NC0021709_Industrial User_20220118

Town of Jefferson
ALDERMEN 302 East Main Street MAYOR
Charles Caudill PO Box 67 Bluferd Eldreth
Mark Johnston Jefferson, NC 28640 TOWN MANAGER
Max Yates Charity Shatley
Wes Williams Phone [phone] FINANCE OFFICER
Cathy Ballou Fax [phone] Kayla Jones
Tax ID # 56-0896625
January 13, 2022
NC DEQ RECEIVE
Division of Water Quality/PERCS $ 2022
1617 Mail Service Center �aN 1
Raleigh, NC 27699-1617 rr����NppES
ATTN: Mr. Michael Montebello, Municipal Permitting Unit n4C® �DNI°
SUBJECT:Town of Jefferson,Ashe County NPDES NC0021709 l�
Renewal/Reissuance of Industrial User Permit#004 American Emergency Vehicles
Dear Mr. Montebello:
The Town of Jefferson requests to renew IUP#004 for American Emergency Vehicles. This IUP was
allowed to expire as this facility has been phasing out of operation for some time and will be vacating
their facility by August,2022. The Town has been informed that renewal of this permit is necessary.
Mr.Alex Lowe of the Winston-Salem Regional Office is assisting the Town in this matter.We are
requesting no revisions to the effluent limits or monitoring requirements found in the most recent
version of this IUP.
Following Section II (3) (5)of Basic IUP Guidance I have included the following documentation:
• The Transmittal Letter that will be sent to the SIU once this IUP renewal is approved by PERCS
• The IUP with a new cover page, including signature and effective date, along with IUP history
• The existing IUP synopsis
• SIU's application
• POTW's most recent inspection of American Emergency Vehicles
• Allocation Table
If you have questions, comments or require additional information regarding this renewal request
please call me at(336)246-2165 or contact me by email at [e-mail]. Thank you for your
assistance in this matter.
Respectfully,
Tim Church,Water Resources Director
Town of Jefferson

Town of Jefferson
ALDERMEN 302 East Main Street MAYOR
Charles Caudill PO Box 67 Bluferci Eldreth
Mark Johnston Jefferson, NC 28640 TOWN MANAGER
Max Yates Charity Shatley
Wes Williams Phone [phone] FINANCE OFFICER
Cathy Ballou Fax [phone] Kayla Jones
Tax ID # 56-0896625
CERTIFIED MAIL February 1, 2022
American Emergency Vehicles
165 American Way
Jefferson, NC 28640
ATTN: Gary Graybeal, Compliance Manager
SUBJECT:Transmittal Letter for Re-Issuance of Industrial User Permit #004
Dear Mr. Graybeal:
Industrial User Permit (IUP#004) is enclosed. This permit is issued in response to the completion of your
Industrial User Wastewater Survey and Application received by this office June 17, 2021. This permit is
issued pursuant to the requirements of North Carolina General Statute 143-215.1 and the local Sewer Use
Ordinance.
Please read this permit carefully.
If any parts, measurement frequencies, or sampling requirements contained in this permit are
unacceptable to you, you have the right to an ajudicatory hearing upon written request within thirty (30)
days following the receipt of this letter. Unless such demand is made, this decision shall be final and
binding.
Sincerely,
Tim Church, Water Resources Director
Town of Jefferson
cc: Charity Shatley, Town Manager
ENCL: Industrial User Permit#004

Town of Jefferson
Control Authority and/or Municipality
PERMIT
Industrial User Pretreatment Permit(IUP)
To Discharge Wastewater Under the
Industrial Pretreatment Program
004 40 CFR 433.17
IUP Number 40 CFR Category(f Applicable)
In compliance with the provisions of North Carolina General Statute 143-215.1, any
applicable federal categorical pretreatment regulations, all other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management
Commission, and the Control Authority and/or Municipality Sewer Use Ordinance. The
following Industry,hereafter referred to by name or as the permittee:
American Emergency Vehicles
Facility Located at Street Address
165 American Way
City
Jefferson
State,Zip
North Carolina 28640
is hereby authorized to discharge wastewater from the facility located at the above listed
address into the sanitary sewer collection system and the wastewater treatment facility of
the Control Authority and/or Municipality listed below:
IUP Control Authority and/or Municipality WWTP name:
Jefferson Wastewater Treatment Plant
NPDES Number:
NC0021709
W WTP Address'
1233 NC Highway 16 South
City,State,Zip
Jefferson,NC 28640
in accordance with effluent limitations, monitoring requirements, and all other conditions
set forth in Parts I, II, and III of this Industrial User Pretreatment Permit(IUP).
Effective date,this permit and the authorization to discharge shall become
effective at midnight on this date:.
February 1, 2022
Expiration date,this permit and the authorization to discharge shall expire at
midnight on this date:
July 31, 2026
February 1,2022 Num,
Date signed Tim Church,Water Resources Director

Industrial User Pretreatment Permit (IUP)
PART I
Specific Conditions
IUP, PART I, OUTLINE:
A.) IUP Basic Information
B.) IUP Modification History
C.) Authorization Statement
D.) Description of Discharges
E.) Schematic and Monitoring Locations
F.) Effluent Limits &Monitoring Requirements
G.) Definitions and Limit Page(s)notes
A. IUP Basic Information:
Receiving Control Authority&WWTP name: POTW NPDES#:
Jefferson Wastewater Treatment Plant NC0021709
IUP Name: IUP Number:
American Emergency Vehicles 004
IUP Effective date: Pipe Numbers,list all regulated pipes:
February 1, 2022 001
IUP Expiration date: IUP 40 CFR#(if applicable),or N/A:
July 31, 2026 433.17
B. IUP History. A Complete Permit History is required):
February 1, Renewal No revisions or changes in effluent limits or
2022 monitoring requirements.
April 15, Modification Reduction in limits for Nickel, Cyanide, Silver to
2019 correct over-allocation.
Provide pH adjustment at or prior to the
categorical sampling point to maintain pH of 5 to
10 su.
2

Industrial User Pretreatment Permit (TUP)
PART I
Specific Conditions
C.) Authorization Statement:
1.) The Permittee is hereby authorized to discharge wastewater in accordance
with the effluent limitations, monitoring requirements, and all other conditions
set forth in this Industrial User Pretreatment Permit (IUP) into the sewer
collection system and wastewater treatment facility of the Control Authority
and/or Municipality.
2.) The Permittee is hereby authorized to continue operation of and discharge
wastewater from the following treatment or pretreatment facilities. These
facilities must correspond to the treatment units listed on both the application
and inspection forms.
IU Treatment Units
List all Treatment Units: Settling Tank Descriptions: Used to collect and remove grit and also is the categorical
sampling point.
The IU shall provide p1-1 adjustment at or prior to the categorical
sampling point to maintain a pH in the discharge between 5 and 10 su
3.) The Permittee is hereby authorized to, if required by the Control Authority
and/or Municipality and after receiving Authorization to Construct (A to C)
from the Control Authority and/or Municipality, construct and operate
additional pretreatment units as needed to meet final effluent limitations.
D.) Description of IUP Discharge(s):
1. Describe the discharge(s) from all regulated pipes.
Pipe # 001 , Description of Discharge: Aluminum bodies are sprayed and rinsed with
Alumiprep, a corrosive that prepares the vehicle for primer and painting. This is
considered a categorical metal finishing process 40CFR 433.17
E.) Schematic and Monitoring Locations:
The facility schematic and description of monitoring location(s) given below must
show enough detail such that someone unfamiliar with the facility could readily
find and identify the monitoring location(s) and connection to the sewer. Include
and identify all regulated pipes.
3

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Process Wastewater
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IUP9 Part 1 Section F: Receiving POTW name=> Jefferson WWTP IU name=> American Emergency
` Vehicles
Effluent Limits and Monitoring Requirements Receiving POTW NPDES #_> NC0021709 IUP#_> 004
Effective date for these Limits=> February 1,2022 Pipe#=> 001
The Permittee may discharge from this specific Expiration date for these Limits=> July 31,2026 40 CFR# _> 433.17
Pipe number according to these specific dates, if not applicable put N/A
effluent limits, and monitoring requirements THE LIMITS ON THIS PAGE ARE, (Check one below):
LIMITS for ENTIRE permit period => x
INTERIM Limits for period# I =>
INTERIM Limits for period#2 =>
FINAL Limits Page =>
•
I Concentration Limits Mass Limits
I Monitoring Frequency
Sample Required
Collection Laboratory
Monthly Monthly Method Detection
Daily Max Average Units Daily Max Average Units By Industry By POTW (C or G) Level
I Flow 0.005 0.005 MGD Continuous Each Sample Metered 10%
2 BOD 400 400 mg/1 Semiannual Semiannual C 2.0
3 TSS 300 I 300 Mg/1 _ Semiannual Semiannual C 1.0
4 I Temperature
5 PH 5-10 I [ _ Each sample Each sample G 0.1
OTHER PARAMETERS: Please List Alphabetically
6 I Aluminum i Semiannual Semiannual C 0.01
7 Cadmium 0.11 0.07 Mg/I Semiannual Semiannual C 0.0002
8 Chromium 2.77 1.71 Mg/I Semiannual Semiannual C 0.001
9 I Copper 3.38 2.07 Mg/I
PPI Semiannual Semiannual C 0.001
10 Lead 0.69 0.43 Mg/I Semiannual Semiannual C 0.01
11 Nickel 0.2 0.1 Mg/I Semiannual Semiannual C 0.001
12 Silver 0.02 0.01 Mg/I Semiannual Semiannual C 0.001
13 Zinc 2.61 1.48 Mg/I Semiannual Semiannual C 0.001
14 Cyanide 0.1 0.05 Mg/I Semiannual . Semiannual G 0.005
15 Oil&Grease 100 100 WO Semiannual Semiannual G 1.0
16 TTO 2.13 J Semiannual n/a C
17
18
19
1-----
")0
21 1 j
22 I 1
4

Industrial User Pretreatment Permit (IUP)
PART I
Specific Conditions
G.) Definitions and Limit Page(s) notes:
In addition to the definitions in the Town of Jefferson Sewer Use Ordinance the
following definitions and requirements apply:
1. Composite Sample:
Unless defined differently below, a composite sample for the monitoring
requirements of this IUP, is defined as the automatic or manual collection
of one grab sample of constant volume, not less than 100 ml, collected
every hour during the entire discharge period on the sampling day.
Sampling day shall be a typical production, and discharge day.
2. Composite Sample, alternative definition:
A composite sample for the monitoring requirements of this IUP is the
same as described above unless specifically defined below as the
automatic or manual collection of constant volume and constant time grab
samples collected and composited according to the following criteria:
specific volume of each grab sample = Milliliters
specific time interval between samples = Hours
total duration of sample collection period = Hours
Total number of grab samples to be composited = Samples
3. . Daily Monitoring Frequency
Daily Monitoring Frequency as specified in this IUP shall mean each day
of discharge.
4. Grab Sample
Grab sample for the monitoring requirements of this IUP, is defined as a
single "dip and take" sample collected at a representative point in the
discharge stream.
5. Instantaneous measurement
An Instantaneous measurement for the monitoring requirements of this
IUP is defined as a single reading, observation, or measurement.
5

Industrial User Pretreatment Permit OIUP)
PART II
General Conditions
Outline of PART II,
1. Representative Sampling 16. Federal and/or State Laws
2. Reporting 17. Penalties
3. Test Procedures 18. Need to Halt or Reduce
4. Additional Monitoring by 19. Transferability
Permittee
5. Duty to comply 20. Property Rights
6. Duty to Mitigate 21. Severability
7._ Facilities Operation, Bypass 22. Modification, Revocation,
Termination
8. Removed substances 23. Reapplication
9. Upset Conditions 24. Dilution Prohibition
10. Right of Entry 25. Reports of Changed Conditions
11. Availability of Records 26. Construction of pretreatment
facilities
12. Duty to provide information 27. Reopener
13. Signatory Requirements 28. Categorical Reopener
14. Toxic Pollutants 29. General Prohibitive Standards
15. Civil and Criminal Liability 30. Reports of Potential Problems
1. Representative Sampling
Samples and measurements taken as required herein shall be representative of the volume and
nature of the monitored discharge. All samples shall be taken at the monitoring points specified in
this permit and, unless otherwise specified, before the effluent joins or is diluted by any other
wastestream, body of water, or substance. Monitoring points shall not be changed without
notification to, and approval by, the permit issuing authority.
2. Reporting
a.) Monitoring results obtained by the permittee shall be reported on forms specified by the
Control Authority and/or Municipality, postmarked no later than the twentieth day of the
month following the month in which the samples were taken. If no discharge occurs
during a reporting period (herein defined as each calendar month) in which a sampling
event was to have occurred, a form with the phrase "no discharge" shall be submitted.
Copies of these and all other reports required herein shall be submitted to the Control
Authority and/or Municipality and shall be sent to the lollowing oddires.
Tint Church
Water Resources Director
Town ()fie ficrson
PC flux 67
Jefferson, NC 28640
b.) If the sampling performed by the permittee indicates a violation, the permittee shall notify the
Control Authority and/or Municipality within 24 hours of becoming aware of the violation.
The permittee shall also repeat the sampling and analysis and submit the results of the repeat
6

Industrial User Pretreatment Permit (IUP)
PART II
General Conditions
analysis to the Control Authority and/or Municipality within 30 days after becoming aware of
the violation.
3. Test Procedures
Test procedures for the analysis of pollutants shall be performed in accordance with the techniques
prescribed in 40 CFR part 136 and amendments thereto unless specified otherwise in the
monitoring conditions of this permit.
4. Additional Monitoring by Permittee
If the permittee monitors any pollutant at the location(s) designated herein more frequently than
required by this permit, using approved analytical methods as specified above, the results of such
monitoring shall be submitted to the Control Authority and/or Municipality. The Control
Authority and/or Municipality may require more frequent monitoring or the monitoring of other
pollutants not required in this permit by written notification.
5. Duty to Comply
The permittee must comply with all conditions of this permit. Any permit noncompliance
constitutes a violation of the Control Authority and/or Municipality Sewer Use Ordinance and is
grounds for possible enforcement action.
6. Duty to Mitigate - Prevention of Adverse Impact
The permittee shall take all reasonable steps to minimize or prevent any discharge in violation of
this permit which has a reasonable likelihood of adversely affecting human health, the POTW, the
waters receiving the POTW's discharge, or the environment.
7. Facilities Operation, Bypass
The permittee shall at all times maintain in good working order and operate as efficiently as
possible, all control facilities or systems installed or used by the permittee to achieve compliance
with the terms and conditions of this permit. Bypass of treatment facilities is prohibited except
when approved in advance by the Control Authority and/or Municipality. Bypass approval shall
be given only when such bypass is in compliance with 40 CFR 403.17.
8. Removed Substances
Solids, sludges, filter backwash, or other pollutants removed in the course of treatment or control
of wastewaters shall be disposed of in a manner such as to prevent any pollutants from such
materials from entering the sewer system. The permittee is responsible for assuring its compliance
with any requirements regarding the generation, treatment, storage, and/or disposal of"Hazardous
waste" as defined under the Federal Resource Conservation and Recovery Act.
9. Upset Conditions
An "upset" means an exceptional incident in which there is an unintentional and temporary
noncompliance with categorical Pretreatment Standard, because of factors beyond the reasonable
control of the permittee. An upset does not include noncompliance to the extent caused by
operational error, improperly designed or inadequate treatment facilities, lack of preventative
maintenance, or careless or improper operations.
An upset may constitute an affirmative defense for action brought for the noncompliance. The
permittee has the burden of proof to provide evidence and demonstrate that none of the factors
specifically listed above were responsible for the noncompliance.
7

Industrial User Pretreatment Permit (IUP)
PART II
General Conditions
10. Right of Entry
The permittee shall allow the staff of the State of North Carolina Department of En.iron mental
Quality, Division of Water Resources, the Regional Administrator of the Environmental
Protection Agency, the Control Authority and/or Municipality, and/or their authorized
representatives, upon the presentation of credentials:
1. To enter upon the permittee's premises where a real or potential discharge is located or
in which records are required to be kept under the terms and conditions of this permit;
and
2. At reasonable times to have access to and copy records required to be kept under the
terms and conditions of this permit; to inspect any monitoring equipment or monitoring
method required in this permit; and to sample any discharge of pollutants.
1 1. Availability of Records and Reports
The permittee shall retain records of all monitoring information, including all calibration and
maintenance records as well as copies of reports and information used to complete the application
for this permit for at least three years. All records that pertain to matters that are subject to any
type of enforcement action shall be retained and preserved by the permittee until all enforcement
activities have concluded and all periods of limitation with respect to any and all appeals have
expired.
Except for data determined to be confidential under the Sewer Use Ordinance, all reports prepared
in accordance with terms of this permit shall be available for public inspection at the Control
Authority and/or Municipality. As required by the Sewer Use Ordinance, effluent data shall not
be considered confidential.
12. Duty to Provide Information
The permittee shall furnish to the Director of Public Works or his/her designees, within a
reasonable time, any information which the Director, his/her designee, or the Division of Water
Resources may request to determine whether cause exists for modifying, revoking and reissuing,
or terminating this permit or to determine compliance with this permit. The permittee shall also
furnish, upon request, copies of records required to be kept by this permit.
13. Signatory Requirements
All reports or information submitted pursuant to the requirements of this permit must be signed
and certified by the Authorized Representative as defined under the Sewer Use Ordinance. lithe
designation of an Authorized Representative is no longer accurate because a different individual or
position has responsibility for the overall operation of the facility, or overall responsibility for
environmental matters for the company, a new authorization satisfying the requirements of this
section must be submitted to the Director of Water Resources prior to or together with am reports
to be signed by an authorized representative.
14. Toxic Pollutants
If a toxic effluent standard or prohibition (including any schedule of compliance specified in such
effluent standard or prohibition) is established under Section 307(a) of the Federal Clean Water
Act for a toxic pollutant which is present in the discharge and such standard or prohibition is more
stringent than any limitation for such pollutant in this permit, this permit may be revised or
modified in accordance with the toxic effluent standard or prohibition and the permittee so
notified.
8

Industrial User Pretreatment Permit (IUP)
PART II
General Conditions
15. Civil and Criminal Liability
Nothing in this permit shall be construed to relieve the permittee from civil or criminal penalties
for noncompliance.
16. Federal and/or State Laws
Nothing in this permit shall be construed to preclude the institution of any legal action or relieve
the permittee from any responsibilities, liabilities, or penalties established pursuant to any
applicable Federal and/or State law or regulation.
17. Penalties
The Sewer Use Ordinance of the Control Authority and/or Municipality provides that any person
who violates a permit condition is subject to a civil penalty not to exceed S25,000 dollars per day
of such violation.
Under state law, (NCGS 143-215.6B), under certain circumstances it is a crime to violate terms,
conditions, or requirements of pretreatment permits. It is a crime to knowingly make any false
statement, representation, or certification in any record or other document submitted or required to
be maintained under this permit, including monitoring reports or reports of compliance or
noncompliance. These crimes are enforced at the prosecutorial discretion of the local District
Attorney.
18. Need to Halt or Reduce not a Defense
It shall not be a defense for a permittee in an enforcement action that it would have been necessary
to halt or reduce the permitted activity to maintain compliance with the conditions of the permit.
19. Transferability
This permit shall not be reassigned or transferred or sold to a new owner, new user, different
premises, or a new or changed operation without approval of the Town.
20. Property Rights
This permit does not convey any property rights in either real or personal property, or any
exclusive privileges, nor does it authorize any injury to private property or any invasion of
personal rights, nor any infringement of Federal, State or local laws or regulations.
21. Severability
The provisions of this permit are severable and, if any provision of this permit or the application
of any provision of this permit to any circumstance is held invalid, the application of such
provision to other circumstances and the remainder of this permit shall not be affected thereby.
22. Permit Modification, Revocation, Termination
This permit may be modified, revoked and reissued or terminated with cause in accordance to the
requirements of the Control Authority and/or Municipality Sewer Use Ordinance and North
Carolina General Statute or implementing regulations.
23. Re-Application for Permit Renewal
The permittee is responsible for filing an application for reissuance of this permit at least 180 days
prior to its expiration date.
9

Industrial User Pretreatment Permit (IUP)
PART II
General Conditions
24. Dilution Prohibition
The permittee shall not increase the use of potable or process water or in any other way attempt to
dilute the discharge as a partial or complete substitute for adequate treatment to achieve
compliance with the limitations contained in this permit.
25. Reports of Changed Conditions
The pennittee shall give notice to the Control Authority and/or Municipality of any planned
significant changes to the permittee's operations or system which might alter the nature, quality, or
volume of its wastewater at least 180 days before the change. The permittee shall nut begin the
changes until receiving written approval from the Control Authority andhor Municipality. Also
see Part II,30 below for additional reporting requirements for spill;slug issues.
Significant changes may include hut are not limited to
(a) increases or decreases to production:
(b) increases in discharge of previously reported pollutants:
(c) discharge of pollutants not previously reported to the Control Authorit\ and/or
Municipality;
(d) new or changed product lines;
(c) new or changed manufacturing processes and/or chemicals: or
(I) new or changed customers.
26. Construction
No construction of pretreatment facilities or additions thereto shall be begun until Final Plans and
Specifications have been submitted to the Control Authority and/or Municipality and written
approval and an Authorization to Construct(A to C)have been issued.
27. Reopener
The permit shall be modified or, alternatively, revoked and reissued to comply with any applicable
effluent standard or limitation for the control of any pollutant shown to contribute to toxicity of
the WWTP effluent or any pollutant that is otherwise limited by the POTW discharge permit. The
permit as modified or reissued under this paragraph may also contain any other requirements of
State or Federal pretreatment regulations then applicable.
28. Categorical Reopener
This permit shall be modified, or alternatively, revoked and reissued, to comply with any
applicable effluent standard or limitation issued or approved under Sections 302(b)(2)(C) and (D),
304(b)(2), and 307(a)(2) of the Clean Water Act, if the effluent standard or limitation so issued or
approved:
1.) contains different conditions or is otherwise more stringent than any effluent
limitation in this permit; or
2.) controls any pollutant not limited in this permit.
The permit as modified or reissued under this paragraph shall also contain any other requirements
of the Act then applicable.
29. General Prohibitive Standards
The permittee shall comply with the general prohibitive discharge standards in 40 CFR 403.5 (a)
and(b) of the Federal pretreatment regulations.
10

Industrial User Pretreatment Permit (IUP)
PART II
General Conditions
30. Potential Problems
The permittee shall provide protection from accidental and slug discharges of prohibited materials
and other substances regulated by this permit. The permittee shall also notify the POT1y
immediately of any changes at its facility affecting the potential for spills and other accidental
discharge. discharge of a non-routine, episodic nature. a non-customary hatch discharge. of a slug
load as defined in the Sewer Use Ordinance.
Additionally. the permittee shall notify by telephone the Control Authority and/or Municipality
immediately of all discharges that could cause problems to the POTW including any slug loadings
as defined in the Sewer Use Ordinance. If the permittee experiences such a discharge, they shall
inform the Control Authority and/or Municipality immediately upon the first awareness of the
commencement of the discharge. Notification shall include location of the discharge, type of
waste, concentration and volume if known and corrective actions taken by the permittee. A
written follow-up report thereof shall be filed by the permittee within five (5) days, unless waived
by the Control Authority and/or Municipality.
11

Industrial User Pretreatment Permit (IUP)
PART III
Special Conditions
1. Slug/Spill Control Measures
Floor drains in the Paint Building should remained plugged.
Required
Completion/
Implementation
Description of Measure. Activity, Plan. etc. Date
The permittee shall provide updates to the Control Authority as required by Part
1I, 30, of this IUP. Modifications to the measures shall be approved by the
Control Authority prior to installation/implementation. If a measure fails. the
Control Authority shall be notified within 24 hours.
2. Sludge Management Plan
Ninety days prior to the initial disposal of sludge generated by any pretreatment
facility, the permittee shall submit a sludge management plan to the Control
Authority.
3. Flow Measurement Requirements
(For SIUs with discharge flow meters)
The permittee shall maintain appropriate discharge flow measurement devices and
methods consistent with approved scientific practices to ensure the accuracy and
reliability of measurements of the volume of monitored discharges. Devices
installed shall be a continuous recording flow meter capable of measuring flows
with a maximum deviation of less than 10% from true discharge rates throughout
the range of expected discharge volumes. The devices shall he installed,
calibrated, and maintained to ensure accuracy. At the time of issuance of the
permit, this method consists of the city water meter for the Paint Building.
Modifications to the flow metering equipment shall be approved by the Control
Authority prior to installation. If a required flow measurement device fails, the
Control Authority shall be notified within 24 hours.
12

Industrial User Pretreatment Permit (IUP)
PART III
Special Conditions
3. Flow Measurement Requirements
(For SIUs currently without discharge flow meters)
a.) Temporary Flow Measurement Method
Until such time as discharge flow measurement devices for individual
regulated pipes are required by the Control Authority, the permittee shall
record the water meter reading providing water to the facility at the
beginning and end of each composite sample collection time period,
convert this to an estimate of the daily discharge flow for each pipe, and
report this value on the discharge monitoring report form.
b.) Installation of Discharge Flow Measurement Devices
If required by any of the following:
the Control Authority,
Submit Plans to Control Authority by
Complete Installation by
Use of production based Effluent Limits
Use of Mass based Effluent Limits
Use of Combined Wastestream Formula Effluent Limits
the permittee shall install appropriate discharge flow measurement devices
and methods consistent with approved scientific practices to ensure the
accuracy and reliability of measurements of the volume of monitored
discharges. Devices installed shall be a continuous recording flow meter
capable of measuring flows with a maximum deviation of less than 10%
from true discharge rates throughout the range of expected discharge
volumes. The devices shall be installed, calibrated, and maintained to
ensure accuracy. If a required flow measurement device fails, the Control
Authority shall be notified within 24 hours. Modifications to the flow
metering equipment shall be approved by the Control Authority prior to
installation.
4. Certified Laboratory Analysis
Pollutant analysis shall be performed by a North Carolina Division of Water
Resources Certified Laboratory that is certified in the analysis of the pollutant in
wastewater.
5. Certified Operator
Pursuant to Chapter 90A-44 of North Carolina General Statutes, and upon
classification of the facility by the Certification Commission, the permittee shall
employ a certified wastewater pretreatment plant operator in responsible charge
(ORC) of the wastewater treatment facilities. Such operator must hold a
certification of the type and grade equivalent to, or greater than the classification
assigned to the wastewater treatment facilities by the Certification Commission.
The permittee must also employ a certified backup operator of the appropriate
type and grade to comply with the conditions of Title 15A, C'haptcr SCE .0200.
The ORC of the facility must visit the wastewater facility as required; must
13

8
Industrial User Pretreatment Permit (IUP)
PART III
Special Conditions
properly manage and document daily operation and maintenance of the facility;
and must comply with all other conditions of Title 15A, Chapter 8G; .0200. The
permittee shall submit a letter designating the operator in responsible charge to
the Certification Commission or their designee within thirty days after facility
classification.
6. Total Toxic Organics (TTO) Definition
"TTO", or Total Toxic Organics, is the sum of the concentrations of the toxic
organic compounds listed ill 40 CFR 433.17 that are found in the permittec's
process discharge at a concentration greater than 0.01 mall.
7. Total Toxic Organics (TTO) Certification
In lieu of monitoring for TTO, the permittee may, upon submitting to the Control
Authority one sample showing TTO compliance and a toxic organic management
plan, make the following certification every six months:
"Based upon my inquiry of the person or persons directly responsible for
managing compliance with the permit limitation for total toxic organics
(TTO), I certify that, to the best of my knowledge, no dumping of
concentrated toxic organics into the wastewaters has occurred since filing of
the last monitoring report. I further certify that this facility is implementing
the toxic organic management plan submitted to the Control Authority."
At a minimum. the certification statements are due by June 30th of each year
covering the January through .tune six month period, and December 7th of each
year covering the July through December six month reporting period. IF the
certification is not submitted for both periods within 7 days of the respective due
dates. the Control Authority shall collect TTO samples before December 31 and
the permittee may be billed for the cost of the 'l-TO sampling and/or analysis}.
8. Toxic Organic Management Plan
Within ninety days of the issuance of this permit, the permittee shall develop and
submit to the Control Authority a toxic organic management plan.
9. Production Records
(for Categorical Industrial Users Covered by Production Based
Categorical Standards only)
The permittee shall keep records of the number of off-pounds of metal processed
each day of production for each core and ancillary operation covered by 40 CFR
. These records shall be submitted to the Control Authority by
and (enter as dates), and shall cover the previous
six month report period (January through June and July through December).
Additionally, the applicable daily production data shall be recorded in all
submittals of sampling data.
14

f
Industrial User Pretreatment Permit (IUP)
PART III
Special Conditions
Additionally, the permitter shall notify the I PO W Directorj within two (2)
business days after the User has a reasonable basis to know that the production
level will significantly change within the next calendar month. 40 CFR
40 3.6(c)(9).
10. Combined Wastestream Formula Flow Condition
(for Categorical Industrial Users only)
Regulated Categorical Process Flow:
The permittee shall have available flow monitoring equipment at such locations as
necessary to measure the total daily volume of wastewater discharged that is
covered by 40 CFR 433.17. This flow monitoring equipment shall also be
capable of measuring flows with a maximum deviation of less than 10% from true
discharge rates throughout the range of expected discharge volumes, however it is
not required that it be continuous recording. At the time of issuance of the permit,
this method consists of the city water meter used for the Paint Building and the
frequency shall be the duration of each sampling event and data shall be collected
and reported as required in Part II, 1-4 of this IUP. Modifications to the flow
metering equipment shall be approved by the Control Authority prior to
installation.
l l. Monitoring Waiver Parameters
Monitoring by the permittee and the Control Authority has been waived for the
following parameters in accordance with 40 CFR 403. 12(e)(2).
Parameter Name 40 CFR Standards
The permittee shall provide the following certification with each report required
by Part II, 2, of this IUP, but in no case less than once every six months.
"Based upon my inquiry of the person or persons directly responsible for
managing compliance with the Pretreatment Standards for 40 CFR
I certify that, to the best of my knowledge. there has been no increase in the
level of
in the wastewaters due to the activities at the facility since filing of the I[[last
monitoring report)I] [[[last periodic report under 40 CFR 403.12(e)( 1 ).1 11"
In the event that a waived parameter is found to be present or is expected to he
present based on changes that occur in the pernuttee's operations, the pet-mince
15

r
IUP Synopsis
A. IUP Basic Information
Receiving POTW: Town of Jefferson WWTP NPDES NC0021709
IUP Name: AMERICAN EMERGENCY VEHICLES IUP 004
IUP Effective Date: February 1, 2022 Pipe 001
IUP Expiration Date: July 31, 2026 40 CFR 433.17
American Emergency Vehicles manufactures new ambulances and emergency response vehicles. The
Jefferson facility produces several styles of ambulances by converting van and truck chassis to
accommodate specific customer needs. The number of employees has significantly reduced to
approximately 20 as this facility is phasing out of operations and plans to close this location in August,
2022. IUP renewal will accommodate this facility until its closure.
AEV's IUP is required due to a process that uses a solution of ethylene glycol, phosphoric acid, and
potassium fluoride known as "alumiprep" to clean and etch patient compartments constructed of raw
aluminum prior to being attached to the truck chassis. This process improves the bonding of primer and
paint to the ambulance body and is considered to be one of the six core metal finishing operations under 40
CFR 433.17. Most metals and organic contaminants have been detected at insignificant concentrations in
this discharge, although an issue involving elevated levels of zinc occurred in 2010. The situation was
corrected by replacing all galvanized components in the patient compartments with less harmful materials
such as aluminum in order to mitigate the leaching impact of the alumiprep. The limits contained in this
permit are based upon guidelines set forth in the Federal Register 40 CFR 433.17.
American Emergency Vehicles contributes a small flow of less than 5000 gallons per day to the Jefferson
WWTP. The nature of their discharge poses no threat to the routine operation and compliance of the POTW.
B. IUP Survey and Application Form
See copy attached.
C. IUP Inspection Form
See copy attached.
D. Rationale for Limitations: Listed on IUP limits page, Part I, Section F of the IUP
Rationale#2: Categorical Industrial Limits with no over-allocation.No combined waste stream calculation
necessary because process flow is measured as a separate and distinct waste stream.
The following pollutants were assigned numerical limits based on categorical regulations. These limits do
not result in over-allocations.
Cadmium, Chromium, Copper, Cyanide, Lead, Nickel, Silver, Zinc, TTO
Rationale#4: Other. The following rationale was used for developing limits, as the organics chloroform,
ethylbenzene, toluene, and total xylenes have been found in the discharge. The parameters are covered
under the TTO limit.The TOMP has documented how the constituents will be prevented from entering the
SIU discharge.
Fluoride is a small constituent in the process flow due to its presence in the alumiprep etching compound
as potassium fluoride. Its presence is insignificant and will not be measured as a parameter.

Paint
storage r`Mix
i
Solvent - --
Recycle - ---
_xi iiiUini -
' Ca.ie3wira � Paint Building
3p Pi
Monitoring —-----* .- -_ . . .—.7.w_.fM^ { a .
- -
i3piinG van ?:1 " 3a
,� �i � 3azard !s Waste.
Flammable Propane ,
- Storage;Building Tank ,
, j
: Process Wastewater_ .
Discharge Piping _
r1 . i !
_ i
• l
E'
i .4',
1.
j t
.
i i f
i ._.___ __ { i i
1 V i
• i....—�...»... t .is 1
1icali"5 U1 in i l"' '
Si imp;p Pit__ : l _ _ #
.' }
Combined Domestic __. .,,.. .__ . , ( Tµ
Processil';a st water - I - , V -
Disc narge Pictrin 1'' Parking ,' ,_.
't+ S
Sto n'water Drain
ij i•t]a^licla - ��
a
American Emergency lli es -r ler ivo Site Ran An iuol i 0 •
"' J IPv.q�i , yf e i i
A+1.�.�( Ni kJ tom..g Y$ ...
i,..:',,,-.,i.,,._,.,ii,..+,.,' ,.,t„ ..,,.;,,: �t` Sfl°i �s � Doc, Ve. . G 1

Industrial User Wastewater S rvey
& Permit Application
Cover Page
Company Name: // -
Arei rsi ei4rJ eM+U 1(r 4.9 .;€�ic
Name of responsible person on site at the acility authorized to represent Name of alternative on site person familiar wish the day to da)the company in official dealings with the Sewer Authority and/or the City. operations, environmental permitting requirements, monitoring, record
gt4, jPd4yanarementin
Tit � a-
Midi ` � Years v,4h firm e� � �� 751
Yearwi firmPhon� `Tl 4.� 4S34 - 9r) - 720_3 Fa336.-9gZ-9 2G Jn0 g77 tD( / �'Z—�/Physical street address of facilit s
//11 (1> Official mailing address,if different. Note if same.
0 t S N nvetLi GA�1 I,L,/A 1
Cityp Coy, Stag a y y Sc'��rG2SD4 State%L z'zeii` o � � lac
I y. c z b/ CJ
The information provided by you on this questionnaire serves two functions:
1. The information is used to determine if your facility needs an Industrial
User Pretreatment Permit (IUP) for the discharge of wastewater to the local
sewer.
2. If an Industrial User Pretreatment Permit (IUP) is required, this survey
serves as the application for an Industrial User Pretreatment Permit (IUP).
Requests for confidential treatment of information provided on this form shall be governed by procedures
specified in 40 CFR Part 2. In accordance with Title 40 of the Code of Federal Regulations Part 403,
Section 403.14 and the Local Sewer Use Ordinance (SUO), information and data provided in this •
questionnaire which identifies the content, volume and frequency of discharge shall be available to the
public without restriction.
•
This is to be signed by an authorized official of your firm,as defined in the Local Sewer Use Ordinance or the NC Model
Sewer Use Ordinance,Section 1.2,after completion of this form.
• I certify under penality 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 upon 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 knowlege and belief, true, accurate
and complete. I am aware that there are significant penalties for submitting false information,
inclu g the ibility of fine and/or imprisonment for knowing violations.
i-vNIE 171 20zI
Sig ture of .athorized Representative Date
listed above (seal if applicable)
Title: IU Wastewater Survey & Permit Application
File neme: IUSApp_Cov
Revision date:-9/1/93
Page 1
1

Industrial User Wastewater Survey
& Permit Application
PART I, GENERAL INFORMATION:
1. Provide a brief narrative description of the type of business,manufacturing
processes, or service activities your firm conducts at this site.
TyPG 1, I I, +i e 1 b,.14,.14 0- nweidu{aa,„z.. W,4-L. OAss s
en 00 g eat;ands ANC p Aug (ha cSS Q.rmj a,ja, Ab b'1i'.+-a
Pa40-4 1y,r plies+-'#.5, AL( A'1•4Jv ra(71v1440 AN [t,63elvs614 )
rhr-) .4••C
2. List the primary products produced at this facility:
Adr,baki-NIccs
3. List raw materials and process additives used:
A IDDitir
ALL A.),/ - PA..1) 3 3 (4.15 a u s a afc�t►.i sN p.(-®c�s5
- e AL w 4-6h S�.,a.p
4. Are biocides added to any water discharged to the POTW,
if yes describe: r; DA Ask,e, pi-
Yes
No
5. Describe weekly production schedule, including shifts worked per day,
employees per shift, and primary operation during shift.
4 so h,av n. Dais plus 5 kis ' J Fay 0a`1
•
6. Production process is: Check, if all continuous
Check, if all batch
If both please enter, % continuous = % %Batch= 67o
Title: IU Wastewater Survey&Permit Application
File name: IU_SApp_o0l Page 2
Revision date: 9/1/93

Industrial User Wastewater Survey
& Permit Application
PART I, GENERAL. INFORMATIONo (continued)
7. Does production vary significantly (+- 20 %) by season. Describe.
Yes
No b/
8. Are any significant (+- 20 %) changes in production that will affect wastewater
discharge expected in the next 5 years. If yes,please describe.
-ME ANY Tac: I. r- eu;l1 c(D C -04,ca4i in1 'ems Yes
‘The
Exi- i 8 n�.�..i-i.s No
J C I i.r P cr -g D u c-14 0,J 6„4.,i I D i N ice;1l it rgui yiv 44 41,4
f @,olttrs LA*i•c y A Lg v s t 2021 .
E Pet NO- S k ete w l) avyvt 41") i N e`P'""47' I'ui 4¢170 (4A,
cri Avs vSI- 2022,
9. List all current waste haulers. Give name, address,phone numbers, volume and materials
hauled off. (labs -700 lbs
C 1 c ah1 I4 A1L bo s P-4 RA f,�,,,4:c g L s-S g..,Q
®g A4-f+r 3 i b a L a b o�{p.. V(L V c kl4 s4- VA;�I+ �' 6-6-4.1.1 Dw.rs
6;a 'T h.:NNra- g SSgv2 04.414s
Res OL S v tIt i' L 2.7 3 2 0 UN;vcAsa.Q vc44sh. bulbs 7 i bs n
���01 $o N vrva s Z.00 16 ryn itto4-1-
A4A10. Attach a copy of laboratory analyses performed in the last`year on� e w stewbade- ter
at.- � a��
discharge(s) from your facilities. Summarize data on the attached ata Summary Form.
11. Attach sketch or schematic showing sampling points and all connections to the sewer.
A-1 hat- .
12. Complete the Wastewater Pollutants Checklist attached to this Survey.
Title: IU Wastewater Survey& Permit Application
File name: lU_SApp_001
Revision date: 9/1/93
Page 3

Industrial User Wastewater Survey
& Permit Application
PART I, GENERAL INFORMATION: (continued) ( .}
13. Do you have, or have you ever applied for, been issued, or been denied
an NPDES permit to discharge to the surface waters or storm sewers of
North Carolina ? If yes, list all other NPDES permits, permit numbers,
dates, and names used to apply for them, or reason denied.
If yes: Permit,#,date,applicant name Yes
A)G tr 0 30, 0 C) 4 n c,es C.arj (�gA -a, (ethics tilex r if
If yes: Permit,#,date,applicant name No
14. Do you have, or have you ever applied for or been issued an Industrial
User Pretreatment Permit (IUP) to discharge wastewater to the sewer
collection system. If yes, list all other IUP permits, permit numbers, -
dates, and names used to apply for them.
If yes: Pe it,#,date,applicant name (si Yes
/UP ooc{ A,nw,i ca„► eirw,y�.45 VJ Aus. Zoi?
If yes: Permit,#,date,applicant name No
15. Do you have, or have you ever applied for or been issued any other
Environmental Permits (for example; air, RCRA, groundwater,
stormwater, general, Non-Discharge, septic tank, etc.). If yes, list all
other'permits,'permit numbers, dates, and names used to apply for them.
If yes: Permit type,#,date,applicant name Yes
Age P t� /3• 0g5S4 �08 fl141 30 Za tad - ,I 2�2t:
If yes: Permit type,#,date,applicant name• No
16. Is a Spill Prevention Control and Countermeasure (SPCC) Plan prepared
for this facility? /
Yes i/
No
17. Is a Spill /Slug Control Plan required by the POTW, prepared for this
facility?
Yes
No o/
Title: IU Wastewater Survey& Permit Application
File name: IU_SApp_OOl Page 4
Revision date: 9/1/93

Industrial User Wastew.ter Survey
& Permit Application
PART I, GENERAL INFORMATION: (continued)
18. Do you have any underground storage tanks at your facility? If yes, list
contents and volume of each tank.
r Tie sAq ha, ' . Iwo ,rek 11.0w3A (..J;1( V
/-gut . ALo Dila6, Alumtntv," 53, Aoia® ry •,r- . Yes
*7 pvKd ,i`N1 8 ed;1 p..Js `!mod •/la/O 4030J st. No
e")c ;S 0060 415111...3 446.)10 is /o( r' .C->i'LL vV S1 &kg.
j 1�Z.5 tANk. v,.,ly tus DI gsl- c Coop 04.4ws 4 i+L �.Id'J rW��11li�l��
�%ak 4••o ; ebbJ- sia rvtLew � ka!osi20O eo.. of
19. Do you have any above ground storage tanks at your facility? If yes, for Ifr•in,tec")"4141"Pf
each tank, list the contents, volume, whether the tank has any spill " ' •
prevention or containment devices, such as dikes, and procedures for
draining any containment devices.
Yes ,✓ #of Tanks 2
has 2 ` ;4,1 -11244I4-5 or) s ri-c. No
j — sea g G'as. _w i4- a
pa 04. AN erm.+s;.6.41- sp; t1 a - c warn
rw ,ck loss a a. b%• 'ph,. c: 14 sysiw-►ti •
I/44A,. 5 Case C.. D it -1-4 k w, ,1-1. T'-4- &IG4 cf'
5olivt.is 4Asak p* -o 6plIt a sy>s --
6041, 01C st. cud -/.Jks.- w;11 ft. or" ►� ,�
J �na,vs- C'A•r�pvs ,o,4 A)I i( !�-c /°GO 1° a.l�
c�ch • c. �.��• "'rk.:5 n*-NIf
i l :Al c9 1J LCt�o� s�
led; 0 nwh... 2o42 •
•
Title: IU Wastewater Survey& Permit Application
File name: IU_SApp_001
Revision date: 9/1/93 Page 5

Industrial User Wastewater Survey & Permit Application
PA F' T II, Water Supply, Use, & Disposal Worksheet: , I
b b b
• Water Avg. Max. 12 Disposal Avg. Max.
Water Used for: al/dagal/dayMetllod(s) gal/day gal/day
Source(s) g, Y . ; W ± W
(see Source=List below) - T (see Disposal List below)
1. Process water - - y0►2.? ' 9.00 f ' 2,OIZ•6' 2V3e) �/
• t tol
2. Washdown water (yo'W•ID: 7Zc ;l: •19 —72.60
3. Water into product :
4. Air Quality Permitted units S / . . eq.4• i. 415' I
5. Domestic - toilets, drinking, cafe t ' O'`t tt :DL1
6. Cooling water,Process NON-Contact ' } ;
7. Boiler/Cooling tower blowdown .,_
8. Cooling water, HVAC .
9. Other:
-'- ' Totals'=> SiSLOce •10.37 Totals =>'01;5I-o b /0/37i
Typical Water *ounces: g' Possible Water.Disposal Methods
l: City IP_ublic"supply I. Sanitary sewer, witlfpretreatment
2. Private wells,drinking 2. Sanitary.sewer, without,pretreatment
3. Groundwater remediation wells . :. 3. Storm sewer-
4". Private ponds .. 4. Surface waters of NC .:
5. Surface waters of NC,please identify 5. Evaporation .
6. Include others if applicable 6. Land applied` -
7. To grounclwate>s .."
8. Septic Tank
9. Waste Haulers (identify)
Title: Water Supply,Use,Disposal Worksheet 10. Water into Product
File name: IU_SApp_002 i i. Include others, if applicable
IU Wastewater Survey Application Form
Rev: 9/1/93 ^1ge: 6

Industrial User Wastewater Survey
& Permit Application
r
PART III, PRETREATMENT FACILITIES:
Are there any pretreatment devices or processes used for treating wastewater
before being discharged to the sewer ? Check all that are present, and describe.
No pretreatment facilities =>
1. Flow equalization Aerated equalization =>
NON-Aerated equalization => to p /O
Total volume of equalization (million gal.) => 60cicic, /O
2. Activated Carbon Yes No Describe any, if present.
3.. Activated Sludge Yes No
4. Air Stripping Yes No
5. Centrifugation Yes No
6. Chemical Precipitation Yes No
7. Chlorination Yes No
8. Cyanide Destruction Yes No
9. Cyclone Yes No
10. Dissolved Air Floatation Yes No
11. Filtration Yes No
12. Floculation Yes No
13. Grease Trap Yes ✓ No +ram- '41'' s"
14. Grit Removal Yes No • aiJo tede--"~b '
'1.
15. Ion Exchange Yes No " ; - Win'u--e +t r
s
16. Neutralize, pH adjust Yes ✓. No 4-,wg&• [ see
17. Other Biological Treatment Yes No re.. pi ( S�
18. Ozonation Yes No
19. Reverse Osmosis Yes No `FDA' A.Stie 's �� B4S
N 6-�p� �e CLSS d Q+* A ?‘
20. Screening Yes No o. i s � aaa P`{
21. Sedimentation Yes ✓ No P s a-cam :ty d� ,pui's'
22. Septic Tank Yes No C •0°i4CC •
23. Silver Recovery Yes No r,, ;s Al" CocIffe..�- A)at
24. Solvent Separation Yes No SIT i ,gap .s0O''t°0
25. Spill protection Yes No �/44 A7" '2 y .
List any others.
Title: IU Wastewater Survey&Permit Application Page: 7
File neme: IU_SApp_003
Revision date: 9/1/93

Industrial User Wastewater Survey
& Permit Application
PART IV, CATEGORICAL INFORMATION:
1. When were operations started at this facility Facility start up date /9 7
2: List all Standard Industrial Classification (SIC) codes for your facility.
These may be found on State Unemployment forms, tax forms,
accounting records, or from the Chamber of Commerce.
37 13
3. Has this facility ever been considered a Categorical Industrial User
• (CIU) as described by the Code of Federal Regulations (40 CFR)?
If yes, give complete 40 CFR number=>
No ✓
•
4. Are any other facilities owned and/or operated by your company
permitted as Categorical Industrial Users (CIUs) as described by the
Code of Federal Regulations (40 CFR)? •
If yes please give name(s), location, and 40 CFR number. Yes
No
•
Title: IU Wastewater Survey&Permit Application
File neme: IU_SApp_004 Page 8
Revision date: 9/1/93

Industrial User Wastewater Survey
& Permit Application
r
PART IV, CATEGORICAL INFORMATION: (continued)
5. Check any activities listed below that are performed at your facility:
Check 40 Industrial ActivityCheck 40
below CFR# below CFR# Industrial Activity J
lel467 Aluminum Forming 432 Meat products
427 Asbestos Manufacturing ✓ 433 Metal finishing •
461 Battery Manufacturing 464 Metal molding and casting
431 Builders paper& board mills 436 Mineral mining and processing
407 Canned &preserved fruits &veg. 471 Nonferrous Metal,Form&Powders
408 Canned&preserved seafood 421 Nonferrous Metals Manufacturing
458 Carbon black Manufacturing 414 OCPSF,Organic Chemicals,Plastics,
411 Cement Manufacturing & Synthetic Fiber Manufacturing
434 Coal Mining 435 Oil &gas extraction
465 Coil Coating / 440 Ore mining and dressing
468 Copper Forming d 446 Paint formulating
405 Dairy products processing 443 Paving and roofing materials Mfg.
469 Electrical,electronic components 455 Pesticide Manufacturing
413 Electroplating 419 Petroleum Refining
457 Explosives Manufacturing 439 Pharmaceutical Manufacturing
• 412 Feedlots 422 Phosphate Manufacturing
424 Ferro allay Manufacturing 459 Photographic supplies
418 Fertilizer Manufacturing / 463 Plastics molding and forming
464 Foundries,Metal Mold &Casting 466 Porcelain enameling •
426 Glass Manufacturing 430 Pulp,paper,and paperboard
406 Grain mills 428 Rubber Manufacturing
454 Gum&Wood Chemicals Mfg. 417 Soap&Detergent Manufacturing
460 Hospitals 423 Steam Electric power Generation
447 Ink formulating 409 Sugar processing
415 Inorganic chemical Manufacturing 410 Textile Mills
' 420 Iron&Steel Manufacturing 429 Timber products proccessing
• 425 Leather Tanning&Finishing Others
Title. 1U Wastewater Survey&Permit Application
File neme: IU_SApp_004
Revision date: 9/1/93
Page 9

Wastewater Pollutant Checklist
EPA Check if Check if Check if Check if Concentration
Storet Present Absent Present in Absent in in Discharge.
Chemical
Name
Code at Facility at Facility Discharge Discharge if Known
(mg/I)
Acid Extractable Organics
2-Chlorophenol 34586 /
2,4-Dichlorophenol 34601 /i
2,4-Dimethylphenol 34606
2,4-Dinitrophenol 34616 ✓/
2-Methyl-4,6-dinitrophenol 34657 - J/
4-Chloro-3-methylphenol 34452 ✓f
2-Nitrophenol 34591 `//
4-Nitrophenol 34646 f
Pentachlorophenol 39032
Phenol 34694 19
2,4,6-Trichlorophenol 34621
Base Neutral Organics f
1,2,4-Trichlorobenzene 34551 ✓
1,2-Dichlorobenzene 34536
1,2-Diphenylhydrazine 34346 J
1,3-Dichlorobenzene 34566 J
1,4-Dichlorobenzene 34571 /
2,4-Dinitrotoluene 34611 V/
2,6-Dinitrotoluene 34626 1
2-Chloronaphthalene 34581 /
3,3-Dichlorobenzidine 34631 d/
4-Bromophenyl phenyl ether 34636 ✓/
4-Chlorophenyl phenyl ether 34641 J
Acenaphthene 03405 /
Acenaphthylene 34200 II
Anthracene 34220
Benzidine 39120 ✓,
Benzo(a)anthracene 34526 ��
Benzo(a)pyrene 34247 V
fi
Benzo(b)fluora hene 34230 V
• Benzo(ghi)pe ene 34521 /
Benzo(k)fluor nthene 34242 J
Bis(2-chloroethoxy)methane 34278 /
Bis(2-chloroethyl)ether 34273 r✓
Bis(2-chloroisopropyl)ether 34283 t�
•
Bis(2-ethylhexyl)phthalate 39100
Butyl benzyl phthalate 34292 /
• Chrysene 34320 ✓/✓
Di-n-butyl phthalate 39110 ✓
WPC,as attachment to the
Title: Wastewater Pollutant Checklist(WPC) IU Wastewater Survey Application Form
Rev: 9/1/93v name: APAM_List.xls Pages:10

Wastewater 'pollutant Checklist
EPA Check if Check if Check if Check if Concentration
Storet Present Absent Present in Absent in in Discharge,
Chemical Name
Code at Facility at Facility Discharge Discharge if Known
(mg/1)
Base Neutral Organics (continued) /
Di-n-octyl phthalate 34596
Dibenzo(a,h)anthracene 34556
Diethyl phthalate 34336
Dimethyl phthalate 34341
Fluoranthene 34376
Fluorene 34381
•
Hexachlorobenzene 39700 iii
Hexachlorobutadiene 34391if
Hexachlorocyc]opentadiene 34386
Hexachloroethane 34396 /✓
Indeno(1,2,3-cd)pyrene 34403 /
Isophorone 34408
//:
N-nitroso-di-n-propylamine 34428
N-nitrosodimethylamine 34438 I
N-nitrosodiphenylamine 34433 •
Naphthalene 34696
Nitrobenzene 34447 7
Phenanthrene 34461 /
Pyrene 34469
MetaIs
Aluminum 01104
Antimony 01097
Arsenic 01002
Beryllium 01012
Cadmium 01027
Chromium 01034
Copper 01042 /
Lead 01051 4 •
Mercury 71900 Molybdenum 01062 4 •
Nickel 01067 /// •
Selenium 01147 ✓ ,
Silver 01077 ✓/
Thalium 00982 J/ •
Zinc 01092 J
Title: Wastewater Pollutant Checklist(WPC) WPC,as attachment to the
File name: APAM_List.xls IU Wastewater Survey Application Form
Rev: 9/1/93 Pages: 11

Wastewater "'Outwit Checklist
r
EPA Check if Check if Check if Check if Concentration
Chemical Name Storet Present Absent Present in Absent in in Discharge,
Code at Facility at Facility Discharge Discharge if Known
(mg/I)
Other Inorganics
Barium 01007
Chloride 00940
Cyanide 00720
Fluoride • 00951
Purgeable Volatile Organics J
1,1,1-Trichloroethane 34506 /
1,1,2,2-Tetrachloroethane 34516 ✓,
1,1,2-Trichloroethane 34511 f
1,1-Dichloroethane 34496 •
•
1,1-Dichloroethylene 34501
1,2-Dichloroethane -- 34531 /
1,2-Dichloropropane 34541 •
2-Chloroethyl vinyl ether 34576
Acrolein 34210
Acrylonitrile 34215 /
/
Benzene 34030 '
•
Bromodichloromethane 32101 4
Bromoform 32104 J/
Bromomethane 34413 ✓
Carbon tetrachloride 32102
Chlorobenzene 34301
Chloroethane 34311 /j
Chloroform 32106 '/
Chloromethane 34418 al
cis 1,3-Dichloropropene 34704
Dibromochloromethane 32105
Ethylbenzene 34371 ✓ •
/
Methylene chloride 34423 f
•
Tetrachloroethylene 34475
Toluene 34010
trans 1,3-Dichloropropene 34699
trans-1,2-Dichloroethylene 34546
Trichloroethylene 39180 /�
Trichlorofluoromethane 34488 /
Vinyl chloride 39175 ✓
Others /
Xylene ✓ .
Title: Wastewater Pollutant Checklist(WPC) WPC,as attachment to the
File name: APAM_List.xls Ill Wastewater Survey Application Form
Rev: 9/1/93 Pages:12

Wastewater Pollutant Checklist
EPA Check if Check if Check if Check if Concentration
Storet Present Absent Present in Absent in in Discharge,
Chemical Name
Code at Facility at Facility Discharge Discharge if Known
(mg/I)
Base Neutral Organics (continued) l
Di-n-octyl phthalate 34596 /
Dibenzo(a,h)anthracene 34556 ,
Diethyl phthalate 34336 /
Dimethyl phthalate 34341
Fluoranthene 34376
Fluorene 34381 !,
Hexachlorobenzene 39700 6
Hexachlorobutadiene 34391 //
Hexachlorocyclopentadiene 34386 /
Hexachloroethane 34396 1/
Indeno(I,2,3-cd)pyrene 34403 Isophorone 34408 //
N-nitroso-di-n-propylamine 34428
N-nitrosodimethylamine 34438 J
N-nitrosodiphenylamine 34433 / .
Naphthalene 34696 ,/
Nitrobenzene 34447
Phenanthrene 34461 I
Pyrene 34469 / ,
Metals /
Aluminum 01104 ✓
Antimony 01097 J
Arsenic 01002
Beryllium 01012 /
Cadmium 01027 1
Chromium 01034 4
Copper 01042
Lead 01051 ii
Mercury 71900 /
Molybdenum 01062 -
Nickel 01067 /
Selenium 01147
Silver 01077
Thalium 00982 J -
Zinc 01092
Title: Wastewater Pollutant Checklist(WPC) WPC,as attachment to the
File name: APAM_List.xls Ill Wastewater Survey Application Form
Rev: 9/1/93
Pages: 11

•
Wastewater Pollutant Checklist
EPA Check if Check if Check if Check if Concentration
Storet Present Absent Present in Absent in in Discharge,
Chemical Name
Code at Facility at Facility Discharge Discharge if Known
(mg/1)
Other Inorganics
Barium 01007 /
Chloride 00940 J
Cyanide 00720
Fluoride 00951
Purgeable Volatile Organics
1,1,1-Trichloroethane 34506 1
1,1,2,2-Tetrachloroethane 34516 /
1,1,2-Tri chloroethane 34511 J
1,1-Dichloroethane 34496 /
il
1,1-Dichloroethylene 34501 / ,
1,2-Dichloroethane 34531
1,2-Dichl oropropane 34541 +�
2-Chloroethyl vinyl ether 34576 /
Acrolein 34210 t/I
Acrylonitrile 34215 I/
Benzene 34030 1
Bromodichloromethane 32101 f
Bromoform 32104
Bromomethane 34413
Carbon tetrachloride 32102 J
Chlorobenzene 0 34301
Chloroethane 34311
Chloroform 32106 di
Chloromethane 34418
ii
cis 1,3-Dichloropropene 34704
Dibromochloromethane 32105
Ethylbenzene 34371
Methylene chloride 34423 J/
Tetrachloroethylene 34475 /
Toluene 34010 f
trans 1,3-Dichloropropene 34699 J
trans-1,2-Dichloroethylene 34546 /
Trichloroethylene 39180 i
Trichlorofluoromethane 34488
Vinyl chloride 39175
Others •
i
Xylene , r
Title: Wastewater Pollutant Checklist(WPC) WPC,as attachment to the
File name: APAM_List.xls IU Wastewater Survey Application Form
Rev: 9/1/93 Pages:12

i
. Data Summary Form
•
<= Receiving POTW
,)64 3oo o D <= Receiving NPDES #
<= Specific Sample Location !
. oa`f i.e., Give IU Name, IUP#, and/or pipe#
•
ROD TSS Ammonia
Lab=> Laboratory performing analysis=>
MDL=> Laboratory Method Detection Limits=>
Notes=>
Notes=>
Q = Flow Conc. Conc. Conc.
Sample Date M=Metered
I Results Results Results
ID,or Sample Notes about Sample E=Estimated
from Lab from Lab from Lab
Count Collected mgd gal/day <? mg/I <? mg/I <-
?
1 orb121 •a4 Pull ki iStaworta A g mg/I
2 .Pak a -t lsi , „�,y� - N I °�•2► �s/1 /0•27 ,�,/r at
- 3 a-jn 12► 5 fA.pin ao Tip P 2/ �
00 Boos -33,3 I4 /1•
"
4 CL' - 3Wt A°St:WV
`/ ^'c3 "IA..
5
6 -
7
8
9
10
11 '
12
etc
TNS=> Total number of samples=>
Max. value=> Maximum data value m /I
( g )=>
Avg. (use 1/2 BDL)=> Average data value,Include BDL values as 1/2 detection limit=>
Title: Data Summary Form(DSF)
File name: DSF_Ol.xls DSF.as attachment to the
Rev:9/1/93 IU Wastewater Survey Application Form
Page: 13

Data Summary Form
<= Receiving POTW
ndC/J-30000 <= Receiving NPDES #
<= Specific Sample Location !
e DD 4 i.e., Give IU Name, IUP#, and/or pipe#
Arsenic Cadmium Chromium COD Copper
Lab=> '
MDL=>
Notes=>
Conc. • Conc. Conc. Conc. Conc.
Sample Date Results Results Results Results Results
ID,or Sample from Lab from Lab from Lab from Lab from Lab
Count - Collected <? mg/1 <? mg/I <? mg/I <? mg/I <? mg/1
I tibiZi _,,,1A- 0.00a3 0.00'17 _ ,1/1+- D.07 �
2 Agar D. odfo<
3 2/17/Z.I aDOS" 4 . Dot, _
4
5
6
7
8
9
10 _
11
12
etc 1
TNS=>
•
Max.value=>
Avg.(use 1/2 BDL)=>
•
DSF,as attachment to the
Ti Data Summary Form(DSF) IU Wastewater Survey Application Form
Filele name
DSF_Ol.xls ,— .--"lec: 14
Rev:9/1/93

• Data Summary Form
<= Receiving POTW
3 coon <= Receiving NPDES #
L� <= Specific Sample Location !
00 T i.e., Give IU Name, IUP#, and/or pipe#
Cyanide Lead Mercury Nickel Silver Zinc
Lab=>
MDL=>
Notes=>
Conc. Conc. Conc. Conc. Conc. Conc.
Sample Date Results Results Results Results
Results Results
ID,or Sample from Lab
from Lab from Lab from Lab from Lab from Lab
Count Collected <? mg/I <? mg/1 <? mg/I <?
1 �Sw/Z I. �I DOS6.003
mg/I <.?
mg/1 <? mg/I
2
D.DO 3 N IA O. 012 O. Op/ D. 07l
34 211712( p. cog ®. o I� D. DDSS& • 000 0.o9y5--
5
6
7
8
9
10 _
11
12
etc
TNS_>
Max. value=>
Avg. (use 1/2 BDL)=>
Title: Data Summary Form(DSF)
File name: DSF_01.xls DSF,as attachment to the
Rev:9/I/91 IU Wastewater Survey Application Form
Page: 15

Data Summary Form
<= Receiving POTW
<= Receiving NPDES #
<= Specific Sample Location !
i.e., Give IU Name, IUP#, and/or pipe#
Other= Other= Other= Other= Other= Other=
Lab=>
MDL=>
Notes=>
Conc. Conc. Conc. Conc. Conc. Conc.
Sample Date Results Results Results Results Results Results
ID,or Sample from Lab from Lab from Lab from Lab from Lab from Lab
Count Collected <? mg/I -, <? mg/I- <? mg/I <? . mg/I '' <? mg/I . <? mg/I
1
2 • . r. - .
3
4
5
6
7 .
8
9 --
]0 _
11
-
12
etc
TNS=>
Max.value=>
Avg.(use'1/2 BDL)=>
Title: Data Summary Form(DSF) DSF,as attachment to the
File name: DSF_OI.xls IU Wastewater Survey Application Form
Rev:9/I/93 '

Industrial User '> aste::ater Survey
& Permit Application
• P T V9 WASTE REDUCTION INFORMATION :
State Pretreatment Rule 15A NCAC 2H.0916 (c)(1)(M) requires Significant Industrial Users to
include a description of waste reduction (pollution prevention) activities being utilized. The
codes listed are standard EPA codes found on Toxic Release Inventory and other environmental
forms. Please checkall applicable codes for your facility related to wastewater discharge.
Utilized _ Code Description
/ W13 Improved maintenance scheduling recordkeeping,or procedures
✓ W14 Changed production schedule to minimim equipment and feedstock
changeovers
✓ W 19 Other changes in operating practices (explain briefly in comments)
W21 Instituted procedures to ensure that materials do not stay in inventory
beyond shelf-life
W22 Began to test outdated material-continue to use if still effective
W23 Eliminated shelf-life requirements for stable materials
✓ W24 Instituted better labeling procedures
W25 Instituted clearinghouse to exchange materials that would otherwise
be discarded
/ W29 Other changes in Inventory control (explain briefly in comments)
✓ W31 Improved storage or stacking procedures
W32 Improved procedures for loading,unloading and transfer operations
W33 Installed overflow alarms or automatic shutoff valves
✓ W34 Installed secondary containment
W35 Installed vapor recovery systems
W36 Implemented inspection or monitoring program of potential spill or
leak sources
• ✓ W39 Other spill and leak prevention(explain briefly in comments)
W41 Increased purity of raw materials
V W42 Substituted raw materials : ': • • -
W49 Other raw material modifications(explain briefly in comments)
W51 Instituted recirculation within a process
W52 Modified equipment,layout,or piping
• • '' W53' • Use of a different"process catalyst • • • • • • • •
W54 Instituted.better.,controls on'operating bulk containers"to minimize
discarding of empty containers .
W55 •
Changed from small volume containers to bulk containers• to .minimize discarding of empty containers
:W58 Other process modifications (explain"briefly in comments) ;' '' - ••
Title: IU Wastewater Survey&Permit Application
File name: I[J SAS 005
Revision date: 8/1/94 Page 17

:i us0f1 L.'1 User Wastewater Survey
& Permit Application
PART V. WASTE REDUCTION INFORMATION (Continued):
Utilized Code Description
/ W59 Modified stripping/cleaning equipment
W60 Changed to mechanical stripping/cleaning devices (from solvents or
other materials)
W61 • Changed to aqueous cleaners (from solvents or other materials)
W62 Reduced the number of solvents used to make waste more amenable
to recycling
W63 Modified containment procedures for cleaning units
W64 Improved draining procedures
W65 Redesigned parts racks to reduce dragout
W66 Modified or installed rinse systems
W67 Improved rinse equipment design
W68 Improved rinse equipment operation •
/ W71 Other cleaning and degreasing operation (explain briefly in comments)
W72 Modified spray systems or equipment
W73 Substituted coating materials used
W74 Improved application techniques
✓ W75 Changed from spray to other system
W78 Other surface preparation and finishing(explain briefly in comments)
• W81 Changed product specifications
W82 Modified design or composition of product •
W83 • Modified packaging
W89 Other product modifications(explain briefly in comments)
W99 Other(specify in comments)
Comments(Please list correspondin code)
L(.-I4 P1to4vo4sA + Its nwt;tA-)LAJra.,I �kc- LICEabuilt ML) la;ll 6- -Cu
S st 4,
•2q taer, • .144rh #i ' i 4 be.; -144.0s4c4tan tXi- REV iermaa,./-
pav< .kawl S lTL•) b� A:uo�ua F VS 20 I.
VI34 iG :ro& Stt lea 4,tvs iwaG.e as;aS,. Cr„d,�
eh' ACV . ,� oft.etak& . . IA 04o$t fan'! • ,also, G ie
bees 0.6.461) r.a to c - -r,f-tia4s�s�� n1.r„arrc,�
w „ +o /► rGf " Zoi9. ') '- vd:ll & 'c ii .. /o/ ka,.3c- Gtulkos
W -it MuMitJu►n ' : 33 t14rS buA e.i;m4IJa4-6o A o uii 11 ao•f- lk. a p44.r f tFl�-
p4�ba1r " ` e4.5 why CAC;sg•bic a&.ale Cs up/cm v P. w tiave
2 r a;GLvv Gw�u.S �: - 6 0C- ' Cass.
Tide: •
IU Wastewater Survey&Pest Application
File name: ILT_SApp_005
Revision date: 8/1/94 Page 18

SIU INSPECTION FORM
Name or Industry: Rm?rirOh Frne.r pn \ehirle5 IUP #
Address Of Indugtr;: IUP Expt Lion Date:
/3//1
Industry Representatives: ��r"'"r"7 Titl
� b •
�jmp1 i 41W-ir Arlrir
POTW Representativ rL 'T)ti'
Jim ( ,llllrrk Wn r�' ,P.tSnurrp.,s Sire or
Date Of Inspection: ROVPmbpr 17, 2021 Time Of Inspection: 1020 alpm
Purpose of Inspection: Annual Other(Describe)
POTW to which IU discharges ilearsnn WWTP-' NPDES # Nf-002,1709
Is SIU currently in SNC? _jjr If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product ! /NO
Raw materials used 4/ NO
Manufacturing processes OD/NO
Categorical, if applicable 1�/NO
Production rate OP/ No
Number of employees /NO <SO
Number of shifts kW/NO 1
Comments: See Q L c imeht
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where
there are drains to the POTW.
• Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? /NO Where do they go? Seller.
2. Are production areas diked,contained,or erwise constructed in spsch a way s to pr vvent harm to the
WWTP, especially from spills or slugs? ES /NO Comments: I I'rpins
3. Are there floor drains in the storage area? CYES)NO Where do they go? SP,wer
4. Are storage tanks and areas diked,contained,or ise constructed in syk h a waxas to prevent harm
to the WWTP, especially from spills or slugs? /NO Comments: YlLIli
5. Are process and storage tanks and pipes labeled? ES NO J r,
6. How are off-spec raw m terials, and produ is dispose or Necessri 0 i 1 Ci l.
CIQnn t rlor,S MIR hrl7�r, �u.S 10171,S
k, /
7. When is the production area leaned? Dt 1 8. Is the wastewater from cleaning the productiony area discharged oche POTW,?, YE /NO
9. What non-process wastewaters are discharged to POTW? KaS oOmS Wft,s Y S
Comments:
Title: SW Inpseetion Form
Ftle name: COMP.INNSP App 7•D
Revision dam August 1,1994 Page l

SW INSPECTION FORM
PART II - Plant Tour Section 8 - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system,
1. Does operator seem knowledgable about the system? YE)/NO Comments:
2. Are all units operational? lr D/NO 3. How often does operator/maintenan " •, �W I f?. daily
ison check system? _
4. Is there an operator for each shift? �/NO
5. How and when is sludge disposed of? A&y rS �l1111r111(�
6. Is there a schedule for preventative maintenance? YES NO J1
Comments: N o e1itki pier,-1- 4-6 malY bir\ . � Ca iS mahlA_iL .
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW
MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES CI If yes, name of lab. _
2. If industry wmpletets sampfing,ask the industry repr ntative to describe sampling procedures.
Comments: rya R�r iG 1AL1 W
3. Is flow measurement equipment operational? YES/NO Comments:
4, there a calibration log for a flow Teter? YES NO Comments: l�i•
N/A 5Inw mPllsurernercr is vyn ut Y rneifer at rain: 6.10l11 .
Comments: m Sur s G, 1PTriC71 - ltW.
PART III - EXIT LNTERVIEW
Review monitoring records and er SIU records required by IUP.
1. Are files well organized? YES /NO Comments: _
2. Are sample collection /chain-of-custody forms filled out properly? YES NO Comments: _
3. Do resul in files agree wit!' f port ser}t to POTW? YES/NO Comments:
lar\/ (,Yryheat Hb5Y1fr
4. Who has authority to shut down pr ctio should a spill or slug discharge occur?
ary Girt be M k� & s her
5. How dpk�ees .inform e loyees f whom call at POTW in case of spill/slug?
JStl.1(e n aroS of
L.
If slug/spill plan is already required by PO view procedures,
6. Is SIU implementing slug/spill plan? NO Comments:
Comments: REV has baah.phasinao14•o- opt n,iofar seuex-aQ
< 20 ev4oyees le • GosinC� ►t1.2AZL
INSPECTION RESULTS
Slug/Spill Control Plan Needed? YES/Q
Comments,Required Or Recommended Actions:
Signature Of Inspector(s) L,.a41. Date:
Date:
Title: STU Inpsection Form
File narnc: COMP.INSP App 7•D
Revision dau: August I, 1994 Page 2

Workbook Name: Jefferson.HWA.AT.2017 31 ju12018; Worksheet Name: HWA Page l of 5
Printed 7/31/2018,2:22 PM
A I B I C I D I E IF IGIHI I I J I K
1 Headworks Analysis Spreadsheet Spreadsheet Instructions:
© POTW Name: Jefferson RrWTP- 1) Applicable Values should be entered in the Heavy Bordered Blue cells.The rest of worksheet Is
II Date:r a"z;,.sl protected,password is"2".
t 2) Addftional pollutants can be added in cells A34 to A42. Note all Pollutant names are linked from
4 POTW NPDES#=>111111E
© POTW Sludge Permft#_> r Class A here to other pages in HWA worksheet and also to AT worksheet(I.e.,automatically entered Into
other pages in HWA worksheet and also AT worksheet from HWA worksheet).
6 POTW Sludge Permit#_> •r t Class B 3) Formulas are discussed in the Comprehensive Guidance HWA Chapter.
mar 4) HWA,AT and HASL worksheets are linked. MAHLs,Basis,and Uncontrollable load are
Q POTW NPDES Permitted 1low(MGD)= 0.6 (need in AT wily automatically entered into AT from this worksheet.
9 POTW Average Flow(MGD)= 0.211 =asedinI WA calculations 5)If red tab notes are not visible,they can be turned on in the"Tools"menu under"options",in the
10 Unoontrollable Flow(MGD)= 0.2056 "view"tab click the"comment indicator only"button.
III 7Q10 Stream Flow(MGD)= 1.4219
m Stream Classification= C+
m Class of Sludge generated(A,or B)111111111211111111
® Sludge to Digestor Flow(MGD)--
16 Sludge to Disposal Flow(MGD)-. 0.002704
m %Solids to Disposal-® Through cats for differentPOTW 1nput"x"to
ID Sludge Site Area(ecres)="..® flows use Design
Criteria
19 Sludge Site Life(yrs) "- Desi:.Values Average Flow Permitted Flow •
20 Age of Sludge Site(yrs) W WTF Influent BOD(mg/1) 200 231.1 81.1
® WWTF Influent TSS(mg/1) 280 926.0 3250 ®'
WR TF Influent NHy(mg/l) 15 215.9 75.8 x
® W W W Influent Total N(mgll) 40
m Pass-Through Loading Calculations WWTF Influent Total P(mg/1) -
al AJI Call” IIIMMLAMIll
Stream Standard Pass Thou
NPDES LIMIT Plant Removal Removal rate NPDES Loading Standard Stream Loading Design Criteria Loading Mlnimwn Pass
Pollutant (mg/I) Rate(%) Source (lbs/daY) (mg/n Standard Source fibs/day) Loading(lbs/day) (lbs/day) Thru Basis
BOB 5 97.84 MR Data 406 1,001 1,001 Design
HTSS . 20 97.84 I MR Data 1,626 1,401 1,401 Design
Ammonia i 2 99.07 )MR elllucnt-S 379 75 75 Design
30 ArsenicMEM 45.00 iterature l 7Xr1 WQS-Dissolve 0.2475 0.2475 Stream SW
31 Cadmium t 67.00 iterature r j s.51,1 VQS-Dissolve 0.0426 0.0426 Stream Std
®Chromium 82.00 Literature jT't;L W S-Dissolve 0.8320 U.8320 Stream Std
_ .,4 f 89.54 Site S.ecifio 0.4197-- 0.4197 NPDES
m Cyanide 0.0084 58.91 Site S ecifie. 0,0359 0.0359 NPDES
®Lend ) ,�;, , $ 1 T ,' .z WQS-Dim oNe 0.2353 0.2353 Stream Std
36 Meraury- ._ 60.00 Literature -17,""at We S-Dissolve 0.00041 0.00041 Stream Std
Ei Molybdenum 33.00 itcralure
Nickel 1.111111111.11. r r .t a}if We 5-Dissolt c 0.1637_ 0.1637 Stream Std
v
40 Selenium 50.00 iterature e ffla RrQS-Dissolve 0.1361- 0.1361 Stream Std
421 ZinolNitro n t Y 3} , 57.07 Site Specific r- 0.0033 1.4644 Stream Std
40 Silver 75.00 rtcrature 5-Dissolve
41 Zino 1.4G44 NPDES
!Se 200.16
ligcohrlPhDs.
god
MIMI MIN
50
Modeled after:Chapter 5-HWA Guidance,Appendix 5-A
Revision Date: February 2008
j )

Workbook Name: Jefiferson.HWA.AT.2017 31ju12018; Worksheet Name: HWA Page 2of5
Printed 7/31/2018,2:22 PM
A I B I . C I D I E I F G 1 H I I I J I K
52 Average Influent NHr(mg/I)
53 Average Anaerobic Digester NH3(mg/1)
54 Inhibition Loading Calculations only enter when have ANAEROBIC digester
A.SJNit/T.F. A.S./Nit/P.P. A.S.iNit,/T.F. Digester Minimum Minimum
Primary Primary Inhibition Inhibition Inhibition Inhibition Digester Inhibition Inhibition
Removal Rate Removal Rate Concentration Concentration Loading Concentration Inhibition Digester Inhibition Loading Loading
55 Pollutant (%) Source (mg/0 Source
56 BOD r r _ P bs/da Y) (mg/i) Conc.Source Londlug(Ibs/dry) abs/day) Source
57 TSS
58 Ammonia 480\Literatnre .842.9689 842.97 AS/Nit/TF loin
59 Arsenio 0.1 Literature 0.175 0.1756 AS/Nit/TF inter 60 Cadmium
,� 1 Literature 1.7562 1.7562 AS/Nit/TF inhi
61 Chromium 0.394 Literature O.6919 0.6919 AS/Nit/TF inhi
62 Copper 0.48 Literature 0.8430 _ 0.8430 AS/Nit/TF inhi
63 Cyanide 0.1 Literature 0.175 0.1756 AS/Nit/TF inhi
64 Lead r
0.5 Literature 0.8781 0.8781 AS/Nit/TF inhi
65 Merourl' 0.1.Literature 0.1756 0.1756 AS/Nit/TF inhi
66 Molybdenum
Nicktl 3
67 0.25 Literature 0.4390 0.4390 AS/Nit/TF inhi
m
68 Selenium s
69 Silver 0.25tLilerature 0.4390 0.4390 AS/Nit/TF inhi
70 Zino 1 Literature 1.7562 1.7562 AS/Nit/TF inter
71 Total Nitrogen ,
72 Total Phos.
730 _ . . .
744 d . _
75e -,
76 f
77 g
78 h
79 I ,
Modeled after:Chapter 5-HWA Guidance,Appendix 5-A
Revision Date: February 2008
J

Workbook Name: Jefferson.HWA.AT.2017 31jul2010; Worksheet Name: HWA Page 3of5
Printed 7/31/2018,2:22 PM
80 A I B I C I D I E I F ( G I H I I I J I K
81 Sludge Loading Calculations
Sludge Ceiling Class A Limits Class A Limits Cues A Limits Minimum i
Sludge Ceiling Sludge Ceiling Load Cumulative Sludge Cumulative Mon
Concentration Load eR MonthlyAvg. b1un.Avg.Load. - SludgeMinimum
-RASE Cnlc.- Rnin Limit Sludge Loading Average Rate Loading AASL Cale.- Loading Sludge
82 Pollutant Limit(mg/kg) (lbs/day) (lbs/day) (lbs/(ocroolife)) (1bs/day) Limit(mg/kg) (Ibs/da
83 DOD Y) (lbs/day) (Ibslckry) Loading Sorce
84 TSS
85 Ammonia
86 Arsenio 75 0.0526
34 41 0.0400 Sludge Ceilin,
87 Cadmium 85 0.0400
88 Chromium
34 39 0.0400 Sludge Ceilin•
89 Copper 4300 1.5160 1338
90 Cyanide 1500 1.5160 Sludge Ceiling
91 Load 840 0,4347
92 Mercury 57 0.0300 2671 300 0.0300 Sludge Ceiling
93 Molybdenum 75 0.0717 17 0.0300 Sludge Ceiling
84 Minkel 420 0.3157 0.0717 Sludge Ceilin.
374 0.3157 Sludge Ceiling
95 Selenium 100 0.0631 89 100
96 Silver 0.0G31 Sludge Ceilin;
97 Zinc 7500 4.1490
98 Total Nitrogen 2498 2800 4.1490 Sludge Ceiling
99 Total Pltos.
100 0
_101 d
102 e
103 f
104 g
105 h
106 I
107
Modeled after:Chapter 5-HWA Guidance,Appendix 5-A
Revision Date: February 2008

Workbook Name: Jefferson.HWA.AT.2017 31ju82018; Worksheet Name: HWA Page 4of5
Printed 7/31/2018,2:22 PM
A I B I C I D I E I F I G I H I I I J I K
108 Maximum Allowable Headworks Loading Calculations
Minimum Pass Minimum Minimum Minimum Minimum Allowable
Through Loading Pass Through Inhibition Loading Inhibition Loading Sludge Loading Sludge Loading Headworks Maximum Allowable
109 pbs/day) Source
110 BOD 0 m
6s/day) Source (Ibs/day) Some Loodl�(Ibslda}') Headworks Loading Bootee
1000.8 Design
111 TSS 1401.1 Design 1000.8 Design
1401.1 Design
112 Ammonia 75.1 Design 842.9689 AS/Nit/IF inhibiti 75.1 Design
113 Arsenio 0.2475 Stream Std 0.1756 AS/NiUTF inhibiti 0.0526 Sludge Ceiling 0.0526 Sludge Ceiling
114 Cadmium 0.0426 Stream Std 1.7562 AS/MUTE inhibiti 0.0400 Sludge Ceiling 0.0400 Sludge Ceiling
115 Chromium 0.8320 Stream Std U.6919 AS/NitTF inhibiti 0.6919 AS/Nit/IF inhibition
116 Copper 0.4197 NPDES 0.8430 AS/Nit"1'F inhibiti 1.5160 Sludge Ceiling 0.4197 NPDES
117 Cyanide 0.0359 NPDES 0.1756 AS/Nit/TE inhibiti 0.0359 NPDES
118 lead 0.2353 Stream Std 0.8781 AS/Nit/TF inhibiti 0.4347 Sludge Ceiling 0.2353 Stream Sal
119 Mercury 0.00041 Stmam Std 0.1756 AS/Nit/TF inhibiti 0.0300 Sludge Ceiling 0.00041 Stream Std
120 Molybdenum 0.0717 Sludge Ceiling 0.0717 Sludge Ceiling
121 Nickel 0.1637 Stream Std 0.4390 AS/Nit/TF inhibiti 0.3157 Sludge Ceiling 0.1637 Stream Std _
122 Selenium 0.1361 Stream Std 0.0631 Sludge Ceiling 0.0631 Sludge Ceiling
123 Silver 0.0033 Stream Std 0.4390 AS/NitTF mhibiti 0.0033 Stream Std
124 Zinc 1.4644 NPDES 1.7562 ASfNiUTF inhibiti 4.1490 Sludge Ceiling 1.4644 NPDES
125 Total Nitrogen
126 Total Phos.
127 a
128 d
129 e
130 f
131j
132 h
133 1
134
Modeled after:Chapter 5-HWA Guidance,Appendix 5-A
Revision Date: February 2008
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Workbook Name: Jeferson.HWA.AT.2017 31jul2013; Worksheet Name: HWA Page 5of5
Printed 7/31/2018,2:22 PM
135 A I B I C I 0 I E I F I G I H I I I J I K
136 Maximum Allowable Industrial Loadings Calculations
Maximum
Allowable Maximum
Uncontrollable Allowable
Hcadworks Loading Check to Use HASL Concentration Uncontrollable Uncontrollable Industrial Load Design vs.Pass-
137 Pollutant libs/day) MARL Basis Coles (x) (mg/I) Source Load bs/d
138 BOO - Cfa Y) (lbs/day) Thru 1Vnrning
1000.8000 Design Muss Balance 241.7645 759.0355
139 TSS 1401.1200 Design Muss Balance 219.2508 1181.8692
140 Ammonia 75.0600 Design 12.78 Mass Balance 21.9084 53.1516
141 Arsenio 0.0526 Sludge Ceiling 0.0084;Mass Balance 0.0144 0.0382
142 Cadmium - -
0.0400 Sludge Ceiling � O.003,AInss Balance ;. 0.0051 0.0349
143 Chromium 0.6919 AS/Nit/TF inhibiti N/A 0.00081 lass Balance 0.0014 0.6905
144 Copper 0.4197 NPDES
0.03650 fuse Balance 0.0626 0.3571
116 Cyanide 0.0359 NPDES N/A 0.00925,lass Balance 0.0159 0.0200
Lead 0.2353 Stream Std 0 00500 Mass Balance 0.0086 0.2267
147 Mercury
0.00041 Stream Std O.000050 Mass Balance `, 0.00009 0,00032
148 Molybdenum 0.0717 Sludge Ceiling0.000500 'a.
149 Nickel -.• .- Mass Balance 0.0009 0.0709
0.1637 Stream Std
150 Selenium .. OA(IU831.lass Balance 0.0014 0.1623
0.0631 Sludge Ceiling 0.005000:dies Balance 0.0086 0.0546
EaSilver
0.0033 Stream Std N/A 0.000500\lass Balance 0.0009 0.0024
Mg Zino . . . .. ....
1.4644 NPDES 0.356027,lass Balance . 0.6104 0.8540
153 Total Nitrogen
11111111111.
154 Total Phos.
155c
156d
157 e
111111.1111111
158 f
159g
160 h _-161 I
Modeled after:Chapter 5-HWA Guidance,Appendix 5-A
Revision Date: February 2008
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