NC0087866_Renewal (Application)_20220407

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Governor „ 1
ELIZABETH S.BISER
Secretary
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
April 07, 2022
Piedmont Triad Regional Water Authority
Attn: Gregory T. Flory, Executive Director
PO Box 1326
Randleman, NC 27317-1326
Subject: Permit Renewal
Application No. NC0087866
John F. Kime WTP
Randolph County
Dear Applicant:
The Water Quality Permitting Section acknowledges the March 8, 2022 receipt of your permit renewal application and
supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW permitting
branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely,
JC014-Alk\,,
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
D_E Qv North Carolinaston-Salem Department ofOffice Environmental450West Quality
ill Division Suite of Wi
Water Resources
Win 300 nston-Salem.North Carolina 27105
dw..M.�..�m..0 336.776.9800

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PIEDMONT TRIAD REGIONAL WATER AUTHORITY
April 5, 2022 RECEIVED
Via Hand Delivery APR 6 2022
Ms. Wren Thedford
NC Division of Water Resources DEO--WATER RESOURCES
Water Quality Permitting Section—NPDES Archdale Building—9t'Floor 401 &BUFFER PERMITTING
1 512 North Salisbury Street
Raleigh,NC 27604
RE: NPDES Permit Renewal
Permit Number NC0087866
Dear Sir or Madam:
Enclosed please find a copy of our renewal application for NPDES permit number NC0087866.
The renewal package includes the original and 2 copies of the NPDES Permit Application—Form
1 with topographic map,NPDES Permit Application—Form 2C with line drawing, Tables A, B,
C, D&E and copies of analytical results and NPDES Permit Application Form 2E. There have
been no significant changes to our facility since our last permit renewal.
We would like to request a waiver for the BOD and Oil and Grease monitoring listed in Section
4.2 of Form 2E and the BOD and COD monitoring listed in Table A of Form 2C. Our facility
discharges solely process water from the water treatment facility and has no domestic
components contributing to the discharge. The biological activity in the wastewater is very
minimal due to the fact that water sent to the wastewater system has gone through several stages
of disinfection in the water treatment process prior to wasting. In addition, the majority of the
organic matter in the water is removed from the wastewater through the thickener and belt
filtration process which should naturally yield very low COD in the discharge. As a water
treatment facility oil and grease are not a part of the treatment process and any oil and grease that
is used with the equipment in the process is required to be food grade in nature,therefore; oil and
grease are not expected to be in the discharge.
With respect to Form 2C, Table C I would also like to note that we have indicated that we
believe that Bromide, Sulfate and Iron could be present in the discharge,however; we have not
performed discharge monitoring for the contaminants as it has never been required. We believe
Bromide may be present as it has been detected in raw water monitoring previously performed in
Mailing Address: P.O.Box 1326•Randleman,NC 27317
Physical Address: 7297 Adams Farm Road•Randleman,NC 27317
Telephone: [phone]•Fax: [phone]

the reservoir. While Bromide can be removed in portions of the water treatment process some
water is sent to the wastewater system prior to going through the treatment stages that would
remove it. We believe that Sulfate and Iron are most likely contained in the wastewater
discharge at some level as the primary coagulant used in the water treatment process is Ferric
Sulfate. While a significant portion of the Iron is most likely removed through the thickening
and belt filter process it is likely that a portion is still present in the discharge.
We would like to note that we are currently investigating why our facility has had issues passing
chronic toxicity over the past year, as our facility has typically passed this sampling. We are
currently in the process of having HDR Engineering review the water treatment additives being
used at our facility to see if they can identify any constituents that could potentially be causing
an issue. In addition, we are working to source an additional laboratory in the region capable of
performing this analysis so that we can conduct quality control sampling on the facility we are
currently using. While we have been using a State certified laboratory for our analysis, we did
have to switch to using this facility at the approximate time that we started noting issues with our
chronic toxicity results. Unfortunately,the laboratory that we had been using prior to switching
is no longer in business. While we do not have any data to indicate that the laboratory we are
using is having quality control issues, we are concerned that the overall sensitivity of this test, in
conjunction with changes in the travel time to the facility and other external factors may
potentially be negatively affecting our results.
Should you need any additional information on any items or need to discuss the renewal further
please give me a call.
Sincerely,
Gregory T. Flory, P.E.
Executive Director
enc.: NPDES Permit Application—Form 1
NPDES Permit Application—Form 2C
NPDES Permit Application—Form 2E

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
Form U.S.Environmental Protection Agency
1 aEPA Application for NPDES Permit to Discharge Wastewater
NPDES GENERAL INFORMATION
SECTION 1.ACTIVITIES REQUIRING AN NPDES PERMIT(40 CFR 122.21(f)and(f)(1))
1.1 Applicants Not Required to Submit Form 1
Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
1.1.1 12
treatment works? 1. . treating domestic sewage?
If yes,STOP. Do NOT complete ❑✓ No If yes, STOP. Do NOT ❑✓ No
Form 1.Complete Form 2A. complete Form 1.Complete
Form 2S.
1.2 Applicants Required to Submit Form 1
1.2.1 Is the facility a concentrated animal feeding 1.2.2 Is the facility an existing manufacturing,
operation or a concentrated aquatic animal commercial,mining,or silvicultural facility that is
a production facility? currently discharging process wastewater?
o ❑ Yes 3 Complete Form 1 ❑✓ No �✓ Yes 4 Complete Form ❑ No
a and Form 2B. 1 and Form 2C.
co 1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
mining,or silvicultural facility that has not yet commercial,mining,or silvicultural facility that
commenced to discharge? discharges only nonprocess wastewater?
c ❑ Yes 4 Complete Form 1 ❑✓ No ❑ Yes 4 Complete Form �✓ No
co
and Form 2D. 1 and Form 2E.
1.2.5 Is the facility a new or existing facility whose
discharge is composed entirely of stormwater
a associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
❑ Yes 4 Complete Form 1 ❑✓ No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x)or
b 15 .
SECTION 2.NAME,MAILING ADDRESS,AND LOCATION(40 CFR 122.21(f)(2))
2.1 Facility Name
John F.Kime Water Treatment Plant
0 2.2 EPA Identification Number
47.
0
0
J
2.3 Facility Contact
d Name(first and last) Title Phone number
-a Gregory Flory Executive Director [phone]
Q
Email address
[e-mail]
2.4 Facility Mailing Address
Street or P.O.box
P.O.Box 1326
City or town State ZIP code
Randleman NC 27317
EPA Form 3510-1(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
d 2.5 Facility Location
.._ Street,route number,or other specific identifier
Q o 7297 Adams Farm Road
0)U
c o County name County code(if known)
Randolph 37151
cif 0
E City or town State ZIP code
z Randleman NC 27317
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
4941
0
v
0
U
co
3.2 NAICS Code(s) Description(optional)
221310
U
U)
SECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
4.1 Name of Operator
Piedmont Triad Regional Water Authority
0 4.2 Is the name you listed in Item 4.1 also the owner?
0 ❑✓ Yes ❑ No
0 4.3 Operator Status
R ❑ Public—federal ❑ Public—state ElOther public(specify)Local Govt.
o ❑ Private ❑ Other(specify)
4.4 Phone Number of Operator
[phone]
4.5 Operator Address
r Street or P.O.Box
E 13 P.O.Box 1326
0
• c City or town State ZIP code
O o Randleman NC 27317
co U
Q Email address of operator
[e-mail]
SECTION 5. INDIAN LAND(40 CFR 122.21(f)(5))
• -0 5.1 Is the facility located on Indian Land?
cca
-J ❑Yes ❑✓ No
EPA Form 3510-1(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
SECTION 6.EXISTING ENVIRONMENTAL PERMITS(40 CFR 122.21(f)(6))
To 6.1 Existing Environmental Permits(check all that apply and print or type the corresponding permit number for each)
d NPDES(discharges to surface 0 RCRA(hazardous wastes) ❑ UIC(underground injection of
water) fluids)
NC0087866
w
a ❑ PSD(air emissions) ElNonattainment program(CAA) 0 NESHAPs(CM)
0,)
w ❑ Ocean dumping(MPRSA) 0 Dredge or fill(CWA Section 404) 0 Other(specify)
SECTION 7.MAP(40 CFR 122.21(f)(7))
7.1 Have you attached a topographic map containing all required information to this application?(See instructions for
specific requirements.)
❑✓ Yes 0 No 0 CAFO—Not Applicable(See requirements in Form 2B.)
SECTION 8.NATURE OF BUSINESS(40 CFR 122.21(f)(8))
8.1 Describe the nature of your business.
The Piedmont Triad Regional Water Authoirty is a local government entity formed by 6 municipalities in the area to
serve as a long-term water supply source for the region. The Water Authority built Randleman Regional Reservoir to
serve as the source of supply and constructed a water treatment plant to supply wholesale treated potable water to
the 6 member governments. Water discharged under this permit is solely process water from the water treatment
m facility that is sent back to the Reservoir downstream from the point of withdrawal for water treatment.
0
is
z
SECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
❑ Yes ❑✓ No 4 SKIP to Item 10.1.
2 9.2 Identify the source of cooling water.(Note that facilities that use a cooling water intake structure as described at
2 40 CFR 125,Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
rn..
c NPDES permitting authority to determine what specific information needs to be submitted and when.)
o
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c
SECTION 10.VARIANCE REQUESTS(40 CFR 122.21(f)(10))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)?(Check all that
apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
aa
❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
Section 301(n)) 302(b)(2))
❑ Non-conventional pollutants(CWA ❑ Thermal discharges(CWA Section 316(a))
Section 301(c)and(g))
❑✓ Not applicable
EPA Form 3510-1(revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
SECTION 11.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
11.1 In Column 1 below,mark the sections of Form 1 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:Activities Requiring an NPDES Permit ❑ w/attachments
❑✓ Section 2:Name,Mailing Address,and Location ❑ w/attachments
❑✓ Section 3:SIC Codes ❑ w/attachments
❑✓ Section 4:Operator Information ❑ w/attachments
❑✓ Section 5:Indian Land ❑ wl attachments
❑✓ Section 6:Existing Environmental Permits ❑ wl attachments
E w/topographic
Section 7:Map ❑✓ map ❑
❑✓ wl additional attachments
o ❑✓ Section 8:Nature of Business ❑ w/attachments
❑✓ Section 9:Cooling Water Intake Structures ❑ w/attachments
❑✓ Section 10:Variance Requests ❑ w/attachments
y_ ❑✓ Section 11:Checklist and Certification Statement ❑ w/attachments
•
11.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted.Based on my inquiry of the person or persons who manage the system,or those persons
directly responsible for gathering the information,the information submitted is,to the best of my knowledge and
belief,true,accurate,and complete.I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Gregory Flory Executive Director
Signature Date signed
03/31/2022
&atio A,
EPA Form 3510-1(revised 3-19) Page 4

John F. Kime WTP NPDES Permit NC0087866
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EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
U.S.Environmental Protection Agency
FORM Application for NPDES Permit to Discharge Wastewater
2E
NPDES - EPA MANUFACTURING,COMMERCIAL, MINING,AND SILVICULTURAL FACILITIES WHICH
DISCHARGE ONLY NONPROCESS WASTEWATER
SECTION 1.OUTFALL LOCATION(40 CFR 122.21(h)(1))
1.1 Provide information on each of the facility's outfalls in the table below.
o Outfall Receiving Water Name Latitude Longitude
Number
0 001 Deep River 35° 51' 42.54" N 79° 49' 19.80" W
J
j ° n ° u
0
SECTION 2.DISCHARGE DATE(40 CFR 122.21(h)(2))
Es'
2.1 Are you a new or existing discharger?(Check only one response.)
s �,co ElNew discharger 0Existing discharger 4 SKIP to Section 3.
N o 2.2 Specify your anticipated discharge date:
0
SECTION 3.WASTE TYPES(40 CFR 122.21(h)(3))
3.1 What types of wastes are currently being discharged if you are an existing discharger or will be discharged if you are a
new discharger?(Check all that apply.)
❑ Sanitary wastes 0 Other nonprocess wastewater(describe/explain
❑ Restaurant or cafeteria waste directly below)
Process Water from Water Treatment Facility
Q ❑ Non-contact cooling water
1- 3.2 Does the facility use cooling water additives?
d
R ❑ Yes ❑✓ No 4 SKIP to Section 4.
3.3 List the cooling water additives used and describe their composition.
Cooling Water Additives Composition of Additives
(list) (if available to you)
SECTION 4.EFFLUENT CHARACTERISTICS(40 CFR 122.21(h)(4))
4.1 Have you completed monitoring for all parameters in the table below at each of your outfalls and attached the results to
this application package?
El Yes Ei No;a waiver has been requested from my NPDES permitting authority
(attach waiver request and additional information)4 SKIP to Section 5.
4.2 Provide data as requested in the table below.' (See instructions for specifics.)
o) Number of Maximum Daily Average Daily Source
y Parameter or Pollutant Analyses Discharge Discharge (use codes
.c (if actual data (specif)units) (specify units) per
0 reported) Mass Conc. Mass Conc. instructions)
R
L Biochemical oxygen demand(BOD5)
Total suspended solids(TSS) 52 35.69 Ib/d 4.5 mg/L 15.38 lb/c 2.0 mg/L 001
cu
Oil and grease
E
W Ammonia(as N) 4 1.6 Ib/d 0.2 mg/L 0.8 Ib/d 0.1 mg/L 001
Discharge flow 365 1.6 MGD 001
pH(report as range) 52 6.51-7.52 001
Temperature(winter) 26 5.9-23.8 C 001
Temperature(summer) 26 14.5-29.4 C 001
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 3510-2E(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
1 NC0087866 John F.Kime Water Plant OMB No.2040-0004
4.3 Is fecal coliform believed present,or is sanitary waste discharged(or will it be discharged)?
❑ Yes ❑ No 4 SKIP to Item 4.5.
4.4 Provide data as requested in the table below.1 (See instructions for specifics.)
Number of Maximum Daily Average Daily Source
Parameter or Pollutant Analyses Discharge Discharge (Use codes
(if actual data (specify units) (specify units) per
reported) Mass Conc. Mass Conc. Instructions.)
Fecal coliform
E.coli
Enterococci
0 4.5 Is chlorine used(or will it be used)?
0 0Yes El No 4 SKIP to Item 4.7.
y 4.6 Provide data as requested in the table below.1 (See instructions for specifics.)
a' Number of Maximum Daily Average Daily Source
Parameter or Pollutant Analyses Discharge Discharge (use codes
U (if actual data (specify units) (speci units) per
reported) Mass Conc. Mass Conc. instructions)
-5
z Total Residual Chlorine 52 0.1 Ib/d 23 ug/L 0.06 Ib/d 8.2 ug/L 001
w 4.7 Is non-contact cooling water discharged(or will it be discharged)?
❑ Yes ElNo 4 SKIP to Section 5.
4.8 Provide data as requested in the table below.t (See instructions for specifics.)
Number of Maximum Daily Average Daily Source
Parameter or Pollutant Analyses Discharge Discharge (use codes
(if actual data (specify units) (specify units) per
reported) Mass Conc. Mass Conc. instructions)
Chemical oxygen demand(COD)
Total organic carbon(TOC)
SECTION 5.FLOW(40 CFR 122.21(h)(5))
5.1 Except for stormwater water runoff,leaks,or spills,are any of the discharges you described in Sections 1 and 3 of this
application intermittent or seasonal?
❑ Yes 4 Complete this section. ❑✓ No 4 SKIP to Section 6.
c 5.2 Briefly describe the frequency and duration of flow.
ii
SECTION 6.TREATMENT SYSTEM(40 CFR 122.21(h)(6))
E 6.1 Briefly describe any treatment system(s)used(or to be used).
°' The wastewater treatmentprocess consists of an equalization lagoon,solids thickener,decant lagoon,flow monitoring
u) 4 g g
co basin,belt filter press and sludge storage area. There are provisions for pH adjustment with caustic soda or sulfuric acid
in the decant lagoon and dechlorination using liquid calcium thiosulfate and or tablets at the flow monitoring basin. A
g cationic polymer is used in conjunction with the operation of the belt filter press. All water from the belt filter press
R
a) and sludge storage basin are directed to a lift station which returns the water to the solids thickener. Processed sludge
~ is land applied through a contract with a local vendor.
I 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 3510-2E(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
SECTION 7.OTHER INFORMATION(40 CFR 122.21(h)(7))
7.1 Use the space below to expand upon any of the above items.Use this space to provide any information you believe the
reviewer should consider in establishing permit limitations.Attach additional sheets as needed.
c Wastewater is generated from filtration backwashes,solids removal from the SuperPulsators(upflow clarifiers),
backwashing and cleaning of the membranes with a citric acid solution and drainage of process monitoring water.
E
0
d
0
SECTIO118.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
8.1 In Column 1 below,mark the sections of Form 2E 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:Outfall Location ❑ w/attachments(e.g.,responses for additional outfalls)
❑✓ Section 2:Discharge Date ❑ w/attachments
❑✓ Section 3:Waste Types ❑ wl attachments
c ❑✓ Section 4: Effluent Characteristics ❑ w/attachments
❑✓ Section 5:Flow ❑ w/attachments
in
o 2Section 6:Treatment System ❑ w/attachments
❑✓ Section 7:Other Information ❑ w/attachments
C) 0 Section 8:Checklist and Certification Statement ❑ w/attachments
1-1) 8.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system,or those persons directly
responsible for gathering the information,the information submitted is,to the best of my knowledge and belief,true,
accurate,and complete.I am aware that there are significant penalties for submitting false information,including the
possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Gregory Flory Executive Director
Signature Date signed
trall 03/31/2022
EPA Form 3510-2E(revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
Form U.S.Environmental Protection Agency
2C —iEPA Application for NPDES Permit to Discharge Wastewater
NPDES EXISTING MANUFACTURING,COMMERCIAL, MINING,AND SILVICULTURE OPERATIONS
SECTION 1.OUTFALL LOCATION(40 CFR 122.21(g)(1))
1.1 Provide information on each of the facility's outfalls in the table below.
Outfall
g Number Receiving Water Name Latitude Longitude
U
0 001 Deep River 35° 51' 42.54" N 79° 49' 19.8" W
R
0
SECTION 2.LINE DRAWING(40 CFR 122.21(g)(2))
p, 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
c .3 balance?(See instructions for drawing requirements.See Exhibit 2C-1 at end of instructions for example.)
J `
o ❑✓ Yes ❑ No
SECTION 3.AVERAGE FLOWS AND TREATMENT(40 CFR 122.21(g)(3))
3.1 For each outfall identified under Item 1.1,provide average flow and treatment information.Add additional sheets if
necessary.
**Outfall Number** 001
Operations Contributing to Flow
Operation Average Flow
SuperPulsator(clarifier)-Blowdown 0.15 mgd
Dual Media Filters-Backwash 0.6 mgd
N
Microfiltration Membranes-Backwash/Cleaning 0.75 mgd
GAC Filters-Backwash 0.15 mgd
Treatment Units
cr) Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C 1 Liquid Wastes Other Than
retention time,etc.) by Discharge
Sludge Thickener-450,000 gallons 5-L
Equalization Lagoon-875,000 gallons 5-T
Decant Lagoon-470,000 gallons
Effluent Chamber 2-E
EPA Form 3510-2C(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
3.1 **Outfall Number**
cont. Operations Contributing to Flow
Operation Average Flow
mgd
mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
Belt Press 5-C Land Application
c
.0
0
U
c
m
E:
0 a
1D **Outfall Number**
y Operations Contributing to Flow
0 Operation Average Flow
mgd
a)
' mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
3.2 Are you applying for an NPDES permit to operate a privately owned treatment works?
d d ❑ Yes ❑✓ No SKIP to Section 4.
3.3 Have you attached a list that identifies each user of the treatment works?
❑ Yes ❑ No
EPA Form 3510-2C(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
SECTION 4. INTERMITTENT FLOWS(40 CFR 122.21(g)(4))
4.1 Except for storm runoff,leaks,or spills,are any discharges described in Sections 1 and 3 intermittent or seasonal?
D Yes ❑✓ No 9 SKIP to Section 5.
4.2 Provide information on intermittent or seasonal flows for each applicable outfall.Attach additional pages,if necessary.
Outfall Operation Frecuency Flow Rate
Number (list) Average Average Long-Term Maximum Duration
Days/Week Months/Year Average Daily
days/week months/year mgd mgd days
days/week months/year mgd mgd days
L
days/week months/year mgd mgd days
a> days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
SECTION 5.PRODUCTION(40 CFR 122.21(g)(5))
5.1 Do any effluent limitation guidelines(ELGs)promulgated by EPA under Section 304 of the CWA apply to your facility?
❑ Yes ❑✓ No 4 SKIP to Section 6.
5.2 Provide the following information on applicable ELGs.
ELG Category ELG Subcategory Regulatory Citation
0.
5.3 Are any of the applicable ELGs expressed in terms of production(or other measure of operation)?
❑ Yes ❑ No 9 SKIP to Section 6.
0
5.4 Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
Outfall Operation,Product,or Material Quantity per Day Unit of
-0 Number Measure
d
0
0
O
0
EPA Form 3510-2C(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
SECTION 6. IMPROVEMENTS(40 CFR 122.21(g)(6))
6.1 Are you presently required by any federal,state,or local authority to meet an implementation schedule for constructing,
upgrading,or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
❑ Yes ❑✓ No+SKIP to Item 6.3.
6.2 Briefly identify each applicable project in the table below.
en
Affected Final Compliance Dates
Brief Identification and Description of Outfalls Source(s)of
o Project (list outfall Discharge Required Projected
number)
h
d
N
0-
Q
6.3 Have you attached sheets describing any additional water pollution control programs(or other environmental projects
that may affect your discharges)that you now have underway or planned?(optional item)
❑ Yes ❑ No ❑✓ Not applicable
SECTION 7.EFFLUENT AND INTAKE CHARACTERISTICS(40 CFR 122.21(g)(7))
See the instructions to determine the pollutants and parameters you are required to monitor and,in turn,the tables you must
complete. Not all applicants need to complete each table.
Table A.Conventional and Non-Conventional Pollutants
7.1 Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A pollutants for any of
your outfalls?
❑✓ Yes ❑ No 4 SKIP to Item 7.3.
7.2 If yes,indicate the applicable outfalls below.Attach waiver request and other required information to the application.
Outfall Number 001 Outfall Number Outfall Number
O 7.3 Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
N requested and attached the results to this application package?
No;a waiver has been requested from my NPDES
❑✓ Yes ❑ permitting authority for all pollutants at all outfalls.
ES Table B.Toxic Metals,Cyanide,Total Phenols,and Organic Toxic Pollutants
7.4 Do any of the facility's processes that contribute wastewater fall into one or more of the primary industry categories
a listed in Exhibit 2C-3?(See end of instructions for exhibit.)
❑ Yes ElNo 4 SKIP to Item 7.8.
7.5 Have you checked"Testing Required"for all toxic metals,cyanide,and total phenols in Section 1 of Table B?
❑ Yes ❑ No
7.6 List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s)identified
in Exhibit 2C-3.
Primary Industry Category Required GC/MS Fraction(s)
(Check applicable boxes.)
❑Volatile 0 Acid 0 Base/Neutral 0 Pesticide
❑Volatile 0 Acid 0 Base/Neutral 0 Pesticide
0 Volatile 0 Acid ❑Base/Neutral 0 Pesticide
EPA Form 3510-2C(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
7.7 Have you checked"Testing Required"for all required pollutants in Sections 2 through 5 of Table B for each of the
GC/MS fractions checked in Item 7.6?
❑ Yes ❑ No
7.8 Have you checked"Believed Present"or"Believed Absent"for all pollutants listed in Sections 1 through 5 of Table B
where testing is not required?
❑✓ Yes ❑ No
7.9 Have you provided(1)quantitative data for those Section 1,Table B,pollutants for which you have indicated testing is
required or(2)quantitative data or other required information for those Section 1,Table B,pollutants that you have
indicated are"Believed Present"in your discharge?
✓❑ Yes ❑ No
7.10 Does the applicant qualify for a small business exemption under the criteria specified in the instructions?
❑ Yes 4 Note that you qualify at the top of Table B, ❑ No
then SKIP to Item 7.12.
7.11 Have you provided(1)quantitative data for those Sections 2 through 5,Table B,pollutants for which you have
c determined testing is required or(2)quantitative data or an explanation for those Sections 2 through 5,Table B,
pollutants you have indicated are"Believed Present"in your discharge?
`—' ❑✓ Yes ❑ No
Table C.Certain Conventional and Non-Conventional Pollutants
7.12 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed on Table C
s for all outfalls?
;� ❑✓ Yes ❑ No
7.13 Have you completed Table C by providing(1)quantitative data for those pollutants that are limited either directly or
indirectly in an ELG and/or(2)quantitative data or an explanation for those pollutants for which you have indicated
r "Believed Present"?
❑✓ Yes ❑ No
w Table D.Certain Hazardous Substances and Asbestos
7.14 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed in Table D for
all outfalls?
✓❑ Yes ❑ No
7.15 Have you completed Table D by(1)describing the reasons the applicable pollutants are expected to be discharged
and(2)by providing quantitative data,if available?
❑✓ Yes ❑ No
Table E.2,3,7,8-Tetrachlorodibenzo-p-Dioxin(2,3,7,8-TCDD)
7.16 Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the instructions,or do you
know or have reason to believe that TCDD is or may be present in the effluent?
❑ Yes-4 Complete Table E. ❑✓ No 4 SKIP to Section 8.
7.17 Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes ❑✓ No
SECTION 8. USED OR MANUFACTURED TOXICS(40 CFR 122.21(g)(9))
8.1 Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
an intermediate or final product or byproduct?
❑ Yes ❑✓ No 4 SKIP to Section 9.
3 to 8.2 List the pollutants below.
E 0 1. 4. 7.
`o
2. 5. 8.
3. 6. 9.
EPA Form 3510-2C(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
SECTION 9.BIOLOGICAL TOXICITY TESTS(40 CFR 122.21(g)(11))
9.1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
within the last three years on(1)any of your discharges or(2)on a receiving water in relation to your discharge?
❑✓ Yes ❑ No 4 SKIP to Section 10.
9.2 Identify the tests and their Durposes below.
Test(s) Purpose of Test(s) Submitted to NPDES Date Submitted
XPermittin. Authori ?
0
m Ceriodaphnia dubia 7 day Regulatory Monitoring 0 Yes 0 No 01/21/2022
co
g •Pass/Fail @ 90%Conc. Quarterly Monitoring
00Yes 0
0 Yes 0 No
SECTION 10.CONTRACT ANALYSES(40 CFR 122.21(g)(12))
10.1 Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
❑Q Yes ❑ No 4 SKIP to Section 11.
10.2 Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1 Laboratory Number 2 Laboratory Number 3
Name of laboratory/firm Meritech,Inc.Lab#027
a)
Laboratory address 642 Tamco Road
= Riedsville,NC 27320
Q
10
0 Phone number
[phone]
Pollutant(s)analyzed Chronic Toxicity
Ammonia,Nitrogen
Aluminum
Copper,Manganese,
Phosphorus,Zinc,Hardness
SECTION 11.ADDITIONAL INFORMATION(40 CFR 122.21(g)(13))
11.1 Has the NPDES permitting authority requested additional information?
❑ Yes ❑✓ No 4 SKIP to Section 12.
0
E 11.2 List the information requested and attach it to this application.
1. 4.
0
2. 5.
3. 6.
EPA Form 3510-2C(Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
SECTION 12.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
12.1 In Column 1 below,mark the sections of Form 2C that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note
that not all applicants are required to complete all sections or provide attachments.
Column 1 Column 2
❑✓ Section 1:Outfall Location ❑ w/attachments
❑✓ Section 2:Line Drawing ✓❑ wl line drawing ❑ w/additional attachments
Section 3:Average Flows and wl list of each user of
❑✓ Treatment ❑ wl attachments Elprivately owned treatment
works
❑✓ Section 4: Intermittent Flows ❑ w/attachments
❑✓ Section 5:Production ❑ wl attachments
w/optional additional
❑✓ Section 6:Improvements ❑ w/attachments ❑ sheets describing any
additional pollution control
plans
❑ w/request for a waiver and ❑ w/explanation for identical
supporting information outfalls
w/small business exemption w/other attachments
❑ request03 ❑
N ❑ Section 7:Effluent and Intake ❑ w/Table A ❑✓ w/Table B
Characteristics
0
.0 ❑✓ w/Table C ❑✓ w/Table D
CD ❑✓ w/Table E w/analytical results as an
c) attachment
❑
Section 8:Used or Manufactured
❑
w/attachments
Toxics
❑ Section 9:Biological Toxicity ❑ w/attachments
Tests
U
❑✓ Section 10:Contract Analyses ❑ w/attachments
❑✓ Section 11:Additional Information ❑ w/attachments
❑ Section 12:Checklist and w/attachments
Certification Statement
12.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly
responsible for gathering the information, the information submitted is, to the best of my knowledge and belief,true,
accurate,and complete. I am aware that there are significant penalties for submitting false information,including the
possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Gregory Flory Executive Director
Signature Date signed
)--euryo Qe6
03/31/2022
EPA Form 3510-2C(Revised 3-19) Page 7

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant 001 OMB No.2040-0004
TABLE A.CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(iii))1
Effluent Intake
Waiver (Optional)
Pollutant Requested Units Maximum Maximum Long-Term
(if applicable) (specify) Daily Monthly Average Daily Number of Long-Term Number of
Discharge Discharge Discharge Analyses Average Value Analyses
(required) (if available) (if available)
❑ Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
1 Biochemical oxygen demand ❑✓ Concentration
(BODs) Mass
2 Chemical oxygen demand ❑✓ Concentration
(COD) Mass
Concentration mg/L 2.64 2.64 1
3. Total organic carbon(TOC) 0
Mass Ib/d 8.81 8.81
Concentration mg/L 4.5 4.5 2.0 52
4. Total suspended solids(TSS) ❑
Mass Ib/d 35.69 35.69 15.38 52
Concentration mg/L 0.2 0.2 0.1 4
5. Ammonia(as N) 0
Mass Ib/d 1.6 1.6 0.8 4
6. Flow 0 Rate MGD 1.6 1.6 0.685 365
Temperature(winter) 0 °C °C 5.9-23.8 26
7.
Temperature(summer) 0 °C °C 14.5-29.4 26
pH(minimum) ❑ Standard units S.U. 6.51 52 6.7 365
8.
pH(maximum) 0 Standard units s.u. 7.52 52 8.9 365
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 9

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
Daily
Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) g Value
(if available)
❑ Check here if you qualify as a small business per the instructions to Form 2C and,therefore,do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table.Note,however,that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1.Toxic Metals,Cyanide,and Total Phenols
Antimony,total Concentration
1.1 (7440 36 0) El 0
Mass
Arsenic,total Concentration
1.2 0 El
(7440-38-2) Mass
Beryllium,total Concentration
1.3 El 0
(7440-41-7) Mass
Cadmium,total1:1 Concentration
1.4 (7440-43-9) Mass
Chromium,total 1:1Concentration
1.5 0 ID
(7440-47-3) Mass
Copper,total Concentration mg/L 0.003 0.003 0.003 4
1.6 (7440-50-8) Mass
Lead,total 1:1Concentration
1.7 El 0
(7439-92-1) Mass
Mercury,total Concentration
1.8 (7439-97-6) El 0 ✓❑
Mass
Nickel,total Concentration
1'9 (7440-02-0) Mass
1.10 Selenium,total 0 0 0 Concentration
(7782-49-2) Mass
Silver,total Concentration
1.11 (7440 22 4) 0 El ❑
Mass
EPA Form 3510-2C(Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant]Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (amity) Maximum Maximum Average Number Long Number
am
Present Absent Daily Monthly Term
Daily
Discharge Discharge Dischar a Analyses Average Analyses
(required) (if available) g Value
(if available)
Thallium,total Concentration
1.12 (7440-28-0) ❑ ❑ ❑ Mass
1.13 Zinc,total 0
0
Concentration met. 0 0 0 4
(7440-66-6) Mass
1.14 Cyanide,total ❑ ❑ Concentration
(57-12-5) Mass
Concentration
1.15 Phenols,total 0 0
0
Mass
Section 2.Organic Toxic Pollutants(GCIMS Fraction—Volatile Compounds)
Acrolein Concentration
2.1 (107-02-8) ❑ ❑ ❑ Mass
2 2 Acrylonitrile ❑ ❑ 0 Concentration
(107-13-1) Mass
2 3 Benzene El ElConcentration
(71-43-2) Mass
2.4 Bromoform ❑ ❑ 1=1 Concentration
(75-25-2) Mass
2.5 Carbon tetrachloride ❑ ❑ 12 Concentration
(56-23-5) Mass
Chlorobenzene 1=1 Concentration
2.6 (108-90-7) El El
Chlorodibromomethane El Concentration
2.7 (124-48-1) ❑ Mass
2 8 Chloroethane 0
0
1:1 Concentration
(75-00-3) Mass
EPA Form 3510-2C(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long Number
Present Absent Daily Monthly Daily of Term of
Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) Value
(if available) _
2.9 2-chloroethylvinyl ether El El0Concentration
(110-75-8) Mass
Concentration ug/L 24.3 24.3 1
2.10 Chloroform(67-66-3) 0 ❑✓ 0 Mass Ib/d 0.1 0.1
2.11 Dichlorobromomethane El ❑ ❑ Concentration
(75-27-4) Mass
212 1,1-dichloroethane El El Concentration
(75-34-3) Mass
1,2-dichloroethane Concentration
2.13 (107-06-2) El ❑ Mass _
2.14 1,1-dichloroethylene ❑ ❑ ElConcentration
(75-35-4) Mass
2.15 12-dichloropropane El El ❑✓ Concentration
(78-87-5) Mass
2.16 13-dichloropropylene ❑ ❑ ❑✓ Concentration
(542-75-6) Mass
217 Ethylbenzene ❑ ❑ ❑✓ Concentration
(100-41-4) Mass _ ____ _ _ _
2.18 Methyl bromide El 0
❑ Concentration
(74-83-9) Mass
2.19 Methyl chloride ❑ ❑ ❑ Concentration
(74-87-3) Mass
2.20 Methylene chloride 0 0
❑ Concentration
(75-09-2) Mass
221 1,1,2,2-tetrachloroethane El El
❑ Concentration
(79-34-5) Mass
EPA Form 3510-2C(Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
Daily Discharge Discharge Disa
gchar Analyses Average Analyses
(required) (if available) Value
(if available)
2.22 Tetrachloroethylene ❑ 0 0Concentration
(127-18-4) Mass
Toluene 0 Concentration
2.23 0 0
(108-88-3) Mass
2.24 1,2-trans-dichloroethylene ❑ 0 Concentration
(156-60-5) Mass
2.25 1,1,1-trichloroethane ❑ Concentration
(71-55-6) Mass
2.26 1,1,2-trichloroethane ❑ ElConcentration
ID
(79-00-5) Mass
2.27 Trichloroethylene El a Concentration
(79-01-6) Mass
2.28 Vinyl chloride 0 Concentration
(75-01-4) Mass
Section 3.Organic Toxic Pollutants(GC/MS Fraction—Acid Compounds)
3.1 2-chlorophenol Concentration
0 El El
(95-57-8) Mass
2,4-dichlorophenol 0 Concentration
3.2 (120-83-2) Mass
2,4-dimethylphenol Concentration
3.3 El 0
(105-67-9) Mass
3.4 4 6-dinitro-o-cresol ❑ Concentration
(534-52-1) Mass
3.5 2,4-dinitrophenol Concentration
(51-28-5) Mass
EPA Form 3510-2C(Revised 3-19) Page 14

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
Daily
Discharge Discharge Discharge Analyses
Average Analyses
(required) (if available) Value
(if available)
3.6 2-nitrophenol Concentration
(88-75-5) Mass
4-nitrophenol Concentration
3.7 ❑ ❑ 0(100 02 7)
Mass
3.8 p-chloro-m-cresol ❑ Concentration .
(59-50-7) ✓ Mass
3.9 Pentachlorophenol ❑ Concentration
(87-86-5) ✓ Mass
Phenol Concentration
3.10 (108-95-2) ❑ 0
Mass
3.11 2,4,6-trichlorophenol Concentration
(88-05-2) Mass
Section 4.Organic Toxic Pollutants(GC/MS Fraction—Base/Neutral Compounds)
4.1 Acenaphthene 0 Concentration
(83-32-9) Mass
Acenaphthylene Concentration
4.2 (208-96-8) Mass
4.3 Anthracene Concentration
(120-12-7) Mass
Benzidine Concentration
4.4 (92 87 5) 0 0
Mass
4.5 Benzo(a)anthracene ❑ Concentration
(56-55-3) Mass
4.6 Benzo(a)pyrene ❑ Concentration
(50-32-8) Mass
EPA Form 3510-2C(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number.if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
Discharge Discharge
(if available) Discharge Analyses AverageValue Analyses
(if available)
4.7 3,4-benzofluoranthene 0 0 Concentration
(205-99-2) Mass
4.8 Benzo(ghi)perylene 0 Concentration
0 El
(191-24-2) Mass
Benzo(k)fluoranthene ✓ Concentration
4.9 El El
(207-08-9) Mass
4.10 Bis(2-chloroethoxy)methane El 0 0 Concentration
(111-91-1) Mass
4.11 Bis(2-chloroethyl)ether 0 0 Concentration
(111-44-4) Mass
4.12 Bis(2-chloroisopropyl)ether 0 Concentration
(102-80-1) Mass
4.13 Bis(2-ethylhexyl)phthalate 0 Concentration
0 El
(117-81-7) Mass
4.14 4-bromophenyl phenyl ether El0 Concentration
(101-55-3) Mass
4.15 Butyl benzyl phthalate El El0Concentration
(85-68-7) Mass
4.16 2-chloronaphthalene ❑ Concentration
(91-58-7) Mass
4-chlorophenyl phenyl ether ✓ Concentration
4.17 (7005-72-3) Mass
4.18 Chrysene Concentration
(218-01-9) Mass
4.19 Dibenzo(a,h)anthracene ❑ 0Concentration
(53-70-3) Mass
EPA Form 3510-2C(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly of of
Term
Discharge Discharge DisDcharge Analyses AValuee Analyses
(required) (if available)
(if available)
4.20 1,2-dichlorobenzene ❑ ❑ Concentration
(95-50-1) Mass
4.21 13-dichlorobenzene El ❑✓ Concentration
El
(541-73-1) Mass
4.22 1,4-dichlorobenzene El El0Concentration
(106-46-7) Mass
4.23 3,3-dichlorobenzidine ❑✓ Concentration
El El
(91-94-1) Mass _
4.24 Diethyl phthalate © Concentration
El El
(84-66-2) Mass _
4.25 Dimethyl phthalate 0Concentration
El El
(131-11-3) Mass
4.26 Di-n-butyl phthalate © Concentration
1=I El(84-74-2) Mass
4.27 2,4-dinitrotoluene ElConcentration
El El(121-14-2) Mass
4.28 2,6-dinitrotoluene ❑✓ Concentration
El El(606-20-2) Mass
4.29 Di-n-octyl phthalate 0 ElConcentration
(117-84-0) Mass
1,2-Diphenylhydrazine Concentration
4.30 El El El
(as azobenzene)(122-66-7) Mass
4.31 Fluoranthene Concentration
0 El El
(206-44-0) Mass
4.32 Fluorene 0Concentration
1=I El
(86-73-7) Mass
EPA Form 3510-2C(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03105/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long-
Number
Present Absent Daily Monthly Term
of of
Discharge Discharge DisDcharge Analyses Average Analyses
(required) (if available) Value
(if available)
4.33 Hexachlorobenzene ❑ 0Concentration
(118-74-1) Mass
4.34 Hexachlorobutadiene El0Concentration
El
(87-68-3) Mass
4.35 Hexachlorocyclopentadiene El El ❑✓ Concentration
(77-47-4) Mass
4.36 Hexachloroethane ❑✓ Concentration
(67-72-1) Mass
4.37 Indeno(1,2,3-cd)pyrene 0 ❑✓ Concentration
(193-39-5) Mass
4.38 Isophorone ❑✓ Concentration
El 0
(78-59-1) Mass
Naphthalene ❑ Concentration
4.39 El 0
(91-20-3) Mass
4.40 Nitrobenzene Concentration
(98-95-3) Mass
4.41 N-nitrosodimethylamine ❑ ElConcentration
El
62-75-9
( ) Mass
4.42 N-nitrosodi-n-propylamine ❑ ❑✓ Concentration
(621-64-7) Mass
4.43 N-nitrosodiphenylamine El El0Concentration
(86-30-6) Mass
Phenanthrene � ❑ Concentration
4.44 (85 01 8) Mass
Pyrene Concentration
4.45 (129-00-0) El El 0 Mass
EPA Form 3510-2C(Revised 3-19) Page 18

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of
Term of
Discha iscrge) Df available) Discharge Analyses AValuee Analyses
(if available)
4.46 1,2,4-trichlorobenzene Concentration
(120-82-1) Mass
Section 5.Organic Toxic Pollutants(GC/MS Fraction—Pesticides)
5.1 Aldrin Concentration
(309-00-2) Mass
a-BHC Concentration
5.2 0 El ❑✓ •
(319-84-6)
Mass
R-BHC Concentration
5.3 (319-85-7) � 0 � Mass —
y-BHC Concentration
5.4 0 El CI
(58-89-9) Mass
b-BHC Concentration
5.5 (319-86-8) 0 El El
5.6 Chlordane Concentration
(57-74-9) Mass
5.7 4,4'-DDT Concentration
El El 0
(50-29-3) Mass
5.8 4,4' DDE Concentration
(72-55-9) Mass
5.9 4,4'-DDD Concentration
El El I=1
(72-54-8) Mass
Dieldrin Concentration
5.10 (60-57-1)
Mass
5.11 a-endosulfan Concentration
(115-29-7) Mass
EPA Form 3510-2C(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0087866 John F.Kime Water Plant
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long-
Number
Present Absent Daily Monthly Daily of Term of
Discharge Discharge Dischar a Analyses Average Analyses
(required) (if available) g Value
(if available)
5.12 R-endosulfan Concentration
(115-29-7) Mass
Endosulfan sulfate Concentration
5.13 (1031-07-8) 0 0 ❑✓ Mass
Endrin Concentration
5.14 0(72-20-8) 0 0
Mass
Endrin aldehyde Concentration
5.15 (7421 93 4) El ❑ 0
Mass
5.16 Heptachlor Concentration
(76-44-8) Mass
Heptachlor epoxide Concentration
5.17 (1024-57-3) ❑ ❑ ❑� Mass
PCB-1242 Concentration
5.18 (53469-21-9) 0 0 0 Mass
PCB-1254 Concentration
5.19 (11097-69-1) 0 0 ❑✓ Mass
PCB-1221 Concentration
5.20 (11104-28-2) ❑ 0 0 Mass
PCB-1232 Concentration
5.21 (11141-16-5) 0 ❑ 0 Mass
PCB-1248 Concentration
5.22 (12672-29-6) ❑ ❑ ❑✓ Mass
PCB-1260 Concentration
5.23 (11096-82-5) 0 El 0 Mass
PCB-1016 Concentration
5.24 (12674-11-2) 0 0 0 Mass
EPA Form 3510-2C(Revised 3-19) Page 20

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly of of
Term
Daily Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) Value
(if available)
Toxaphene Concentration
5.25 (8001-35-2) El ❑ 0 Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 21

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0087866 John F.Kime Water Plant
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence
(check one) Effluent Intake
(Optional)
Pollutant Units Maximum Long-Term
Believed Believed (specify) Maximum Daily Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
(required) Discharge Discharge Analyses Value Analyses
(if available) (if available)
❑ Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall.You need not complete the`Presence or Absence"column of Table C for
each pollutant.
1-1 Check here if you believe all pollutants on Table C to be absent in your discharge from the noted outfall.You need not complete the"Presence or Absence"column of Table C for
each pollutant.
1 BromideEl Concentration
(24959-67-9) ❑ Mass
Chlorine,total Concentration ug/L 23 23 8.2 52
2. residual 11Mass Ib/d 0.3 0.3 0.06 52
3. Color ❑ Concentration nm 26 26 1
Mass
4. Fecal coliform 0 0 Concentration
Mass
5 Fluoride 0 ❑ Concentration mg/L 0.29 0.29 0.26 4
(16984-48-8) Mass Ib/d 3.9 3.9 2.0 4
Concentration mg/L 0.51 0.51 0.19 4
6 Nitrate-nitrite 0 ❑
Mass Ib/d 6.8 6.8 1.45 4
Nitrogen,total Concentration mg/L 0.7 0.7 1
7' organic(as N) 0El Mass Ib/d 2.3 2.3 1
Concentration
8. Oil and grease 0 0 Mass
Phosphorus(as Concentration mg/L 0.03 0.03 0.02 4
9' P),total(7723-14-0) 0 El Ib/d 0.4 0.4 0.2 4
10. Sulfate(as SO4) 0 ❑ Concentration
(14808-79-8) Mass
Concentration
11. Sulfide(as S) 0 0
Mass
EPA Form 3510-2C(Revised 3-19) Page 23

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence
(check one) Effluent Intake
(Optional)
Pollutant Units Maximum Long-Term
Believed Believed (specify) Maximum Daily Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
Discharge Discharge Analyses Analyses
(required) Value
(if available) (if available)
12. Sulfite(as SO3) ❑ ❑ Concentration
(14265-45-3) Mass
Concentration
13. Surfactants 0 ❑✓ Mass
14. Aluminum,total ❑ ❑✓ Concentration mg/L 0 0 0 4
(7429-90-5) Mass
15. Barium,total ❑ ❑ Concentration
(7440-39-3) Mass
Boron,total Concentration
16. (7440-42-8) ❑ 0
Mass
17 Cobalt,total ❑ ❑ Concentration
(7440-48-4) Mass
18 Iron,total 0 ❑ Concentration
(7439-89-6) Mass
19 Magnesium,total ❑ ❑✓ Concentration
(7439-95-4) Mass
Molybdenum, Concentration
20. total 0 ✓❑ Mass
(7439-98-7)
21 Manganese,total El ❑ Concentration mg/L 1.65 1.65 0.79 4
(7439-96-5) Mass Ib/d 22 22 12.69 4
Tin,total Concentration
22' (7440-31-5) El 0
Mass
23 Titanium,total 0 0 Concentration
(7440-32-6) Mass
EPA Form 3510-2C(Revised 3-19) Page 24

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))1
Presence or Absence
(check one) Effluent Intake
(Optional)
Pollutant Units Maximum Long-Term
Believed Believed (specify) Maximum Daily Long-Term
f
Present Absent Discharge Monthly Average Daily Number of Average Number Discharge Discharge Analyses Analyses
(required) Value
(if available) (if available)
24. I Radioactivity
Concentration
Alpha,total ❑ ❑✓
—
Mass
Concentration
Beta,total ❑ ❑✓
Mass
Concentration
Radium,total ❑ 0 Mass
Concentration
Radium 226,total ❑ ❑✓
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 25

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
1. Asbestos ❑ ❑✓
2. Acetaldehyde ❑ 0
3. Allyl alcohol 0 ❑✓
4. Allyl chloride 0 ❑�
5. Amyl acetate 0 ❑✓
6. Aniline ❑ ❑✓
7. Benzonitrile ❑ ❑✓
8. Benzyl chloride ❑ ❑✓
9. Butyl acetate ❑ ❑✓
10. Butylamine ❑ ❑✓
11. Captan ❑ ❑�
12. Carbaryl 0 0
13. Carbofuran ❑ ❑✓
14. Carbon disulfide ❑ 0
15. Chlorpyrifos ❑ ❑�
16. Coumaphos ❑ ❑✓
17. Cresol ❑ ❑✓
18. Crotonaldehyde ❑ ❑�
19. Cyclohexane ❑ ❑�
EPA Form 3510-2C(Revised 3-19) Page 27

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent
20. 2,4-D(2,4-dichlorophenoxyacetic acid) 0 ❑✓
21. Diazinon ❑ ❑✓
22. Dicamba ❑ ❑✓
23. Dichlobenil ❑ ❑✓
24. Dichlone 0 ❑✓
25. 2,2-dichloropropionic acid 0 ❑✓
26. Dichlorvos 0 ❑✓
27. Diethyl amine 0 ❑✓
28. Dimethyl amine 0 ❑✓
29. Dintrobenzene ❑ ❑✓
30. Diquat 0 ❑✓
31. Disulfoton 0 ❑✓
32. Diuron 0 ❑✓
33. Epichlorohydrin 0 ❑✓
34. Ethion 0 ❑✓
35. Ethylene diamine 0 ❑✓
36. Ethylene dibromide 0 ❑✓
37. Formaldehyde ❑ ❑✓
38. Furfural ❑ ❑✓
EPA Form 3510-2C(Revised 3-19) Page 28

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent
39. Guthion 0 ❑✓
40. Isoprene 0 ❑✓
41. Isopropanolamine 0 ❑✓
42. Kelthane 0 ❑✓
43. Kepone 0 ❑✓
44. Malathion 0 ❑✓
45. Mercaptodimethur 0 ❑✓
46. Methoxychlor 0 ❑✓
47. Methyl mercaptan 0 ❑✓
48. Methyl methacrylate 0 ❑✓
49. Methyl parathion 0 ❑✓
50. Mevinphos 0 ✓❑
51. Mexacarbate 0 ❑✓
52. Monoethyl amine 0 ❑✓
53. Monomethyl amine 0 ❑✓
54. Naled 0 ❑✓
55. Naphthenic acid 0 ❑✓
56. Nitrotoluene 0 ❑✓
57. Parathion 0 ❑✓
EPA Form 3510-2C(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
58. Phenolsulfonate 0 ❑✓
59. Phosgene 0 ❑✓
60. Propargite 0 ❑✓
61. Propylene oxide ❑ ❑✓
62. Pyrethrins 0 ❑✓
63. Quinoline ❑✓ ❑ Has previously been detected in raw water sampling in reservoir
64. Resorcinol ❑ ❑✓
65. Strontium ❑✓ 0 Has previously been detected in raw water sampling in reservoir
66. Strychnine 0 ❑✓
67. Styrene ❑ ❑✓
68 2,4 5-T(2,4,5-trichlorophenoxyacetic ❑ ❑✓
acid)
69. TDE(tetrachlorodiphenyl ethane) ❑ ❑✓
70 2,4,5-TP[2-(2,4,5-trichlorophenoxy) ❑ ❑✓
propanoic acid]
71. Trichlorofon 0 ❑✓
72. Triethanolamine 0 ❑✓
73. Triethylamine 0 ❑✓
74. Trimethylamine 0 ❑✓
75. Uranium 0 ❑✓
76. Vanadium ❑✓ 0 Has previously been detected in raw water sampling in reservoir
EPA Form 3510-2C(Revised 3-19) Page 30

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
77. Vinyl acetate ❑ ❑✓
78. Xylene ❑ ❑✓
79. Xylenol ❑ ❑✓
80. Zirconium ❑ ❑✓
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 31

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0087866 John F.Kime Water Plant OMB No.2040-0004
TABLE E.2,3,7,8 TETRACHLORODIBENZO P DIOXIN(2,3,7,8 TCDD)(40 CFR 122.21(g)(7)(viii))
TCDD Presence or
Congeners Absence
Pollutant (check one) Results of Screening Procedure
Used or
Manufactured Believed Believed
Present Absent
2,3,7,8-TCDD 0 00
EPA Form 3510-2C(Revised 3-19) Page 33

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Meritech, Inc.
A'' Environmental Laboratory
Laboratory Certification No.165
IMO
Contact: Thomas Hedrick Report Date: 2/1/2021
Client: PTRWA NPDES#: NC0087866
7297 Adams Farm Rd
Randleman,NC 27317 Date Sample Rcvd: 1/19/2021
Meritech Work Order# 01192132 Sample: Effluent Grab 1/19/21
Parameters Results Analysis Date Reporting Limit Method
Ammonia,Nitrogen <0.1 mg/L 1/26/21 0.10 mg/L EPA 350.1
Aluminum,total <0.050 mg/L 1/27/21 0.050 mg/L EPA 200.7
Copper,total <0.002 mg/L 1/27/21 0.002 mg/L EPA 200.7
Manganese,total 0.357 mg/L 1/27/21 0.005 mg/L EPA 200.7
Phosphorus,total 0.011 mg/L 1/26/21 0.020 mg/L EPA 200.7
Zinc,total <0.010 mg/L 1/27/21 0.010 mg/L EPA 200.7
Hardness (titration) 44 mg/L 1/21/21 1 mg/L SM 2340C
Meritech Work Order# 01192133 Sample: Upstream Grab 1/19/21
Parameters Results Analysis Date Reporting Limit Method
Hardness(titration) 32 mg/L 1/21/21 1 mg/L SM 2340C
I hereby certify that I have reviewed and approve these data. l
a-40 ----
Laboratory Representative
642 Tamco Road,Reidsville,North Carolina 27320
tel.[phone] fax.[phone]

8/9l18 Chain of Custody Record (COC) NPDES#: N 0o8-4-&,,c;
Client: T211/4- Phone: 336 1-1q8. C-s/0
MERITECH, INC. Address: 2R7 Ad Fa ivi 12c1 Fax:
ENVIRONMENTAL LABORATORIES t /VC Email:-frheclf,Ck L p-Erl4t/d • 09
642 Tamco Rd. Phone: [phone] 2-7 3 14' Project:
-► Reidsville NC 27320 Fax: [phone] P.O.#:
e
Email: [e-mail] Attention: Turn Around Time*
*RUSH work needs prior approval,
How would you like your report sent? Ctarses Aool
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Person Taking Sample(Sign/P int))
Sampling Dates &Times � . 14-em64 kleSsa Lab Use Only
Sample Location and/or ID#
Start End Comp? #of Test(s) Required On Ice? pH OK?
Date Time Date Time Grab? Cont. P / No CI OK?
Eabevt+ l/,6I/2( 627 q 6-1 2. 7for1;` lox Sc-Q L c,
Foi0 44 i4 1101 o'24Mi en I Nafd,Tes g
PPIt,•wt " OM' 13''z5 , 0 I Me-ta-(5 CZ ielel Nlanyi.ne,e) A%viina;*l, I Y
-Ek-'L cry.k 1/Iq/.1 8'21 ( / i , • ft( 'P/ h gAt
r_Ik i,6sA d- I/rq/j I -Atli 61 Allmon fi M ro i
()Po1-rev Ocil21 B'Kccrf C-2 ) kafkerfj . 3
Temperature Uappc r
Receipt: �`
Method of ***Dechlorination(<0.5 ppm)of Ammonia,Cyanide,Phenol and TkN samples must be done in the field prior to preservation.***
E
Comments: Compositor#
Shipment:
U UPS Jug#
Li Fed Ex Are these results for regulatory purposes? Yes Li No port results in: mg/L E mg/kg Q. ug/L U
Hand Delivery Relinquished by: Date: Time: R e , DAT. Time: fret)
U Other unyl by: ?ate./Jl / Time: / ' 1 Rec ,ed : ' Date: Time:
'Relinquish d by: Date: Time: U( b Rec Date: Time:
� edby� La�rl� f Iq �� I,ZQ

Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 01/28/21
Facility: PIEDMONT TRIAD REGIONAL WATER NPDES#: NC0087866 Pipe#: County: RANDOLPH
Laboratory Performing Test: MERITECH LABS, INC.
Comments:
X
Signature of,Operator in Responsible Charge
X . 7 /2"--e(: 4.4-
Signature ot Laboratory Supervisor * PASSED: 5.38% Reduction *
mommommimm
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 = 1.603
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = 5.38
% Mortality Avg.Reprod.
# Young Produced 21 25 25 25 25 20 22 21 23 24 22 26
0.00 23 .25
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 22.00
Treatment 2 Treatment 2
Effluent %: 90%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
8.627% PASS FAIL
# Young Produced 23 21 25 23 22 20 21 20 24 19 23 23 % control orgs X
producing 3rd
I 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: 01/20/21
Control 8.01 7.99 8.12 8.01 8.07 8.02 Collection (Start) Date
Sample 1: 01/19/21 Sample 2: 01/27/21
Treatment 2 7.30 7.55 7.13 7.48 7.38 7.33 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 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X hrs T P P
1st sample 1st sample 2nd sample -
D.O. Hardness(mg/1) 46 ".....
Control 8.03 7.90 7.95 8.15 7.89 7.59
Spec. Cond. ()imhos) 164 201 184
Treatment 2 8.22 7.83 8.07 7.87 8.35 7.55
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 0.5 0.9
(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)

Meritech, Inc. (Lab # 027)
n FCt/ 76 � Mini Chronicn Pass/Fail Test Cenodaphnia dubia Incubator#: —5
Client: f j ' f" 7t l h-(/., t 1 i Pipe#: County: / 47'?(- )/p \ Date Start: /- 0--2 j Date End: I - '7
NPDES#: NC( (.;774(,• Date/Time of Culture Transfer: )•-i0�'�W )0•, -2 74r, Time Start: //./ .)4,n Time End: /(�: qJ; /r
Dilution Water: Lake Brandt Date/Time Neonates born: rt. 1. '.q)>:,,-Lt• I)y",r- 1st Renewal Date: /--2<,"" I Time: //: /3
Test Organism Source: Tray# 1 Age of eonates at Test Start: P- , hours 2nd Renewal Date: /.-7 r 2-4 Time: g,' ,_94,¢,M
Stirred/Aerated for D.O.: Y / N� Randomized: )/ N Culture Tray Temp: 3S O °C Analyst(s): MR,t v,Ks,KL Reviewed by: f,k.i\,
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
Sample 1: /- /<-s 2 l Sample 2: / - -2(
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 ,,
•
Adults Live/ Dead i_- -- �� - - Sample Information
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 100% pH G/C? Duration
#Young Produced ='t',' `(t/rf `t ci `fa//J -�l) -',' qk 'VA 3/4; 11/' f • i'/C Sample 1 j, 17 8. --- hours
Adults Live/ Dead L.- L_- C._-- (_--• L_ L- L.- L-- ( __ L., -(__ C_. Sample 2 (o, CI 4 a- - hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Transferred by: Fed by:
#Young Produced I ( % i j /(---; i, Batch# I 1'1��;> .�,, Sample Sample2 Day 0 '`%f, (,:,-/_ L
Adults Live/ Dead L. L _ L_- L- 1--- t-- L._ 1___ (-- 1._ L Transfer Day I 0 2 5 Day 1 M2
Hardness �/- ) ^—� Day 2 /7/1t fn/
_ n (mg/L) `!4.J `�I i_ r
Total Produced )-1 2-c 2 � 9-D 9 9k :.fl?� 962 Spec.Cond. )� ` + Day 3
/C 1 (umhostcm) ( l (G -{`2 ,2() 14 Day 4 ��
Percent of Control producing third brood: / % Chlorine 1
(mg/L) .�C 11 40. l Day 5 t-U
Test Sample Organism Reproduction Receipt Sample Day 6 '(---
Temp.(°C) J.5 6. `( Terminated by: /--
Effluent%: q�
pH 1st Sample 2nd Sample 2nd Sample
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control <-(i I 7`19 (9((2 8.01 $,O? 8.02.
Adults Live/ Dead L r- - — - __- _ --3
Sample 7i 3 7 SS 7r l3 7 0 p 7 3 ? 733
Day#5 1 2 3 4 5 6 7 8 ill/.9 9 10 11 12, initial final initial final initial final
/ `7#Young Produced "� LI� 4//n 4/04/03//%'; 7,1 ((/'� 3/ef; rtl '''',7‘,,' L1/t) D.O. _ 1st Sample 2nd Sample 2nd Sample
r 759
Adults Live/Dead L. 1,___ <<. i-- L„.. ! Z....., --- ,2::_1 L Control co. 7r�Q 77 5 8, (57.�9
Day#7 1 2 I 33 (4,� /5� I 6 I
(f7 8 9 10 , 11 12 (�
#Young Produced I f 0 I /0 I /! ( 1 6 I et �J I /0 74I TO /!') Sample P•'l1 7 Q 3 8,07 7.97 8.35 7r SS
ff i I ( f initial final initial final mdiar final
Adults Live/Dead I (r I L-- 1 L-- I t-- 1 L IL IL— ill— it— I I �- I L•— I
^� ++ l ,1 Temp. 1st Sample 2nd Sample 2nd Sample
3I g� - W g( (9-) .9-`/ J �J ,2 Control P1.1 ;� . '3 .?`�• )-'-j.ij 9y- ,y 7
Total Produced � � �
Comments: Sample ;�LI, L 9y �tf S ?11,4/;>t/•5
initial final initial final instal final

Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 01/28/21
Facility: PIEDMONT TRIAD REGIONAL WATER NPDES#: NC0087866 Pipe#: County:RANDOLPH
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: 5.38% CONTROL 90% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 279 264
Mean # Neonates 23 .250 22.000
Standard Deviation 2.006 1.809
Coefficient of Variation 8.627%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 C 20 -3 .2500 13 C 24 0.7500
2 E 19 -3 .0000 14 E 23 1.0000
3 C 21 -2.2500 15 E 23 1.0000
4 C 21 -2.2500 16 E 23 1.0000
5 E 20 -2.0000 17 E 23 1.0000
6 E 20 -2.0000 18 C 25 1.7500
7 C 22 -1.2500 19 C 25 1.7500
8 C 22 -1.2500 20 C 25 1.7500
9 E 21 -1.0000 21 C 25 1.7500
10 E 21 -1.0000 22 E 24 2.0000
11 C 23 -0.2500 23 C 26 2.7500
12 E 22 0.0000 24 E 25 3.0000

SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 3.0000 -3.2500 0.4493 6.2500
2 2.7500 -3.0000 0.3098 5.7500
3 2.0000 -2.2500 0.2554 4.2500
4 1.7500 -2.2500 0.2145 4.0000
5 1.7500 -2.0000 0.1807 3.7500
6 1.7500 -2.0000 0.1512 3.7500
7 1.7500 -1.2500 0.1245 3.0000
8 1.0000 -1.2500 0.0997 2.2500
9 1.0000 -1.0000 0.0764 2.0000
10 1.0000 -1.0000 0.0539 2.0000
11 1.0000 -0.2500 0.0321 1.2500
12 0.7500 0.0000 0.0107 0.7500
1
W = X 75.4140
80.2500
Calculated W = 0.940 Critical W = 0.884
0.940 a 0.884
The reproduction data is normally distributed
evaluated at a 99% confidence interval.
Test Passes!
F test for Homogeneity of Variance
Control variance 4.0227
F = _ = 1.23
Effluent variance 3.2727
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
1.23 5 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

EQUAL VARIANCE t TEST
23 .3 - 22.0
t = = 1.603
0.780
Degrees of freedom = 22
Critical t = 2.508
1.603 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99. confidence interval.
Chronic Test PASSES

MERITECH, INC. (Lab #027) Meritech Sample ID#: 0 f ((1 '} )t-
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedPmeritechlabs.com Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: 1(2k)!k PO#:
` NPDES#: NC t iC u/ O 2C)
Contact Person: I Ac,fei;Li de.c./r-,ch
Address: .72(1 7 ACil�...44Z=i �,-7-,--,n't p_ci Phone: 3 3'6. 8, 5 iU
City: (2 4./,'1 al(.604.;t f Pipe#:
County: State: 1V Zip: 2 ,51 -
SAMPLE INFORMATION
tl/)
Sample Site: L1- (V,wt
Sample Type: XGrab ❑Composite #of containers: Z
Sampling Time: Start Date: Start Time: AM PM
End Date: t l 0`Z- ( End Time: a•'2 1J. PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE. Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
),,/.� i
Collectors Name: Print: I r ?vv r% �e,if Signature: i,-2^' ?s! _e"71/
TOXICITY TEST INFORMATION
Test Required: gChronic(7 days) Test Organism: 0Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday*"
Comments:
//� J SHIPPING INFORMATION
Relinquished by: '„'/:414,4l!���/� Date: V/q/11 Time: e2c5 d)PM
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Sample Temperature(°C): 6. U
Method of Shipment:❑ UPS ❑ Fed EX j Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED"
SAMPLE RECEIVING(Laboratory Use Only)
I Relinquished by: \.(0)C .)rc;'r 1
f lI )
�' 0 AM PM
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S .� uci
Sample Temperatures(C): l' . i i / Sample Condition: _
WHITF = Laboratory cony YELLOW= Client coDv -4111111MEMI�

MERITECH, INC. (Lab #027) Meritech Sample ID#: L'i 31)1 —fi
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedAmeritechlabs.com Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: T' wr\��ci \ c PO#: -
aC
Contact Person: - � C - YI .F-_.� NPDES#: NC C II:
Address: \^ n�f 1 � -r-1� *'-ley- I.ti. ) .4 , Phone: iLc - 4C ?— 55IU
City: G_Y at 9,1'rJcf) Pipe#: 1
` `—t
County: {�qr1[„ elf—) State: Zip: I ,
I I SAMPLE INFORMATION
Sample Site: E 1'/U L.�. -
Sample Type: 1iGrab ❑Composite #of containers:
Sampling Time: Start Date: Start Time: AMM PM
End Date: I —21 - 1 1 End Time: e t 33 AM PM
"""Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
T sample must be<0.f6°C upone receipt at Meritech'""
Collectors Name: Print: i 11Ol1'1& 4e_d i'c(G Signature: au---` to Z
TOXICITY TEST INFORMATION
Test Required: J1 Chronic(7 days) Test Organism: [X Ceriodaphnia dubia (water flea)
ElAcute(24-48 hours) <❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: % """Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
��/�� SHIPPING INFORMATION i f
Relinquished by: i/.!2'z:s; .���, . Date: I- 2 1"Z 1 Time: I 3 t AM 0
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Sample Temperature(°C): 7' 1--
Method of Shipment:❑ UPS ❑ Fed EX Meritech Pick-up ❑Delivered 0 Other
A-
1*Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED"'
SAMPLE RECEIVING(Laboratory Use Only)
Relinquished by: L.— C !�/'�
r
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Received by: Date: �/ I \�
Sample Temperatures GC. I i tii 1 I I Sample Condition: 1 /i 2 iy
i
WHITE= Laboratory copy YELLOW=Client copy -

Meritech, Inc.
Environmental Laboratory
. Laboratory Certification No.165
imo
Contact Thomas Hedrick Report Date: 5/4/2021
Client: PTRWA NPDES#: NC0087866
7297 Adams Farm Rd
Randleman,NC 27317 Date Sample Rcvd: 4/20/2021
Meritech Work Order# 04202198 Sample: Effluent Grab 4/20/21
Parameters Results Analysis Date Reporting Limit Method
Ammonia,Nitrogen 0.2 mg/L 4/26/21 0.1 mg/L EPA 350.1
Aluminum,total <0.050 mg/L 4/29/21 0.050 mg/L EPA 200.7
Copper,total 0.002 mg/L 4/29/21 0.002 mg/L EPA 200.7
Manganese,total 0.757 mg/L 4/29/21 0.005 mg/L EPA 200.7
Phosphorus,total 0.032 mg/L 4/27/21 0.020 mg/L EPA 200.7
Zinc,total <0.010 mg/L 4/29/21 0.010 mg/L EPA 200.7
Hardness(titration) 52 mg/L 4/22/21 1 mg/L SM 2340C
Meritech Work Order# 04202199 Sample: Upstream Grab 4/20/21
Parameters Results Analysis Date Reporting Limit Method
Hardness(titration) 36 mg/L 4/22/21 1 mg/L SM 2340C
I hereby certify that 1 have reviewed and approve these data. ,d ,rfio[ N a `±,/
Laboratory Representative
642 Tamco Road,Reidsville,North Carolina 27320
tel.[phone] fax.[phone]

59,E Chain of Custody Record (COC) NPDES#: N� OG�Y,' , , •(�6
M ERITECH INC. lient: I Phone: ��? . yqe - srt1
�, ) �' Address: �1 �11��N1�i tA1V4 !7 Fax:
!'+� ENVIRONMENTAL LABORATORIES IZFci�l��1 M�iN / �(L Email: - :''drtc k id, #i- -tnlc) •Or`-i
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Start End Comp? #of On Ice? pH OK.
Date Time Date Time Grab? Cont. Test(s) Required On
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FF1-UFAJ Wain 111' 11ldi}) 6 I 1-INVRIC-S.S `t`o
LT II t.rat—, Ll1Zuf•ZI `•l : Ill',Al 61 I 1 / LiAi-, (7.11, Mn;Ai,cu)
En:i-[OK 1///W/xl `I'1"i2r, 6-1 I KKT J. Qlo\
[if F).uklkrr (-/f2d/a_\ 61.15Lrr 6-7 I ArJNtoxrTA J J TIZOwc?t
t)rsi -cA 1)/1.o(,ri ri 0(', 10 (-i I I It IzD J B5 5
Temperature Upon
Receipt:
Method of ***Dechlorination(<0.5 ppm)of Ammonia,Cyanide,Phenol and TKN samples must be done in the field prior to preservation.***
Comments: Compositor#
Shipment:
UPS lug#
Li Fed Ex Are these results for regulatory purposes? Yes ❑ No Li Report results in: mg/L Ti mg/kg U ug/L I i
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Hand Dali,yary .e.$c i, E [�1 / /V
��J�/V �iJ(��y��n, J „uwL /�(Q/� r�> J •.. i—,ti /" 1^� I/c'u/G i
LI Other Relinquiss) 1': / ,// t� Time: Received by: �, / Date: Time:
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Relinquished by: Date: Time: Rec ef `by La : (,(f 2 Date: Time: 9i Y,0
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Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 04/28/21
Facility: PIEDMONT TRIAD REGIONAL WATER NPDES#: NC0087866 Pipe#: County: RANDOLPH
Laboratory Performing Test: MERITECH LABS, INC.
Comments:
X
Signature of Operator in Responsible Charge
X 2 if
Signature of Laboratory Supervisor * PASSED: -4.31% 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 = -0.545
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -4.31
% Mortality Avg.Reprod.
# Young Produced 24 16 11 24 16 21 18 19 20 23 22 18 -
0.00 19.33
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 20.17
Treatment 2 Treatment 2
Effluent %: 90%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 ii 12 Control CV
19.891% PASS FAIL
# Young Produced 19 22 18 28 25 17 20 18 19 16 23 17 % control orgs X
producing 3rd 1
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: 04/21/21
Control 7.90 8.08 7.93 8.01 7.93 7.86 Collection (Start) Date
Sample 1: 04/20/21 Sample 2: 04/22/21
Treatment 2 7.69 7.56 7.60 7.55 7.44 7.01 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 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X hrs T P P
1st sample 1st sample 2nd sample -
D.O. - Hardness(mg/1) 44
Control 7.86 7.66 7.86 7.72 7.91 7.39
Spec. Cond. (pmhos) 158 217 200
Treatment 2 8.10 7.50 8.27 7.80 8.07 6.81
Chlorine(mg/1) <0 .1 <0.1 I
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 0.9 0.5
(Mortality expressed as %, combining replicates) I
Note: Please
% % % % Concentration Complete This
Section Also
% % % o % % % % % Mortality
start/end start/end
LC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit _
% -- a 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)

Meritech, Inc. (Lab #027)
/� T Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#: 3
Client: /"r Pi//'1611 1/ /c 4 R I✓ Pipe#: County: n7(i I ,k_ Date Start: Li- a I- I Date End: (-/- 2 7 .2/
NPDES#: NCL'_ ',a'l(,, Date/Time of Culture Transfer:y".?6-� !0 : A-A Time Start: /%', "> ,,q,,-k Time End: . ' rn
Dilution Water: Lake Brandt Date/Time Neonates born: I / ?Ofi .- Of,n 1st Renewal Date: Li- �3 Time:
Test Organism Source: Tray# �j Age of onates at Test Start: 9a•7� hours! 2nd Renewal Date: ','�L aj Time: / 64,-,
Stirred/Aerated for D.O.: Y/NV Randomized:(Y/N Culture Tray Temp: )-y •'' °C Analyst(s): MR,Lv,KS,KL Reviewed by:
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
Sample 1: Li-2')--.( Sample 2: 14-,;27-- /
#Young Produced 0 0 0 0 0 0 0 , 0 0 0 0 0
Adults Live/Dead L__ (_-, L L L L_ L L L--- L j ( Sample Information
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 100% pH G/C? Duration
#Young Produced 4110 `4I(p Lill tom qi t6 CIE iI(6. 3 lei 31 q y(8 `f 17 tIls Sample 1 7, 7 r CJ a- — hours
Adults Live/Dead t-- l_ L _ L- t— t- L _ 1. L- L L 1- Sample 2 7i (Q G — hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Transferred by: Fed by
#Young Produced /r) UBatch# Sample 1 Sample 2
b �� 7 ` // 1 �C�) SC `-�� Day 0 ✓V< L✓
Adults Live/Dead L., C.__ L_ [_ L L< L I_ L_ _ L L ( Transfer Day 0 2 5 , Day 1 --
Hardness
u t�/ _-� Day 2 /` n . /
d Total Produce / a „ (-/ /6 1( f f 1 �j Day 3 Nt17
l Spec.czci; p
� (umhos/cm /j/1 / .)• > a� 11 0C Day 4 N't-'
Q
Percent of Control producing third brood: !/ 7 % chlorine //-� Day 5 �/
(mg/L) L O. I .-C(i
Test Sample Organism Reproduction Receipt Sample Day 6 t
Effluent%: goTemp.('C) -Y=a ¶ '9 t Terminated by:/v4
Day#2 1" 2 3 4 5 6 7 8 9 10 11 12 pH 1st Sample 2nd Sample 2nd Sample
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control 7 (C ( ,ct; 7?3 t?,01 7,13 7 (,
Adults Live/Dead j_ C..— (_ L. L L, L L L_ -7 ��p t `7 5
Sample ,, (, � 7)4Q 7.,`j5 7,�f� �.U1
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 initial final ' initial final initial final
#Young Produced 3/$ 9 K 3t1 1 (pht Y(l) z mil( (Q((4 u
"N II5j 3/5 31,v /:/ D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/Dead L L- L l_ L L I- L L-- t- Control ' 6 771b6 7 6 472 7,(1( 121
Day#7 1 2 3 4 5 6 7a 8 9 10 11 12
#Young Produced 1 % I /C, 1 1 it 1 /I ( 9- 1 `� /c I/5. I i( l L__ Sample S, I° 7'1C 6127 7, N ,Q7 b.`�I
initial final initial final in a nal
Adults Live/Dead L r 1 t i i„_ L _
t t t f t t It t t t.r t_ t L t I
I
Temp. 1st Sample 2nd Sample 2nd Sample
Total Produced ( � r' fi9,y5-.4. 9 ' ! l L 9.7 /7 Control 1,1_,e Z.6' tf,q'-5-j) 1?`4`1 .N
Comments: �+R y,z 7 2J Sample �qt 4n'1.a 121f,'i 3'f. 1 1- .7 .�7
mitia final initial final m is final

MERITECH, INC. (Lab #027) Meritech Sample ID#: G 7ac --5")
Bioassay Sample Chain of Custody
.* 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reed anmeritechlabs.com Web Site: www.meritechlabs.com
� ' t A CLIENT INFORMATION
Client: l R tN PO#:
Contact Person: NbMf1.5 ue-DP Z- NPDES#: NC008'7-p“,
Address: Zq 1 ADIMv, FAR-AA 129 Phone: 3336.>- 4 96- -S 5-(0
I City: Npi-t=MPvN Pipe#:
County: State: /VC Zip: 27311
SAMPLE INFORMATION
Sample Site: EFFLU>rkr
Sample Type: 5XE,Grab ❑Composite #of containers: 2
Sampling Time: Start Date: /�J�/ 7 Start Time: q �1 AM PM
End Date: Lt/Z,o Z`1 End Time: 1 't'1Lr✓I AM PM
**".Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with Ice. The
sample must be<0.6°C upone receipt at Meritech"*
Collector's Name: Print: 1GMktS REDUCK Signature: ,7:
TOXICITY TEST INFORMATION
Test Required: X Chronic(7 days) Test Organism: Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday*"
Comments:
SHIPPING INFORMATION
Relinquished by: Date: "/ / l/OZ / Time: /992 AM PM-
Received by: Date: AYZ/ Time: I9 tiZ A M
Relinquished by: Date: /20 Z( Time: ),-LILT AM M
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ( Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED"
�/� SAMPLE RECEIVING(Laboratory Use Only)
Relinquished by: A I t Y?C`(,'(A
Received by: W `V•,`il'\_ v e '��'Date: i � Time: I`ct! AM gt 1 I
Sample Temperatures(°C): \ t.;'i / C r / / Sample Condition: IC. y/
WHITE=Laboratory copy YELLOW=Client copy -4111111111•111

MERITECH, INC. (Lab #027) Meritech Sample ID#: 0IAaaA""S
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reed@ meritechlabs.com Web Site: www.meritechlabs.com
j� CLIENT INFORMATION
l ` t `Client: l/, PO#:
Contact Person: �1-toNtit5 4EI9ATC(C NPDES#: NC OC 5(cIi✓
Address: -}�j7.,d{I- &OAM S I"jh;QM. Rp Phone: 33(o gig--5 S to
City: 'A.Ni)i-(:fAot Pipe#::
County: State: AY C Zip: 21311
t� SAMPLE INFORMATION
Sample Site: L FFL, _t Sample Type: / Grab CD Composite #of containers: 2
Sampling Time: Start Date: Start Time: AM PM
End Date: 4/21007-\ End Time: `6.2a44'1 6 PM
•"Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech—*
Collector's Name: Print: Signature:
TOXICITY TEST INFORMATION
Test Required: ( Chronic(7 days) Test Organism: ❑Ceriodaphnia dubia (water flea)
(❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday'"
Comments:
SHIPPING INFORMATION
Relinquished by: Date: V j z/aQ 2 I Time: q i v q AM PM
Received by: Date: Li r `art Time: 0 l Oy AM PM
Relinquished by: Date: pa t OQ.t Time: IP' A 9,
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS 0 Fed EX •Meritech Pick-up ❑Delivered ❑ Other
"Samples shipped on Friday must be FedEx and must clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED"
SAMPLE RECEIVING(Laboratory Use Only)
Relinquished by: Q rc
Received b ( Date: Y ()1 `, Time: L (.0 AM 1i;M
Sample Temperatures(°C): 0-5 / G.\ / / Sample Condition: T L
WHITE= Laboratory copy YELLOW=Client copy -411111 •111111

Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 04/28/21
Facility: PIEDMONT TRIAD REGIONAL WATER NPDES#: NC0087866 Pipe#: County:RANDOLPH
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -4.31% CONTROL 90% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 232 242
Mean # Neonates 19.333 20.167
Standard Deviation 3.846 3.639
Coefficient of Variation 19.891%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the of survival is not
proportion
significantly different for the control and the effluent groups.
Test Passes:
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 C 11 -8.3333 13 C 19 -0.3333
2 E 16 -4.1667 14 E 20 -0.1667
3 C 16 -3.3333 15 C 20 0.6667
4 C 16 -3.3333 16 C 21 1.6667
5 E 17 -3.1667 17 E 22 1.8333
6 E 17 -3.1667 18 C 22 2.6667
7 E 18 -2.1667 19 E 23 2.8333
8 E 18 -2.1667 20 C 23 3.6667
9 C 18 -1.3333 21 C 24 4.6667
10 C 18 -1.3333 22 C 24 4.6667
11 E 19 -1.1667 23 E 25 4.8333
12 E 19 -1.1667 24 E 28 7.8333

SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 7.8333 -8.3333 0.4493 16.1666
2 4.8333 -4.1667 0.3098 9.0000
3 4.6667 -3.3333 0.2554 8.0000
4 4.6667 -3.3333 0.2145 8.0000
5 3.6667 -3.1667 0.1807 6.8334
6 2.8333 -3.1667 0.1512 6.0000
7 2.6667 -2.1667 0.1245 4.8334
8 1.8333 -2.1667 0.0997 4.0000
9 1.6667 -1.3333 0.0764 3.0000
10 0.6667 -1.3333 0.0539 2.0000
11 -0.1667 -1.1667 0.0321 1.0000
12 -0.3333 -1.1667 0.0107 0.8334
1
W = X 300.3852
308.3333
Calculated W = 0.974 Critical W = 0.884
0.974 a 0.884
The reproduction data is normally distributed
evaluated at a 99% confidence interval.
Test Passes!
F test for Homogeneity of Variance
Control variance 14.7879
F = _ = 1.12
Effluent variance 13.2424
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
1.12 s 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

EQUAL VARIANCE t TEST
19.3 - 20.2
t = _ -0.545
1.528
Degrees of freedom = 22
Critical t = 2.508
-0.545 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99W confidence interval.
Chronic Test PASSES

' . Meritech, Inc.
Environmental Laboratory
Laboratory Certification No. 165
g<
Contact: Thomas Hedrick Report Date: 7/27/2021
Client: PTRWA NPDES#: NC0087866
7297 Adams Farm Rd
Randleman, NC 27317 Date Sample Rcvd: 7/13/2021
Meritech Work Order# 07132185 Sample: Effluent Grab 7/13/21
Parameters Results Analysis Date Reporting Limit Method
Ammonia, Nitrogen <0.1 mg/L 7/14/21 0.1 mg/L EPA 350.1
Aluminum,total <0.050 mg/L 7/23/21 0.050 mg/L EPA 200.7
Copper,total 0.003 mg/L 7/23/21 0.002 mg/L EPA 200.7
Manganese,total 0.387 mg/L 7/23/21 0.005 mg/L EPA 200.7
Phosphorus,total 0.025 mg/L 7/20/21 0.020 mg/L EPA 200.7
Zinc,total <0.010 mg/L 7/23/21 0.010 mg/L EPA 200.7
Hardness (titration) 48 mg/L 7/20/21 1 mg/L SM 2340C
Meritech Work Order# 07132186 Sample: Upstream Grab 7/13/21
Parameters Results Analysis Date Reporting Limit Method
Hardness (titration) 40 mg/L 7/20/21 1 mg/L SM 2340C
I hereby certify that 1 have reviewed and approve these data. 11/C1
Laboratory Representative
642 Tamco Road,Reidsville,North Carolina 27320
tel.[phone] fax.[phone]

5-9-1J1e Chain of Custody Record (COC) NPDES#: NC0087866
N M ERITECH1 INC. Client: PTRWA Phone: [phone]
Address: 7297 Adams Farm Rd Fax:
'% ENVIRONMENTAL LABORATORIES Randleman, NC 27317 Email: [e-mail]
642 Tamco Rd. Phone: [phone] Mailing: PO Box 1326 Project:
Reidsville NC 27320 Fax: [phone] Randleman, NC 27317
Email: [e-mail] Attention: Thomas Hedrick Turn Around Time*
How would you like your report sent? *RUSH work needs prior approval.
www.meritechlabs.com Email: [e-mail] Sld(10 Is) 3-5 Days 24-4RHrc
Person T king Sa le,�si /Print
Sampling Dates &Times �l '/ Lab Use Only
Sample Location and/or ID #
Start End Comp? #of Test(s) Required On Ice? pH OK?
Date Time Date Time Grab? Cont. (VT / No CI OK?
Effluent 7ff31zl e:3`12,,, G 1 Hardness ,e)
Effluent /�3 Jy, e 3N,,rn G 1 Metals (Zinc, Manganese,Aluminum,Copper)!
Effluent -1�11/?-i 0' ttIZr� G 1Phosphorus Total I,
Effluent 7/i3]7 l '6y14,1 G 1 Ammonia Nitrogen r
`d
Upstream 7/13/z 1 L;'XIAYI G 1 Hardness ti_,
Temperature Upon
Receipt:
Method of ***Dechlorination(<0.5 ppm)of Ammonia,Cyanide,Phenol and TKN samples must be done in the field prior to preservation.***
Comments: Compositor f#
Shipment:
_0 UPS Jug#
❑ Fed Ex Are these results for regulatory purposes? Yes ❑ No ❑ Report results in: mg/L ❑ mg/kg ❑ ug/L 1 i
El Relinquished by: Date: Time: Receive y. )(/ Jute/ Time:
Hand Delivery '//r119���i�►GLr�/ ��t3/rl U 5/1,✓7 i /U A,,.. '7//2/7./ � ��
❑ Other Relin d by1'( y� eyz, Time: I , 00 Receiv�dby: �� Da�eV Time: w
Re nguished by: / Die: Time: !� (J Received by Lab; -7^1 1,11 Date: Time:

Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 07/21/21
Facility: PIEDMONT TRIAD REGIONAL WATER NPDES#: NC0087866 Pipe#: County: RANDOLPH
Laboratory Performing Test: MERITECH LABS, INC.
Comments:
• Signature of O erator in Responsible Charge
• 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 = 7.630
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = 24.50
% Mortality Avg.Reprod.
# Young Produced 24 27 26 24 26 27 23 24 25 24 26 22
0.00 24 .83
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 18.75
Treatment 2 Treatment 2
Effluent %: 90%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
6 .386% PASS (FAIL
# Young Produced 20 17 17 21 20 19 22 17 16 15 21 20 % 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: 07/14/21
Control 8.23 8.07 8.15 8 .00 7.90 8.02 Collection (Start) Date
Sample 1: 07/13/21 Sample 2: 07/15/21
Treatment 2 7.65 7.76 7.66 7.62 7.54 7.61 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 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X hrs T P P
1st sample 1st sample 2nd sample -
D.O. Hardness (mg/1) 48
Control 8.15 7.60 8.02 7.75 8.04 7.25
Spec. Cond. (pmhos) 165 264 245
Treatment 2 7.97 7.68 7.87 7.74 8.13 7.23
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.3 1.6
(Mortality expressed as %, combining replicates) I
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)

Meritech, Inc. (Lab #027) -?
n_ Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#: J
Client: /`" I &WA Pipe#: County: i-. Date Start: -7✓I -Z( Date End: a/-,,,/
NPDES#: NC 7F( Date/Time of Culture Transfer: 7. 3, "/ Time Start: /1;a7AM Time End: .'D p\
Dilution Water: Lake Brandt Date/Time Neonates born: 4,. ) . .r 1st Renewal Date: 7- 1(, ,,-- .4 Time: 'S
Test Organism Source: Tray# Age of onates at Test Start:?,' 5 hours 2nd Renewal Date: 7'-1?- 1 Time: ice.' ►
Stirred/Aerated for D.O.: Y/iV Randomized. Y/N Culture Tray Temp: .S°C Analyst(s): MR,LV,KS,KL Reviewed by: 4,/•-.,
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Sample 1: -1 - 13-�1 Sample 2: -1_lc-d \
Adults Live/Dead _k_ - - - — i Sample Information
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 _ 100%pH G/C? Duration
#Young Produced q(s' ►1.I i I (1/t s /q T( �//c., L(/i 1140 ilk) ,.'/,,, ,, 6(/' ,Sample 1 7, t, , 6 — hours
Adults Live/Dead L_ I 1_ r✓ / L___ (_ 1 _ / _ LG L,"______ Sample 2 -7, ID( 6 — hours
Day#7 1 2 3 4 5 6 7 `8 9 10 11 12 Transferred by: Fed by:
#Young Produced 1112 /� ( /( 12 (o' (C' ID 1 q j( i(T Batch# 5r, ffin Sample 1 Sample 2 Day 0 /"l+2 i,✓
Adults Live/Dead •'t_ L_ L_ L L- I . � L- L L_ L Transfer Day 0 2 5 7 Day 1 pt(Z
Hardness �y Day 2
- — (mg/L) �Z Y .
Total Produced '� h-Z 2L f 97 ?3 2'f 74 ,�t, 2 AI
Day 3 ltiii-
Spec.s/cm) // _paingi
/ (umhosicm) 16 Day 4 1�
Percent of Control producing third brood: / C ti % Chlorine `: ,f
(mg/L) c k LO I Day 5 /�'�L 1/
Test Sample Organism Reproduction Receipt Sample -- '4 Day 6 /r'�
Effluent%: p Temp.(°C) Lt,;} : , II!' • , '.' h.Ip Terminated by: /.A.
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 pH 1st Sample 2nd Sample 2nd Sample
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control 2-A3 B•07 Igi .IS .00 7,9c (5.02
Adults Live/Dead (_- ..._....-4Sample �1•� lilo (9.1pb 7.62 ,54 761
Day#5 1 2 3 4 5 6 7 8 9 10 11 1 withal final initial final initial final
#Young Produced /x 3/ 3„ L(/, 1/7 3/7 Lys y � 3 3/6 Y/7 7 D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/Dead L, L_ L L_ L_ y 2- L l _ L 221
L
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Control $,I S� -1.12 o ��7S �'0
'%�L`
I #Young Produced 7 , T 9 j 61 ? q /0 10 5 /6, /13 Sample ?.fit 1 i.41 71 74f 1117,23
Adults Live/Dead 1-- L- L._. ` I L_ L L 1 L_ L L L India] final inin
Temp. 1st Sample 2nd Sample 2nd Sample
Total Produced 17 17 IA I9' )1 O� )7 (9 / Control y 9 7L f 7 tj 14 9 ac,1
Comments: Sample P.a 2.5,v ?to/ Ai 4 )11- a+1.7
initial final A withal final initial final

MERITECH, INC. (Lab #027) Meritech Sample ID#:0 (� )2I
%' Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedt meritechlabs.com Web Site: www.merltechlabs.com_
�� �� CLIENT INFORMATION
Client: 'I PO#:
Contact Person: 1 i4cN4.4 /t,6f7li lL NPDES#: NC 0OS 4E3 c E;
Address: -7"2.1-7- ACPAM,h FARtvt 120 Phone: .'7(_i, ~1 K 6 • 5,5 1 o
City: 1Zpol)Di-L`MA1I Pipe#:
County: State: AJC Zip: G 71 i 1-
SAMPLE INFORMATION
Sample Site: rrrW ENT
Sample Type: M Grab ❑Composite #of containers: 2
Sampling Time: Start Date: Start Time: AM PM
End Date: 0/7 1 End Time: 8.32 AM PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print: ((}0. ri H tf)/Z.Gf( Signature: '
TOXICITY TEST INFORMATION
Test Required: Chronic(7 days) Test Organism: [ ('Ceriodaphnia dubia (water flea)
Li Acute(24-48 hours) /❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
/� SHIPPING INFORMATION /�
Relinquished by: -/� J/ ,,„. CG,/! Date: 7 117/ I Time: •`03 AMA •M
Received by: f Date: 7/1- Time: /ii.0 AMi 40
Relinquished by: f/ ail_ Date: Time: /50d AM falp
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:[] UPS ❑ Fed EX Meritech Pick-up ❑Delivered ❑ Other
-*Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED
II l �, SAMPLE RECEIVING(Laboratory Use Only)
Relinquished by: 1\ ' v'efe:gyp.
n
Received by: (({(Y� j � Date: 7 �� ��( Time: AM OM
Sample Temperatures(°C): i 1 / k r I / Sample Condition: t_Ctft( _
WHITE=Laboratory copy YELLOW=Client copy -.11111MMINIIIIIIIIIII

MERITECH, INC. (Lab #027) Meritech Sample ID#:C11'9 I-- 13
Alkt Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: [e-mail]_ Web Site: www.meritechlabs.com
-{ CLIENT_INFORMATIONI, � 1 �
Client: Pie,Ci pi(j1'1� I r 1 U IRetool I/1( 1-t At)-I'ilof( PO#:
Thoma. Nei NPDES#: NC Ott q-066,
Contact Person: 1 t
Address: t IA"4- /kJ94 15 f 2.fyY1 2d Phone: CM) ` ct e--5 5-IU
City: Rand 1e4'Vl/41 Pipe#:
County: rza,{r,hii. ih State: A)C Zip: 27111
SAMPLE INFORMATION
('-
Sample Site: t- lu 't"- �f
Sample Type: Grab El Composite #of containers: �^
Sampling Time: Start Date: Start Time: AM PM
End Date: -7/l5 / 1, End Time: Q 3 Z 6 PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with fce. The
sample m ust be<0.6°C upone receipt at Meritech***
Collectors Name: Print: i1C11✓1( i 44-0 4 Signature: fit //�' 1
TOXICITY TEST INFORMATION
Test Required: !X Chronic(7 days) Test Organism: ,fCeriodaphnia dubia (water flea)
❑ Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
Li Mysidopsis bahia (mysid shrimp)
IWC: % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATIONA
Relinquished by: •4/,b{l+j -� Date: 7' I ( Time: 1 !2.3 AM 0
Received by: Date: 2 Time: /Z :2, AM
Relinquished by: Date: 2/ Time: ig/Q AM ö
Received by: Date: Time: AM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:0 UPS ❑ Fed EX Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED"
SAMPLE RECEIVING(Laboratory Use Only)
Relinquished by: M I ' ►/�f� if GV f)
,� M 17 () AM
Received by: 6 1, J Date: rl`. t i) , Time: 1 (4v1
Sample Temperatures(°C): [1 U / 1 t 6 / / Sample Condition: I.k.TJ _
WHITE= Laboratory copy YELLOW=Client copy -411011111111.111111111111=

Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 07/21/21
Facility: PIEDMONT TRIAD REGIONAL WATER NPDES#: NC0087866 Pipe#: County:RANDOLPH
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: 24.50% CONTROL 90% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 298 225
Mean # Neonates 24.833 18.750
Standard Deviation 1.586 2.261
Coefficient of Variation 6.386%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 15 -3.7500 13 E 19 0.2500
2 C 22 -2.8333 14 C 26 1.1667
3 E 16 -2.7500 15 C 26 1.1667
4 C 23 -1.8333 16 C 26 1.1667
5 E 17 -1.7500 17 E 20 1.2500
6 E 17 -1.7500 18 E 20 1.2500
7 E 17 -1.7500 19 E 20 1.2500
8 C 24 -0.8333 20 C 27 2.1667
9 C 24 -0.8333 21 C 27 2.1667
10 C 24 -0.8333 22 E 21 2.2500
11 C 24 -0.8333 23 E 21 2.2500
12 C 25 0.1667 24 E 22 3.2500

SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 3.2500 -3.7500 0.4493 7.0000
2 2.2500 -2.8333 0.3098 5.0833
3 2.2500 -2.7500 0.2554 5.0000
4 2.1667 -1.8333 0.2145 4.0000
5 2.1667 -1.7500 0.1807 3.9167
6 1.2500 -1.7500 0.1512 3.0000
7 1.2500 -1.7500 0.1245 3.0000
8 1.2500 -0.8333 0.0997 2.0833
9 1.1667 -0.8333 0.0764 2.0000
10 1.1667 -0.8333 0.0539 2.0000
11 1.1667 -0.8333 0.0321 2.0000
12 0.2500 0.1667 0.0107 0.0833
1
W = X 79.6226
83.9167
Calculated W = 0.949 Critical W = 0.884
0.949 x 0.884
The reproduction data is normally distributed
evaluated at a 99k confidence interval.
Test Passes!
F test for Homogeneity of Variance
Effluent variance 5.1136
F = _ = 2.03
Control variance 2.5152
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
2.03 s 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

EQUAL VARIANCE t TEST
24.8 - 18.8
t = = 7.630
0.797
Degrees of freedom = 22
Critical t = 2.508
7.630 a 2.508
Test fails. There is a significant difference in reproduction
between the Control and the effluent evaluated at a 99% confidence interval.
Chronic Test FAILS
The mean # of young produced by each group is dissimilar

Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 08/05/21
Facility: PIEDMONT TRIAD REGIONAL WATER NPDES#: NC0087866 Pipe#: County: RANDOLPH
Laboratory Performing Test: MERITECH LABS, INC.
Comments:
X
Signature of^OpOperatoorr in Responsible Charge
X Signature f LaaboraEaiy-Supervisor ** Mann-Whitney U = 15.0
mummimimm
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t =
Tabular t =
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = 35.74
% Mortality Avg.Reprod.
# Young Produced 21 26 26 27 19 28 25 27 27 27 28 24
0.00 25.42
Control Control
Adult (L) ive (D)ead L L L L L L L L L L L L
16.67 16.33
Treatment 2 Treatment 2
Effluent %: 90%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
11.060% PASS FAIL
# Young Produced 23 23 19 6 24 0 3 22 23 7 23 23 % control orgs [ X
producing 3rd
brood Check One
Adult (L)ive (D)ead L L L L L D D L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 07/28/21
Control 8.02 7.98 7.99 8.11 8.07 8.04 Collection (Start) Date
Sample 1: 07/27/21 Sample 2: 07/29/21
Treatment 2 7.52 7.43 7.35 7.60 7.37 7.61 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 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X hrs T P P
1st sample 1st sample 2nd sample D.O. Hardness(mg/1) 48
Control 7.95 7.46 8 .01 7.80 7.92 7.62
Spec. Cond. (pmhos) 167 253 265
Treatment 2 7.98 7.42 8.07 7.80 8.43 7.55
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.3 1.8
(Mortality expressed as %, combining replicates) I -
Note: Please
% % % % % % % % % % Concentration Complete `Phis
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)

Meritech, Inc. (Lab # 027)
Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#:
Client: f77?14J4 Pipe#: County: Date Start: 7",2 r ( Date End: $--Y, 24
NPDES#: NC 4)CJ�37 (a(,Date/Time,or��LCultua Transfer-7.-P-7 Time Start f/;?ja,,¢w` Time End: 5: 3PAA\
Dilution Water: Lake Brandt Date/TimeTNeonatet born: : .` -SF I is 1st Renewal Date: '2 3( -2-1 Time: //-S�7.J,M
Test Organism Source: Tray# / Age of ygonates at Test Start:..37 hours 2nd Renewal Date: g -2/ Time: /0.`Og'4 M
Stirred/Aerated for D.O.: Y/ Randomized.Y/N Culture Tray Temp: )-y. , °C Analyst(s): MR,LV,KS,KL Reviewed by: /yyl
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
Sample 1: 7 272( Sample 2: 1'act-(
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0
Adults Live/Dead L_ - t- i ' Sample Information
Day#5 1 2 3, 5 6 7 8 9 1 11 �11 100%pH G//I C? Duration
#Young Produced 3 0-ri /i `s ( 7 ti% c ti14 4/`, -7/d Sample 1 7r I c> hours
Adults Live/Dead L L (__ L_ (-- t_ L i` L L Sample 2 7. Z41( C., hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Transferred by: Fed by:
#Young Produced Vg- 13 13 I S oA 1 y 15-1-3 /3 04 lc- (1 Batch# MAIM sample l Sample 2 Day 0 1"ik L. /
Transfer Day 0 2 5 Day1 '�
Adults Live/Dead L L L. L L.- IL L L. L L L �..�--.. ----'-=- -
HardnesMEI
Day 2 r`:- L '
42 Z 27 ) ' a$ 2ct `c Co
Total Produced �'7 �/ �7 �� �� Spec.Cond. ILI Day 3 �'
(umhos/cm) 167 so (5 Elm
Day 4 A"-
Percent of Control producing third brood:l/)(,) % Chlorine ('`
(m9iL) Q L G t Day 5/0 t \ /��.
Test Sample Organism Reproduction RecelPtsampie Day 6 /'^'Z
Effluent%:10 Temp.(CC) j 1.3 1.' Terminated by:.
pH 1st Sample 2nd Sample 2nd Sample
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 qq C C
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control t11.02 7'15 7.`99 8( it 6,C7 f7I21f
Adults Live/Dead L `__ ,- - -
Sample 7 52 7 43 7 3c 7,60 7,37 7,61
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 India! final initial final initial final
#Young Produced C 3/9 3/7 tj (. C 3 3 r., D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/Dead L L (_ L L 1 (- L I-- 1 _ L L Control 7 35 - pin 7 O '92 7, 2
Day#7 1 2 3 4 5 6 7 8 9 10 11 1 �Q� 71�Z G7 7�r y 7 �5
#Young Produced 7 Ip /1 C? r/it / 19 7io r i y . ,k i9 Sample 0, ( '
1 ` r/it
final initial final initial final
Adults Live/Dead L L ` L L L L - Tern'. 1st Sample 2nd Sample 2nd Sample
Total Produced t a3I gl ) q (p ay C 3 _' -33 7 j 3 Control Elmo MEE ?1'"C j. k
Comments: Sample EIM ►r , mom ✓', _2-4.
in is ma in to mat initial final

MERITECH, INC. (Lab #027)
Bioassay Sample Chain of Custody Meritech Sample iDft: 0,�1'J` _` )
E� 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reed agrneritechlabs.com Web Site: www.meritechlabs.com
f (� I f d CLIENT INFORMATION
Client: I�t1VV WA PO#:
Contact Person: �1 t}GMkS Cl}50rat44r NPDES#: NC 00578 (p(p
Address: 7�'2 I 1 AG1 1 5 I pi 2 Phone: (550 LI 15-- `7 7«J
City: LZ g j1 ci 1L}r'1,2/) Pipe#:
County: R a.uIr lr t1 State: I p L L Zip: 131 1'
r)-1j1 SAMPLE INFORMATION
Sample Site: !- 'U�.}-
Sample Type: Grab ❑Composite #of containers: ;-
Sampling Time: Start Date: 1- Start Time: AM PM
�T End Date: 7.1 l y Gj AM PM
End Time: ci :.2 PM
•**Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print: l f'�(IYj7 d,(1,- ck Signature: 4/he.1.k4,441
TOXICITY TEST INFORMATION I
Test Required: AChronic(7 days) Test Organism: AiCeriodaphnia dubia (water flea)
❑ Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: % '**Friday Samples for Chronic Fathead test must be collected after 9:00 a.m. on Friday***
Comments:
SHIPPING INFORMATION _
Relinquished by: '�iliYMi<er / Date: i12ili I Time: / ,`/O AM M
Received by: 44‹ MAW".
(. Date: 7/7 Z1 z f Time: 1 I /1 0 AM P l
Relinquished by: (r Date: 7/27(Z/ Time: y3v AM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C): _------
Method of Shipment:❑ UPS I j Fed EX ❑ Meritech Pick-up O Delivered ❑ Other
**Samples shipped on Friday must he FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED"
/I�� 1/1 SAMPLE RECEIVING{Laboratory Use Only)
Relinquished by: ' I ( C:ri Stln 1 ^� (J
Received by: ,� ,V`�A11' Date: 7'L 7 C I Time: f r �� AM `PI)A
vY�/ Pt/
Sample Temperatures(°C): (/ 7 / ( r' / / - Sample Condition:
WHITE= Laboratory copy YELLOW=Client copy

MERITECH, INC. (Lab #027) Meritech Sample ID#: U el 41`l _3
Bioassay Sample Chain of Custody
A 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: [e-mail] Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: P rrlo ti- __r�/i gri Z 5 one l Wale( ()4 Of rt-5 PO#:
Contact Person: i ma5 1ecLr is k / NPDES#: NC oo81-SG6
Address: 1-2.q 1. AC(evri6 Farm TL Cl.,. Phone: (330'j Q 8`6510
City: 1215 lalGrrla-V) Pipe#:
County: 2.am t 1 P I2 State: MC Zip: 213 l i•
SAMPLE INFORMATION
Sample Site: E J ,P I uC:r :t.
Sample Type: I/11.0rab ❑Composite #of containers: 2
Sampling Time: Start Date: Start Time: AM PM
End Date: 112 l I2OZ I End Time: 8.,33 AM PM
""Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech °
Collector's Name: Print: ThO rtus Pear lck Signature: -0 dY�G�Q%��t cG"
TOXICITY TEST INFORMATION
Test Required: pitChronic(7 days) Test Organism: Cerlodaphnia dubla (water flea)
❑ Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysldopsis bahia (mysid shrimp)
IWC: % ""Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION� p
Relinquished by: //. / Date: '"f f l 120 2- 1 Time: 5I AM PM
Received by: '? r, /4tf,`��,// Date: 7 ag d_ I Time: S 7 PM
Relinquished by: A e,k- -ce Date: 7. vZ% ' Time: 1 11 13 AM I A
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX N Meritech Pick-up ❑Delivered ❑ Other
Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED"
/� SAMPLE RECEIVING(Laboratory Use Only)
Relinquished by: /V i h )73 tC,(i(..w t 1,I
Received by: 1\rr Date: 7-)1 ) I Time: i (l l t
) AM `1-4N
Sample Temperatures(°C): 1 i / L ij / / Sample Condition: L tcl
WHITE= Laboratory copy YELLOW=Client copy -411111111MIIIMIN

Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 08/05/21
Facility: PIEDMONT TRIAD REGIONAL WATER NPDES#: NC0087866 Pipe#: County:RANDOLPH
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: 35.74% CONTROL 90% Effluent
# Replicates 12 12
Female Live 12 10
Adult Male 0 0
Adult Dead 0 2
Adult Mortality 0.00% 16.67%
# Neonates 305 196
Mean # Neonates 25.417 16.333
Standard Deviation 2.811 9.335
Coefficient of Variation 11.060%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 10
a/A = 1.00 b/B = 0.83
Success is: survival
Critical b value = 8
10 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 0 -16.3333 13 C 27 1.5833
2 E 3 -13.3333 14 C 27 1.5833
3 E 6 -10.3333 15 C 28 2.5833
4 E 7 -9.3333 16 C 28 2.5833
5 C 19 -6.4167 17 E 19 2.6667
6 C 21 -4.4167 18 E 22 5.6667
7 C 24 -1.4167 19 E 23 6.6667
8 C 25 -0.4167 20 E 23 6.6667
9 C 26 0.5833 21 E 23 6.6667
10 C 26 0.5833 22 E 23 6.6667
11 C 27 1.5833 23 E 23 6.6667
12 C 27 1.5833 24 E 24 7.6667

SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 7.6667 -16.3333 0.4493 24.0000
2 6.6667 -13.3333 0.3098 20.0000
3 6.6667 -10.3333 0.2554 17.0000
4 6.6667 -9.3333 0.2145 16.0000
5 6.6667 -6.4167 0.1807 13.0834
6 6.6667 -4.4167 0.1512 11.0834
7 5.6667 -1.4167 0.1245 7.0834
8 2.6667 -0.4167 0.0997 3.0834
9 2.5833 0.5833 0.0764 2.0000
10 2.5833 0.5833 0.0539 2.0000
11 1.5833 1.5833 0.0321 0.0000
12 1.5833 1.5833 0.0107 0.0000
1
W = X 914.6317
1045.5833
Calculated W = 0.875 Critical W = 0.884
0.875 < 0.884
The reproduction data is not normally distributed
evaluated at a 99% confidence interval
Test Failed!
Wilcoxon Rank Sum Test
Rank Sum - Effluent Group(treatment) : 93 Control Group: 207
Mann-Whitney U = 15.0 nl(treatment) = 12 n2(control) = 12
The critical value from TABLE A.15 (0.01 Level of T) for the above n values:
Critical T = 109
93 s 109
The Sum of the Ranks of the effluent group is less than or equal to the
significant value from the table. Therefore there is a significant
difference between the means of the effluent and control groups and the:
TEST FAILS
Chronic Test FAILS
One or both of the groups do not have an Normal Distribution

Meritech, Inc.
Environmental Laboratory
. Laboratory Certification No. 165
11111100
Contact: Thomas Hedrick Report Date: 10/29/2021
Client: PTRWA NPDES#: NC0087866
7297 Adams Farm Rd
Randleman,NC 27317 Date Sample Rcvd: 10/19/2021
Meritech Work Order# 10192139 Sample: Effluent Grab 10/19/21
Parameters Results Analysis Date Reporting Limit Method
Ammonia, Nitrogen 0.2 mg/L 10/21/21 0.1 mg/L EPA 350.1
Aluminum,total <0.050 mg/L 10/21/21 0.050 mg/L EPA 200.7
Copper,total 0.003 mg/L 10/21/21 0.002 mg/L EPA 200.7
Manganese,total 1.650 mg/L 10/21/21 0.005 mg/L EPA 200.7
Phosphorus,total <0.020 mg/L 10/27/21 0.020 mg/L EPA 200.7
Zinc,total <0.010 mg/L 10/21/21 0.010 mg/L EPA 200.7
Hardness(titration) 48 mg/L 10/21/21 1 mg/L SM 2340C
Meritech Work Order# 10192140 Sample: Upstream Grab 10/19/21
Parameters Results Analysis Date Reporting Limit Method
Hardness (titration) 40 mg/L 10/21/21 1 mg/L SM 2340C
I hereby certify that I have reviewed and approve these data. 1
)'(1-1—Lf I
Laboratory Representative
642 Tamco Road,Reidsville,North Carolina 27320
tel.[phone] fax.[phone]

Chain of Custody Record (COC) NPDES#: NC- Dab 4SG6
MERITECH lient: � Phone: L ;0� 196 ci-5/0
INC.�' � l�Address: R 29 1- Aac v]O Nii r) A Fax:
ENVIRONMENTAL LABORATORIES g4�()d etuo, �i}L. 2'-?i--1 Email: -�'�J�t��ic_l�U `� l 1- .0r)
642 Tamco Rd. Phone: [phone] Project:
(ii . ,
Reidsville NC 27320 Fax: [phone]
_ P.O.#:
Email: [e-mail] Attention: I �lul4;15 t DIZ1 (-1( Turn Around Time*
*RUSH work needs prior approval,
How would you like your report sent? charges Apply
www.meritechlabs.com Circle all that apply: l4preferred), Fax, Mail St(d( 0 Is) 3- 51___/)a s zn aB"rs
Person Taking Sa ie ig�P rint):
Sampling Dates & Times *le,t46.v l�l `-kif�l0i Redrick Lab Use Only
Sample Location and/or ID # Start End
Comp? #of Test(s) Required On Ice? pH OK?
Date Time Date Time Grab? Cont. �s / No CI OK?
�(( ' j I , llaidne,. "3 `i
(T�ily�1 '��r�t/��I v 1�.Jy�'. ��1 � /�'
ueevi-
i 6) 1 --[(1,-1-6,t Pilex,r t\o)-0,7
c'�/L(
4' 1 u L) '- ,NI;464 0 A),4- :le
Or A-fe 'fi}M /N/`r// i f'd0 zrl C-1 1- acucille. y U ..
Temperature Upon
Receipt: ,
Method of ***Dechlorination(<0.5 ppm)of Ammonia,Cyanide,Phenol and TKN samples must be done in the field prior to preservation.*** - i
Comments: Compositor#
Shipment:
D UPS
Jug#
LJ Fed Ex Are these results for regulatory purposes? Yes ❑ No ❑ Report results in: mg/L (] mg/kg Li ug/L [J
ri Relinquished by: � / Date: Time: Received by: l ate: . Timer Hand Delivery -'/` ?f;,(J' i -L!L. I�/i,r//,i ? it)
_ f / )�R, > / 0
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Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 10/27/21
Facility: PIEDMONT TRIAD REGIONAL WATER NPDES#: NC0087866 Pipe#: County: RANDOLPH l
LaboI%%i rat y Pe� s ing T MERITECH LABS, INC.
-,11,-----
Comments:
X
Signature o Op atori Responsible Charge
X f , %Zeo
Signature o a oratory Supervisor
millimimi
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 = 7.282
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = 34.63
% Mortality Avg.Reprod.
# Young Produced 19 21 20 23 24 22 22 24 22 22 19 19
0. 00 21.42
Control Control
Adult (L) ive (D)ead L L L L L L L L L L L L
8.33 14.00
Treatment 2 Treatmen 2
Effluent %: 90%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
8.554% PASS FAIL
# Young Produced 11 14 18 10 10 15 18 15 12 18 15 12 % control orgs [ X
- producing 3rd
brood Check One
Adult (L) ive (D)ead L L L L L L L L L L L D 100%
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 10/20/21
Control 8 .05 7.99 8. 01 8.14 8.10 8 . 01 Collection (Start) Date
Sample 1: 10/19/21 Sample 2: 10/21/21
Treatment 2 7.52 7.66 7.31 7.75 7.26 7.34 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 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X hrs T P P
1st sample 1st sample 2nd sample -
D.O. Hardness (mg/1) 48
Control 7.88 7.06 7.68 6.98 7.58 7.33
Spec. Cond. ()imhos) 162 266 280
Treatment 2 7.75 7. 17 7.35 7.15 7.59 7.30
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt (°C) 1.E 1.2
(Mortality expressed as %, combining replicates) l
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)
l

Meritech, Inc. (Lab # 027) -'
Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#: )
Client: 7 1 1-2-- 'v A Pipe#: County: 17Lks- _! Date Start: IL, -i_t -. t Date End: 0-2-7_2 i
NPDES#: NCC CSI1 t.:4' Date/Time of Culture Transfer: 10`lci -Al/ l L. '.. 1 ,- '•' Time Start: 1 1'.'-4(1 Pvf Time End: ;? �fit,,,\
Dilution Water: Lake Brandt Date/Time Neonates born: A / i -L,,,tr.- 5.-hc^rrf 1st Renewal Date: ) U--29. - ?•] Time: 1/.7/ Al-)
Test Organism Source: Tray# c Age of Neonates at Test Start: r\ hours 2nd Renewal Date: / " -.-?/ Time: ?. Li,241-7
Stirred/Aerated for D.O.: Y/© Randomized:0/N Culture Tray Temp: -i i °C Analyst(s): MR,Lv,KS,KL Reviewed by: . 1--
Control Organism Reproduction Collection (Start) Dates:
Day #2 1 2 3 4 5 6 7 8 9 10 11 12 Sample 1: I(2:-1c1-.It Sample 2: tCl--XI -). I
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0
Adults Live/ Dead C/ - Sample Information
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 100% pH G/C? Duration
#Young Produced 3f"1 318 3h7 41,13 31/c 'l4-1 31C1 LIIti 4-I0, ficl 3/- L // Sample 1 --1 , 14 L2 hours
Adults Live/Dead L- L- L- L- \•- L- L- (_ L-- L- L- /1_ Sample 2 l( .L i:, C.7 hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Transferred by: Fed c
f Batch# -� Sample 1 Sample 2
#Young Produced /O l U q ] 1 U l L, / 2, c` c, l C' :-' 'L�� S 3( Day 0 M 1- 1��
/ .�,• L r^ r LTransfer Day 0 2 5 Day 1
Adults Live/ Dead / 4— L L_ —
Hardness Day 2/-4L-- u
(mg/L) l 9 e
C,) 7,_,-.2) z-i : .� 2� ;�.,3 i
Total Produced ]1Spec.Cond.
(umhos/cm) Le
)'``y L.0 as
Day 4 /y .
Percent of Control producing third brood: /i.'f'- '% Chlorine
(mg/L) LG j 4C,. Day 5 /`�` L i
Test Sample Organism Reproduction Receipt Sample Day 6 r^'r'/
Temp.(°C) -l'% I'�1 Terminated by: L...
Effluent%: Ct C
pH 1st Sample 2nd Sample 2nd Sample
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control ,� C 1 C(4 1, ( l/ (Q 1 8'0]
Adults Live/ Dead i____` l— 3
Sample 7.5� �-40 1.3{ '�t�� 7,%�,
Day#5 1 2 3 4 5 6 7 8 �9 10 11 y1�2 moral final ra d ial final initial final
#Young Produced 3 I "L 3 :� 3 :3 9- t Li 3 / D.O. 1st Sample 2nd Sampllep 7,7(f 2nd Sample
Adults Live/ Dead it L L- L- l- L..- L �- �- �
Control .�`' c w 46 G rl Q 1; 5'E 7,33
Day#7 1 2 3 4 5 6 7 8 9 10 11 12
"15�,t�
1 #Young Produced ,� ,4iLi /Ci t 77 1/� �7- (/Y ((`? ( r� Sample 1 - ((4 70
/ t
� I� � � inrt�al final initial final !ntlial final
[Adults Live/ Dead I L- 1 L I i_ I <`- 1 1 /-• I �_ I i_ I Z- I �- I -- I `) I
Temp. 1st Sample 2nd Sample 2nd Sample
Control )`�,t '7 )-L/..3 )`( `S .e 25, 1
Total Produced 1 I I L{ 1,7 in ).0 /� 17 ]5 1� I =� .� i/� ,
Comments: • i Sample "I'Lf-• )1,`1 ?to. y 7 A7 ;26-37 final initial final initial final

•
MERITECH, INC. (Lab #027) Meritech Sample ID#: 1,01c) l -Jg.
Bioassay Sample Chain of Custody
A. 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: [e-mail] Web Site: www.merltechlabs.com
� CLIENT INFORMATION`,,y_ `��
Client: FelYv1E2tJl�`, Ur ta IGLc� OVIiy� �-te'r t� k r PO#: �7 �p
Contact Person: I iIGVY1f13 ,t�.-�••e r"ck NPDES#: NC 000I't 6,(0
Address: 72'1 i- Aztuis 1 f 11 Phone:(536.$) `q5.-- '5) 10
City: gQ, -_ teiWtd4/1 A , Pipe#:
'i2 County: . 'd o l pU 1 State: .�v - Zip: 2 q-ll
SAMPLE INFORMATION
g4J
Sample Slte: L)
Sample Type: Grab ❑Composite #of containers: 2-
Sampling Time: Start Date: 10//'1.!Z I Start Time: 0 i Z PM
End Date: I v f t(,l Z t 1 End Time: CJ l PM
""Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
e�sample1must be,<0 "
J.6°C upone receipt at Meritech"
Collector's Name: Print: g f<e r,I 4'r l Signature: .42,0-1 r Yt,
TOXICITY TEST INFORMATION
Test Required: Chronic(7 days) Test Organism: [ eriodaphnia dubia (water flea)
Cl Acute(24-48 hours) ❑ Pimephales promotes (fathead minnow)
❑ Mysidopsis bailie (mysid shrimp)
IWC: % `"`Friday Samples for Chronic Fathead test must be collected after 9:00 a.m. on Friday***
Comments:
/
SHIPPING INFORMATION /�
Relinquished by: !1 Date: /o/ q( 1 Time: 7-��C/ All PM
Received by: Date: r,Qr-/?-2 / Time: `�0 PMe
Relinquished by: ` Date((n-/ �/ .? // Time: 2 --7 AM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX Al Meritech Pick-up ❑Delivered ❑ Other
"Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED"
SAMPLE RECEIVING (Laboratory Use Only)
Relinquished by: P( �n -CI�C 4(l`i
Received by:
I()'`^‘ �f \ Date: 1 o -1 l 2( Time: 1 7 AM F(I)
1 r
,C
Sample Temperatures(°C): (i G / / / / Sample Condition: ` Ut( _
11111111111111101111111111111111,► WHITE = Laboratory cony YELLOW= Client cony -4110111.11=IMI

//11 \ 1`
INC. (Lab #027) Meritech Sample 10 tt: 1v v 1� 1 '�
MERITECH, P
1A Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedt meritechtabs.com Web Site: www.meritechlabs.com
CLIENT__ _ INFORMATION
�' •
�,
Client: 'P Pe(Yvrnr>,ir- 1`1 r ge`c,'�1/U f d Waif?, T 1V�'L PO#:
Contact Person: 1 l7n"6. I'-`C k.Yi C_. 0 NPDES#: NC QQ- e118tpi�
Address: l-7 ' 1 S I?Lrm .J. Phone: 33LP- `l IB- 5 I
City: `Q-frl an — Pipe#:
County: 1 ph State: /VC..., Zip: o?",3/ 7
SAMPLE INFORMATION
1
Sample Site: V 1 t O'li-
Sample Type: E Grab ❑Composite #of containers: p2
Sampling Time: Start Date: k0" O(1-o�` Start Time: e .li 4, AM PM
End Date: End Time: AM PM
**'Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech'**
_�
l
Collectors Name: Print:�4.'v1 n� `1--curl Signature: l L
AQA/ TOXICITY TEST INFO MATION
Test Required: E Chronic(7 days) Test Organism: [ Cerlodaphnia dubia (water flea)
❑ Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
/�/� L
A SHIPPING INFORMATION
Relinquished by: // , uitA,\) ./L Date: J O- o)1 - 02 I Time: 7 0 y ,�� PM
Received by: CO1--J L - Date: /2/LI/2,l Time: ! 0 L( 6'J) PM
Relinquished by: Date: (ej/Z( /2 .i Time: 1 93 Q AM i�t 1
Received by: Date: J Time: AM PM
Relinquished by: Date: Time: AM PM I
Received by: Date: Time: AM PM 1
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED'*
f SAMPLE RECEIVING(Laboratory Use Only)
Relinquished by: P�I �IId L4Pco u.j
Received by: f W'V�• MVA Date: I 0 `2( 2 Time: / 7 0 AM lPt�l
Sample Temperatures(°C): dt2 I (r i i Sample Condition: 1 L P.0J _ \
WHITF = I ahnratnry cony YFI I OW= Client cony `ommi

Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 10/27/21
Facility: PIEDMONT TRIAD REGIONAL WATER NPDES#: NC0087866 Pipe#: County:RANDOLPH
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: 34 .63% CONTROL 90% Effluent
# Replicates 12 12
Female Live 12 11
Adult Male 0 0
Adult Dead 0 1
Adult Mortality 0.00% 8.33%
# Neonates 257 168
Mean # Neonates 21.417 14.000
Standard Deviation 1.832 3.015
Coefficient of Variation 8.554%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 11
a/A = 1.00 b/B = 0.92 1
Success is: survival
Critical b value = 8
11 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 10 -4.0000 13 C 22 0.5833
2 E 10 -4.0000 14 C 22 0.5833
3 E 11 -3 .0000 15 C 22 0.5833
4 C 19 -2.4167 16 E 15 1.0000
5 C 19 -2.4167 17 E 15 1.0000
6 C 19 -2.4167 18 E 15 1.0000
7 E 12 -2.0000 19 C 23 1.5833
8 E 12 -2.0000 20 C 24 2.5833
9 C 20 -1.4167 21 C 24 2.5833
10 C 21 -0.4167 22 E 18 4.0000
11 E 14 0.0000 23 E 18 4.0000
12 C 22 0.5833 24 E 18 4.0000

SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont. )
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 4.0000 -4.0000 0.4493 8.0000
2 4.0000 -4.0000 0.3098 8.0000
3 4.0000 -3 .0000 0.2554 7.0000
4 2.5833 -2.4167 0.2145 5.0000
5 2.5833 -2.4167 0.1807 5.0000
6 1.5833 -2.4167 0.1512 4.0000
7 1.0000 -2.0000 0.1245 3 .0000
8 1.0000 -2.0000 0.0997 3 .0000
9 1.0000 -1.4167 0.0764 2.4167
10 0.5833 -0.4167 0.0539 1.0000
11 0.5833 0.0000 0.0321 0.5833
12 0.5833 0.5833 0.0107 0.0000
1
W = X 129.3055 1
136.9167
Calculated W = 0.944 Critical W = 0.884
0.944 a 0.884
The reproduction data is normally distributed
evaluated at a 990 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Effluent variance 9.0909
F = _ = 2 .71
Control variance 3 .3561
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
2.71 s 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

Sodium Potassium Permanganate
Hypochlorite
Ferric Sulfate Fluoride
pH Adjustment pH Adjustment
Sodium Hypochlorite Polymer Sodium Hypochlorite Corrosion Inhibitor
Raw Water v , Raw Water v v v V V Dual Media Microfiltration v v V v 2-3 MG
> Flash Mix Clarifier > > > GAC Filters >
Intake 16.35 MGD Pump Station 16.35 MGD 16.35 MGD 16.2 MGD Filtration 15.6 MGD Membranes lass MGD 14.7 MGD Clearwells
14.7 MGD, Sodium Hypochlorite
0.15 MGD 0.6 MGD 0.75 MGD 0.15 MGD Ammonia
Sludge Blowdown { pH Adjustment
V
Finished Pump
Backwash V V V Station
10.51 MGD 4.19 MGD
V V
`/ Decant > V Llorth System South System
^ > Sludge Equalization
Thickener ( Sludge Lagoon
V Decant A > Decant Lagoon
pH Adjustment
Polymer Randleman Lake
v 1.75 MGD > Effluent > Outfall 001
Chamber/Meter
Plant Water Belt Press
0.1 MG Dechlorination
Press Decant
A
> Sludge Storage > Landfill/Land
Application
Drain V
JFK Water Treatment Plant Process Flow Schematic