy Creek Wastewater 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.
-Continuous dose of Sodium Hypochlorite to outfall 001&sub outfall 002.
42
0
0
Outfall Number 001 Outfall Number 002 Outfall Number
c Disinfection type
Sodium Hypochlorite Sodium Hypochlorite
4,
as
Seasons used
All Seasons All Seasons
Dechlorination used? ❑ Not applicable El Not applicable El Not applicable
❑✓ Yes ❑✓ Yes El Yes
O No 0 No El No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
El 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 002 Outfall Number
Acute Chronic Acute Chronic Acute Chronic
Number of tests of discharge 17 0
water
Number of tests of receiving 0 0
water
3.13 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
ElYes El No 4 SKIP to Item 3.16.
0 3.14 Does the POTW use chlorine for disinfection,use chlorine elsewhere in the treatment process,or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑✓ Yes 4 Complete Table B,including chlorine. ❑ No 4 Complete Table B,omitting chlorine.
3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
CD
package?
❑✓ Yes El 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 4 Complete Tables C,D,and E as
❑ applicable. ElNo 4 SKIP to Section 4.
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
I _

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0050342 Muddy Creek Wastewater 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?
No 4 Complete tests and Table E and SKIP to
❑✓ Yes ❑ Item 3.26.
3.20 Have you previously submitted the results of the above tests to your NPDES permitting authority?
El 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(MM/DD/YYYY) Summary of Results
a 08/17/2021 Pass>22
co 3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
a toxicity?
❑ Yes ❑✓ No-4 SKIP to Item 3.26.
w 3.23 Describe the cause(s)of the toxicity:
c
d
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 sermittin. 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
9 2
4.3 Does the POTW have an approved pretreatment program?
❑✓ Yes ❑ No
a
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?
y ❑✓ Yes ❑ No 4 SKIP to Item 4.6.
0
o 4.5 Identify the title and date of the annual report or pretreatment program referenced in Item 4.4.SKIP to Item 4.7.
17)
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
NC0050342 Muddy Creek Wastewater 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 0 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
U
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
N
N ❑ Truck ❑ Rail
co
❑ Dedicated pipe ❑ Other(specify)
1 co
N
4.9 Does the POTW receive,or has it been notified that it will receive,wastewaters that originate from remedial activities,
including those undertaken pursuant to CERCLA and Sections 3004(7)or 3008(h)of RCRA?
❑ Yes ❑✓ No 4 SKIP to Section 5.
173
11) 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 122.21(j)(8))
5.1 Does the treatment works have a combined sewer system?
❑ Yes ❑✓ No 4SKIP to Section 6.
-0 5.2 Have you attached a CSO system map to this application?(See instructions for map requirements.)
❑
Yes ❑ No
a
m
0
5.3 Have you attached a CSO system diagram to this application?(See instructions for diagram requirements.)
o ❑ Yes El No
U
EPA Form 3510-2A(Revised 3-19) Page 10

i
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0050342 Muddy Creek Wastewater 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
•a State and ZIP code
u
1 H
o County
71
Latitude
0
0 o 0
N Longitude °
o
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 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
a)
c
o CSO flow volume 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
CSO pollutant 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
o concentrations
o Receiving water quality 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
CSO frequency 0 Yes 0 No 0 Yes 0 No ❑ Yes ❑ No
Number of storm events 0 Yes ❑ No 0 Yes 0 No 0 Yes 0 No
5.6 Provide the following information for each of your CSO outfalls.
CSO Outfall Number CSO Outfall Number CSO Outfall Number
L
CO Number of CSO events in events events events
1, the past year
as
Average duration per hours hours hours
c event 0 Actual or 0 Estimated 0 Actual or❑ Estimated 0 Actual or 0 Estimated
N
w
o Average volume per event million gallons million gallons million gallons
c`".) 0 Actual or 0 Estimated 0 Actual or 0 Estimated 0 Actual or 0 Estimated
Minimum rainfall causing inches of rainfall inches of rainfall inches of rainfall
a CSO event in last year 0 Actual or 0 Estimated 0 Actual or 0 Estimated 0 Actual or 0 Estimated
EPA Form 3510-2A(Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0050342 Muddy Creek Wastewater 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/
stream system
U.S.Soil Conservation 0 Unknown ❑ Unknown ❑ Unknown
15
Service 14-digit
watershed code
> (if known)
CU
Name of state
management/river basin
U.S.Geological Survey 0 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.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 ❑✓ w/topographic map ❑✓ w/process flow diagram
Information ✓❑ w/additional attachments
✓❑ w/Table A ❑✓ w/Table D
❑ Section 3:Information on El 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
u' ❑✓ Discharges and Hazardous
Wastes ✓❑ w/additional attachments
Section 5:Combined Sewer 0 w/CSO map ❑ w/additional attachments
❑ Overflows
❑ w/CSO system diagram
Section 6:Checklist and
❑ Certification Statement El w/attachments
11)
Y 6.2 Certification Statement
c /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
Cou a Driver,P.E. Utilities Director
Sig atur Date sig ed
Ll
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0050342 Muddy Creek Wastewater 001 OMB No.2040-0004
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method' Include
Value Units Value Units Samples ( units)
Biochemical oxygen demand
LI ML
❑BODs or o CBOD5 40 mg/L 11 mg/L 523 SM 5210 B 2011 2 mg/L 0 MDL
reiort one
El ML
Fecal coliform 2420 mpn/100 68 mpn/100 564 IDEXX Colilert 18 #/100mL 0 MDL
Design flow rate 54.90 MOD 16.94 mgd 1096
pH(minimum) 5.1 S.U.
pH(maximum) 7.5 S.U.
Temperature(winter) 27 C 19 C 454
Temperature(summer) 27 C 20 C 642
0 ML
Total suspended solids(TSS) 682 mg/L 14 mg/L 747 SM 2540 D 2011 2.5 mg/L 0 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
NC0050342 Muddy Creek Wastewater 001 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 Number of
Value Units Value Units Method1 (include units)
Samples
ML
Ammonia(as N) 95.7 mg/L 0.9 mg/L 650 SM 4500 D 2011 0.02 mg/L 0 MDL
Chlorine O ML
(total residual,TRC)2 46 ug/L <20 ug/L 735 SM 4500 CL G 2011 20 mg/L Ei MDL
Dissolved oxygen 9.3 mg/L 7.2 mg/L 1095 SM 4500 0 G 2011 NA O MDL
Nitrate/nitrite 39.5 mg/L 21.6 mg/L 50 SM 4500 B&D 2011 0.1 mg/L 0▪MDL
0 ML
Kjeldahl nitrogen 11.5 mg/L 3.4 mg/L 48 SM 4500 C 2011 1 mg/L 0 MDL
0 ML
Oil and grease <S mg/L <5 mg/L 2 EPA 1664B 5 mg/L 0 MDL
Phosphorus 6.30 mg/L 3.61 mg/L 58 SM 4500 P E 2011 0.5 mg/L 0▪MDL
Total dissolved solids 466 mg/L 460 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 Outlall Number Form Approved 03/05/19
NC0050342 Muddy Creek Wastewater 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 Method' (include units)
Value Units Value Units Samples
Metals,Cyanide,and Total Phenols
ML
Hardness(as CaCO3) ❑MDL
ML
Antimony,total recoverable 0 MDL
Arsenic,total recoverable o ML
❑MDL
ML
Beryllium,total recoverable o MDL
Cadmium,total recoverable o ML
❑MDL
Chromium,total recoverable o ML
❑MDL
Copper,total recoverable o ML
❑MDL
Lead,total recoverable o ML
❑MDL
ML
Mercury,total recoverable o MDL
Nickel,total recoverable o ML
❑MDL
Selenium,total recoverable ❑ML
❑MDL
Silver,total recoverable o ML
❑MDL
Thallium,total recoverable ❑ML
❑MDL
Zinc,total recoverable o ML
❑MDL
❑ML
Cyanide o MDL
ML
Total phenolic compounds ❑MDL
Volatile Organic Compounds
Acrolein ❑ML
❑MDL
Acrylonitrile ❑ML
❑MDL
Benzene ❑ML
_ ❑MDL
Bromoform o ML
❑MDL
EPA Form 3510-2A(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03105119
NC0050342 Muddy Creek Wastewater 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
Carbon tetrachloride °ML
°MDL
Chlorobenzene ❑ML
❑MDL
Chlorodibromomethane ❑ML
❑MDL
Chloroethane ❑ML
❑MDL
0 ML
2-chloroethylvinyl ether ❑MDL
Chloroform 0 ML
❑MDL
Dichlorobromomethane 0 ML
❑MDL
1,1-dichloroethane ❑ML
❑MDL
1,2-dichloroethane ❑ML
❑MDL
trans-1,2-dichloroethylene 0 ML
❑MDL
1,1-dichloroethylene ❑ML
❑MDL
ML
1,2-dichloropropane ❑MDL
ML
1,3-dichloropropylene ❑MDL
ML
Ethylbenzene ❑MDL
0 ML
Methyl bromide ❑MDL
0 ML
Methyl chloride ❑MDL
Methylene chloride ❑ML
❑MDL
1,1,2,2-tetrachloroethane ❑ML
❑MDL
Tetrachloroethylene ❑ML
❑MDL
Toluene 0 ML
❑MDL
1,1,1-trichloroethane ❑ML
O MDL
1,1,2-trichloroethane o 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
NC0050342 Muddy Creek Wastewater 001 OMB No.2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Value Units Value Units Number of Methods (include units)
Samples
❑ML
Trichloroethylene ❑MDL
ML
Vinyl chloride o MDL
Acid-Extractable Compounds
_._...._. ❑ML
p-chloro-m-cresol ❑MDL
❑ML
2-chlorophenol ❑MDL
2,4-dichlorophenol ❑ML
❑MDL
0 ML
2,4-dimethylphenol ❑MDL
4,6-dinitro-o-cresol ❑ML
❑MDL
2,4-dinitrophenol ❑ML
❑MDL
0 ML
2-nitrophenol ❑MDL
❑ML
4-nitrophenol ❑MDL
0 ML
Pentachlorophenol ❑MDL
Phenol ❑ML
❑MDL
❑ML
2,4,6-trichlorophenol 0 MDL
Base-Neutral Compounds
0 ML
Acenaphthene ❑MDL
ML
Acenaphthylene 0 MDL
Anthracene ❑ML
❑MDL
Benzidine ❑ML
❑MDL
0 ML
Benzo(a)anthracene ❑MDL
ML
Benzo(a)pyrene o 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
NC0050342 Muddy Creek Wastewater 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
ML
Benzo(ghi)perylene 0 MDL
ML
Benzo(k)fluoranthene ❑MDL
0 ML
Bis(2-chloroethoxy)methane o MDL
ML
Bis(2-chloroethyl)ether o MDL
Bis(2-chloroisopropyl)ether o ML
❑MDL
Bis(2-ethylhexyl)phthalate ❑ML
❑MDL
0 ML
4-bromophenyl phenyl ether ❑MDL
ML
Butyl benzyl phthalate o MDL
2-chloronaphthalene o ML
❑MDL
0 ML
4-chlorophenyl phenyl ether o MDL
Chrysene o ML
❑MDL
di-n-butyl phthalate o ML
❑MDL
0 ML
di-n-octyl phthalate ❑MDL
Dibenzo(a,h)anthracene o ML
❑MDL
1,2-dichlorobenzene o ML
❑MDL
1,3-dichlorobenzene o ML
❑MDL
1,4-dichlorobenzene o ML
❑MDL
3,3-dichlorobenzidine ❑ML
❑MDL
Diethyl phthalate ML
o MDL
Dimethyl phthalate o ML
❑MDL
2,4-dinitrotoluene o ML
o MDL
2,6-dinitrotoluene o 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
NC0050342 Muddy Creek Wastewater 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 Method1 (include units)
Value Units Value Units Samples
0 ML
1,2-diphenylhydrazine MDL
Fluoranthene 0 ML
o MDL
Fluorene 0 ML
0 MDL
Hexachlorobenzene 0 ML
❑MDL
Hexachlorobutadiene 0 ML
❑MDL
0 ML
Hexachlorocydo-pentadiene 0 MDL
Hexachloroethane 0 ML
❑MDL
0 ML
Indeno(1,2,3-cd)pyrene 0 MDL
ML
Isophorone 0 MDL
Naphthalene 0 ML
❑MDL
Nitrobenzene 0 ML
o MDL
N-nitrosodi-n-propylamine 0 ML
❑MDL
N-nitrosodimethylamine 0 MDL
0 ML
N-nitrosodiphenylamine ❑MDL
Phenanthrene 0 ML
❑MDL
❑ML
Pyrene ❑MDL
1,2,4-trichlorobenzene 0 ML
0 MDL
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
NC0050342 Muddy Creek Wastewater 001 OMB No.2040-0004
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Pollutant Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
(list) Value Units Value Units Number of Method" (include units)
Samples
❑✓ No additional sampling is required by NPDES permitting authority.
o
Co-Cobalt <0.002 mg/L <0.002 mg/L 2 EPA 200.8 0.002 ML
D MDL
Sb-Antimony <0.0005 mg/L <0.0005 mg/L 2 EPA 200.8 0.0005 0 ML
❑MDL
ML
Sn-Tin* <0.01 mg/L <0.01 mg/L 2 EPA 200.8 0.025 ❑MDL
ML
Ti-Tintanium <0.005 mg/L <0.005 mg/L 2 EPA 200.8 0.005 p MDL
0 ML
V-Vanadium <0.005 mg/L <0.005 mg/L 2 EPA 200.8 0.04 0 MDL
❑ML
0 MDL
*Estimate ❑ML
O MDL
❑ML
l7 MDL
0 ML
❑MDL
0 ML
❑MDL
❑ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
0 ML
0 MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
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
NC0050342 Muddy Creek Wastewater 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: ❑ Grab ❑ Grab ❑ Grab
❑ 24-hour composite ❑24-hour composite ❑24-hour composite
Sample Location
Check one: ❑ Before Disinfection ❑ Before Disinfection ❑ Before disinfection
❑After Disinfection 0 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 El 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
NC0050342 Muddy Creek Wastewater 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 ❑ Static ❑ Static
response.)
❑Static-renewal ❑Static-renewal ❑Static-renewal
❑ Flow-through ❑ Flow-through ❑ Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check ❑ Laboratory water ❑ Laboratory water ❑ Laboratory water
one response.)
❑ Receiving water ❑ Receiving water ❑ 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
sea salts or brine used. ❑ Salt water(specify) ElSalt water(specify) ❑ Salt water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series.
Parameters Tested
Check the parameters tested. ❑pH ❑Ammonia ❑pH ❑Ammonia ❑pH ❑ Ammonia
❑ Salinity ❑ Dissolved oxygen ❑ Salinity ❑ Dissolved oxygen ❑ Salinity ❑ Dissolved oxygen
❑Temperature ❑Temperature ❑Temperature
Acute Test Results
Percent survival in 100%effluent % % %
LCso
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
NC0050342 Muddy Creek Wastewater ow. 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
IC25
Control percent survival
Other(desaibe)
Quality Control/Quality Assurance
Is reference toxicant data available? ❑ Yes ❑ No ❑Yes ❑ No 0 Yes 0 No
Was reference toxicant test within ❑Yes ❑ No ❑Yes ❑ No ❑Yes ❑ No
acceptable bounds?
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(desaibe)
EPA Form 3510-2A(Revised 3-19) Page 27

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0050342 Muddy Creek Wastewater OMB No.2040-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three Sills.Copy the table to report information for additional SIUs.
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
affect or contribute to the SIU's discharge. Not Applicable Not Applicable Not Applicable
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 0 No 0 Yes 0 No 0 Yes 0 No
Is the SIU subject to categorical standards?
0 Yes ❑ No 0 Yes 0 No 0 Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0050342 Muddy Creek Wastewater 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
SIU subject? Not Applicable Not Applicable Not Applicable
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

MUDDY CREEK OUTFALL ,� „�,, °,- �r ",` �_ a� >. �t.>�:9 '� a�
>
" ` "' SOUTHFORK CREEK OUTFACE
.•t +fir MUDDY CREEK WWTP
..
, e
c
• .r
•
DISCHARGE NC005034I 002 1
1 inch = 3818 feet
i
,
•
w`' " DISCHARGE NC0050342-001
I
a
' � w 1 inch = 2081 feet
Facility s;a�����/� i'�j ,,
NC0050342 —Muddy Creek WWTP , Location i��L+7=���1aKr+1!� ai'r#
Latitude(001): 35°55'52.9" ; •y w�at�r~•~►���Z* #r��.
Longitude(001): 80°22'08.3" N �t•
Latitude(002): 35°58'36.1"
t
Longitude(002): 80°20' 19.9" City of Winston Salem
North Forsyth County
Receiving Stream: Yadkin River(001);Muddy Creek(002)

Transfer
CIPS Transfer Force Main Pumps(2)
4 Muddy Creek Wastewater Treatment Plant effluent flow average is 15.12 MGD with a design flow
to Archie Elledge WWTP CO rate of 43 MGD and max effluent flow of 54 MGD.There are three bar screens rated 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 the five influent pumps.Flow is pumped
Archie into two EQ tanks to balance the flow into the plant.
Centrate
from , Chlorine Contact
Elledge WWTP Centrifuges (Outfall Pipe)
36 ._..4,„,,,.
len
T Screens(3) ® 316 South For is
_ TA.
Interceptor Primary Clarifiers(4) AerationSecondary Clarifiers(5)
Grit Removal(2) I 1 1 1 I I ( t Basins(3) - 15.12 MGD
I``� srMuddy Creek = J� "e° `�t` "° *
Interceptor Influent FB
:,,,,....1„:
Pumps(5) O
6
+ Overflow to Muddy Creek
Screenings to Landfill
A Grit to
•Landfill
ID ® RAS Outfall to Yadkin River
I-1 WAS RAS Pumps
PS
Q Based on plant conditions,a portion of this flow is
Stormwater pumped/transferred to Archie Elledge WWTP daily.The
Overflow Basins(2) WAS Thickener wastewater remaining at MC flows by gravity through the
Day Tanks(2) IN primary
plant process.This flow will travel through 4
primary basins,then into three aeration basins.Once the
4 `—RCY settling/biological process is complete,it flows into five
secondary clarifiers.The effluent flow is disinfection with
\' .' Hypochlorite,followed by Sodium Bisulfite for
dechlorination before discharge into the Yadkin River.
All settled solids from the primary basins and
r waste-activated sludge is pumped into 3 Anaerobic
Anaerobic digesters,and methane gas is captured for beneficial
..--"--4 Digesters(4) reuse.Once digestion is complete,biosolids are
F pumped to the AEWWTP,where solids are dried into
Sample Legend class"A"pellets for distribution to agricultural operations.
!D_ Tvoe• Parameters
31 C SS,VSS,NH3-N,COD,CBOD,TKN
35 C SS,VSS,NH3-N,COD,CBOD,TKN,Alkalinity,TP
316 G ZSV,SVI,02,pH
36 G COD,Conductivity,NO2,Alkalinity -Gen- -Gen- -Gen-
37 C SS,VSS,NH3-N,NO3,NO2,DO,COD,CBOD,pH,TP,TKN CAT CAT Jembacher CHP
311 C SS,VSS 1250 kW 2000 kW 1137 kW DT Digested Sludge to
317 G SS,VSS Regional Biosolids Drying Facility
318 C SS,VSS Muddy Creek has two diesel generators and a Combined Heat and Power
FB G Fecal,Low Level Cl2,Conductivity,Chronic Tax. generator that burns methane gas to provide standby power and utilize methane gas.
DT C SS,TS Muddy Creek has two generators and a CHP unit to backup the two generators.
301 C SS,VSS,NH3-N,COD,CBOD,TKN
302 C SS,VSS,NH3-N,COD,CBOD,TKN WINSTON-SALEM/FORSYTH COUNTY
,c-Composite,G-Grab UTILITIES COMMISSION
11
BLACK&VEATCH MUDDY CREEK WWTP 21 PROCESS FLOW DIAGRAM WITH SAMPLING LOCATIONS
195964.6100-la PFD ADI 01-08-18

Table A

uo In In
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T m O 'O TI m O -O TI ` m O -O
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C - U co ro ro hi C E -, U ro CD n (D C 0- So c3 m ro
c c C -o v v Di 6 6 °Ci 6 °mac° c C -0 -, v CD 6 6 6 6 °c c c tt -0 °' v v 6 6 °C 6
U v m m m m U v m m m m U D n m m m m
1111 [ 1111 , 111111111N N N N N N N N N N !V N N N N N N N N N11111111111 , 1 , , 1
F I-, F CD
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H
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co coIA lD NJ W O A Ui LC) NJA U1 al NJ CT) V J W CO I-' A CD CO NJ NJJ lD V NJ (A) V O1 CO L 00 D ~ la,
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CU f
NJ CO In Cl Cl Cl CO In J LU Cl Cr) J LU CT) NJIn J Cl Ol l71 W Cr) A Cl CO C1 J J Ol C1 CO A A OO A
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5' 91 W NJ W A In CO Oo U1 J Lo Cl U7 CO A Us lD Cl N - J A A A l� UlLc) U7 C1 J 0 0 I-, lD CO Cr, D O O
, VD 0 J O Cl W NJ CD NJ UD • CO C1 I--' O Cl A F, V In lD In O LU C1 C1 • U7 F, Cl F, O lD C
m A NJ NJ W lD W J A W U7 00 00 lO Cl NJ lD NJ Cl A , N NJ I, Ul N UJ W U7 CO l0 W I, NJ W CO cn v C W
-, N FP
O N
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N O W W W W W W N W W W W W W W W W W W N W W W W W W W W W W W N W W W W W C31 (D
NJ F, F, O F, O F, W F, F, O F, O �, F, O F, O F-' l0 F, F, O F, O F, F, O �, O F, CC F, F, O F, O v
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3 N A •C1 J C1 W J A J CO U1 J Ut Cl 00 i.n U7 in C1 Cr) J In C1 J CO 00 V In Cl C1 Cl Cl J J In F, 'co 5 C X rt
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V IV V A N O J Cl V lD N W Cl O1 Ol (11).)
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n 13
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lD F, , O O O CC O I, O F, I, O F, O F, lD O I, O I, F-+ O O F, OO I-' I, O O 3 d0 3
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A O V I A NJ Cl NJ V In W U1 Cr) J A — 1-, O I-, Ol O F, H., 1-' GUW V ----II-, C1 CO NJ W O mPO VI
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V N F, F, O O W lD LID I, CO NJ I, V, NJ NJ O I, NJ O I, I, lD UJ O NJ NJ O NJ 1-' IA O 1-' lO LID W CO 3 (n
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Table B

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I E V) ul
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o . w o 0 o 0 0 0 0 0 0 0 0 0 o O o 0 0 0 0 0 0 0 o O o o O o o O 0 0 0 0 0 0
.0 to > O N t0 N CO CO CO h CD Ol .0 V, M N V N C vl vl h CO .1 01 O M i0 O h v.)1 V V Vl Vl 00 IN
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p x O O O O O O O O O O O O O O O 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
L 00 10 0 M V Vl N CO CO N CO C CO t0 OO or) .-i V .0 CO vl vl N h .--1 01 0 V1 .O 0 M V, V V vl Vl 00 hl M
a E C Lc; V M V V M M M M V V M V 6 V M M N vl N .--1 M V1 N Vl N M V V N M N Vl M M V, .0
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f 0 eo > h M M .-1 M - N 00 Q1 h M V N 6 01 W O O 00 N 6 .-1 h M M 00 M 6O h 01 .i O M h at .-1
O.. Z E a N N N .-I .-I .i .i .i .-1 .-1 N N N .i N .-1 N N N N .-I N N N M .-i N N N .1 .-1 M N .1 .1 M N
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N N N .--1 .i .-1 .i N - .-1 N N N .i N .i N N N N .i N N N M N N N N N - M N .1 .-i M M
ll
C 0EN N N N N N N N N N N N N N N N N N N N N O N N N N N N N N N NI
C N NN M N O
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x .O 00 00 V1 Vl .i M COUT/ v,vl . .O INVl N CO 1 N .O h CT, 0 1 01
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0 00 0l al N O N . N O N N 0 N N O NI M
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p TJ a 000000000000000000000000000000000000 ,
V V V V V V V V V V V V V V V V V V V V V V V V V V V V V V V V V V V V
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
N , O nr vl O h N V V1 .O CO o 0 0 0 0 0 co h V ;JD 0 0 N .O O M CO .O O O O O O O 0 0 VD 1
C.l V C N N N N N N N N N N N N N N (.., N N N N V N N M N N N N N N N N N N N N N V
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ZE a O V 000000000000 M .i 0 0 0 0 0 0 0 0 0 0 .i O .-i O O O O .i O O O O O O O O .i N O O O
m vl h .O CO 0, M N h Ln N .O i .i N N CO 0 N M N V In CO CO Vl CO N M Vl _ V1 N h
X 00 M O V1 .. N V M 0 •.i O O .-I• O N .1 O O• a .i N .--I O N O Vl .i O .--I .i O n'1 n, O - Ol O O Lc;z E 2 v rn .i v V V V V V V v v v m
CO 00 CO CO 01 01 Ot O1 m 01 CT Ol 6 m 01 Ol O O O 0 0 O 0 O 0 0 O 0 - - .-i .-i .-1 .-1 .i -
.i .i .i .i 1-1 .i .i .i .i .i .i .1 .i .i .1 .i N N N N N N Ni N N N N Ni N N N N N N N N
`w `w w w Z- Z'` = k c �' N v 0 w 0 Z' Z 5 _ c - 0 w v w Z' Z = m c �. i;
E 0 E E > > 0 O.
- ' a7o E o a > > A ¢a` � m E o E E > > ro < 7 m
II./ a al m 0 2 Q7 w a0i w m 0 2 < al t al aa/ m .o 2 C
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1

Table C & D
Priority Pollutant Analysis

October 2017

Annual Monitoring and Pollutant Scan
Facility Name: Muddy Creek WWTP/NC0050342/Pipe 01 ORC: Keith Jones
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 CO610 Composite EPA 350. 1 0.02 <0.02 mg/L
Chlorine (total residual, TRC) 2 50060 Grab Hach 100 14 20 <20 mg/L
Dissolved Oxygen 2 00300 Grab SM 45000 G 6.94 mg/L
Nitrite plus Nitrate Total (as N) <1 00630 Composite EPA 353.2 0.1 30.3 mg/L
Total Kjeldahl Nitrogen <1 00625 Composite EPA 35 1. 1 0.2 <0.20 mg/L
Oil and Grease <1 00556 Grab EPA 1664B 5 <5 mg/L
Total Phosphorus <1 CO665 Composite EPA 200.7 0.02 4.52 mg/L
Total Dissolved Solids <1 70295 Composite SM 2540C 10 540 mg/L
Hardness <1 00900 Composite SM 2340C 1 <140 mg/L
Metals (total recoverable), cyanide and total phenols <1
Antimony 01097 Composite EPA 200.8 0.0005 0.008 mg/L
Arsenic 0 1002 Composite EPA 200.8 0.002 <0.002 mg/L
Beryllium 0 10 12 Composite EPA 200.8 0.0005 <0.0005 mg/L
Cadmium 0 1027 Composite EPA 200.8 0.00015 <0.00015 mg/L
Chromium 0 1034 Composite EPA 200.8 0.002 0.003 mg/L
Copper 0 1042 Composite EPA 200.8 0.002 0.006 mg/L
Lead 0 105 1 Composite EPA 200.8 0.0005 <0.0005 mg/L
Mercury (Method <163<lE) 3 COMER Composite EPA 1631 1 <1.0 ng/L
Nickel 0 1067 Composite EPA 200.8 0.0005 0.003 mg/L
Selenium 0 1 147 Composite EPA 200.8 0.002 <0.002 mg/L
Silver 0 1077 Composite EPA 200.8 0.0005 <0.0005 mg/L
Thallium 0 1059 Composite EPA 200.8 0.0005 <0.0005 mg/L
Zinc 0 1092 Composite EPA 200.8 0.005 0.057 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 342 10 Grab EPA 624 50 <50 ug/L
Acrylonitrile 342 15 Grab EPA 624 10 <10 ug/L
Benzene 34030 Grab EPA 624 1 <1 ug/L
Bromoform 32 104 Grab EPA 624 1 <1 ug/L
Carbon Tetrachloride 32 102 Grab EPA 624 1 <1 ug/L
Chlorobenzene 3430 1 Grab EPA 624 1 <1 ug/L
Chlorodibromomethane 34306 Grab EPA 624 1 4.48 ug/L
Chloroethane 858 1 1 Grab EPA 624 5 <5 ug/L
2-chloroethyl vinyl ether 34576 Grab EPA 624 5 <5 ug/L
Chloroform 32 106 Grab EPA 624 1 6.95 ug/L
Dichlorobromomethane 32 10 1 Grab EPA 624 1 8.6 ug/L
<1,<1-dichloroethane 34496 Grab EPA 624 1 <1 ug/L
<1,2-dichloroethane 32 103 Grab EPA 624 1 <1 ug/L
Trans-<1,2-dichloroethylene 34546 Grab EPA 624 1 <1 ug/L
Form - DMR- PPA-1 Page 1

Annual Monitoring and Pollutant Scan
Parameter Sample Analytical Quantitation Sample Units of
Parameter Code Type Method Level Result Measurement
<1,<1-dichloroethylene 3450 1 Grab EPA 624 1 <1 ug/L
<1,2-dichloropropane 3454 1 Grab EPA 624 1 <1 ug/L
<1,3-dichloropropylene 77 163 Grab EPA 624 2 <2 ug/L
Ethylbenzene 3437 1 Grab EPA 624 1 <1 ug/L
Methyl Bromide 344 13 Grab EPA 624 5 <5 ug/L
Methyl Chloride 344 18 Grab EPA 624 5 <5 ug/L
Methylene Chloride 34423 Grab EPA 624 1 <1 ug/L
<1,<1,2,2-tetrachloroethane 8 1549 Grab EPA 624 1 <1 ug/L
Tetrachloroethylene 34475 Grab EPA 624 1 <1 ug/L
Toluene 340 10 Grab EPA 624 1 <1 ug/L
<1,<1,<1-trichloroethane 34506 Grab EPA 624 1 <1 ug/L
<1,<1,2-trichloroethane 345 1 1 Grab EPA 624 1 <1 ug/L
Trichloroethylene 39 180 Grab EPA 624 1 <1 ug/L
Vinyl Chloride 39 175 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 3460 1 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 346 16 Grab EPA 625 50 <50 ug/L
2-nitrophenol 3459 1 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 3462 1 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 39 120 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 3452 1 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 39 100 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 3458 1 Grab EPA 625 10 <10 ug/L
4-chlorophenyl phenyl ether 3464 1 Grab EPA 625 10 <10 ug/L
Chrysene 34320 Grab EPA 625 10
<10 ug/L
Form - DMR- PPA-1 Page 2

' Annual Monitoring and Pollutant Scan
Parameter Sample Analytical Quantitation Sample Units of
Parameter Code Type Method Level Result Measurement
Di-n-butyl phthalate 39 1 10 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 3457 1 Grab EPA 625 10 <10 ug/L
3,3-dichlorobenzidine 3463 1 Grab EPA 625 50 <50 ug/L
Diethyl phthalate 34336 Grab EPA 625 10 <10 ug/L
Dimethyl phthalate 3434 1 Grab EPA 625 10 <10 ug/L
2,4-dinitrotoluene 346 1 1 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 3438 1 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 3446 1 Grab EPA 625 10 <10 ug/L
Pyrene 34469 Grab EPA 625 10 <10 ug/L
<1,2,4,-trichlorobenzene 3455 1 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."
Authorized Repres tative name
0 47", L
Signature
(2— I f5 1 2-0 k7
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.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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 C0610 C0530 31616 00300 C0600
= E B
P. F n
en' 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 a i- g -
i u° f, i O S. Recorder Grab Grab Grab Composite Composite Grab Grab Composite
. E f-. x. aua
C el o o z FLOW TEMP-C pH CHLORINE NH3-N-Cone TSS-Cone FCOLI BR DO TOTAL N-
2400 clock Hn 2400 clock Hrs Y/B/N mgd deg c su ug/I mg/1 mg/1 #/100m1 mg/1 mg/I
1 0600 24 0800 24 Y 15.07 15 6.8 <20 <0.5 8 I 8.5
2 0600 24 0800 24 Y 15.6 15 6.8 <20 <0.5 8 5 7.7
3 0600 24 0800 24 Y 15.54 16 6.8 <20 <0.02 8 15 8.3 23
4 0600 24 0800 24 Y 15.32 16 7.1 <20 <0.5 7 34 7.3
5 0600 24 0800 24 Y 17.96 17 7 <20 <0.5 7 8.3
6 0600 24 0800 24 B 16.22 17 8.2
7 0600 24 0800 24 13 15.67 16 7.8
8 0600 24 0800 24 Y 15.9 17 6.8 <20 <0.5 6 3 8
9 0600 24 0800 24 Y 18.18 17 7 <20 <0.5 6 3 7.4
to 0600 24 0800 24 B 18.55 17 6.8 <20 <0.5 6 10 7.2
11 0600 24 0800 24 B 16.13 18 6.7 <20 <0.5 7 8 7.7
12 0600 24 0800 24 B 19.63 18 6.7 25 <0.5 7 7.6
13 0600 24 0800 24 Y 22.04 17 6.9
14 0600 24 0800 24 B 19.15 17 6.7
15 0600 24 0800 24 B 19.29 16 6.8 <20 1 7 6 7.5
16 0600 24 0800 24 B 16.83 17 7.1 <20 0.9 7 5 8
17 0600 24 0800 24 B 16.6 17 6.8 <20 0.7 6 11 7.3
18 0600 24 0800 24 B 15.91 18 6.9 <20 <0.5 S 7.9 19.5
19 0600 24 0800 24 B 17.25 18 H H II II H 8.2
20 0600 24 0800 24 Y 17.52 17 8
21 0600 24 0800 24 B 16.19 17 8.3
22 0600 24 0800 24 Y 16.08 17 6.8 <20 <0.5 6 1 7.6
23 0600 24 0800 24 Y 16.03 18 6.8 25 <0.5 8 3 7.9
24 0600 24 0800 24 Y 14.43 19 6.7 <20 <0.5 7 3 7.2
25 0600 24 0800 24 Y 16.16 18 6.8 <20 1.7 S 12 7.6
26 0600 24 0800 24 Y 15.8 19 6.8 <20 0.9 6 7.9
27 0600 24 0800 24 B 15.4 17 7.9
28 0600 24 0800 24 B 15.28 17 7.9
29 0600 24 0800 24 Y 15.46 18 6.8 <20 1.2 6 2 7.9
30 0600 24 0800 24 B 15.35 18 6.6 <20 <0.5 6 5 8
r
Monthly Average Limit: 21 14 30 200
1
Monthly Average: 16.684667 17.133333 2.380952 0.304762 6.904762 4.955046 7.756667 21.-5
Daly Maximum: 22.04 19 7.1 _25 1.7 8 34 8.5 24
Daily Minimum: 14.43 15 6.6 0 0 6 1 6.7 195
****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_NC0050342_Ver 3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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 80082 THP3B 00094 00900 TCP3B NC01 34506 34511 34496 34501
E E
F E Pa
d P t _ O 4°
- -
tII
Monthly 2 X week Monthly 5 X week Quarterly Quarterly Annually
t G -
u t 3 E. Composite Composite Composite Grab Composite Composite Grab Grab Grab Grab Grab
t a 0V.
0 z`
C U F O O O 7 TOTAL P- CBOD 20C CER7DCHV CNDUCTVY TOT HARD CERI7DPF ANN POL 111-TCE I12-TCE 1,I-DCE 1,1-DCEY
2400 clock Hrs 2400 clock Hrs Y/B/N mg/I mg/I percent umhos/cm mg/1 pass/fail yes=1 no=0 ug/I ug/I ug/I ug/I
1 0600 24 0800 24 Y 462 1
2 0600 24 0800 24 Y 10 463 P <10 <10 <10 <10
3 0600 24 0800 24 Y 2.24 7 512 112
4 0600 24 0800 24 Y 10 541
5 0600 24 0800 24 Y 10 563
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y 475
9 0600 24 0800 24 Y 7 479
10 0600 24 0800 24 B 7 497
11 0600 24 0800 24 B 3.21 8 496
12 0600 24 0800 24 B 8 528
13 0600 24 0800 24 Y
14 0600 24 0800 24 B
1s 0600 24 0800 24 B 429
16 0600 24 0800 24 B 6 437
17 0600 24 0800 24 B 8 480
18 0600 24 0800 24 B 8 506
19 0600 24 0800 24 B H H
20 0600 24 0800 24 Y
21 0600 24 0800 24 B
22 0600 24 0800 24 Y 458
23 0600 24 0800 24 Y 6 473
24 0600 24 0800 24 Y 9 490 112
25 0600 24 0800 24 Y 13 506
26 0600 24 0800 24 Y 8 513
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y 504
38 0600 24 0800 24 B 6 495
Monthly Average Limit: 25
Monthly Average: 2.725 8.1875 490.809524 112 1 0 0 0 0
Daily Maximum: 3.21 13 563 112 1 0 0 0 0
Daily Minimum: 2.24 6 429 112 I 0 0 0 0
****No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENV WTHR=No Visitation—Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation—Holiday
Discharge Monitoring Report-Copy Of Record(COR NC0050342_Ver 3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
ri 34551 34536 32103 34541 34346 34546 77163 34566 34571 34621 34601
E E' F O C
E . F
u22 u
' O . Grab Grab Grab Grab Grab Grab Grab Grab Grab Grab Grab
„ E A .0. 0 z 00
O :J F O O O z 124-TCB 1,2-DCB 1,2-DCE 1,2-DCP 12DIPHEN t-12DCEY I,3-DCPE 1,3-DCB 1,4-DCB 246-TCPH 2,4-DCPH
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I
I 0600 24 0800 24 Y
2 0600 24 0800 24 Y <10 <10 <10 <I0 <10 <10 <20 <10 <10 <10 <10
3 0600 24 0800 24 Y
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
I 0600 24 0800 24 B
II 0600 24 0800 24 B
12 0600 24 0800 24 B
13 0600 24 0800 24 Y
14 0600 24 0800 24 B
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 B
18 0600 24 0800 24 B
19 0600 24 0800 24 B
20 0600 24 0800 24 Y
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 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_NC0050342_Ver_3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
34606 34616 34611 C0626 34576 34581 34586 34591 34631 34657 34636
I E E —
d E `o
F _ m
E I C
va ' a,
o
5
O °.
a
Grab Grab Grab Grab Grab Grab Grab Grab Grab Grab Grab
d E a
G U 2 O O 5O Z 2,4-DNIPH 2,4-DNPH 2,4-DNT 26DINITR- 2-CEVE 2-CLILNAP 2CPHENOL 2NPHENOL 3,3'-DCB 46DN-o-C 4-BPPETH
2400 clock Hrs 2400 dock Hrs Y/B/N ug/I ug/1 ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I
I 0600 24 0800 24 Y
2 0600 24 0800 24 Y <I <50 <10 <10 <50 <10 <10 <10 <50 <50 <10
3 0600 24 0800 24 Y
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 B
II 0600 24 0800 24 B
12 0600 24 0800 24 B
13 0600 24 0800 24 Y
14 0600 24 0800 24 B
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 B
18 0600 24 0800 24 B
19 0600 24 0800 24 B
20 0600 24 0800 24 Y
21 0600 24 0800 24 B
22 0600 24 0800 24 Y
�3 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 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_NC0050342_Ver_3.0_4_2019.pd0

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
34641 34646 34205 34200 34210 34215 CO220 01097 01002 34030 39120
E E
F• s F a
u F O
E a
o - = c
It O E. Grab Grab Grab Grab Grab Grab Grab Composite Composite Grab Grab
d E a ce
U a'C U E- O O O z° 4-CPPETH 4NPHENOL ACENAPEN ACENAPYL ACROLEIN ACRYLONI ANTHRACE ANTIMONY As-TOTAL BENZENE BENZIDIN
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ugh ug/I ug/I ug/I ug/I ug/1 mg/I mg/I ug/I ug/I
I 0600 24 0800 24 Y
2 0600 24 0800 24 Y <10 <50 <10 <10 <500 <100 <10 <10 <50
3 0600 24 0800 24 Y <0.0005 <0.002
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 B
11 0600 24 0800 24 B
12 0600 24 0800 24 B
13 0600 24 0800 24 Y
14 0600 24 0800 24 B
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 B
18 0600 24 0800 24 B
19 0600 24 0800 24 B -
20 0600 24 0800 24 Y
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 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_NC0050342_Ver_3.0_4_2019.pd0

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
34526 34247 34230 34521 34242 01012 34278 34273 34283 39100 80091
E
E E- .0 Oi. C
E e`
.a u° O . Grab Grab Grab Grab Grab Composite Grab Grab Grab Grab Calculated
<. E n ` u C
G U 2 O O O 7 BNZO-A-A BNZO-A-P BNZO-B-F BNZO-ghi BNZO-K-F BERYLIUM BIS2CXMT BIS2CYET BIS2CIET B2E PHTH CBODS-%R
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/I ug/I ug/I mg/I ug/I ug/I ug/I ug/I percent
I 0600 24 0800 24 Y
2 0600 24 0800 24 Y <10 <10 <10 <10 <10 <10 <10 <10 <10
3 0600 24 0800 24 Y <0.0005
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 B
11 0600 24 0800 24 B
12 0600 24 0800 24 B
13 0600 24 0800 24 Y
14 0600 24 0800 24 B
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 B
18 0600 24 0800 24 B '
19 0600 24 0800 24 B
20 0600 24 0800 24 Y
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 B 95.4
Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0 0 0 0 95.4
Daily Maximum: 0 0 0 0 0 0 0 0 0 0 95.4
Daily Minimum: 0 0 0 0 0 0 0 0 0 0 95.4
****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_NC0050342_Ver 3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
32104 34292 01027 32102 34301 34306 85811 32106 01034 34320 THP6C
I E '
F iE .Ts
o
e` = _ E z`
11 E —
u O a Grab Grab Composite Grab Grab Grab Grab Grab Composite Grab Composite
d E z 0 U a`'
G U 2 O O O i BROMOFR BU-BZ-PH CADMIUM CARBNTET CHLROBNZ CLRDBRME CLROETHA CHLRFORM Cr-TOTAL CHRYSENE FTH7DCHV
2400 dock Hrs 2400 clock Hrs Y/B/N ug/l ug/I mg/I ug/I ug/I ug/I ug/I ug/1 mg/I ug/I percent
I 0600 24 0800 24 Y
2 0600 24 0800 24 Y <10 <10 <10 <10 <10 <50 <10 <10
3 0600 24 0800 24 Y <0.00015 <0.002
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
l0 0600 24 0800 24 B
II 0600 24 0800 24 B
12 0600 24 0800 24 B
13 0600 24 0800 24 Y
14 0600 24 0800 24 B
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 B
18 0600 24 0800 24 B
19 0600 24 0800 24 B
28 0600 24 0800 24 Y
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 B
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_NC0050342_Ver_3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
01037 01042 00720 34556 32101 34336 34341 39110 34596 34371 C0376
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F t:2 P F
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o
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G U 4 O O O 7 COBALT COPPER CN-TOT DBNZO-ah DICLBRJTT DIETY-PH DIMET-PH DNBPHTH D-n-OCPH ETHYLBEN FLUORANT
2400 clock Hrs 2400 clock Hrs Y/B/N mg/I mg/I mg/I ug/I ug/I ug/1 ug/I ug/I ug/I ug/I ug/I
1 0600 24 0800 24 Y
2 0600 24 0800 24 Y 0.005 <10 <10 <10 <10 <10 <10 <10 <10
3 0600 24 0800 24 Y <0.002 0.004
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 B
n 0600 24 0800 24 B
12 0600 24 0800 24 B
13 0600 24 0800 24 Y
14 0600 24 0800 24 B
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 B
18 0600 24 0800 24 B
19 0600 24 0800 24 B
20 0600 24 0800 24 Y
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 B
Monthly Average Limit:
Monthly Average: 0 0.004 0.005 0 0 0 0 0 0 0 0
Daily Maximum: 0 0.004 0.005 0 0 0 0 0 0 0 0
Daily Minimum: 0 0.004 0.005 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_NC0050342_Ver_3.0_4_2019.pd0

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
34381 00951 C0700 39702 34386 34396 34403 34408 01051 01055 COMER
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d E
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C U 2 O O O z FLUORENE F-TOTAL HCB-Cone HEXCLBD HCCP HCE 1123CDPY ISPHRONE LEAD MANGNESE MERCURY-
2400 dock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I mg/I ug/I ng/I
I 0600 24 0800 24 Y
2 0600 24 0800 24 Y <10 <10 <I <50 <10 <10 <10 1.95
3 0600 24 0800 24 Y <0.0005
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 B
It 0600 24 0800 24 B
12 0600 24 0800 24 B
13 0600 24 0800 24 Y
14 0600 24 0800 24 B
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 B
18 0600 24 0800 24 B
19 0600 24 0800 24 B
20 0600 24 0800 24 Y
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 B
Monthly Average Limit:
Monthly Average: 0 0 0 0 0 0 0 0 1.95
Daily Maximum: 0 0 0 0 0 0 0 0 1.95
Daily Minimum: 0 0 0 0 0 0 0 0 1.95
****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_NC0050342_Ver_3.0_4_2019.pd0
i

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
34413 34418 34423 1111162 34696 01067 00630 34447 00625 00620 00615
E H
6 $C
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p u 8 a Grab Grab Grab Composite Grab Composite Composite Grab Composite Composite Composite
d e s U a"
t] U [-' O O O Z METHYLBR METHYLCH MECL2 MOLY NAPTHALE NICKEL NO2&N KJ 03 NITROBEN TOT EL NO3-N NO2-N
2400 clock Hn 2400 clock Hrs Y/B/N ug/1 ug/1 ug/1 ug/1 ug/1 mg/I mg/I ug/1 mg/1 mg/1 mg/I
I 0600 24 0800 24 Y 19
2 0600 24 0800 24 Y <50 <50 <10 <10 17.4
3 0600 24 0800 24 Y 0.0016 22.I I0 I.89 17.3
4 0600 24 0800 24 Y 15.5
5 0600 24 0800 24 Y 13.6
6 0600 24 0800 24 B
7 0600 24 0800 24 B
8 0600 24 0800 24 Y 26.7
9 0600 24 0800 24 Y 20.6
10 0600 24 0800 24 B 18.3
II 0600 24 0800 24 B 16.6
12 0600 24 0800 24 B 18.1
13 0600 24 0800 24 Y
14
0600 24 0800 24 B
15 0600 24 0800 24 B 14.1
16 0600 24 0800 24 B 16
17 0600 24 0800 24 B 13.1
18 0600 24 0800 24 B 3.9 15.3 0.31
19 0600 24 0800 24 B
20 0600 24 0800 24 Y
21 0600 24 0800 24 B
22 0600 24 0800 24 Y 18.3
23 0600 24 0800 24 Y 17.9
24 0600 24 0800 24 Y 19.4
25 0600 24 0800 24 Y 13.4
26 0600 24 0800 24 Y 15.7
27 0600 24 0800 24 B
28 0600 24 0800 24 B
29 0600 24 0800 24 Y 21.1
30 0600 24 0800 24 B 22
Monthly Average Limit:
Monthly overage: 0 0 0 0 0.0016 22.1 0 _2.895 17.590476 0.31
Daily Maximum: 0 0 0 0 0.0016 22.1 0 3.9 26.7 0.31
Daily Minimum: 0 0 0 0 `0.0016 22.1 0 1.89 13.1 0.31
****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_NC0050342 Ver 3.0_4 2019.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
34438 34428 34433 00556 34452 39032 34461 34694 32730 34469 01147
F F .1 G
E
E a' -
o a Grab Grab Grab Grab Grab Grab Grab Grab Grab Grab Composite
o a E u c"
if, U 4 O O O NDMA NDnPA NDPA OIL-GRSE pCLRmCR PCP PHENANTH PHENOL PHEN,TR PVRENE Se-TOTAL
2400 clock Hrs 2400 clock Hrs 1013/N ug/I ug/I ug/I mg/I ug/I ug/I ug/I ug/I mg/I ug/1 mg/I
1 0600 24 0800 24 Y
2 0600 24 0800 24 Y <10 <10 <10 <5 <10 <50 <10 <10 <0.01 <10
3 0600 24 0800 24 Y <0.001
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 B
II 0600 24 0800 24 B
12 0600 24 0800 24 B
13 0600 24 0800 24 Y
14 0600 24 0800 24 B
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 B
18 0600 24 0800 24 B
19 0600 24 0800 24 B
20 0600 24 0800 24 Y
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 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_NC0050342_Ver 3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
01077 70295 81011 81549 34475 01059 01102 01152 34010 39180 01087
IE F F T. O x
E < i —
E et
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d E m u
G U F O O re
O < SILVER RES/DISS TSS-%R TETCLETH TETCLETY THALLIUM TIN TITANIUM TOLUENE TCETHYLE VANADIUM
2400 clock Hrs 2400 clock Hrs Y/B/N mg/I mg/I percent ug/1 ug/I mg/I mg/I mg/I ug/I ug/I mg/I
1 0600 24 0800 24 Y
2 0600 24 0800 24 Y <10 <I <10 <10
3 0600 24 0800 24 Y <0.0005 466 <0.0005 <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 B
It 0600 24 0800 24 B
12 0600 24 0800 24 B
13 0600 24 0800 24 Y
14 0600 24 0800 24 B
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 B
18 0600 24 0800 24 B
19 0600 24 0800 24 B
20 0600 24 0800 24 Y
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 B 97.2
Monthly Average Limit:
Monthly Average: 0 466 97.2 0 0 0 0 0 0 0 0
Daily Maximum: 0 466 97.2 0 0 0 0 0 0 0 0
Daily Minimum: 0 466 97.2 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_NC0050342_Ver_3.0_4_2019.pd0

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
39175 1111192
I _
p, E E P ti
m I- _ 0 a
8 - > C
6 ¢ F ui —
S u° O S. Grab Composite
E a U B
C U [2 O 0' O 7 V[NYLCHL ZINC
2400 clock Hrs 2400 clock Hrs Y/B/N ugh mg/1
1 0600 24 0800 24 Y
2 0600 24 0800 24 Y <50
3 0600 24 0800 24 Y 0.052
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 B
11 0600 24 0800 24 B
12 0600 24 0800 24 B
13 0600 24 0800 24 Y
14 0600 24 0800 24 B
15 0600 24 0800 24 B
16 0600 24 0800 24 B
17 0600 24 0800 24 B
18 0600 24 0800 24 B
19 0600 24 0800 24 B
20 0600 24 0800 24 Y
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 B
Monthly Average Limit:
Monthly Average: 0 0.052
Daily Maximum: 0 0.052
Daily Minimum: 0 0.052
****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 NC0050342_Ver_3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: INFLUENT DISCHARGE NO.: 001
C0530 80082 50050 00010 110400 50060 C0610 00300
is E
i-
c a x
2Xweek 2Xweek
E
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E °C
.74
. U' I z TSS-Conc CBOD 20C FLOW TEMP-C pH CHLORINE NH3-N-Cone DO
2400 lira mg/1 mg/1 mgd deg c su ug/I mg/I mg/I
I 0600 24 332
2 0600 24 232 138
i 0600 24 276 212
4 0600 24 244 214
s 0600 24 320 306
r, 0600 24
7 0600 24
8 0600 24 178
9 0600 24 236 154
to 0600 24 324 206
it 0600 24 216 159
12 0600 24 384 209
13 0600 24
14 0600 24
15 0600 24 148
16 0600 24 226 115
17 0600 24 188 158
18 0600 24 264 194
19 0600 24 II H
20 0600 24
21 0600 24
22 0600 24 196
23 0600 24 284 128
24 0600 24 220 134
25 0600 24 280 237
26 0600 24 248 160
27 0600 24
28 0600 24
29 0600 24 203
J0 0600 24 224 I20
1
Monthly Average Limit:
Monthly Avenge: 248.714286 178.25
Daily Maximum: 384 306
Daily Minimum: 148 115
****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_NC0050342_Ver_3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 002 NO DISCHARGE*: YES
50050 00010 00400 50060 C0610 C0530 31616 00300 C0600
F P F
71
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a Continuous 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week 5 X week Monthly
F'
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G U [-' O O O < FLOW TEMP-C pH CHLORINE NH3-N-Cone TSS-Cone FCOLI BR DO TOTALN-
2400 clock Hrs 2400 clock Hrs Y/B/N mgd deg c su ug/1 mg/I mg/I #/100m1 mg/I mg/I
1 0800 24 Y 0
2 0800 24 Y 0
3 0800 24 Y 0
4 0800 24 Y 0
5 0800 24 Y 0
6 0800 24 B 0
7 0800 24 B 0
8 0800 24 Y 0
9 0800 24 Y 0
10 0800 24 B 0
II 0800 24 B 0
12 0800 24 B 0
I3 0800 24 Y 0
14 0800 24 B 0
15 0800 24 B 0
16 0800 24 B 0
17 0800 24 B 0
18 0800 24 B 0
19 0800 24 B 0
20 0800 24 Y 0
21 0800 24 B 0
22 0800 24 Y 0
23 0800 24 Y 0
24 0800 24 Y 0
25 0800 24 Y 0
26 0800 24 Y 0
27 0800 24 B 0
28 0800 24 B 0
29 0800 24 Y 0
30 0800 24 B 0
Monthly Average Limit: 14 30 200
Monthly Average: 0
Daily Maximum: 0
Daily Minimum: 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_NC0050342_Ver_3.0_4_2019.pd0

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 002 NO DISCHARGE*: YES (Continue)
C0665 80082 00094 C0310 81010 00630 00625 81011
E •
F E F ia
F _ O m
E - a
_ Monthly 5 X week 5 X week
o a u O . Grab Grab Grab Grab Calculated Grab Grab Calculated
a I. Ts 'W _
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G U 2 O O O Z TOTALP-Cone CBOD20C CNDUCTVY BOD-Cone BOD5-VeR NO2&NO3 TOTKJEL TSS%R
2400 clock Hrs 2400 clock Hrs Y/B/N mg/I mg/I umhos/Cm mg/I percent mg/I mg/I percent
1 0800 24 Y
2 0800 24 Y
3 0800 24 Y
4 0800 24 Y
5 0800 24 Y
6 0800 24 B
7 0800 24 B
8 0800 24 Y
9 0800 24 Y
10 0800 24 B
11 0800 24 B
12 0800 24 B
13 0800 24 Y
14 0800 24 B
15 0800 24 B
16 0800 24 B
17 0800 24 B
18 0800 24 B
19 0800 24 B
20 0800 24 Y
21 0800 24 B
22 0800 24 Y
23 0800 24 Y
24 0800 24 Y
25 0800 24 Y
26 0800 24 Y
27 0800 24 B
28 0800 24 B
29 0800 24 Y
30 0800 24 B
Monthly Average Limit: 25
Monthly Average:
Daily Maximum:
Daily Minimum:
****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_NC0050342_Ver_3.0_4_2019.pd0

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3_0 STATUS:Submitted
SAMPLING LOCATION: INFLUENT DISCHARGE NO.: 002
C0530 80082 50050 00010 00400 50060 C0310 C0610 00300
E = c
5 X week 5 X week
_ E
Composite Grab Recorder Grab Grab Grab Composite Composite Grab
E a
o V F i TSS-Cone CBOD20C FLOW TEMP-C pH CHLORINE ROD-Cone NH3-N-Cone DO
2400 Hrs mg/I mg/I mgd deg c su ug/I mg/I mg/I #/100m1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Monthly Average Limit:
Monthly Average:
Daily Maximum:
Daily Minimum:
****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_NC0050342_Ver_3.0_4_2019.pd0

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
SAMPLING LOCATION: INFLUENT DISCHARGE NO.: 002 (Continue)
i -
E x
_ E
U c
C U 4 z
2400 Hrs
2
3
4
5
6
7
8
9
10
1
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Monthly Average Limit:
Monthly Average:
Daily Maximum:
Daily Minimum:
****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_NC0050342_Ver 3.0_4_2019.pdt)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE: 12/06/2021
Electronically Certified by Ozie K Jones on 2021-12-02 11:38:36.346
ORC / Certifier Signature : Ozie K Jones Phone # : 336 - 397 - 7679 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 08:04:15.667
Permittee/Submitter Signature: * **James F Crump Phone #:[phone] Date
Permittee Address:4561 Cooper Rd Winston Salem NC 27102 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:Keith Jones
PARAMETER CODES
Parameter Code assistance may be obtained by visiting https://deq.nc.gov/aboutldivisions/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_NC0050342_Ver 3.0_4_2019.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:04-2019(April 2019) VERSION:3.0 STATUS:Submitted
Report Comments:
Outside laboratory was Meritech Certification#165.
On April 3 Total Phosphorus was run in house and by Meritech. The results were 2.09 mg/L and 2.39 mg/L 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.
April 19,2019 was a Holiday.
Version 2.0 contains Priority Pollutant Analysis.
PPA was sampled on April 2&3.The volatile analysis foamed and had to be resampled on June 11,2019.
Version 3.0 was revised to update the Tin results on 12/2/21.

June 2019

Annual Monitoring and Pollutant Scan
Facility Name: Muddy Creek WWTP/NC0050342/Pipe 01 ORC: Keith Jones
Date of sampling: April 2 &3, 2019 &June 11, 2019 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 100 14 20 <20 mg/L
Dissolved Oxygen 2 00300 Grab SM 45000 G 7.7 mg/L
Nitrite plus Nitrate Total (as N) 1 00630 Composite EPA 353.2 0.1 22.1 mg/L
Total Kjeldahl Nitrogen 1 00625 Composite EPA 35 1. 1 0.2 1.89 mg/L
Oil and Grease 1 00556 Grab EPA 1664B 5 <5 mg/L
Total Phosphorus 1 C0665 Composite EPA 200.7 0.02 2.24 mg/L
Total Dissolved Solids 1 70295 Composite SM 2540C 10 466 mg/L
Hardness 1 00900 Composite SM 2340C 1 112 mg/L
Metals(total recoverable), cyanide and total phenols 1
Antimony 01097 Composite EPA 200.8 0.0005 <0.0005 mg/L
Arsenic 0 1002 Composite EPA 200.8 0.002 <0.002 mg/L
Beryllium 0 10 12 Composite EPA 200.8 0.0005 <0.0005 mg/L
Cadmium 0 1027 Composite EPA 200.8 0.00015 <0.00015 mg/L
Chromium 0 1034 Composite EPA 200.8 0.002 <0.002 mg/L
Cobalt 01037 Composite EPA 200.8 <0.002 <0.002 mg/L
Copper 0 1042 Composite EPA 200.8 0.002 0.004 mg/L
Lead 0 105 1 Composite EPA 200.8 0.0005 <0.0005 mg/L
Mercury (Method 1631E) 3 COMER Composite EPA 1631 1 1.95 ng/L
Nickel 0 1067 Composite EPA 200.8 0.0005 0.0016 mg/L
Selenium 0 1 147 Composite EPA 200.8 0.002 <0.001 mg/L
Silver 0 1077 Composite EPA 200.8 0.0005 <0.0005 mg/L
Thallium 0 1059 Composite EPA 200.8 0.0005 <0.0005 mg/L
Tin 01102 Composite EPA 200.7 0.025 <0.025 mg/L
Titanium 01152 Composite EPA 200.8 0.005 <0.005 mg/L
Vanadium 01087 Composite EPA 200.8 0.04 <0.005 mg/L
Zinc 0 1092 Composite EPA 200.8 0.005 0.052 mg/L
Cyanide 00720 Grab EPA 335.4 0.005 0.005 mg/L
Total phenolic compounds 32730 Grab EPA 420.1 0.01 <0.01 mg/L
Volatile organic compounds 1
Acrolein 342 10 Grab EPA 624 500 <500 ug/L
Acrylonitrile 342 15 Grab EPA 624 100 <100 ug/L
Benzene 34030 Grab EPA 624 10 <10 ug/L
Bromoform 32 104 Grab EPA 624 10 <10 ug/L
Carbon Tetrachloride 32 102 Grab EPA 624 10 <10 ug/L
Chlorobenzene 3430 1 Grab EPA 624 10 <10 ug/L
Chlorodibromomethane 34306 Grab EPA 624 10 <10 ug/L
Chloroethane 858 1 1 Grab EPA 624 50 <50 ug/L
2-chloroethyl vinyl ether 34576 Grab EPA 624 50 <50 ug/L
Form - DMR- PPA-1 Page 1

Annual Monitoring and Pollutant Scan
Parameter Sample Analytical Quantitation Sample Units of
Parameter Code Type Method Level Result Measurement
Chloroform 32 106 Grab EPA 624 10 <10 ug/L
Dichlorobromomethane 32 10 1 Grab EPA 624 10 <10 ug/L
1,1-dichloroethane 34496 Grab EPA 624 10 <10 ug/L
1,2-dichloroethane 32 103 Grab EPA 624 10 <10 ug/L
Trans-1,2-dichloroethylene 34546 Grab EPA 624 10 <10 ug/L
1,1-dichloroethylene 3450 1 Grab EPA 624 10 <10 ug/L
1,2-dichloropropane 3454 1 Grab EPA 624 10 <10 ug/L
1,3-dichloropropylene 77 163 Grab EPA 624 20 <20 ug/L
Ethylbenzene 3437 1 Grab EPA 624 10 <10 ug/L
Methyl Bromide 344 13 Grab EPA 624 50 <50 ug/L
Methyl Chloride 344 18 Grab EPA 624 50 <50 ug/L
Methylene Chloride 34423 Grab EPA 624 10 . <10 ug/L
1,1,2,2-tetrachloroethane 8 1549 Grab EPA 624 10 <10 ug/L
Tetrachloroethylene 34475 Grab EPA 624 10 <10 ug/L
Toluene 340 10 Grab EPA 624 10 <10 ug/L
1,1,1-trichloroethane 34506 Grab EPA 624 10 <10 ug/L
1,1,2-trichloroethane 345 1 1 Grab EPA 624 10 <10 ug/L
Trichloroethylene 39 180 Grab EPA 624 10 <10 ug/L
Vinyl Chloride 39 175 Grab EPA 624 50 <50 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 3460 1 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 346 16 Grab EPA 625 50 <50 ug/L
2-nitrophenol 3459 1 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 3462 1 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 39 120 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 3452 1 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 39 100 Grab EPA 625 10 <10 ug/L
Form - DMR- PPA-1 Page 2

Annual Monitoring and Pollutant Scan
Parameter Sample Analytical Quantitation Sample Units of
Parameter Code Type Method Level Result Measurement
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 3458 1 Grab EPA 625 10 <10 ug/L
4-chlorophenyl phenyl ether 3464 1 Grab EPA 625 10 <10 ug/L
Chrysene 34320 Grab EPA 625 10 <10 ug/L
Di-n-butyl phthalate 39 1 10 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 3457 1 Grab EPA 625 10 <10 ug/L
3,3-dichlorobenzidine 3463 1 Grab EPA 625 50 <50 ug/L
Diethyl phthalate 34336 Grab EPA 625 10 <10 ug/L
Dimethyl phthalate 3434 1 Grab EPA 625 10 <10 ug/L
2,4-dinitrotoluene 346 1 1 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 3438 1 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 3446 1 Grab EPA 625 10 <10 ug/L
Pyrene 34469 Grab EPA 625 10 <10 ug/L
1,2,4,-trichlorobenzene 3455 1 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."
1 Anayyzed by Meritech Authorized Representative name
2 Analyzed by Archie Elledge WWTP
3 Analyzed by Prism 0 5______,
**The Volatile sample was diluted due to Signa re
foaming. This analysis was resampled and re- 9 !� �,�
analyzed. Results attached on page 4.
Date
Form - DMR- PPA-1 Page 3

Annual Monitoring and Pollutant Scan
Parameter Sample Analytical Quantitation Sample Units of
Parameter Code Type Method Level Result Measurement
Volatile organic compounds 1 Sample Collection:06/11/2019
Acrolein 342 10 Grab EPA 624 50 <50 ug/L
Acrylonitrile 342 15 Grab EPA 624 10 <10 ug/L
Benzene 34030 Grab EPA 624 1 <1 ug/L
Bromoform 32 104 Grab EPA 624 1 <1 ug/L
Carbon Tetrachloride 32 102 Grab EPA 624 1 <1 ug/L
Chlorobenzene 3430 1 Grab EPA 624 1 <1 ug/L
Chlorodibromomethane 34306 Grab EPA 624 1 2.61 ug/L
Chloroethane 858 1 1 Grab EPA 624 5 <5 ug/L
2-chloroethyl vinyl ether 34576 Grab EPA 624 5 <5 ug/L
Chloroform 32 106 Grab EPA 624 1 6.76 ug/L
Dichlorobromomethane 32 10 1 Grab EPA 624 1 5.94 ug/L
1,1-dichloroethane 34496 Grab EPA 624 1 <1 ug/L
1,2-dichloroethane 32 103 Grab EPA 624 1 <1 ug/L
Trans-1,2-dichloroethylene 34546 Grab EPA 624 1 <1 ug/L
1,1-dichloroethylene 3450 1 Grab EPA 624 1 <1 ug/L
1,2-dichloropropane 3454 1 Grab EPA 624 1 <1 ug/L
1,3-dichloropropylene 77 163 Grab EPA 624 2 <2 ug/L
Ethylbenzene 3437 1 Grab EPA 624 1 <1 ug/L
Methyl Bromide 344 13 Grab EPA 624 5 <5 ug/L
Methyl Chloride 344 18 Grab EPA 624 5 <5 ug/L
Methylene Chloride 34423 Grab EPA 624 1 <1 ug/L
1,1,2,2-tetrachloroethane 8 1549 Grab EPA 624 1 <1 ug/L
Tetrachloroethylene 34475 Grab EPA 624 1 <1 ug/L
Toluene 340 10 Grab EPA 624 1 <1 ug/L
1,1,1-trichloroethane 34506 Grab EPA 624 1 <1 ug/L
1,1,2-trichloroethane 345 1 1 Grab EPA 624 1 <1 ug/L
Trichloroethylene 39 180 Grab EPA 624 1 <1 ug/L
Vinyl Chloride 39 175 Grab EPA 624 5 <5 ug/L
Form - DMR- PPA-1 Page 4

January 2021

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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 C0610 C0530 31616 00300 C0600
E
- E. Fo
u I: _ C r.
Ez
',2E1.., Continuous 5 X week 5 X week 5 X week 2 X week 2 X week 2 X week 5 X week Monthly
u E F a
.g u O a Recorder Grab Grab Grab Composite Composite Grab Grab Composite
a E -13 ` PUGI
o 5 F' O d O O C Z° FLOW TEMP-C pH CHLORINE NH3-N-Cone TSS-Cone FCOLI BR DO TOTALN-
2400 clock Hrs 2400 clock Hrs Y/B/N mgd deg c su ug/I mg/I mg/I #/100m1 mg/I mg/I
1 0600 24 0800 24 Y HOLIDAY
2 0600 24 0800 24 B 15.76 17 7.7
3 0600 24 0800 24 B 14.88 17 7.5
4 0600 24 0800 24 Y 15.09 17 6.8 <20 <0.5 12 8 7.2
5 0600 24 0800 24 Y 14.52 16 6.9 <20 <0.5 12 9 7.8
6 0600 24 0800 24 Y 14.74 16 7.2 <20 <0.1 11 14 7.6 22.1
7 0600 24 0800 24 Y 15.44 16 7 <20 <0.5 13 6 7.8
8 0600 24 0800 24 Y 14.75 17 7 <20 <0.5 11 7.4
9 0600 24 0800 24 B 14.44 16 8.6
10 0600 24 0800 24 B 14.24 16 8.1
11 0600 24 0800 24 Y 14.5 16 6.9 <20 <0.5 12 4 8.1
12 0600 24 0800 24 Y 13.65 16 7.1 <20 <0.5 13 2 8.3
13 0600 24 0800 24 Y 14.56 16 7.1 <20 <0.2 12 22 8 22.8
14 0600 24 0800 24 Y 13.45 16 7 _<20 <0.5 12 6 8.4
15 0600 24 0800 24 Y 14.4 16 7.1 <20 <0.5 13 7.7
16 0600 24 0800 24 B 13.77 16 7.8
17 0600 24 0800 24 B 14.7 16 7.3
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y 14.68 16 7.1 <20 <0.5 16
<1 7.9
20 0600 24 0800 24 Y 14.84 16 7.I <20 <0.5 18 13 7.3
21 0600 24 0800 24 Y 15.3 16 7 <20 <0.5 18 8 7.3
22 0600 24 0800 24 Y 15.15 17 6 9 <20 <0.5 16 7.5
23 0600 24 0800 24 B 14.58 16 ,7
24 0600 24 0800 24 B 13.75 16 7.5
25 0600 24 0800 24 Y 15.17 16 6.8 <20 <0.5 17 5 8
26 0600 24 0800 24 Y 15.81 16 6.7 <20 <0.5 18 5 7.6
27 0600 24 0800 24 Y 13.84 16 6.8 <20 <0.5 18 7 7.4
28 0600 24 0800 24 Y 22.92 15 6.7 <20 <0.5 20 22 7.8
29 0600 24 0800 24 Y 17.6 15 6.7 <20 <0.5 25 8.4
30 0600 24 0800 24 B 15.39 15 7.1
31 0600 24 0800 24 B 20.78 15 8.4
Monthly Average Limit: 21 30 200
Monthly Average: 15.265517 16.034483 0 0 15.105263 6.717144 7.741379 22.45
Daily Maximum: 22.92 17 7.2 _0 Il 25 22 8.6 22.8
`
Daily Minimum: 13.45 15 6.7 0 0 11 0 7 22.1
•5*0 No Reporting Reason:ENFRUSE=No Flow-Reuse/Recycle; ENV WTHR=No Visitation-Adverse Weather; NOFLOW=No Flow; HOLIDAY=No Visitation-Holiday
Discharge Monitoring Report-Copy Of Record(COR_NC0050342 Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
C0665 80082 THP38 00094 00900 TGP3B NC01 34506 34511 34496 34501
E.
1- E F in 8
d F _ O q
'E.' 1 Monthly 2 X week Monthly 5 X week Quarterly Quarterly Annually
E C - -
.g a o` 2. Composite Composite Composite Grab Composite Composite Grab Grab Grab Grab Grab
e
G U f2 O O O z TOTALP- CBOD20C CER7DCHV CNDUCTVY TOT HARD CERI7DPF ANNPOL 111-ICE 112-TCE 1,1-DCE 1,1-DCEY
2400 dock Hrs 2400 clock Hrs Y/B/N mg/I mg/I percent umhos/cm mg/I pass/fail yes=l no=0 ug/I ug/I ug/I ug/I
1 0600 24 0800 24 Y HOLIDAY
2 0600 24 0800 24 B
3 0600 24 0800 24 B
4 0600 24 0800 24 Y 669
5 0600 24 0800 24 Y 6 622 122 1 <I <1 <1 <1
6 0600 24 0800 24 Y 3.34 703 120 PASS
7 0600 24 0800 24 Y 8 688
8 0600 24 0800 24 Y 742
9 0600 24 0800 24 B
10 0600 24 0800 24 B
II 0600 24 0800 24 Y 723
12 0600 24 0800 24 Y 660
13 0600 24 0800 24 Y 3.46 8 691
14 0600 24 0800 24 Y 666
15 0600 24 0800 24 Y 8 660
16 0600 24 0800 24 B
17 0600 24 0800 24 B
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y 10 670
20 0600 24 0800 24 Y 10 699
21 0600 24 0800 24 Y 8 682
22 0600 24 0800 24 Y 10 693
23 0600 24 0800 24 B
24 0600 24 0800 24 B
25 0600 24 0800 24 Y 666
26 0600 24 0800 24 Y 8 671
27 0600 24 0800 24 Y 4.34 7 631
28 0600 24 0800 24 Y II 635
29 0600 24 0800 24 Y 10 502
30 0600 24 0800 24 B
31 0600 24 0800 24 B
3lnnthly Average Limit: 25
Monthly overage: 3.713333 8.666667 667 121 I 0 0 0 0
Daily Maximum: 4.34 II 742 122 1 0 0 0 0
Daily Minimum. 3.34 6 502 120 1 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_NC0050342_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
34551 34536 32103 34541 34346 34546 77163 34566 34571 34621 34601
I 44 E E.8 n -
44 F Ti O
E x
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u° il
2
o Grab Grab Grab Grab Grab Grab Grab Grab Grab Grab Grab
e a 4 z z
C U 2 O O O 124-TCB 1,2-DCB 1,2-DCE I,2-DCP 12DIPHEN t-I2DCEY 1,3-DCPE I,3-DCB 1,4-DCB 246-TCPH 2,4-DCPH
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/1 ug/1 ugh ug/I ug/I ug/I ugh ug/I ug/1
I 0600 24 0800 24 Y 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 <I <I <10 <I <1 <10 <10 <10 <10
6 0600 24 0800 24 Y
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24 B
10 0600 24 0800 24 B
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 B
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 B
24 0600 24 0800 24 B
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_NC0050342_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
34606 34616 34611 C0626 34576 34581 34586 34591 34631 34657 34636
E E
i= E i= E.
E
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E 7.< - f.
O a Grab Grab Grab Grab Grab Grab Grab Grab Grab Grab Grab
d 6 m u le
d F= O O O x 2,4-DMPH 2,4-DNPH 2,4-DNT 26DINITR- 2-CEVE 2-CLRNAP 2CPHENOL 2NPHENOL 3,3'-D03 46DN-o-C 4-BPPETH
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I
I 0600 24 0800 24 Y 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 <50 <10 <10 <5 <10 <10 <10 <50 <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 B
10 0600 24 0800 24 B
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 B
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 B
24 0600 24 0800 24 B
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_NC0050342_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:01-202I (January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 001 NO DISCHARGE*: NO (Continue)
34641 34646 34205 34200 34210 34215 CO220 01097 01002 34030 39120
E 2`
F E = n i
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O U 4 O O O 4-CPPETH 4NPHENOL ACENAPEN ACENAPYL ACROLEIN ACRYLONI ANTHRACE ANTIMONY As-TOTAL BENZENE BENZIDIN
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/I ug/I ug/I 41 ug/I mg/1 mg/1 ug/I ug/I
I 0600 24 0800 24 Y 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 <50 <10 <10 <50 <10 <10 <I <50
6 0600 24 0800 24 Y <0.0005 <0.002
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24 B
IO 0600 24 0800 24 B
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 B
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 B
24 0600 24 0800 24 B
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
J1 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_NC0050342_Ver_2.0_1_2021.pd0

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
34526 34247 34230 34521 34242 01012 34278 34273 34283 39100 32104
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G U 4 .8CIO z BNZO-A-A BNZO-A-P BNZO-B-F BNZO-ghi BNZO-K-F BERYLIUM BI52CXMT BIS2CYET BIS2CIET B2E PHTH BROMOFR
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/I ug/I ug/I mg/I ug/I ug/I ug/I ug/I ug/I
1 0600 24 0800 24 Y 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 <10 <I0 <10 <I0 <l0 <I
6 0600 24 0800 24 Y <0.0005
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24 B
10 0600 24 0800 24 B
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 B _
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 B
24 0600 24 0800 24 B
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_NC0050342_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
34292 01027 32102 343U1 34306 85811 32106 01034 34320 01037 01042
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d E A C
c' U F O O O i BU-BZ-PH CADMIUM CARBNTET CHLROBNZ CLRDBRME CLROETHA CHLRFORM Cr-TOTAL CHRYSENE COBALT COPPER
2400 dock Hrs 2400 dock Hrs Y/B/N ug/I mg/I ug/I ug/I ug/I ug/I ug/I mg/I ug/I mg/I mg/I
1 0600 24 0800 24 Y 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 <I <I 2.5 <5 4.86 <10
6 0600 24 0800 24 Y <0.00015 <0.002 <0.002 0.003
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24 B
10 0600 24 0800 24 B
11 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y <0.00015 <0.002 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 B
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 B
24 0600 24 0800 24 B
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
3' 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 0 0 0 0 2.5 0 4.86 0 0 0 0.0025
Daily Maximum: 0 0 0 0 2.5 0 4.86 0 0 0 0.003
Daily Minimum: 0 0 0 0 2.5 0 4.86 0 0 0 0.002
****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_NC0050342_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
00720 34556 32101 34336 34341 39110 34596 34371 C0376 34381 C0700
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O '<' CN-TOT DBNZO-ah DICLBR1T DIETY-PH DIMET-PH DNB PHTH D-n-OCPH ETHYLBEN FLUORANT FLUORENE HCB-Conc
2400 dock Hrs 2400 clock Hrs Y/B/N ug/I ug/I ug/1 ug/I ug/I ug/I ug/I ug/I ug/I ug/I ug/I
I 0600 24 0800 24 Y 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 <20 <10 5.28 <10 <10 <10 <10 <1 <10 <10 <10
6 0600 24 0800 24 Y
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24 B
10 0600 24 0800 24 B
II 0600 24 0800 24 Y
12 0600 24 0800 24 Y <20
'3 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 B
19 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 B
24 0600 24 0800 24 B
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 5.28 0 0 0 0 0 0 0 0
Daily Maximum: 0 0 5.28 0 0 0 0 0 0 0 0
Daily minimum: 0 0 5.28 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_NC0050342_Ver_2.0_1_2021.pd0
l

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
39702 34386 34396 34403 34408 01051 COMER 34413 34418 34423 01062
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:J C F O O O i HEXCLBD HCCP HCE 1123CDPY ISPHRONE LEAD MERCURY- METHYLBR METHYLCH MECL2 MOLY
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I ugh ug/I ug/I ug/1 mg/I ng/I ug/I ug/I ug/I mg/1
1 0600 24 0800 24 Y 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 <50 <10 <10 <10 <5 <5 <I
6 0600 24 0800 24 Y <0.0005
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y 1.26
9 0600 24 0800 24 B
10 0600 24 0800 24 B
11 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y <0.0005 <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 B
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 B
24 0600 24 0800 24 B
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 1.26 0 0 0 0
Daily Maximum: 0 0 0 0 0 0 1.26 0 0 0 0
Daily Minimum: 0 0 0 0 0 0 1.26 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_NC0050342_Ver_2.0_1_2021.pdf)
l

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
34696 01067 00630 34447 00625 00620 34438 34428 34433 00556 34452
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E R W 8 a a'G U [= O O O i NAPTHALE NICKEL NO2&NO3 NITROBEN TOT KJEL NO3-N NDMA NDnPA NDPA OIL-GRSE pCLRmCR
2400 clock Hrs 2400 clock Hrs Y/B/N ug/I mg/I mg/I ug/I mg/I mg/I ug/1 ug/I ug/I mg/I ug/I
1 0600 24 0800 24 Y HOLIDAY
2 0600 24 0800 24 B
3 0600 24 0800 24 B
4 0600 24 0800 24 Y 27.9
5 0600 24 0800 24 Y <10 <10 26.8 <10 <10 <10 <5 <10
6 0600 24 0800 24 Y 0.0016 20.9 1.2 19.9
7 0600 24 0800 24 Y 20.9
8 0600 24 0800 24 Y
9 0600 24 0800 24 B
10 0600 24 0800 24 B
11 0600 24 0800 24 Y ,24.2
12 0600 24 0800 24 Y 23.1
13 0600 24 0800 24 Y 0.0014 20.6 2.2
14 0600 24 0800 24 Y 22.4
15 0600 24 0800 24 Y 27.8
16 0600 24 0800 24 B
17 0600 24 0800 24 B
18 0600 24 0800 24 B HOLIDAY
19 0600 24 0800 24 Y 23.1
20 0600 24 0800 24 Y
21 0600 24 0800 24 Y 15.3
22 0600 24 0800 24 Y 18.1
23 0600 24 0800 24 B
24 0600 24 0800 24 B
25 0600 24 0800 24 Y 23.9
26 0600 24 0800 24 Y 24.1
27 0600 24 0800 24 Y 23.3
28 0600 24 0800 24 Y 23.1
29 0600 24 0800 24 Y 20.4
30 0600 24 0800 24 B
31 0600 24 0800 24 B
Monthly Average Limit:
Monthly Average: 0 0.0015 20.75 0 1.7 22.76875 0 0 0 0 0
Daily Maximum: 0 0.0016 20.9 0 2.2 27.9 0 0 0 0 0
Daily Minimum: 0 0.0014 20.6 0 1.2 15.3 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_NC0050342_Ver_2.0_1_2021.pd0

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
E
39032 34461 34694 32730 34469 01147 01077 70295 81549 34475 01059
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A U [= O O O < PCP PHENANTH PHENOL PHEN,TR PYRENE Se-TOTAL SILVER RES/DISS TETCLETH TETCLETY THALLIUM
2400 clock Hrs 2400 clock Hrs Y/R!N ug/I ug/I ug/I mg/I ug/I mg/I mg/I mg/I ug/I ug/I mg/1
I 0600 24 0800 24 Y 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 <50 <I0 <10 0.042 <10 <I <I
6 0600 24 0800 24 Y <0.001 <0.0005 454 <0.0005
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24 B
10 0600 24 0800 24 B
II 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 B
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 B
24 0600 24 0800 24 B
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 Avenge: 0 0 0 0.042 0 0 0 454 0 0 0
Daily Maximum: 0 0 0 0.042 0 0 0 454 0 0 0
Daily Minimum: 0 0 0 0.042 0 0 0 454 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 NC0050342_Ver_2.0_1_2021.pd0

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
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)
• 01102 01152 34010 39180 01087 39175 01092
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G U 4 O O O Z TIN TITANIUM TOLUENE TCETHYLE VANADIUM VINYLCHL ZINC
2400 clock Hrs 2400 clock Hrs Y/B/N mg/1 mg/I ug/I ug/I mg/I ug/I mg/I
I 0600 24 0800 24 Y 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 <I <5
6 0600 24 0800 24 Y <0.01 <0.005 <0.005 0.038
7 0600 24 0800 24 Y
8 0600 24 0800 24 Y
9 0600 24 0800 24 B
IO 0600 24 0800 24 B
II 0600 24 0800 24 Y
12 0600 24 0800 24 Y
13 0600 24 0800 24 Y 0.042
14 0600 24 0800 24 Y
15 0600 24 0800 24 Y
16 0600 24 0800 24 B
17 0600 24 0800 24 B
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 B
24 0600 24 0800 24 B
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 0.04
Daily Maximum: 0 0 0 0 0 0 0.042
Daily ntinimnm: 0 0 0 0 0 0 0.038
****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 NC0050342_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:01-2021(January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: INFLUENT DISCHARGE NO.: 001
C0530 80082 50050 00010 00400 50060 C06111 00300
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0 aa U 2 i TOO-Cone CBOD 20C FLOW TEMP-C pH CHLORINE NH3-N-Cone DO
2400 Hrs mg/I mg/I mgd deg c su ugA mg/1 melt
I 0600 24 HOLIDAY
0600 24 1
3 0600 24
4 0600 24 191
5 0600 24 180 150
6 0600 24 180
7 0600 24 206 200
9 0600 24 300
9 0600 24
l0 0600 24
11 0600 24 158
12 0600 24 194
13 0600 24 177 154
14 0600 24 197
15 0600 24 200 209
16 0600 24
17 0600 24
18 0600 24 HOLIDAY
19 0600 24 174 170
20 0600 24 203 124
21 0600 24 197 191
22 0600 24 183 240
23 0600 24
24 0600 24
25 0600 24 173
26 0600 24 213 156
27 0600 24 207 140
28 0600 24 156 135
29 0600 24 230 161
30 0600 24
31 0600 24
Monthly Average Limit:
Monthly Average: 195.736842 169.166667
Daily Maximum: 300 240
Daily Minimum: 156 124
****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 NC0050342_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:01-2021 (January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 002 NO DISCHARGE*: YES
50050 00010 00400 50060 C0610 C0530 31616 00300 C0600
F E E
4: I: 1"' w
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8 U F= O O O FLOW TEMP-C pH CHLORINE NH3-N-Cone TSS-Cone FCOLI BR DO TOTALN-
2400 clock Hrs 2400 clock Hrs v/B/N mgd deg c su ugh I mg/I mg/I #/I00m1 mg/I mg/I
I 0800 24 Y HOLIDAY
2 0800 24 B 0
3 0800 24 B 0
4 0800 24 Y 0
5 0800 24 Y 0
6 0800 24 Y 0
7 0800 24 Y 0
8 0800 24 Y 0
9 0800 24 B 0
10 0800 24 B 0
11 0800 24 Y 0
12 0800 24 Y 0
13 0800 24 Y 0
14 0800 24 Y 0
15 0800 24 Y 0
16 0800 24 B 0
17 0800 24 B 0
18 0800 24 B HOLIDAY
19 0800 24 Y 0
20 0800 24 Y 0
21 0800 24 Y 0
22 0800 24 Y 0
23 0800 24 B 0
24 0800 24 B 0
25 0800 24 Y 0
26 0800 24 Y 0
27 0800 24 Y 0
28 0800 24 Y 0
29 0800 24 Y 0
30 0800 24 B 0
31 0800 24 B 0
Monthly Average Limit: 30 200
Monthly Average: 0
Daily Maximum: 0
Daily Minimum: 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 NC0050342_Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:01-2021 (January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: EFFLUENT DISCHARGE NO.: 002 NO DISCHARGE*: YES (Continue)
C0665 80082 00094 C0310 81010 00630 00625 81011
E E
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4 P. _ O a
E54 a
E Monthly 5 X week 5 X week
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v E 9 t '5' U C
G :J 2 O O O z TOTALP-Cone CBOD2UC CNDUCTVY BOD-Cone B0135-%R No2&NO3 TOTKJEL TSS-%R
2400 clock Hrs 2400 clock Hrs Y/B/N mg/I mg/I umhos/cm mg/1 percent mg/I mg/1 percent
1 0800 24 Y HOLIDAY
2 0800 24 B
3 0800 24 B
4 0800 24 Y
5 0800 24 Y
6 0800 24 Y
7 0800 24 Y
8 0800 24 Y
9 0800 24 B
10 0800 24 B
11 0800 24 Y
12 0800 24 Y
13 0800 24 Y
14 0800 24 Y
15 0800 24 Y
16 0800 24 B
17 0800 24 B
18 0800 24 B HOLIDAY
19 0800 24 Y
20 0800 24 Y
21 0800 24 Y
22 0800 24 Y
23 0800 24 B
24 0800 24 B
25 0800 24 Y
26 0800 24 Y
27 0800 24 Y
28 0800 24 Y
29 0800 24 Y
30 0800 24 B
31 0800 24 B 1
Monthly Average Limit: 25
Monthly Average:
Daily Maximum:
Daily Minimum:
****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_NC0050342_Ver_2.0_1_2021.pdf)

' NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:01-2021 (January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: INFLUENT DISCHARGE NO.: 002
C0530 8008E 50050 00010 00400 50060 C0310 C0610 00300
E I
i E -
5 X week 5 X week
_ E
u a Composite Grab Recorder Grab Grab Grab Composite Composite Grab
E
TSS-Cane CBOD20C FLOW TEMP-C pH CHLORINE BOD-Cone NH3-N-Cone DO
2400 Hrs mg/I mg/I mgd deg c su ug/I mg/I mg/I mg/I
HOLIDAY
•
3
4
5
6
7
8
9
10
11
12
13
14
Is
16
17
18 HOLIDAY
19
20
21
22
23
24
25
26
27
28
29
30
31
Monthly Average Limit:
Monthly Average:
Daily Maximum:
Daily Minimum:
****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_NC0050342_Ver_2.0_1_2021.pd0

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:01-2021(January 2021) VERSION:2.0 STATUS:Submitted
SAMPLING LOCATION: INFLUENT DISCHARGE NO.: 002 (Continue)
F E
I—
t
y _
U F 7_
2400 Hrs
HOLIDAY
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18 HOLIDAY
19
20
21
22
23
24
25
26
27
28
29
30
31
Monthly Average Limit:
Monthly Average:
Daily Maximum:
Daily Minimum:
"""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 NC0050342 Ver_2.0_1_2021.pdf)

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:01-2021(January 2021) VERSION:2.0 STATUS:Submitted
COMPLIANCE STATUS:Compliant CONTACT PHONE#:[phone] SUBMISSION DATE: 12/06/2021
Electronically Certified by Ozie K Jones on 2021-12-02 11:38:10.898
ORC/Certifier Signature : Ozie K Jones Phone # : 336 - 397 - 7679 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 08:03:43.054
Permittee/Submitter Signature: * **James F Crump Phone #:[phone] Date
Permittee Address:4561 Cooper Rd Winston Salem NC 27102 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_NC0050342_Ver_2.0_1_2021.pdf)
L

NPDES PERMIT NO.:NC0050342 PERMIT VERSION:4.0 PERMIT STATUS:Active
FACILITY NAME:Muddy Creek WWTP CLASS:WW-4. COUNTY:Forsyth
OWNER NAME:City of Winston-Salem ORC:Ozie Keith Jones ORC CERT NUMBER:985577
GRADE:WW-4. ORC HAS CHANGED:No
eDMR PERIOD:01-2021(January 2021) VERSION:2.0 STATUS:Submitted
Report Comments:
Subcontract Laboratory=Meritech#165
Subcontract Laboratory=Waypoint Analytical#402
1/1/21 was a Holiday.
On 1/6/21 the Effluent ammonia was run in house with a result of<0.5mg/l.It was also analyzed by Meritech with a result of<0.l mg/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 1/11/21 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/I Calibration Check Standard failed QC at 30.4mg/l.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.
1/18/21 was a Holiday.
On 1/19/21 the cBOD G&G Control Standard failed at 197mg/1 affecting the Influent and Effluent samples collected on 1/19/21 and 1/20/21.
On 1/19/21 the nitrate spike duplicate%recovery was outside of QC at 126%.
On 1/29/21 the dilution water blank failed QC because the DO Used was 0.22 mg/L. This has recently happened several times.We believe it is due to a weak acid wash and an
old dishwasher. The analyst made up a stronger acid wash to wash jugs and bottles,the tubing and air stones were changed out,and the laboratory got a new dishwasher.
Version 2.0 revised to update the Tin results on 12/2/21.

Table E
Chronic Toxicity

Effluent Toxicity Report Form-Chronic Fathead Minnow Multi-Concentration Test Date:4/20/2018
Facility: Winston Salem-Muddy Creek NPDES#NCO() 50342 Pipe#: 001 County: Forsyth
Labor : Meritech, Inc. it Comments!
x C
Signature of Opar in Responsibl hare l
Signature of Laboratory Supervisor
MAIL ORIGINAL TO: Water Sciences Section
Aquatic Toxicology Branch
Division of Water Resources
1621 Mail Service Center
Raleigh,NC 27699-1621
Test Initiation Date/Time 4/10/2018 3:58 PM Avg Wt/Surv. Control 0.844 Test Organisms
%Eff. Repl. 1 2 3 4 I_ Cultured In-House
Control Surviving# 10 10 9 10 %Survival 97.5 Fr Outside Supplier
Original# 10 10 10 10
Wt/original(mg) 0.923 0.720 0.774 0.871 Avg Wt(mg) 0.822 Hatch Date: 4/9/18
1.5 Surviving# 10 10 10 10 %Survival 100.0 Hatch Time: 3:00 pm CT
Original# 10 10 10 10
Wt/original(mg) 0.806 0.788 0.834 0.815 Avg Wt(mg) 0.811
2.75 Surviving# 10 10 10 10 %Survival 100.0
Original# 10 10 10 10
Wt/original(mg) 0.965 0.886 0.768 0.906 Avg Wt(mg) 0.881
5.5 Surviving# 10 10 10 10 %Survival 100.0
Original# 10 10 10 10
Wt/original(mg) 0.805 0.929 0.749 0.776 Avg Wt(mg) 0.815
11 Surviving# 10 10 10 10 %Survival 100.0
Original# 10 10 10 10
Wt/original(mg) 0.886 1.034 0.958 0.838 Avg Wt(mg) 0.929
22 Surviving# 10 10 10 9 %Survival 97.5
Original# 10 _ 10 10 10
Wt/original(mg) 0.919 0.858 0.767 0.800 Avg Wt(mg) 0.836
Water Quality Data Day
Control 0 1 2 3 4 5 6
pH(SU)Init/Fin 7.97 / 7.84 8.11 / 7.81 8.06 / 7.78 8.22 / 7.99 8.22 / 7.80 8.21 / 7.92 8.13 / 7.81
DO(mg/L) Init/Fin 7.81 / 7.06 7.87 17.27 8.08 / 6.66 7.75 17.48 8.03 / 6.44 7.60 17.08 7.57 / 7.09
Temp(C)Init/Fin 25.7 / 25.0 25.0 / 24.1 24.6 / 24.4 25.0 124.2 24.3 / 24.5 24.2 124.3 24.6 / 24.8
High Concentration o 1 2 3 4 5 6
pH(SU)Init/Fin 7.74 / 7.87 7.83 / 7.68 7.74 / 7.72 7.81 / 7.81 7.86 / 7.66 7.79 / 7.85 7.93 / 7.68
DO(mg/L) Init/Fin 7.91 / 7.20 7.77 / 6.82 7.87 / 6.62 7.93 / 7.03 7.95 / 6.12 7.41 / 7.10 7.65 / 6.30
Temp(C)Init/Fin 25.4 124.3 24.6 124.3 25.7 / 24.2 24.8 / 24.5 24.2 / 24.5 24.6 / 24.0 25.4 124.2
Sample 1 2 3 Survival Growth Overall Result
Collection Start Date 4/9/2018 4/11/2018 4/12/2018 Normal i, Fl ChV >22
Grab Horn.Var. ri F1
Composite(Duration) 24.0 23.7 23.8 NOEC 22 22
Hardness(mg/L) 114 117 120 LOEC >22 >22
Alkalinity(mg/L) 53 53 49 ChV >22 >22
Conductivity(umhos/cm) 581 613 613 Method Steel's Dunnett's
Chlorine(mg/L) <0.1 <0.1 <0.1
Temp.at Receipt(°C) 1.2 1.5 0.4 Stats Survival Growth
Conc. Critical Calculated Critical Calculated
Dilution H2O Batch# 1255 1256 1257 1258 1259 1.5 10 20 2.41 0.2121
Hardness(mg/L) 44 44 44 44 46 2.75 10 20 2.41 -1.1171
Alkalinity(mg/L) 52 54 52 51 54 5.5 10 20 2.41 0.1367
Conductivity(umhos/cm) 188 204 200 211 199 11 10 20 2.41 -2.0173
22 10 18 2.41 -0.2639
r)IA//1 Fnrm dT--c,iv/)el

Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 04/19/18
Facility: WINSTON SALEM - MUDDY CREEK NPDES#: NC0050342 Pipe#: 01 County: FORSYTH
Laboratory Perfor in Test: MERITECH LABS, INC.
/ Comments:
X �. (
Signature o Operatoi) in Response e Charge
Signature of Laboratory Supervisor * PASSED: 5.15% 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 = 1.036
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Reduction = 5.15
% 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 23 .00
Treatment 2 Treatment 2
Effluent %: 5.5%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
10.272% PASS FAIL
# Young Produced 24 19 22 18 24 27 27 24 17 26 24 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 7.83 8 .04 7.86 8.11 7.93 8.14 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 23 .7 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) 180 581 613
Treatment 2 8.00 7.89 7.86 7.41 7.94 7.60
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.2 1.5
(Mortality expressed as %, combining replicates) 1
Note: Please
% % % a o e % %
Concentration Complete This
Section Also
% % a % 96 o % o % % Mortality
start/end start/end
LC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit
% -- o Spearman Karber _ Other High
Conc.
pH D.O.
11
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 DUBIA ver. 4 .41)
1

Etauent Toxicity Report Form-Chronic Fathead Minnow Multi-Concentration Test Date:7/19/2019
Facility: Winston Salem-Muddy Creek NPDES#NC00 50342 Pipe#: 001 County: Forsyth
Laboratory: Merit ch, Inc,, Comments
x < ,J _,_____ (_=,, \ _
Signature of Operator] Respo slale Charge
,, ;.-
Signature of Laboratory Supervisor
MAIL ORIGINAL TO: Water Sciences Section
Aquatic Toxicology Branch
Division of Water Resources
1621 Mail Service Center
Raleigh,NC 27699-1621
Test Initiation Date/Time 7/9/2019 5:20 PM Avg Wt/Surv. Control 0.593 Test Organisms
%Eff. Repl. 1 2 3 4 7 Cultured In-House
Control Surviving# 10 10 10 10 %Survival 100.0 7 Outside Supplier
Original# 10 10 10 10
Wt/original(mg) 0.675 0.481 0.536 0.681 Avg Wt(mg) 0.593 Hatch Date: 7/8/19
1.5 Surviving# 10 10 10 10 %Survival 100.0 Hatch Time: 3:00 pm CT
Original# 10 10 10 10
Wt/original(mg) 0.549 0.529 0.569 0.549 Avg Wt(mg) 0.549
2.75 Surviving# 10 10 10 10 %Survival 100.0
Original# 10 10 10 10
Wt/original(mg) 0.671 0.589 0.571 0.589 Avg Wt(mg) 0.605
5.5 Surviving# 10 10 9 10 %Survival 97.5
Original# 10 10 10 10
Wt/original(mg) 0.553 0.529 0.479 0.621 Avg Wt(mg) 0.546
11 Surviving# 10 10 9 10 %Survival 97.5
Original# 10 10 10 10
Wt/original(mg) 0.564 0.591 0.539 0.626 Avg Wt(mg) 0.580
22 Surviving# 10 10 10 10 %Survival 100.0 I
Original# 10 10 10 10
Wt/original(mg) 0.507 0.601 0.511 0.531 Avg Wt(mg) 0.538
Water Quality Data Day
Control 0 1 2 3 4 5 6
pH(SU)!nit/Fin 8.10 / 7.98 8.14 / 8.12 8.17 / 7.95 8.19 / 8.02 8.19 / 8.08 8.21 / 7.99 8.19 / 7.67
DO(mg/L) Init/Fin 7.76 17.70 7.99 / 7.66 7.76 / 7.40 7.88 / 7.62 7.85 / 7.90 8.01 / 7.88 8.01 / 7.36
Temp(C)Init/Fin 24.3 / 25.1 24.1 / 24.6 24.2 / 25.8 24.3 / 24.8 24.0 / 24.1 24.3 / 24.4 24.6 / 25.0
High Concentration o 1 2 3 4 5 6
pH(SU)Init/Fin 7.71 / 7.88 7.96 / 8.06 7.89 / 7.89 8.00 / 8.02 8.06 / 8.08 8.14 / 7.95 7.96 / 7.74
DO(mg/L) !nit/Fin 7.79 17.68 7.97 / 7.68 7.85 / 7.27 7.90 17.50 7.83 18.00 8.04 / 7.75 8.03 / 7.43
Temp(C)!nit/Fin 24.4 / 24.0 24.3 / 24.6 24.6 / 25.5 25.1 / 24.0 24.4 / 24.1 24.3 / 24.4 25.1 / 24.6
Sample 1 2 3 Survival Growth Overall Result
Collection Start Date 7/8/2019 7/10/2019 7/11/2019 Normal ri Fl ChV >22
Grab Hom.Var. ri Fl
Composite(Duration) 24.0 23.6 23.6 NOEC 22 22
Hardness(mg/L) 142 130 128 LOEC >22 >22
Alkalinity(mg/L) 62 82 83 ChV >22 >22
Conductivity(umhos/cm) 550 562 574 Method Steel's Dunnett's
Chlorine(mglL) <0.1 <0.1 <0.1
Temp.at Receipt(°C) 2.7 1.3 0.8 Stats Survival Growth
Conc. Critical Calculated Critical Calculated
Dilution H2O Batch# 1413 1414 1415 1416 1.5 10 18 2.41 1.1080
Hardness(mg/L) 44 42 44 42 2.75 10 18 2.41 -0.2942
Alkalinity(mg/L) 55 53 53 52 5.5 10 16 2.41 1.1957
Conductivity(umhos/cm) 216 200 197 201 11 10 16 2.41 0.3318
22 10 18 2.41 1.3960
1

Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 07/17/19
Facility: WINSTON SALEM - MUDDY CREEK NPDES#: NC0050342 Pipe#: 01 County: FORSYTH
Laboratory Performing ;Test: MERITECH LABS, INC.
{;...\ ( \ Comments:
X ( J ,
Signature%of Operatorlin Responsible Charge
Signature of Laboratory Supervisor * PASSED: -1.96% 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 = -0.380
Tabular t = 2 .508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -1.96
% 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 21.67
Treatment 2 Treatment 2
Effluent %: 5.5%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
15.298% PASS FAIL
# Young Produced 18 25 25 21 20 23 21 21 22 21 22 21 % 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 7.97 8.04 7.98 8 .01 7.93 7.92 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 24.6 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. (pmhos) 154 550 562
Treatment 2 7.93 7.60 7.92 7.69 7.90 7.82 I
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt (°C) 2.7 1.3
(Mortality expressed as %, combining replicates) I
Note: Please I
% % % %% % % % % Concentration Complete This%
Section Also
% % o % % % o% % Mortality
a % % %
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:10/28/2020
Facility: Winston Salem-Muddy Creek NPDES#NCOO 50342 Pipe#: 001 County: Forsyth
La oratory: Meritech)Inc. Comments'
x `) -%
Sig a ure of✓perator in Resp ri lble Cha e
Signature of Laboratory Supervisor
MAIL ORIGINAL TO: Water Sciences Section
Aquatic Toxicology Branch
Division of Water Resources
1621 Mail Service Center
Raleigh,NC 27699-162I
Test Initiation Date/Time 10/20/2020 4:28 PM Avg Wt1Surv.Control 0.674 Test Organisms
Eff. Repl. 1 2 3 4 [ Cultured In-House
'Control Surviving# 10 10 10 9 %Survival 97.5 ly Outside Supplier
Original# 10 10 10 10
Wt/original(mg) 0.660 0.599 0.703 0.662 Avg Wt(mg) 0.656 Hatch Date: 10/19/20
1.38 Surviving# 9 10 8 10 %Survival 92.5 Hatch Time: 3:00 pm CT
Original# 10 10 10 10
Wt/original(mg) 0.656 0.712 0.669 0.552 Avg Wt(mg) 0.647
2.75 Surviving# 10 10 10 10 %Survival 100.0
Original# 10 10 10 10
Wt/original(mg) 0.608 0.622 0.818 0.687 Avg Wt(mg)J 0.684 I
f 5.5 I Surviving# 10 10 10 10 %Survival 100.0
Original# 10 10 10 10
Wt/original(mg) 0.718 0.640 0.754 0.641 Avg Wt(mg) 0.688
11 Surviving# 10 10 10 6 %Survival 90.0
Original# 10 10 10 10
Wt/original(mg) 0.744 0.696 0.691 0.546 Avg Wt(mg) 0.669
22 Surviving# 9 10 10 10 %Survival 97.5
Original# 10 10 10 10
Wt/original(mg) 0.674 0.729 0.709 0.667 Avg Wt(mg) 0.695
Water Quality Data Day
Control 0 1 2 3 4 5 8
pH(SU)Init/Fin 7.64 1 7.79 7.78 1 7.60 7.66 1 7.67 7.87 / 7.73 7.76 1 7.52 7.84 / 7.84 7.79 1 7.48
DO(mg/L) Init/FIn 7.86 17.48 7.87 / 7.16 7.81 / 7.50 7.93 1 7.59 7.81 16.33 7.73 / 7.68 7.92 / 6.90
Temp(C)Init/Fin 24.2 / 24.7 24.0 / 25.8 24.1 / 24.5 24.0 / 24.8 24.0 1 24.4 24.5 / 24.9 24.6 / 24.5 1
High Concentration 0 1 2 3 4 5 6
pH(SU)Init'Fin 7.50 / 7.76 7.75 / 7.75 7.62 17.69 7.79 / 7.82 7.74 / 7.48 7.64 / 7.92 7.80 1 7.55
DO(mg/L) Init/Fin 7.89 / 7.40 7.84 / 7.04 7.84 / 7.11 7.91 / 7.44 7.92 / 5.70 7.65 / 7.50 7.73 16.58 1
Temp(C)Init/Fin 24.9 / 24.8 24.8 125.5 24.5 / 24.3 24.1 124.7 24.9 / 25.0 25.1 / 25.4 25.2 / 24.5
Sample 1 2 3 Survival Growth Overall Result
Collection Start Date 10/19/2020 10/21/2020 10/22/2020 Normal ri Fl ChV >22
Grab Horn.Var. r,) ri
Composite(Duration) 24.0 24.0 24.1 NOEC 22 22
Hardness(mg/L) 118 120 122 LOEC >22 >22
Alkalinity(mg/L) 87 103 108 ChV >22 >22
Conductivity(umhoslcm) 646 715 703 Method Steel's Dunnet€'s
Chlorine(mg/L) <0.1 <0.1 <0.1
Temp.at Receipt(°C) 2.2 1.9 0.8 Stats Survival Growth
Conc. Critical Calculated Critical Calculated
Dilution H2O Batch# 1514 1515 1516 1.38 10 15.5 2.41 0.1842
Hardness(mg/L) 44 44 44 2.75 10 20 2.41 -0.5842
Alkalinity(mg/L) 52 54 31 5.5 10 20 2.41 -0.6790
Conductivity(umhos/cm) 157 169 161 11 10 17.5 2.41 -0.2790
22 10 18 2.41 -0.8158
l

Effluent Toxicity Report Form Chronic Pass/Fail and Acute LC50 Date: 10/28/20
Facility: WINSTON SALEM - MUDDY CREEK NPDES#: NC0050342 Pipe#: 001 County: FORSYTH
Labors ry Perform g est: MERITE LABS, INC.
�'C Comments:
X
Signatu er f Operator esponsible Charge
X :V s
Signature of Laboratory Supervisor * PASSED: -4.55% 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 = -1.020
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -4.55
% Mortality Avg.Reprod.
# Young Produced 20 21 20 20 23 21 18 19 17 24 20 19
0.00 20.17
Control Control
Adult (L) ive (D)ead L L L L L L L L L L L L
0.00 21.08
Treatment 2 Treatment 2
Effluent %: 5.5%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
9.651% PASS FAIL
# Young Produced 21 18 18 19 18 23 23 22 21 21 25 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: 10/21/20
Control 7.96 7.90 8.04 8.20 8.04 8.08 Collection (Start) Date
Sample 1: 10/19/20 Sample 2: 10/21/20
Treatment 2 7.93 8.03 7.97 8.17 8.07 8.07 Sample Type/Duration 2nd
1st P/F
1 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) 42
Control 8.13 7.69 8.09 7.73 7.74 7.59
Spec. Cond. (pmhos) 159 646 715
Treatment 2 8.05 7.70 8 .19 7.70 7.86 7.55
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 2.2 1.9
(Mortality expressed as %, combining replicates) I
Note: Please
% % % % % % % % % % Concentration Complete This
Section Also
% o o % % o % % % % Mortality
0 o a o 0 0 o a o 0
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 Pass/Fail and Acute LC50 Date: 10/14/21
Facility: WINSTON SALEM - MUDDY CREEK NPDES#: NC0050342 Pipe#: 001 County: FORSYTH
Labor ry Perfor ing est: MERITECH LABS, INC.
Comments: Test organism #12
X „-' 6
Signatu o Oper in Resp nsi e C arge missing. Not included in final
X %' "III - . results.
c� ' � * PASSED: 4.79% Reduction *
Signature of Laboratory Supervisor
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 = 1.124
Tabular t = 2.518
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = 4.79
% 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 22.45
Treatment 2 Treatment 2
Effluent %: 5.5%
' TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
5.847% PASS FAIL
# Young Produced 22 20 26 25 18 26 17 22 22 26 23 0 % control orgs X
producing 3rd
brood Check One
Adult (L) ive (D)ead 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 7.80 8.00 7.87 8.07 7.95 8.18 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 24.3 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
Spec. Cond. (pmhos) 152 827 797
Treatment 2 8.04 7.30 7.72 7.66 8.40 7.19
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.4 1.1
(Mortality expressed as %, combining replicates) 1
Note: Please
% % % % % % % % % % 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-Muddy Creek NPDES#NCO() 50342 Pipe#: 001 County: Forsyth
atory: Meritech In Comments)
x I
Si ure of erator i as nsi Charge/Email/Phone Number
x l'iQV
Signature of Laboratory Supervisor
MAIL ORIGINAL TO: Water Sciences Section
Aquatic Toxicology Branch
Division of Water Resources
1621 Mail Service Center
Raleigh,NC 27699-1621
Test Initiation Date/Time 11/30/2021 3:32 PM Avg Wt/Surv.Control 0.517 Test Organisms
%Eff. Repl. 1 2 3 4 r Cultured In-House
Control Surviving# 9 10 8 10 %Survival 92.5 7 Outside Supplier
Original# 10 10 10 10
Wt/original(mg) 0.401 0.464 0.500 0.534 Avg Wt(mg) 0.475 Hatch Date: 11/29/21
1.38 Surviving# 9 10 10 9 %Survival 95.0 Hatch Time: 4:00-5:00 pm
Original# 10 10 10 10
Wt/original(mg) 0.474 0.566 0.539 0.596 Avg Wt(mg) 0.544
2.75 Surviving# 10 10 9 9 %Survival 95.0
Original# 10 10 10 10
Wt/original(mg) 0.554 0.593 0.447 0.478 Avg Wt(mg) 0.518
5.5 Surviving# 9 8 10 10 %Survival 92.5
Original# 10 10 10 10
Wt/original(mg) 0.509 0.510 0.567 0.518 Avg Wt(mg) 0.526
11 Surviving# 10 10 10 10 %Survival 100.0
Original# 10 10 10 10
Wt/original(mg) 0.559 0.570 0.603 0.565 Avg Wt(mg) 0.574
22 Surviving# 10 9 10 7 %Survival 90.0
Original# 10 10 10 10
Wt/original(mg) 0.514 0.633 0.601 0.427 Avg Wt(mg) 0.544
Water Quality Data Day
Control 0 1 2 3 4 5 6
pH(SU)Init/Fin 7.22 / 7.70 7.83 / 7.56 7.77 / 7.75 7.91 / 7.67 7.95 / 7.91 7.93 17.66 7.73 / 7.41
DO(mg/L) Init/Fin 8.04 / 7.63 8.20 / 7.45 7.94 / 7.60 7.94 / 7.57 7.89 / 8.08 8.14 / 7.44 8.08 / 7.27
Temp(C)Init/Fin 24.9 / 24.8 24.8 / 25.2 25.6 / 24.5 25.2 / 24.9 25.0 / 24.6 24.6 / 24.4 24.6 / 25.2
High Concentration o 1 2 3 4 5 6
pH(SU)Init/Fin 7.05 / 7.74 7.65 / 7.57 7.49 / 7.75 7.65 / 7.75 7.60 / 7.86 7.84 / 7.50 7.60 / 7.57
DO(mg/L) Init/Fin 7.92 / 7.77 8.13 / 7.17 7.89 / 7.54 8,07 / 7.49 7.90 / 8.00 8.17 / 7.01 8.10 / 7.00
Temp(C)Init/Fin 24.9 / 24.7 25.9 / 25.3 25.5 124.5 24.4 / 24.7 24.9 124.4 25.6 / 24.3 24.8 / 24.5
Sample 1 2 3 Survival Growth Overall Result
Collection Start Date 11/29/2021 12/1/2021 12/2/2021 Normal Fl Fl ChV >22
Grab Flom.Var. ri Fl
Composite(Duration) 24.0 23.9 24.0 NOEC 22 22
Hardness(mg/L) 110 134 130 LOEC >22 >22
Alkalinity(mg/L) 72 84 82 ChV >22 >22
Conductivity(umhos/cm) 700 780 800 Method Steel's Dunnett's
Chlorine(mg/L) <0.1 <0.1 <0.1
Temp.at Receipt(°C) 1.1 2.6 0.7 Stats Survival Growth
Conc. Critical Calculated Critical Calculated
Dilution H2O Batch# 1617 1618 1619 1.38 10 19 2.41 -1.6819
Hardness(mg/L) 44 46 42 2.75 10 19 2.41 -1.0542
Alkalinity(mg/L) 31 32 29 5.5 10 18 2.41 -1.2492
Conductivity(umhos/cm) 159 168 168 11 10 22 2.41 -2.4254
22 10 17.5 2.41 -1.6819

Table F
Pretreatment Annual Report 2020

Winston-Salem/Forsyth County
Uti I(ties
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 arc the following:
• Narrative
• Public Notice
• Pretreatment Program Summary(PPS)
• Significant Non-Compliance Report(SNCR)
• SlUs In SNC Historical Report
• Industrial Data Summary Forms(IDSF)
• Allocation Tables for Permits NC0037834 and NC0050342
• SIU's Inspection Summary
Sincerely,
Joel Freeman
Industrial Waste Control Supervisor
� � City C.Larson,Sooth Ward;Jeff
Deniseci D.s,North eMst or Pro Kevinore,Mu Ndy, Ward; a HAanes tBurke,Nortast Ward;Robert Clark,West Ward;
John C.Larson,South Ward;Jeff Macintosh,Northwest Ward;Kevin Mundy,Southwest Ward;Annette Sdppio,Fast Ward;James Taylor,Jr.,Southeast Ward; I
City Manager:Lee D.Garrity
County Commissioners:David R.Piyler,Chair;Don Martin,Vice Chair;Fleming EI-Amin;Ted Kaplan;Richard V.Linville;Tonya McDaniel;Gloria D.Whisenhunt;
Call 311 or 336-727-8000 County Manager:Dudley Watts,Jr.
Wlnston•Salem/Forsyth County Utility Commission:Randall S.Tuttle,Chair;1.Wesley Curtis,Jr.,Vice Chair;Harold E.Day;Tom Griffin;Yvonne H.Hines;
[e-mail] cityolws.org 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.
tAZA)/ .
oe1 Freeman Date
1
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(i). [15ANCAC 02.0908(f); 40 CFR 403.12(o)1. 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 SIU 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

II
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.
r
Clarios, lUP#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,
L

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, IUP#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 NC00 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 lUs 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

Chapter 9, PAR Guidance
Pretreatment Performance Summary (PPS)
1. Pretreatment Town Name: City of Winston-Salen
2. "Primary"NPDES Number NCOO 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 12/31/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 8.=> 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 1.1.=> 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
1 s 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.=> 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 19._> $ 0
20. Number of'Us from which penalties collected 20.=> 0
'Foot Notes: AO Administrative Order IUP Industrial User Pretreatment Permit POTW Publicly Owned Treatment Works
CRU Categorical Industrial User NNC Notice of Non-Compliance SIU Significant Industrial User
CO Consent Order NOV Notice of Violation SNC Significant Non-Compliance
11.1 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
SIC = 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 Sills in SNC during calendar year
SNC ? (Yes/No)
RIP 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 SlUs 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: I/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
3054 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

h[5t Pg REPORT
Winston-Salem
2013 2014 2015 2016 2017 2018 2019
1st half 1 2nd half 1st half I 2nd half 1st half 12nd half 1st half I 2nd half 1st half 12nd half 1st half 12nd half 1st half 12nd half
Sonoco Display& Packaging PreviousNames: Sonoco CorrFlex,'_LC
IUP# 1042 Pipe# 01 CorrFlex Display sIu Word Description:
Chesapeak Display&Pack. paper,comp displays,packaging
IUP Status:Active
Reporting I I XI I 1 I I
Grass America Inc. PreviousNames:
IUP# 2103 Pipe# 01 S1U Word Desolation:
metals
IUP Status:Active
Cyanide I I I IX I I I
Tex-Tech Coatings PreviousNames: Highland Industries Inc.
IUP# 2010 Pipe# 01
SlU Word Desolation:
textile
IUP_Status:Active
EPA 624 IX I IX I I
HOH Corporation PreviousNames:
IUP# 1998 Pipe* 01 SIU Word Description:
CWr-vn/sludge trtrnt
IUP_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 sill 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:12l16/2020 P
Contact the local pretreatment coordinator or state pretreatment staff if errors are noted.

h istgr1��,j
1IVV%.•REPORT
Stratford Metal Finishing PreviousNarnes:
IUP# 1152 Pipe* 01 SIU word Descriptlon:
metals.Job Electroplating shop
UP_Status:Active
Cyanide I 1 I I I I X,
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.

Prot eat-mut Program Info I atalase printed on: 12/22/2020
for Program Name Winston-Salem c o
WWTP Name Archie Elledge
Stream Information Iwc /o at 7Q10 75.59
Program Approval Date 06/15/1983 7010 Flow cfs/mgd 15 / 9.69
1010 Flow cfs/mgd 12.41 / 8.02
Pretreatment Status
Full Stream Classification C
Region WSRO Basin Number YAD04
County Forsyth ` Receiving Stream Name SALEM CREEK
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 128 " .
WWTP CIU's 8 Program ClUs 10 HWA LTMP IWS SUO ERP
date Inactive Date Next Due 10/01/2022 07/01/2021
Date Received by DWR 10/02/2017 12/20/2018 07/01/2016 01/13/2012 01/13/2020
Date Approved 02/28/2018 03/05/2019 09/02/2016 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 I 1336-659-4320 II 1/30/2008 ( 6/11/2012 I 1/24/2012 1 Industri
al ial Waste Control Supervisor Manson Meads Complex 27103
Mr.Olu Browne I II(336)-397-7621 j 1336-659-4320 II I I
[e-mail] Senior Chemist 2799 Griffith Road 27103
Mr.Michael Gearren I II(336)-397-7620 j 1336-659-4320 11 1 I
[e-mail] Chemist Manson Meads Complex 27103
(Pretreatment Related NOVs from DWQ — . DWR Central Office Contact Monti Hassan
DWR Regional Contact Jim Gonsiewski
L

Pretrgatm,ent PrQgram W4 natakase printed inted on: 12/22/2020
1 for Program Name Winston-Salem
Stream Information s IWC%at 7010 5.54
WWTP Name Muddy Creek 554 / 357.88
Program Approval Date 06/15/1983 7010 Flow cfs/mgd
1010 Flow cfs/mgd 446.82 / 288.78
Pretreatment Status Full WS-IV
Stream Classification
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
NPDES Expire Date Current Fiscal 06/14/2019 required
P 06/30/2022 Year PCI Done
POT is Primary WWTP
FALSE Last Audit on 05/09/2018 Audit Year Next22/23 Yes
W
Design Flow mgd 21.0000 %Design mgd is SIU permitted 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 10/01/2022 II 1 1 07/01/2021
Date Received by DWR 10/02/2017 ri 112/20/2018 1 ' 07/01/2016 01/13/2012 01/13/2020
Date Approved 02/28/2018 1 j 03/05/2019 1 s 09/02/2016 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.Prirne Phone1 ext Fax HWA Wksp IUP Wksp PAR Wksp
Mr.Joel Freeman 'Prim 11(336)-397-7621 1336-659-4320 I) 1/30/2008 1 6/11/2012 11/24/2012 1
[e-mail] Industrial Waste Control Supervisor Manson Meads Complex 27103
Mr.Olu Browne l 11(336)-397-7621 j 1336-659-4320 II
[e-mail] Senior Chemist 2799 Griffith Road 27103
Mr.Michael Gearren ' 11(336)-397-7620 1 1336-659-4320 II
[e-mail] Chemist Manson Meads Complex 27103
Pretreatment Related NOVs from DWQ ) DWR Central Office Contact Monti Hassan
DWR Regional Contact Jim Gonsiewski

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 WWTP Tame=> Archie�;lledge IIJP# 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
r low, mgd -J$UV -1 Ammonia
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd b 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 NiA N/A N/A N/A N/A N/.A I N/A
IArsenic Cadmium- _Chromium' 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=> 2 2 2 2 2 2
* Maximum (mg/I)=>
* 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(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 11st 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 (lb/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/l=>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 y Significant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BD"..1/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: Pf dgFkhais deNaii dgflhaflt> tsl�cti�l:zlB,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) IUP# 2020
Use separate forms for each industry/pipe Pipe# 1
rr icicel selenium 1 sliver Linc
1st 6 months '2nd 6 months ' Ist 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
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <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 NIA N/A N/A N/A N/A
pH total Yhosphorus tKrr 11''luoride
1st 6 months 2nd 6 months 1st 6 months 2nd months 1st 6 monks' 2nd 6 months lst 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 _Violybdenum
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 (lb/d)—>
* or Average(mg/1)_> 0.0075 0.01 <0.005 <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
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: PA Podig hmlts 3elliiarellahafltigat*t.RRAB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each 1UP pipe-Page 7 of 7

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 DTP Name=> Archie EIledge 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
rlow,mgd l3Ul) 17a 'Ammonia
1st b months 2nd 6 months 1st 6 months 2nd b months 1st b months 2nd 6 months 1st 6 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 1st 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 (lb/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(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 lbid'>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: PP IOS sliceiCiaibde¢ffiratingrR#tcti 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
Industrial Data Summary Form (IDSF) Name
# Ardagh
3010
Use separate forms for each industry/pipe Pipe# 1
1vicKei selenium - silver zinc
1st b months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2,nd 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/1)_> 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
loll 1H luoride Manganese 1 otal Yhosphorus
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=> 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(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 U & U(riexane) U & (. Hydro Carb I KIN
1st 6 months 12nd 6 months 1st 6 months 2nd 6 months 1st 6 months '2nd 6 months 1st 6 months 2nd 6months
Total#of samples=> 10 6 10 10 2
* Maximum (mg/1)_>
* or Maximum (lb/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/l=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/d y pounds per day
four rows, Please indicate how averages were calculated SNC y 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: PP di1)sThmbsi(dcvfibitdetl alst ikttct&Br3B,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 Bekaert
Use separate forms for each industry/pipe �rP Name=> Archie 1=;lledge IiJP# 2018
Enter BDL values as< (value) NPDES#_> NC OO i71S34 Pipe# I
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
Ir>tow, mga piti.0 -1 b5 Ammonia
1st 6 months 2nd b months st 6 months -lad 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/I)_>
* or Maximum (lb/d)_>
* or_6_Average(mg/1)_> 0.0101 0.0149 955 869 334 751 N/A 94
* 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 (...:U]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 6 8 6 8 6
* Maximum (mg/I)_>
* or Maximum (lb/d)=>
* or Average(mg/I)_> <0.01 <0.01 <0.002 <0.002 <0.005 <0.0067 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 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 6 1 8 6 3
* Maximum (mg/1)_>
* or Maximum (lb/d)_> ,
* or Average(mg/I)_> 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 RUP=>Industrial User Permit Ibld=>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: PARnTIPITterisficeQuidzildhaistrgdastatIt90,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of ?

Pretreatment Annual Report (PAR) Industry Name Bekaert
Industrial Data Summary Form (IDSF) luP# 2018
Use separate forms for each industry/pipe Pipe# 1
T icKel -selenium silver iGmc
1st 6 months 2nd 6 months 1st 6 months 2nd b months 1st 6 months '2nd 6 months 1st 6 months 2nd b 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 NIA N/A N/A N/A N/A N/A N/A
PH t+luorlde 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=> 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 Phosphorus 'I KIN
I 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 12nd 6 months
Total#of samples=> 1 1
* Maximum (mg/1)_>
* or Maximum (]b/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/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: P,dzotlTO&$tdsiZe iidad�kt':aptectSt teilit9i48,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
Use separate forms for each industry/pipe WWTP Name=> Archie 1✓lledge IUP# 1044
Enter BDL values as<(value) NPDES#_> NC UO3`/834 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
1+low,mgd Isuu 1bb 1Ammonla
1st 6 months 2nd 6 months 1st 6 months And 6 months 1st 6 months 2nd 6 months ft 1st 6 months -,And 6 months
Total#of samples=> 6 6 2 2 1
* Maximum (mg/1)=>
* or Maximum (lb/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 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=> 16 6 16 6 16 6 N/A N/A
* Maximum (mg/1)_>
* or Maximum (Ib/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 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 (lb/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 y 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 WW1?=>wastewater treatment plant
Chapter PAR Guidance File name: PpSiftaitsidev(i$ibde apt>gattcIRIMB,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 Claris
Industrial Data Summary Form (IDSF) IUP# 1044
Use separate forms for each industry/pipe Pipe# 1
INicKel selenium i silver - Line
1st 6 months lnd 6 months 1st b months 2nd 6 months 1st 6 months 2nd o months ist 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/1)_> <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 fluoride Manganese I 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=> 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 - 1,K1\
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/I)=>
* or Maximum (lb/d)—>
* or Average(mg/1)_> <0.005 <0.005 N/A 24.0
* 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 TUP=>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. Qdl S heisRe ia)ea aQt f sl c1R9r1B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each TUP pipe-Page 2 of 2

F
(PAR) Control Authority, Industry
PretreatmentAnnual Report
Town Name Cityof Winston-Salem Name Crothall
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe WWTT'Name=> Muddy Creek TUP# 3100
Enter BDL values as<(value) NPDES#_>NC005U342 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
I+low, mga tiUL .I.ba Ammonia
1st 6 months Ind 6 months 1st 6 months 2nd 6 months ,1st 6 months 2nd 6 months 1st b months 2nd 6 months
Total#of samples=> 6 6 4 6 4 6 I
* Maximum (mg/1)_>
* or Maximum (Ib/d)=>
* or_6_Average(mg/1)_> 0.0102 0.0143 145 140 33 27 N/A <0.5
* 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 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 1 1 1
* 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(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 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 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 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,I/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PARodli dladsRexei6deQietha¢tr s cll29riB,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# 1
IN'Mel Selenium 1 -Silver t IGine
Ist 6 months 2 2nd 6 months'2nd 6 months 1st 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 I I 1 1 1
* Maximum (mg/I)=> ,
* or Maximum (1b/d)_>
* or Average(mg/I)_> <0.01 <0.01 <0.01 <0.01 <0.085 <0.005 0.241 0.216
* 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 NIA N/A N/A
PH .1 luoride Molybdenum 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/I)_> 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"KI Manganese
11st 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/I)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> N/A 4 <0.005 <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
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,I/2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PAPotirpSdha i3evati ded t�Yha{atrgi stslectB9i4B,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 Deere-Hitachi
Use separate forms for each industry/pipe DTI'Name=> Arcine Elledge IUP# 2014
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
xi tow, mga -BUJ) Ibb Ammonia
1st b months 2nd b months 1st b months -2nd b months 1st b months -2.nd b months 1st 6 months Ind 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 CLII)
1st 6 months 2nd 6-months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
1 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 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 14 3 7 3 9 2
* Maximum (mg/I)_>
* 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(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/I=>milligrams per liter
* POTW must enter at least one of these IUF=>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?Laidiiil aisideliki cirri afatzgatskclR9slB,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
1sitcKe1 (selenium Saver I Lanc
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 8 3 9 8 14
* 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(lb/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A NIA N/A N/A N/A N/A N/A
pH fuoride -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 4 of samples=> 8 15 1 2 8 1 1
* Maximum=> 8.58 8.7
* or Minimum=>
* or Average(mg/1)_> 0.92 N/A 0.194 0.1060 2990 3,660.000
* 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 NA
Molybdenum ' 'I'KI\ -
I
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—> 2 7 1 1
* Maximum (mg/I)_>
* or Maximum (Ib/d)_>
* or Average(mg/I)_> 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: Rkitrif&theisideNCmi drd a¢tegt&tsleciBArtB,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 Deere-Hitachi
Use separate forms for each industry/pipe DTP Name=> Archie l;lledge IUP# 2014
Enter BDL values as<(value) NPDES#_> NC;OQ37b34 Pipe# 2
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
Flow,mgd 'DUD 1 J7 Ammonia
1st b months 2nd b 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/1)>
* or Maximum (Ib/d)_>
* or Average(mg/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 'N/A N/A N/A N/A N/A N/A N/A
Arsenic I I Cadmium Chromium I COI) -
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 (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
%TRC violations,(SNC is>=33%)_> N/A N/A N/A N/A N/A N/A
1 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=>
* Maximum (mg/1)=>
* or Maximum (lb/d)>
* or Average(mg/I)_> 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 x 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 BDI,,1t2BDL,or zero values used. TRC=>Technical Review Criteria W WTP=>wastewater treatment plant
Chapter. PAR Guidance File name: P zll»lerisRev(ihiode¢ aft slyctRIMB,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)
�# Deere-Hitachi
2014
Use separate forms for each industry/pipe Pipe# 2
IN low! 1 Selenium -buyer - Luke
1st 6 months Ind 6 months 1st 6 months Ind 6 months 1st 6 months Ind 6 months 1st 6 months Ind b months
Total#of samples=>
* Maximum (mg/1)=>
* / =>or Maximum (lb/d)
* or Average(mg/I)=> 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
pit f luorlde Manganese 1 otal Phosphorus
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=> N/A N/A
* or Minimum=>
* or Average(mg/l)_> N/A N/A N/A N/A 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 N/A
Molybdenum IKIN
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 11st 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(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—>BeIow Detection Limit mg/1>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
Ays 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: PARoifliMitdsiteCtaiizteghtfthafttrgats%ctibk4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each TUP pipe-Page 2 of 9

Pretreatment Annual Report(PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Environmental Relief Tech
Use separate forms for each industry/pipe DTP Name=> Archie L;lledge IUP# 3054
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
now, mgd -ISUJJ 1 S Ammonia
i st 6 months 2nd b months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months Ina 6 months
Total#of samples=> 6 - 6 12 11 14 11
* Maximum (mg/I)_>
* or Maximum (lb/d)_>
* or_6_Average(mg/I)=> 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 -C;hromium - 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=>
* 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 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(Ib/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0
%TRC violations,(SNC is>=33%)y 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 w>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,Otr,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: P .;r4 fithatsRelibibte4a t telB9 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) IUP# 3054
Use separate forms for each industry/pipe Pipe# 1
i'\lcKel ��eienium i -SiIver Line
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months ist 6 months 2nd o 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 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 ' Huoride Molybdenum I 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=> 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
1iti.1\ Manganese 1<ats,Ui1& tirease
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months- 1st 6 months 2nd 6 months 1st 6months 2nd 6 months
Total#of samples=> 16 14
* Maximum (mg/1)=> ,
or Maximum (lb/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/I=>milligrams per liter
* POTW must enter at least one of these IIJP=>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: PADaitigeheisi<iedaiided2fdtafitugdxslect994B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each 1UP pipe-Page 2 of, 7

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Grass
Use separate forms for each industry/pipe �'R'T'P Name=> Archielledge IIJP# 2103
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
.ti IOW, mgo. .13UIJ -.1N" Ammonia
1st b months 2nd 6 months 1st 6 months 2nd 6 montns 1st 6 months 2nd 6 months jlst 6 months -2nd 6 months
Total#of samples=> 1
* Maximum (mg/I)—>
* or Maximum (lb/d)_>
* or_6 Average(mg/l)=> 0.0025 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 0 0
%TRC violations,(SNC is>=33%)_> N/A N/A N/A N/A N/A N/A N/A N/A
iArsenic - Cadmium' Chromium ! CUD 1st 6 months 2nd 6 months 1st gi 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 (Ib/d)_=>
* or Average(mg/1)_> 0.014 N/A 0.004 N/A <0.005 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 2nd 6 months 1st b months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples—> I 1 1
* Maximum (mg/1)_>
* or Maximum (1b/d)_>
* or Average(mg/1)_> 0.004 N/A <0.005 N/A <0.01 N/A N/A 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/I=>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=>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: PAlBotl f ltaisiileNtisiixted ajit *cli9lB,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 (IDSF) 112# 2103
Use separate forms for each industry/pipe Pipe# 1
i'ieKei setenlum - itver I Line ,
1st 6 months 1nd 6 months list 6 months 1nd 6 months 1st 6 months Ind 6 months 1st b 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
Ip1i 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=> 1 1
* Maximum—> 6.7 N/A
* or Minimum=>
* or Average(mg/I)_> 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'\'1 K -
•
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 (lb/d)_>
* or ____Average(mg/I)=> 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 IUP=>Industrial User Permit Ib/d y 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 BDI,.12BDL.or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PA orfpEdheisite ided tad es2,tsl�c11294B,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 Hanes Dye
Use separate forms for each industry/pipe WWTP Name=> Azclue Eliedge IUP# 1155
Enter BDL values as < (value) NPDES#_> NC0037ii34 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
How, mgd Iis" -' 1 S 'Ammonia
1st 6 months 2nd 6 months ist 6 months lad 6 months 1st 6 months 'Ind 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(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 J COD
1st 6 months 2nd 6 months Ist 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples—> 1 1 I NA NA
* Maximum (mg/I)_>
* or Maximum (lb/d)_>
* or_ Average(mg I)=> N/A <0.01 N/A <0.002 N/A <0.005
* 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 Uryanide 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/I)_>
* 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 NIA
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.Otr.or 6-month&if BDL.112BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter. PAR Guidance File name: P /IT)S aisilesfiaiirted t taattgt9;Iskct&9AB,pages I2,13,14 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
1ricKel selenium �allver -Lame
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months -end 4 months
Total#of samples=> 1 1 2 1
* Maximum (mg/I)_>
* or Maximum (lb/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
pH - .I.KIN 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=> 4 5 1 1 1
* Maximum=> 9.7 7
* or Minimum=>
* or Average(mg/I)=> N/A 36 N/A 0.025 N/A <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 N/A
1 otal rbospborusI
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=> 1
* Maximum (mg/I)=>
* 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/I=>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->Sitificant Non-Compliance mgd=>million gallons per day
Avg period could be month,Qtr.or 6-month&if BM.,,1/2BDL.or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter PAR Guidance File name: PAgoifiXdheisliteNaitdodaThafttusdk,tskci9klB,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 Herbalife
UseWV✓TP Name—> Archie Llledge IUP# 2UU 1
separate forms for each industry/pipe
Enter BDL values as < (value) NPDES#=> NC 003/834 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates—> 7/1/2020 12/31/2020
Flow, mga iiOM 11 -Ammonia
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months lnd 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(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 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 N/A N/A
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/I)=> N/A <0.01 N/A <0.002 N/A 0.007
* or Average Loading(1b/d)=>
%violations, (chronic SNC is>=66%)—> 0 0 0
%TRC violations,(SNC is>=33 %)_> N/A N/A N/A
Copper Cyanide Lead Mercury
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 1 1 1
* Maximum (mg/I)_>
* or Maximum (lb/d)_>
* - or Average(mg/1)_> 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/I=>milligrams per liter
* POTW must enter at least one of these 1UP=>IndustriaI User Permit lb/d=>pounds per day
four rows, Please indicate how averages were calculated SNC->Sio ificant 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 WW:P=>wastewater treatment plant
Chapter: PAR Guidance File name: P,aLPonTh eirs e'CAiaded aOgtat tc19514B,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) MT Herbalife# 2001
Use separate forms for each industry/pipe Pipe# 1
Iry icKel -Selenium Silver Line
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st b months 2nd b months 1st 6 months 2nd b months
Total#of samples=> 1 1 1 1
* Maximum (mg/1)_>
* or Maximum (Ib/d)_>
* or Average(mg/l)_> N/A <0.01 NIA <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 I.otal Phosphorus Manganese Molybdenum
1st 6 months 2nd 6 months Ist 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 NIA
IKN
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
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or Average(mg/I)_> NIA 188
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0
%TRC violations, (SNC is>=33%)_> N/A
BDL=>Below Detection Limit mgil=>milligrams per liter
* POTW must enter at least one of these 1UP=>Industrial User Permit Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance rngd=>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: PAPerAgfid'ntal siRe bdediaaltt s ct$8t3B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of__z__

Pretreatment Annual Report(PAR)
Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name HOH
Use separate forms for each industry/pipe DTP Name=> Archie 1 lledge SUP# 1998
Enter BDL values as< (value) NPDES#_> NC;UU37Z;34 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
r tow,mga nv13 1 ammonia
1st 6 months 2nd 6 months 1st 6 months Lnd 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(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' UW 1 Certi.tication
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 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(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=> 14 23 6 10 14 23 9 14
* Maximum (mg/1)=>
* or Maximum (1b/d)_>
* or 6 Average(mg/1)=> 0.0474 <0.094 <0.005 <0.0885 <0.0107 <0.3475 <0.000'2 <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 BDL,I/2BDL,or zero values used. TRC a>Technical Review Criteria WWTP>wastewater treatment plant
Chapter: PAR Guidance File name: PA1llbrENdlaisiteleni led afttlg8,ts1~ctt 4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each RIP pipe-Page 1: of 4

•
Pretreatment Annual Report (PAR) Industry Name HOH
Industrial Data Summary Form (IDSF) IUP# 1998
Use separate forms for each industry/pipe Pipe# 1
Enter BDL values as < (value)
Antimony 'Cobalt l.m - litanxum
1st 6 months 2nd b 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 (lb/d)_>
* or Average(mg/I)_> <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-ethylbexlphthalate 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/I)_>
* 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(lb/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-llecane JIuoranthene
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 2 3 2 3 2 3
* Maximum (mg/1)'->
* or Maximum (lb/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/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,112BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PodPAPodiPSEheisiteCtaideclaahafAttgliktsctlIPMB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each 11:P pipe-Page 9 of 4

Pretreatment Annual Report (PAR) Intl
ustryIndustrial Data Summary Form (IDSF) ' HOH
# 1998
Use separate forms for each industry/pipe Pipe# 1
1r1CKel beienlum ,over -Lane
lnd 6 months 1st 6 months 2nd 6 months 1st 6 months 1st 6 months Ind 6 months 1st 6 months 2nd 6 months
Total#of samples=> 14 23 8 17 14 23 14 23
* Maximum (mg/I)=> -
* or Maximum (Ib/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 Manganese 'I otal Yhosphorus
1st 6 months 2nd 6 months 1st 6 months l 2nd 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 LI'A 624 t:YA blb 11i1V
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 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/I=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lbid->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?(J :r•iotabsi3evbia le(ldbatitgattcl k4143,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 3 of 4

r
Pretreatment Annual Report (PAR) Industry HOH
Industrial Data Summary Form (IDSF)
'# 1998
Use separate forms for each industry/pipe
Enter BDL values as < (value) Pipe# 1
n-Uctadecane
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 12nd 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 (lb/d)=>
* or Average(mg/1)=>
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)—>
%TRC violations, (SNC is>=33 %)_>
I ,
1st?months 2nd 6 months 1st 6 months 2nd 6 months Ist 6 months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=>
* Maximum (mg/1)_>
* or Maximum (1b/d)=> .
* or Average(mg/I)_>
* or Average Loading(1b/d)=>
%violations,(chronic SNC is>=66%)_>
%TRC violations,(SNC is>=33 %)_>
BDL=>Below Detection Limit mgil°_>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: PAPotfTPfitlh ide�aiiaied t,iaftttgtBtshe11 1B,pages 12,13,14 Blank IDSF Form.Copy and use in your PAR Number each set for each TUP 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 �'�'Tl'Name=> Archie�;lledgc IUP� 1191
Enter BDL values as< (value) NPDES#_> N C003/834 Pipe 1
1st 6 months, dates=> I/1/2020 6/30/2020
2nd 6 months, dates=> 7/1/2020 12/31/2020
now, mgd 13VL i 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/I)=>
* or Maximum (lb/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 Arsenic " Cadmium Chromium CUD
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=> 2 7 2 7 2 7 N/A N/A
* Maximum (mg/I)—>
* 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/I)_>
* or Maximum (lb/d)_>
* or Average(mg/I)_> 0.019 0.0151 <0.005 N/A <0.01 <0.01 <0.0002 <0.0002
* 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
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,i/2BDL,or zero values used. TRC—>Technical Review Criteria WWiP=>wastewater treatment plant
Chapter: PAR Guidance File name: PjiiiOSThedsReNGeii d raf tzgat iyc18 1B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each TUP pipe-Page 1 of 9

Pretreatment Annual Report (PAR) Industry Name Ingedion
Industrial Data Summary Form (IDSF) rLTP# 1191
Use separate forms for each industry/pipe Pipe# 1
1\1CKel j�elenium f ssulver 'Line
m 1st 6 ontns 2nd 6 months 1st b months 2nd 6 months 1st 6 months 2nd b months 1st 6 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 I otal Phosphorus
1st 6 m—onths 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/l)_> 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 1 K.LV
1st 6 months-2nd 6 months 1st 6 months ,nd 6 months j I st 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(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 mgil=>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: PPff?ori ElliaisReNCtiaiidecl aiNttgat*ct 1B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page _ ? of 2

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 NP# 3102
Enter BDL values as< (value) NPDES#=> NCUUSU34Z 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 1101) 1 bb Ammonia
1st 6 months 'Ind 6 months 1st 6 months 2nd b months 1st b months 2nd 6 months 1st 6 months -2nd b months
Total#of samples=> 6 6 3 6 3 6 1
* Maximum (mg/I)_>
* or Maximum (lb/d)=>
* or_6 Average(mg/l)_> 0.0356 0.0231 92 126 11 45.0 N/A 20
* 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
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 If
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
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=> 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 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?dairti Edhaisi!leeitdeddlhafitegz$gste11 B,pages 12,13,14 Blank IDSF Fonn,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Lantal
Industrial Data Summary Form (IDSF) IUP# 3102
Use separate forms for each industry/pipe Pipe# 1
Nickell Selenium I Saver - Line
1st 6 months 2nd 6 months 1st b months 2nd 6 months 1st 6 months 2nd 6 months I st 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
pH - Fluoride -1Vianganese 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 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
I K N 1 ota!Phosphorus
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=> 1 1
* Maximum (mg/1)_>
* or Maximum (Ib/d)_>
* or f 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 me/I=>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: PA r T heirsReNCiakdedetdia*tatsScH 1B,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
WWTP Name => Archie hiledge IUP# 2020
Use separate forms for each industry/pipe NPDES#_> NC0037834 Pipe# 1
• Enter BDL values as< (value) 1st 6 months,dates=> IR/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
P low, Ingo '13Ull I., !Ammonia
1st b months '2nd b months 1st 6 months 2nd 6 months 1st b months 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 6 6 8 6 8 6 2
* Maximum (mg/I):-:>
* 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 IChromium- - CUD
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1 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/1)_> 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 Cyanide Lead Mercury I
1st 6 months -2nd 6 months+ 1st 6 monts 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 (lb/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/1=>milligrams per liter
* POTW must enter at least one of these RIP=>Industrial User Permit tb/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: PAPAPorlii3fAirriERevatitdedelhaOtiegaxtct9.54B,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 Liquid Environmental
Industrial Data Summary Form (IDSF)• iUP# 2020
Use separate forms for each industry/pipe Pipe# 1
1r1cXei - selenium i Silver ILulc
1st 6 months 2nd b months 1st b months 2nd 6 months 1st b months 2nd b months `1st b months 2nd 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(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 - 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=> 140 136 2 2
* Maximum=> 7.6 7.6
* or Minimum=>
* or Average(mg/1)_> N/A N/A N/A 02165 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 (Sz CitHexane) Ili-IN
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 13 12 2
* Maximum (mg/1)_>
* or Maximum (1b/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 y 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 W WTP< wastewater treatment plant
Chapter. PAR Guidance File name: PARodigfid<ratsRefihitdrelaglhafttsgrl 9CctRIMB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each M'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 4_> 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
How, raga BUD 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 4 6 4 6 1
* Maximum (mg/1)=> ,
* or Maximum (lb/d)_>
* or 6_Average(mg/1)_> 0.1.456 0.1687 2259 2,493 56 131 0.505 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 %)_> NIA N/A N/A N/A N/A N/A N/A N/A
IArsenic ' 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
* Maximum (mill)_>
* 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 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 '.b/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mad=>million gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,1I2BDL.or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter. PAR Guidance File name: PAPorlfgelliEntsReVkliirleddlhafittgatect9AFIB,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) Ind
ustry Industrial Data Summary Form (IDSF) Name Pepsi
1036
Use separate forms for each industry/pipe Pipe# 1
jlv1exe1 p seienium �uver ',Ulnae
list 6 months lnti 6 months 1st 6 months Ind 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)=> <0.0I0 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
p11 - 1+luoride Manganese 1otalYhosphorus
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(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 I.KIN - 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 1
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/1)_'> <0.005 N/A 2.88 N/A
* or Average Loading(1b/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 Ib/d=>pounds per day
four rows, Please indicate how averages were calculated SNC=>Significant Non-Compliance mgd=>milIion gallons per day
Avg period could be month,Qtr,or 6-month&if BDL,12BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter. PAR Guidance File name: P.P(Riefg misReeaitdeddhaatrg*shc1&lh4B,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>;lledge IUP# 3051
Enter BDL values as<(value) NPDES#_> NC;UU3"1834 Pipe# 1
1st 6 months,dates=> 1/1/2U2U 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
1+1ow, mga BUM 1 6 Ammonia
1st 6 months Ind 6 months 1st 6 months And 6 months 1st 6 months :Lnd b months 1st 6 months And 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(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 - Coll
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/1)_>
* or Maximum (1b/d)=>
* ' or Average(mg/I)_> 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
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=>
* 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 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 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 W WTP y wastewater treatment plant
Chapter. PAR Guidance File name: P o irksRetikiiodetl iafingattctR 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 Pepsi 02 WOW
Industrial Data Summary Form (IDSF) 115P# 3051
Use separate forms for each industry/pipe Pipe# 1
INicKel eienium "silver Lille
1st 6 months Ind 6 months 1st 6 months ,2nd 6 months 1st 6 mourns J?nd 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 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 f 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=> 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(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&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=>
* Maximum (mg/1)_> ,
* 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<l=>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 rngd=>million gallons per day
Avg period could be month,Otr.or 6-month&if BDL,I l213DL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PF olffPfilhaisiteCti'eialellaha¢t r ctgli4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 2

7
Pretreatment Annual Report(PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Progress Rail
Use separate forms for each industry/pipe WWTP Name=> Archie�lledge IUP# 1038
Enter BDL values as< (value) NPDES#=> NC0037834 Pipe# 1
1st 6 months,dates=> 1/I/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
r low,alga -.13t1D 'i.Ja Ammonia
1st 6 months lnd 6 months 1st 6 months 2nd b months 1st 6 months -2nd 6 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(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
Arsenic Cadmium -Chromium CUD
lst 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 4 13 4 I3 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(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 1 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 (Ib/d)_>
* or Average(mg/1)_> 0.1668 0.2845 <0.007 <0.0021 <0.0029 <0.0059 <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 mgf 1=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit Ibld=>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 y Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PAStoffillalhaitsRofitaiixtetlatilhafttzglftstalifh4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1, of 2

1
Pretreatment Annual Report (PAR) Industry Name Progress Rail
Industrial Data Summary Form (IDSF) IUP# 1038
Use separate forms for each industry/pipe Pipe# 1
1N1CKet 3eienium ' luver 1 -Line
1st 6 months Ina b months i st 6 months lnd 6 months 1st b months lnd 6 months 1st 6 months 2.nd 6 months
Total#of samples=> 4 13 1 6 2 13 4 13
* Maximum (mg/1)_>
* 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(lb/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 •I otal Yhosphorus
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 7 1 6
* Maximum=> 9.8 9.8
* or Minimum=>
* or Average(mg/1)_> 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 - L+•YA 624 1+; 'A 6Lb 11.0
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=> 1 6 1 1
* Maximum (mg/l)=>
* or Maximum (Ib/d)_>
* or 6 mo Average(mg/1)> 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 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: PAPoifilehaistlelGstiiduddthaftugilkts%clia94B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 2

r
Pretreatment Annual Report(PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name RJR Tobaccoville
forms for each industry/pipe �'TP Name=> Muddy Creek IUP# 3001
Use separate
NPDES#--> N C 0050342 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
.1(tow, mga DUD -1 bb IAmmonla
1st b months -2nd 6 months 1st b months -2nd 6 months 1st 6 months 2nd b months 1st b months in b 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(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 ' cub
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/I)_>
* or Maximum (lb/d)=>
* or Average(mg/1)=> <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
Copper cyanide Lead Mercury 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 1 1 2 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/I)_> 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: Paorti li h titeNGaibieddha tctit&4B,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 RTRTobaccoville
Industrial Data Summary Form (IDSF) TUP# 3001
Use separate forms for each industry/pipe Pipe
1
- selenium - Silver Line
ricKei t 6 months 2nd 6 months 1st 6 months "2nd 6 months 1st 6 months 2nd o months 1st 6 months 2nd 6 months
Total#of samples=> I 2 1 2 1 2 1 2
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/I)_> 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
PH ` _Nluoride Manganese Molybdenum
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd a 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'K'_N
1st 6 months 2nd 6 months 1st 6 months- 2nd 6 montTis 1st 6 months 2nd 6 months 1st 6 months-2nd 6 months
Total#of samples=> 1 1 1 1
* Maximum (mg/I)=> .
* or Maximum (Ib/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/I=>miIligrams 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: P. diNdlia isiice\6kiitted uhafttegtf 's'ecl-PAIB,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 RJR Whitaker Park
WWTP Name=> Muddy Creek I1JP# 3014
Use separate forms for each industry/pipe
EnterNPDES#_> NC 00�0342 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
r low,mgd lit/1/ 1.SS Ammonia
1st 6 months -2nd 6 months 1st 6 months 2nd 6 months 1st 6 months -Zne 6 months 1st b months Ind 6 months
Total#of samples=> 6 6 8 6 9 6 1 2
* Maximum (mg/1)_>
* or Maximum (1b/d)_>
* or6Average(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" JChromlum) COI)
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 2 2 N/A NT-A
* Maximum (mg/1) '>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <0.01 <0.01 0.0055 0.0055 0.0095 0.0155
* 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 2nd 6 months 1st 6 months 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+l=>milligrams per liter
* POTW must enter at least one of these TUP=>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.112BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance Pile name: PPlltortipf isftiteCaiirirciaaa¢t t t*ct&BrIB,pages I2,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

r
Pretreatment Annual Report (PAR) Industry Name RJR Whitaker Park
Industrial Data Summary Form (1DSF) 1UP# 3014
Use separate forms for each industry/pipe Pipe#
1
1vllcmel se>enium stiver ILzlnc
1st b 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=> 2 2 2 2 2 2 2 2
* Maximum (mg/1)—>
* or Maximum (Ib/d)_>
* or Average(mg/1)_> 0.0125 0.0220 <0.01 <0.01 <0.005 <0.005 0.5865 0.368
* or Average Loading(1b/d)_>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0 0 0
cYo TRC violations,(SNC is>=33 %)_> N/A N/A N/A N/A N/A N/A N/A N/A
pH 1 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=> 9 6 2 2 2 2
* Maximum=> 6.9 7
* or Minimum=>
* or Average(mg/l)_> 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.'&N 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/1)=>
* or Maximum (lb/d)_>
* or Average(mg/I)=> 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 mgil=>milligrams per liter
* POTW must enter at least one of these IUP=>Industrial User Permit lb/3=>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: Pl ilfpFamisRedmiiried tlta trgiit#sl~ctl 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
WVJTP Name=> Muddy Creek IUP# 3026
Use separate forms for each industry/pipe
Enter BDL values as<(value)
NPDES#=> NC;UOSU342 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
r tow,mga 'nut 1 a;5 (Ammonia
1st 6 months 2nd b months 1st 6 months -2nd 6 months 1st 6 months 2nd 6 months Cst 6 months 2nd 6 months
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 L01)
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 10 12 10 12 N/A N/A
* Maximum (mg/1)_>
* or Maximum (Ib/d)=>
* 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
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=> 10 12 7 10 10 12 1 2
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/I)_> <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/l—>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: PtCRotTiil8$tabsRelliiadedaDhaftr shclBf 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 Siemens
Industrial Data Summary Form (IDSF) IUP# 3026
Use separate forms for each industry/pipe Pipe# 1
IIN 1cKe1 seiemu m silver ILine
1st 6 months '2nd 6 months 1st 6 months 2na 6 months 1st b months lnd 6 months 1st 6 months lnd 6 months
Total#of samples=> 10 12 3 6 10 12 10 12
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 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
%TR.0 violations,(SNC is>=33%)_> 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 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 f 1 K_'N - 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 1 1 1
* Maximum (mg/l)=> ,
* or Maximum (1b/d)=>
* or __ Average(mg/1)_> 0.317 0.714 7.8 6.7
* 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
BDI._>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.Adto frlhedsReIGai d2fchajitgat eci 13,pages 12,13,14 BIank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 9

f
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.�;lledge IUP# 1042
Enter BDL values as< (value) NPDES#_> Nt;UU:37ii34 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
I tow, mga m
`13U1.1 I SS Amonia
1st 6 months 2nd 6 months 1st 6 months lnd 6 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/1)_>
* or Maximum (lb/d)=>
* or_6_Average(mg/1)_> 0.0156 0.0159 199 696 306 808 6.97 5.6
* 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 WI)
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 12nd 6 months
Total#of samples=> 1 2 1 2 1 2 N/A N/A
* Maximum (mg/I)=>
* 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 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=> 7 8 1 2 1 2 1 2
* Maximum (mg/1)_>
* or Maximum (lb/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/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 y 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 Poi il)Edtutlsiteva>8itde¢dtai tegtJ>sxshcliA413,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 Sonoco
Industrial Data Summary Form (1DSF) IUP# 1042
Use separate forms for each industry/pipe Pipe# 1
i icKel v 1s elenitum slily er LAn c
1st b months 2nd b months 1st 6 months lnd 6 months lit 6 months 2nd b months lst 6 months 2nd 6 months
Total#of samples=> 1 2 1 2 1 2 1 2
* Maximum (mg/I)=>
* or Maximum (lb/d)_>
* or Average(mg/I)_> <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 NIA 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 rKIN
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 (1b/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 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: PFt9orli h ReNCaiaiedelhaOt tsect ln,pages 12,13,14 Blank 1DSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page _, of 9

Pretreatment Annual Report (PAR) Control Authority, Industry
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name Stratford Metals
WWTP Name=> Archie Elledgc MP# 1152
Use separate forms for each industry/pipe
Enter BDL values as< (value) NPDES#_> NC 00373� Pipe# 1 j
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates—> 7/1/2020 12/31/2020
now, mull ISUU 1 ss (Ammonia
1st 6 months 2nd 6 months 1st 6 months "2nd 6 months 1st 6 months 2nd 6 months li i st 6 mouths 2na 6 months
Total#of samples=> 2 9
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or_6 Average(mg/I)=> 0.02 0.02 N/A N/A N/A N/A N/A N/A
* or Average Loading(lb/d)_>
%violations,(chronic SNC is>=66%)_> 0 0
%TRC violations,(SNC is>—33 %)_> N/A NIA
Arsenic " Cadmium (Chromium I CUD 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=> 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(1b/d)=>
%violations,(chronic SNC is>=66%)_> 0 0 0 0
%TRC violations,(SNC is>=33 %)=> N/A N/A NIA N/A
Copper Cyanide - Lead Mercury
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=> 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(lb/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
BDI.,_>Below Detection Limit mg/1_>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: Pf dlpSlhasisiieViaiideddfdrapt s zctli B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each TUP pipe-Page 1 of 2

Pretreatment Annual Report (PAR) Industry Name Stratford Metals
Industrial Data Summary Form (IDSF) IUP# 1152
Use separate forms for each industry/pipe Pipe# 1
A1cKe1 �eientum 1 silver Lille
1st 1st 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=> 6 7 2 3 6 7 6 7
* Maximum (mg/I)_>
* 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 I 2nd 6 months 1st 6 months 2nd 6 months I st 6 months 2nd 6 months I 1st 6 months 2nd 6 months
Total#of samples=> 2
* Maximum (mg/1)=>
* or Maximum (lb/d)=>
* or Average(mg/I)_> 0.0475 0.069
* 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,Otr,or 6-month&if BDL,1f2BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance Pile name: PiDoitrOdhei side iufiedafahatttrgJ3;*1&f34B,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 Elledge IUP# 1189
Use separate forms for each industry/pipe
Enter BDL values as< (value) NPDES#_> N(:UU3"l�S34 Pipe# 1
1st 6 months,dates=> 1/1/2020 6/30/2020
2nd 6 months,dates=> 7/1/2020 12/31/2020
r low,Ingo 1I501J I bb 'AMMO ma
1st b months 2nd 6 months 1st b months -2nd b months 1st 6 months 2nd 6 months 1st 6 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
IArsenic - Cadmium jcluromlum cull'
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months l 1st 6 months 2nd 6 months
Total#of samples=> 1 1 1 1 1 1 N/A N/A
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/I)_> <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 head 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 (1b/d)_>
* or Average(mg/I)_> 0.028 0.0230 0.019 0.007 <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 N/A N/A N/A N/A N/A
BDL-i>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.1t2BDL,or zero values used. TRC>Technical Review Criteria WWTP-->wastewater treatment plant
Chapter. PAR Guidance File name: PAPorliAlheisReNGsitcteclefiliaftizglaAclki4B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 1 of 2

r
Pretreatment Annual Report (PAR) Industry Name Suiza Dairy Group
Industrial Data Summary Form (IDSF) IITP# 1189
Use separate forms for each industry/pipe Pipe# 1
AIM' Jelenlum bfiver -Lime
1st 6 months 2nd 6 months 1st b months 2nd 6 months 1st 6 months 2nd b months 1st b months 2nd 6 months
Total#of samples=> 1 1 1 1 1 1 1 1
* Maximum (mg/I)=>
* or Maximum (1b/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 rluorlde -Manganese '1 otal Phosphorus 1
1st 6 months 2nd Z 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(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 '1KUN
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months-2nd 6 months Ist 1 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 1UP=>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: PAPoillp136halafteNaitialedriDhatittglittskcIRA4B,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 Superior
WWTP Name=> Muddy Creek IUP# 3141
Use separate forms for each industry/pipe
NPDES#=>NC0030342 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
V tow,mga isuu �1 J -Ammonia
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months lnd b 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 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 4 1 4 1 4 N/A N/A
* Maximum (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 (Ib/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/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: PAIltodpfi iai ite'§iiiellintaistegt/4tell RIPB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each P pipe-Page 1 of 2

r
Pretreatment Annual Report (PAR) Industry Name Superior
Industrial Data Summary Form (IDSF) IUP# 3101
Use separate forms for each industry/pipe Pipe# I
iNiickel beienium - silver - Gznc
1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months lst 6 months 'end 6 months
Total#of samples=> 1 4 1 4 1 4 3 9
* Maximum (mg/I)_>
* or Maximum (lb/d)_>
* or Average(mg/I)_> 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 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 4 1 4
* Maximum=> 9.9 10.5
* or Minimum=>
* or Average(mg/1)_> N/A N/A 0.029 <0.016 N/A NIA
* or Average Loading(lb/d)—>
%violations,(chronic SNC is>=66%)_> 0 0 0 0 0 0
%TRC violations,(SNC is>=33 %)_> NIA N/A N/A N/A N/A N/A N/A
1 K1V Manganese
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=> 1 4
* Maximum (mg/I)_>
* or Maximum (lb/d)=>
* or Average(mg/1)=> N/A N/A 0.011 <0.0115
* 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 TUP=>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,1/213DL,or zero values used. TRC->Technical Review Criteria WVrTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PPdPn3'WhaisReNGsialcd taftt> A;*clRBriB,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 Tex-Tech
Usea'wTP Name=> �Archie 1✓lledge IUP# 2010
separate forms for each industry/pipe
d NPDES#_> NC;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
x low,mga 113UL -1 Ammonia
1st 6 months 2nd 6 months 1st 6 months Ind 6 months 1st 6 months 2nd 6 months 1st b months 2nd b months
Total#of samples=> 6 6 3 1 3 1
* Maximum (mg/1)=>
* or Maximum (lb/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
1 Arsenic I - Cadmium Chromium CUD
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=> 3 3 3 3 3 3
* 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
%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=> 3 3 1 1 3 3 • 1 1
* Maximum (mg/I)_>
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.2697 0.1033 <0.005 <0.005 <0.01 <0.01 <0.002 <0.0002
* 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/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,12BDL.or zero values used. TRC=e>Technical Review Criteria WWI?=>wastewater treatment plant
Chapter: PAR Guidance File name: PA2orBi3Fdhmfsiae thi6de{iahaistrgatslycti B,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 Tex-Tech
Industrial Data Summary Form (IDSF) IUP# 2010
Use separate forms for each industry/pipe Pipe# 1
1N1CKC1 ( Selenium liver -Gun
1st 6 months Ind 6 months 1st 6 months 2nd 6 months 1st 6 months 2nd 6 months 1st 6 months Ind 6 months
Total#of samples=> 3 3 3 3 3 3 3 3
* Maximum (mg/1)_>
* or Maximum (1b/d)_>
* or Average(mg/1)_> <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 • i,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=> 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 EPA 624 EPA b2 ' 1.KN
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 (1b/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 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.12BDL,or zero values used. TRC=>Technical Review Criteria WWTP=>wastewater treatment plant
•
Chapter: PAR Guidance File name: P?tai igeh ibditelabindeditEt tajttrgilktsketR9AB,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
Industrial Data Summary Form (IDSF) Town Name=> City of Winston-Salem Name UniFirst
DTP Name=> Archie Elledge IUP# 2015
Use separate forms for each industry/pipe
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
1'low, mga 151-11) 1 bS Ammonia
1st 6 months lad 6 months 1st 6 months /nd 6 months 1st 6 months ind 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 COD
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=> 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(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 J 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 (1b/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: PAIrodigiludsRafaiixteclialhaittegat dactRlig13,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 UniFirst
Industrial Data Summary Form (IDSF) IUP# 2015
Use separate forms for each industry/pipe Pipe# 1
IINIcKe1 - selenium ( river -L1nC
1st 6 months �nd 6 months 1st 6 months lnd 6 months 1st b months tnd 6 months *1st 6 months 2nd 6 months
Total#of samples=> 1 7 1 7 1 7 1 7
* Maximum (mg/1)_> .
* or Maximum (lb/d)_>
* or Average(mg/1)_> 0.104 0.061 <0.0I <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 Fluoride Manganese ivlolybdenum
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 1 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 ritosphorus - 1'KIN
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=> 1 1 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)=>
* or Average(mg/I)=> 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 y 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: P d atsiPtelaiaiedellhaftteg s>yc1i B,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 WestRockol
Use separate forms for each industry/pipe WWTP Name=> Muddy Creek IUP# 3041
NPDES#=> NC005O342 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
r low,mga 'tsvli 1 S -Ammonia
1st 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=> 6 6 10 12 10 12 1
* Maximum (mg/1)_>
* or Maximum (1b/d)_>
* or_6_Average(mg/1)_> 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 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 4 1 4 1 4 N/A N/A
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/1)_> <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 I Lead Mercury
1 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 1 1
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/I)_> 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=>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: PAlRodlifSTdsfdevf ie¢allhafti gs9gtctR8$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 WestRock01
industrial Data Summary Form (IDSF) rUP# 3041
Use separate forms for each industry/pipe Pipe# 1
lvlcnet -1 peienium -sliver LAIC
1st b months lnd 6 months 1st 6 months 2nd 6 months AluLst 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(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 r'luorlde -lvtanganese 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 - 1KIN
1st 6 months-nd 6 months 1st 6 months 2nd 6-months 1st 6 months I 2nd 6 months 1st 6 months 2nd 6 months
Total#of samples=> 1 1
* Maximum (mg/1)=>
* or Maximum (lb/d)_>
* or Average(mg/I)_> 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/I=>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 rHigkiitale:Redreiafi allhatit sltict rlB,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page 2 of 2

7
Pretreatment Annual Report(PAR) Control Authority, Industry
Town Name=> City of Winston-Salem Name WestRock02 Display
Industrial Data Summary Form (IDSF)
separate forms for each industry/pipe WWTP Name=> Muddy Creek IUP# 3052
Use
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
.r low,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=> 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- 'Chromiumi 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 N/A N/A
* Maximum (mg/1)_>
* or Maximum (lb/d)_>
* or Average(mg/I)_> <0.0I 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 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=> 3 2 3' 1
* Maximum (mg/I)=>
* 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(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 1UP y 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 W WTP=>wastewater treatment plant
Chapter. PAR Guidance File name: PlikaNdheIsfteiStibleclaltaftttrkeectlI94B,pages 12,13,14 Blank IDSF Form,Copy and use in your PAR Number each set for each IUP pipe-Page I of 7

r
Pretreatment Annual Report (PAR) IndustryName WestRock02 Display
Industrial Data Summary Form (IDSF) 'up# 3052
Use separate forms for each industry/pipe Pipe# 1
1NicKel - I�eienium sliver - Lime
1st 6 months Ind 6 months 1st 6 months Ind 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 rluoride 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 3 3
* Maximum=> 8 7.7
* or Minimum=>
* or Average(mg/I)=> N/A N/A 0.0463 N/A 0.4643 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
•
Total Yliospllorus MN
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
* Maximum (mg/1)>
* or Maximum (lb/d)=>
* or Average(mg/1)=> 14 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/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 y Technical Review Criteria WWTP=>wastewater treatment plant
Chapter: PAR Guidance File name: PARAN hatsiteli iutedffiHratit tetiil 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

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-Ilitachi 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 1I011 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
Lantal Textiles >25 000 Potential to Impact October
3102 p 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.
Sj�}cerely,
Courtney i
Utilities Division Director
CC: Frank Crump, Superintendent
Keith Jones, MCWWTP Supervisor
Matt Lavigne, AEWWTP Supervisor