NC0055786_2021 Pretreatment Annual Report_20220223

City of Lexington
Pretreatment Program Annual Report
January 1, 2021 to December 31, 2021

Narrative Summary
January 1, 2021 — December 31, 2021
City of Lexington
General Program Information:
A. AT, LTMP, HWA, SUO, ERP, IWS and IUP are up to date.
B. LTMP was updated and approved on 3/11/2021.
C. All dates on the Divisions Database Program Info Sheet are correct. A copy of our Program Info
Sheet is enclosed.
D. IUP for a new SIU (Egger Wood Products LLC,) was sent for approval to the Municipal Permitting
Unit on 2/17/2020. There were some concerns regarding BOD, TSS, and Silver and an updadate
of HWA was requested.
E. HWA was updated and sent for approval on 3/31/2021. Removal Rate spreadsheet reflected the
2020 BOD and TSS values and compared the site -specific removal rates to the literature values.
In addition, an updated HWA—AT spreadsheet with the updated BOD and TSS removal rate
values in the Pass -through loading calculations table was sent for approval too.
IUP for Egger Wood Products LLC, was approved on 12/15/2021
II. Toxicity Bioassay Analyses:
During the year of 2021, Lexington Regional WWTP has passed February (Ceriodaphnia Dubia,
Pimephales promelas), May (Ceriodaphnia Dubia, Pimephales promelas ), August (Ceriodaphnia
Dubia) and November (Ceriodaphnia Dubia) bioassay.
III. Letter of Delegation of Pretreatment Signatory Authority: Enclosed
IV. Asco Power Technologies — IUP #0038
A. SIU was not on SNC this PAR year.
B. Half of the BDL was used for the IDSF.
C. Annual inspection was performed on 12/10/2021. Inspection form is enclosed.
D. Certification letters for TTO are enclosed.
V. Schultz Container Service — IUP #0010
A. IU Permit was modified and approved on2/3/2021 reflecting the name change from Cardinal
Container Services, Inc. to Schultz Container Services, Inc

B. SIU was not on SNC this PAR year.
C. The IDSF for Schultz Container Services reflects monthly averages and half of BDL
D. Annual inspection was performed on 12/14/21. Inspection form is enclosed
VI. Hollywood Bed & Spring Mfg. Co., LLC— IUP #0028
A. IU Permit was modified and approved on 2/4/2021 reflecting the name change from Linwood
Hospitality LLC to, Hollywood Bed & Spring Mfg. Co., LLC
B. SIU was not on SNC this PAR year
C. Half of the BDL was used for the IDSF.
D. Annual inspection was performed on 11/30/2021. Inspection form is enclosed.
E. Certification letters for TTO are enclosed
VII. Matcor Metal Fabrication — IUP #0012
A. Half of the BDL was used for the IDSF
B. A NOV was issued on 3/1/2021for permit limit exceedance for Cu and Zn during routine
monitoring form the City of Lexington 1/25-29/2021. The situation was assessed, and corrected
measurements were taken to resolve and prevent the problem.
C. SIU was not on SNC this PAR year.
D. Annual inspection was performed on 12/17/2021. Inspection form is enclosed
E. Certification letters for TTO are enclosed
VIII. Tier Rack — IUP #0045
A. The IDSF for Tier Rack is not enclosed. No discharge has occurred in 2020. Tier Rack is
continuing to pump and haul to HAZMAT. The manifest is enclosed.
B. Annual inspection was performed on 12/16/2021. Inspection form is enclosed.
C. Certification letters for TTO are enclosed.
VIV. Egger Wood Products- IU #1114
A. New IU Permit was issued effective 3/16/2021. Approved on 12/15/2021
B. New plant inspection was performed on 2/5/2021. Inspection form is enclosed
C. A new sapling point will be used in 2022 and sedimentation with sludge removal will be added to
the process wastewater treatment after two days of sampling

PAR covers this calendar year => 2021
Control Authority=Program=Town Name => City of Lexin ton
WWTP = Wastewater Treatment Plant, use separate form for each WWTP. WWTP Name => Lexington Regional WWTP
SIU = Significant Industrial User NPDES # => NCO055786
SNC = Significant Non -Compliance
A SNCR Form must be submitted with every PAR- please wr;ta "IVnvro ;f ... I —A TAT_ CUT.. :« QATf" a..
Pretreatment Annual Report (PAR)
Significant Non -Compliance Report (SNCR)
uuTTTTg calendar year
SNC ? ( Yes / No)
IUP Pipe Industry Name Parameter for each 6-month period.
# # or "Reporting" Jan. - June July - Dec.
NONE
A L.
�y,y VL LllL. 1J1VIO V11 S ,,JLL)S ill 31Nk- n1sioricai xeport" for your POTW's SIUs behind this page.
Is the database correct ? Notify the Division of any errors ! Database indicates SNC history for previous years.
EVERY SNC MUST be explained in the Narrative, How was, is, or will it be resolved?
REPEAT SNCs are serious matters that MUST be explained in the Narrative.
Form name: PAR,SNCR,2001
Date Revised: 1/4/2001

Chapter 9, PAR Guidance
Pretreatment Performance Summ
PS
1.
Pretreatment Town Name: CRYof Lexington
2.
"Primary" NPDES Number NCO0 55786
or Non —Discharge Permit # if applicable =>
3.
PAR Begin Date, please enter 01/01/yyyy
4.
PAR End Date, please enter 12/31/yyyy
3 _>
1/1/2021
5.
Total number of SIUs, includes CIUs
4. _>
12/31 /2021
6.
Number of CIUs
5• =>
6
7.
Number of SIUs with no IUP, or with an expired IUP
6. =>
5
8.
Number of SIUs not inspected by POTW
7. =>
0
9.
Number of SIUs not sampled by POTW
8• _>
0
10.
Number of SIUs in SNC due to IUP Limit violations
9. =>
0
IL
Number of SIUs in SNC due to Reporting violations
10. =>
0
12.
13.
Number of SIUs in SNC due to violation of a Compliance Schedule, CO, AO or similar
Number of CIUs in SNC
_
11 >
12 _>
0
0
14.
Number of SIUs included in Public Notice
13 _>
0
15
Total number of SIUS on a compliance schedule, CO, AO or similar
14 —>
0
16.
Number of NOVs, NNCs or similar assesed to SIUS
15. _>
0
17.
Number of Civil Penalties assessed to SIUs
16.
18.
Number of Criminal Penalties assessed to SIUs
17. =>
0
19.
Total Amount of Civil Penalties Collected
18. =>
0
20.
Number of IUs from which penalties collected 19. _> $
0
20. _>
0
Administrative orderIUP Industrial User Pretreatment Permit
T
POTW
Categorical Industrial User NNC Notice of Non -Compliance
Publicly Owned Treatment Works
Consent Order SIU
NOV Notice of ViolationIndustrial
Significant Industrial
User
User SNC
PAR Pretreatment Annual Report
Significant Non
-Compliance
revised 1/2018: PAR —PPS 2018

Pretreatment Program Info Database
for Program Name Lexington
WWTP Name City of Lexington
Program Approval Date 06/10/1983
Pretreatment Status Full
Region WSRO
County Davidson
printed on: 1 /18/2022
Stream Information IWC % at 7Q10 60.03
() 1 17 {-low cfs / mgd 6.7 / 4.33
1 Q10 Flow cfs / mgd 5.57 / 3.60
Stream Classification WS-V & B
Basin Number YAD07
Receiving Stream Name ABBOTTS CREEK
NPDES Number NCO055786
Last PAR Rec 02/25/2021
PAR Due Date 03/01/2022
mercury
NPDES Effective Date 02/01/2021
1631
NPDES Expire Date
P� 04/30/2025
Current Fiscal 04/14/2021
required
Year PCI Done
es
POTW is Primary WWTP TRUE
Last Audit on 09/21/2017
Audit Year Next21/22
Design Flow mgd 6.5000 % Design
mgd is SIU permitted F-2.52-1
Permitted SIU flow (mgd) [Pt_SIU) •164
WWTP SIU's Program SIUs
WWTP CIU's P Program CIUsR
HWA LTMP
IWS SUO
ERP
date Inactive Date Next Due
07/01/2024
11/23/2025
Date Received by DWR
01/30/2020 09/24/2020
11/28/2020 01/08/2013
02/03/2020
Date Approved
07/16/2020 03/11/2021
12/02/2020 01/09/2013
02/13/2020
Adopt Date Required
Date Adopted
Info in this Box from Pt Contacts
PT Pro
Formal Name o.Prime Phonel ext
Ms. Eglantina Minerali jPrim 336) 357-7889
[e-mail] I Pretreatment
NOV: Failure to provide information
Date Date
Date
Attended Attended
Attended
Fax HWA Wksp IUP Wksp
PAR Wksp
11 1 /30/2019 1 5/17/2016
1 1 /29/2019
Program 128 W. Center Street
DWR Central Office Contact McGee & Miller
which DWR Regional Contact .iim Gonsiewski
No h i s-�oric� s N c

DocuSign Envelope ID: 9D3BB82D-06AE-4017-07AA-6997CA6FC72F
ROY COOPER
Governor
DIONNE DELLFGATTI
Secretary
S. DANIEL SMITH NORTH CAROLINA
oirector Environmental Quality
3/11/2021
Via Electronic Mail ([e-mail])
Ms. Eglantina Minerali
Pretreatment Program Coordinator
City of Lexington
28 W. Center Street
Lexington, NC 27292
Subject: Pretreatment Review of Long Term Monitoring Plans (LTMPs)
Program: City of Lexington
WWTP: City of Lexington WWTP - NPDES Number NCO055786
Davidson County
Dear Ms. Minerali:
The Municipal Unit of the Division of Water Resources has reviewed the updated Long Term Monitoring Plan
(LTMP) for the City of Lexington. The submission was received by the Division on September 24, 2020.
Additional information was received on March 1, 2021.
The review indicates that the LTMP is adequate and meets the requirements needed to establish a site -specific
Headworks Analysis (HWA). Proper implementation of a LTMP is also required by your NPDES permit. Please
refer to the Comprehensive Guidance for North Carolina Pretreatment Programs (Comprehensive Guide) for
additional information and examples. Modifications to this LTMP must be approved by the Division.
Regardless of this approval action today, within 180 days of the effective date of any reissued NPDES permit (or
any subsequent NPDES permit modification) the Permittee would be required to submit to the Division a written
technical evaluation of the need to revise local limits (i.e., an updated IWS, or documentation of why one is not
needed). This action may include revising, updating or adding to the list of Significant Industrial Users (SIU's).
If you have any questions or comments, please contact Michael Montebello at [phone] [email:
[e-mail]]. Thank you for your continued support of the Pretreatment Program.
Sincerely,
C464631431644FE...
for S. Daniel Smith, Director
Division of Water Resources
ksl/lexington LTMP _004
Ec: Municipal Unit File
Jim Gonsiewski, WSRO
Central Files (Laserfische)
.�_ North Carolina Department of Environmental Quality I Division of water Resources
512 North Salisbury Street 1 1617 Mail Service Center I Raleigh. North Carolina 27699-1617
r.�a,Ncaac--nn
/i°� 919.707.9000

LEXINGTON
NORTH CAROL 1 N A
WATER RESOURCES
QUALITY FIRST
January 28, 2019
NC Division of Water Resources - PERCS Unit
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Delegation of Pretreatment Program Signatory Authority
City of Lexington (NPDES Permit NC0055786)
Davidson County
Dear PERCS:
As the Mayor of City of Lexington, I hereby delegate responsibility for overall operation of the
City of Lexington's Pretreatment Program to E antina MineralL Laboratory Supervisor /
Pretreatment Coordinator.
This designation will provide Ms. Minerali with the authority to sign all required documents
under the Pretreatment Program, including the authority to sign the Pretreatment Annual Report
(PAR) and submit it to NC DWR PERCS.
If you have any questions, please contact me at [phone] or Eglantina Minerali at
[phone].
Sincerely,
Newell Clark,
Mayor
cc: Tom Johnson, Water Resources Utility Director, Public Services Admin
500 Glendale Road - "Lexington, NC 27292 - 336,357.7889
www.Ll.xlNGT0NNC.(; N,

ASCO POWER TECHNOLOGIES
UP #0038

Sample Location:
ASCO
MO.003237
Sample Date
1/11-1/12/2021
Spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells.
Rest of
worksheet is
protected,
password is
"2"
2) For below
detection data,
enter "<" in "<"
column, and
enter detection
level in Influent
or Effluent mg/I
columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 1/2 value
entered.
1/12-1/13/2021
0.002335
1/13-1/14/2021
0.003607
1/14-1/15/2021
0.002875
4/12-4/13/2021
0.000385
4/13-4/14/2021
0.001651
4/14-4/15/2021
0.000462
4/15-4/16/2021
0.00000
Used in Calculated
< mg/L Calculation lbs/day
Used in Calculated
< mg/L Calculation Ibs/day
.1
•1
1
Column Averages => 0.00182 123.525001 123.53 1 1.83 299.25000 299.25 6.21
Maximum 1 0.003607 234 1 1 6.10 743 22.35

AMMONIA
Used in Calculated
< mg/L Calculation lbs/day
1 .
1 •
1 11
��
11
111
0.32700 0.31 0.00
0.764 0.00
CADMIUM
Used in Calculated
< mg/L Calculation lbs/day
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0000
<
1 0.001
0.0005
0.0000
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0000
0.00100 0.00050 0.00001
0.001 1 0.00050 1.504E-05

CHROMIUM
Used in Calculated
< mg/L Calculation lbs/day
0.083
0.083
0.0022
0.064
0.064
0.0012
0.049
0.049
0.0015
0.042
0.042
0.0010
0.133
0.133
0.0004
0.014
0.014
0.0002
0.045
0.045
0.0002
0.09
0.09
0.0000
0.06500
0.06500
0.00085
0.133
0.133
0.0022407
<
•-
mg/L
Used in Calculated
Calculation lbs/day
0.228
0.228
0.0062
0.17
0.17
0.0033
0.089
0.089
0.0027
0.109
0.109
0.0026
0.145
0.145
0.0005
0.045
0.045
0.0006
0.133
0.134
0.133
0.134
0.0005
0.0000
0.13163
0.13163
0.00204
0.228
0.228
0,0061552
0.00250 0.00004
0.005 0.0025 6.749E-05

Used in Calculated
< mg/L I Calculation lbs/day
<
0.005
0.0025
0.0001
<
0.005
0.0025
0.0000
<
0.005
0.0025
0.0001
<
0.005
0.0025
0.0001
<
0.005
0.0025
0.0000
<
0.005
0.0025
0.0000
<
0.005
0.0025
0.0000
<
0.005
0.0025
0.0000
0.00500
0.00250
0.00004
0.005
0.0025
7.521E-05
#DIV/0!
0.00000

NICKEL
Used in Calculated
< mg/L Calculation lbs/day
0.226
0.226
0.0061
0.241
0.174
0.241
0.174
0.0047
0.0052
0.143
0.143
0.0034
0.122
0.03
0.122
0.03
0.0004
0.0004
0.123
0.123
0.0005
0.252
0.252
0.0000
Used in Calculated
< mg/L Calculation lbs/day
0.005
0.005
0.0001
0.012
0.012
0.0002
0.023
0.023
0.0007
0.008
0.008
0.0002
0.013
0.013
0.0000
0.013
0.013
0.0002
0.007
0.007
0.0000
0.007
0.007
0.0000
0.16388 0.16388 0.00259 0.01100 0.01100 0.00019
0.252 0.252 0.0061012 0.00 0.023 0.023 0.0006919

Used in Calculated
< mg/L I Calculation lbs/day
1.073
1.073
0.0290
1.232
1.232
0.0240
1.443
1.443
0.0434
0.7050
0.705
0.0169
0.438
0.438
0.0014
0.023
0.023
0.0003
0.92
0.92
0.0035
1.769
1.769
0.0000
0.95038
0.95038
01.01482
1.769
1.769
0. D4340 99

56.40000 56.40000 10.43532
94.48 94.48 18.32

Used in Calculated
Calculation lbs/day
45.25500
45.25500
1.06534
77.36
77.36
2.0884554

Pretreatment Annual Report (PAR)
Control Authority,
Industry
Town Name =>
City of Lexington
Name Asco Power Tech.
Industrial Data Summary Form (IDSF)
WWTP Name =>
Lexington Regional WWTP
IUP # 0038
Use separate forms for each industry/pipe
NPDES # _>
NC0055786
Pipe # 'O1
Enter BDL values as < (value)
1st 6 months, dates =>
1/1/2021 to 06/30/2021
2nd 6 months, dates =>
7/1/2021 to 12/31/2021
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations,(chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
w, mAmmonia
s mon is
2771 o months
I st 6 months
2ncl 0 months TITmonrs
znZl b mon hS s mon s
2nZi 6 mon s
8
8
8
8 8
8
8
234
23 730
170
9.16
123.5
15.00 299.3
48.9
1.38
Arsenic
UaOmium
Cliromium
st mont s2nd
6 months
I st 6 months
n i mont is
IstOmonths
2nt . months
8
8
8
8
0.0005
0.0005
0.133
0.103
0.0005
0.0005
0.065
0.019
0%
0%
0%
0%
0%
0%
0%
0%
opper
Uyanid a 1
Leadmercury
st mont s
2n mont is
st mont is
2n mont is
st mont is
2n y mont is
st i mont is
_nc mont is
8
8
2
2
8
8
0.228
0.125
0.0025
0.0025
0.0025
0.0025
0.132
0.041
0.0025
0.002
0.0025
0.0025
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
1 0%
0%
BDL => Below Detection Limit mg/I => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit Ib/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Ave period could be month, Qtr, or 6-month & if BDL, 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP => wastewater treatment plant
*Reflect monthly and daily limits half of BDL
Chapter: PAR Guidance File name: PAiBlIrBORAmkReV-mink jz *t *cIWB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or 6 mth Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Industry Name ASCO POWER TECHNOLOGIES
IUP # 0038
Pipe # 1
Nickel e
e e ium
Tilver
I
st 6 months
2nd 6 months
s mon s 2n(l()months
Islomonths
indt)Montlis
Ist6months
2n(16montiis
8
8
8
8
8
8
0.252
0.039
0.023
0.04
1.769
0.678
0.164
0.0185
0.011
0.0088
0.95
0.278
0%
0%
0%
10%
0%
0%
0%
0%
0%
0%
0%
0%
st 6 months
2nd6months
Ist6months
2nd6months
Ist6months
2nd6months
lst6months
2nd6months
2
2
2
2
94.48
11.17
19.6
15.76
56.400
8.57
18.67
15.40
st 6 mont s
2nd6months
Ist6months
2nd6months
Ist6months
2nd 6 months
I st 6 months
2nd 6 months
BDL => Below Detection Limit mg/I => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, f 1r, or 6-month & if BDL, 1/2BDL or zero values used. TRC => Technical Review Criteria WWTP => wastewater treatment plant
Chapter: PAR Guidance File name: P �LBorH�t�e�Geia�IlaQtJ sl�clliIB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each ]UP pipe - Page of

ASCO
Power
Technologies -
December 6, 2021
Ms. Eglantina Minerali
Lab Supervisor
Water Resources Department
500 Glendale Road
Lexington, NC 27292
RE: Permit (IUP #0038) TTO Statement
Dear Ms. Minerali,
Per the requirements of our TTO program I am submitting the following statement:
ASCO Power Technologies
PO Box 689
325 Welcome Center Blvd
Welcome, NC 27374
USA
T [phone]
"Based on my inquiry of the person or persons directly responsible for managing compliance with the
standards for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no
dumping of concentrated organics into the waste -streams has occurred since filing the last discharge
monitoring report. I further certify that this facility is implementing the toxic organic management plans
submitted to the Control Authority."
Best regards,
F,W=1101
Scott Baker
Welcome, NC Plant Manager
Life is On Schneider
Electric
i�tz��a�

ASCOPower
Technologies -
June 11, 2021
Ms. Eglantina Minerali
Lab Supervisor
Water Resources Department
500 Glendale Road
Lexington, NC 27292
RE: Permit CIUP #0038) TTO Statement
Dear Ms. Minerali,
Per the requirements of our TTO program I am submitting the following statement:
ASCO Power Technologies
PO Box 689
325 Welcome Center Blvd
Welcome, NC 27374
USA
T [phone]
"Based on my inquiry of the person or persons directly responsible for managing compliance with the
standards for total toxic organics (TTO), I certify that to the best of my knowledge and belief, no dumping of
concentrated organics into the waste -streams has occurred since filing the last discharge monitoring report. I
further certify that this facility is implementing the toxic organic management plans submitted to the Control
Authority."
Best regards,
ywpa
Scott Baker
Welcome, NC Plant Manager
Ii:_ tii l
Schneider
0 E I e c t r i c

SIU INSPECTION FORM
Name Of Industry: 4ti S IUP #
Address Of Industry: IUP Expiration Date:
Lz'
Industry Representatives: Title
. /..
POTW Representatives: Title--�2,f�
Date Of Inspection: .2 i0 Time Of Inspection: l ! am/ m
Purpose of Inspection: Annual Other De cribe)
POTW to which IU discharges lni _NPDES # S 5;
Is SIU currently in SNC? &60 — If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES
t
Raw materials used YES
Manufacturing processes YES
Categorical, if applicable Y NO
Production rate &NO
NO Io'%o
Number of employees SE3
Number of shifts YES / NO !_3 ra.
Comments:
4-1
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? (9 / NO Where do they go? Caye�.
2. Are production areas diked, co�ed, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? u" / NO Comments:
3. Are there floor drains in the storage area? YE O Where do they go?
4. Are storage tanks and areas diked, conta' r otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? S O Comments:
5. Are process and storage tanks and pipes labeled? O �} ,, ,,�
6. How are off -spec raw materials, and products disposed of? g4'C'jk
7. When is the production area cleaned?0��
8. Is the wastewater from cleaning the production area dk*arged to the POTW? ' YES
9. What non -process wastewaters are discharged to POTW?
Comments:
Title: SIU Inpsection Form
File name: COMPINSP App 7-D
Revision data: August 1, 1994 Page I

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? E / NO Comments:
—'e1
2.
3.
4.
5.
Are all units operational? /ft / NO
How often does operator/ma enancc
Is there an operator for each shift?
How and when is sludge disposed of?
person check system?
YES 40
6. Is there a schedule for preventative maintenance?
Comments:
YES / NO
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.) �
1. Does an outside lab complete sampling? C'� �/ NO If yes, name of lab. 9'
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3. Is flow measurement equipment operational? gTE� NO Comments:
4. Is there a calibration log for the flow meter? " / NO Comments:
Comments:��7'`�'
PART III - EXIT INTERVIEW
Review monitoring records and other SIU records required by IUP.
1. Are files well organized? 0�1 / NO Comments:
2. Are sample collection / chain -of -custody forms filled out properly? Y / NO Comments:
3. Do results in files agree with reports sent to POTW? Y� / NO Comments:
4. Who has authority to shut down production shoutda spill or s ug discharge occur?-
(3F 9.,✓ 7a rwe s Po In I c � _ v► 5fi � . C In ✓I. � Sln c,.� r.Y S P� r►d n
5. How does SIU inform employees of whom to call at POTW in case of spill/slug? '
If slug/spill plan is already required by PO�review procedures.
6. Is SIU implementing slug/spill plan? / NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? 0 NO
Comments, Required Or Recommended Actions:
Signature Of Inspector(s)
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
Date: r (r
Date: 1614 J O
Page 2

SHUTZ CONTAINER SERVICE
I U P #0010

Used in Calculated
7"1 mg/L I Calculation lbs/day
1926
1926
169.66
1800
1800
211.89
409
464
409
464
40.93
85.85
835
835
38.62
1027
1027
205.63
1728
1728
378.99
971
971
290.54
1149.8
127.1
1140.3
228.4
<
Used in Calculated
mg/L Calculation lbs/day
304 304 26.78
360
360
42.38
328
328
32.82
692
692
128.04
260
260
12.03
246
246
49.26
248
248
54.39
260
260
77.80
olumn Averages => 0.01882 1145.00 E37
.8 337.25 52.94
Maximum 0.035877 .99 128.04

•
a�
.
CADMIUM
Used in Calculated
< mg/L Calculation lbs/day
<
0.0005
0.00025
0.000022
<
0.0005
0.00025
0.000029
<
0.0005
0.00025
0.000025
<
0.0005
0.00025
0.000046
<
0.0010
0.0005
0.000023
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
3.07E-05
0.0001
0.0004 0.0001
0.0001

CHROMIUM
Used in Calculated
< mg/L Calculation lbs/day
0.019
0.019
0.0017
0.01
0.01
0.0012
0.007
0.007
0.0007
0.013
0.013
0.0024
0.005
0.005
0.0002
<
0.005
0.0025
0.0005
0.02
0.02
0.0044
0.048
0.048
0.0144
0.0015
0.0049
P.0156 0.0032
0.0144
Used in Calculated
< mg/L Calculation lbs/day
11 �
11 �
111 1
11
11
111
11
11
11
11 •
11 '
111
1 1
1 1
1 11� 1
0.0364 0.0063
0.0144

Used in Calculated
Calculation lbs/day
Used in Calculated
< mg/L I Calculation lbs/day
0.002
0.002
0.0002
0.003
0.003
0.0004
<
0.002
0.001
0.0001
<
0.002
0.001
0.0002
<
0.005
0.0025
0.0001
<
0.005
0.0025
0.0005
<
0.005
0.0025
0.0005
<
0.005
0.0025
0.0007
0.0002
0.0005
MERCURY
Used in Calculated
< mg/L I Calculation lbs/day
<
0.0002
0.0001
0.00001
<
0.0002
0.0001
0.00001
<
0.0002
0.0001
0.00001
<
0.0002
0.0001
0.00002
<
0.0002
0.0001
0.00000
<
0.0002
0.0001
0.00002
<
0.0002
0.0001
0.00002
<
0.0002
0.0001
0.00003
0.00001
0.00002
0.0021 0.0003 P-0-00
10 0.00002
0.00 0.0007 0.00003

Used in Calculated
< mg/L Calculation lbs/day
0.019
0.019
0.0017
0.012
0.012
0.0014
<
0.01
0.005
0.0005
0.015
0.015
0.0028
0.01
0.01
0.0005
<
0.01
0.005
0.0010
0.02
0.025
0.02
0.025
0.0044
0.0075
0.0016
0.0033
0.0139 0.0025
0.0075

SILVER
Used in Calculated
< mg/L Calculation lbs/day
0.002
0.002
0.0002
<
0.001
0.0005
0.0001
0.006
0.006
0.0006
0.016
0.009
0.016
0.009
0.0030
0.0004
0.003
0.003
0.0006
0.024
0.024
0.0053
0.022
0.022
0.0066
0.0009
0.0032
0.0103 0.0021
0.0066
Used in Calculated
< mg/L Calculation lbs/day
1.94
1.94
0.1709
5.5458
5.5458
0.6528
2.887
2.887
0.2889
1.055
0.519
0.675
1.149
1.055
0.519
0.675
1.149
0.1952
0.0240
0.1352
0.2520
0.912
0
0.0000
0.3270
0.1028
1.7214 0.2149
0.6528

Phosphorus
Used in Calculated
11 0.4008
0.65452

Conductivity Sodium TN
Used in Calculated
�. �.Calculation lbs/day

Used in Calculated
7"1 mg/L Calculation lbs/day
<
Used in Calculated
mg/L Calculation lbs/day
580
580
29.53
840
840
145.09
429
429
93.96
586
586
162.34
420
420
16.54
270
270
46.26
440
440
76.12
128
128
22.29
olumn Averages => 0.01915 634.50 99.5 461.63 74.02
Maximum 0.033217 264.65 1 162.34

<
AMMONIA
mg/L
Used in Calculated
Calculation lbs/day
6.28
6.28
0.32
10.8
10.8
1.87
4.12
4.12
0.90
3.24
3.24
0.90
3.69
3.69
0.15
64.1
64.1
10.98
13.7
13.7
2.37
6.61
6.61
1.15
14.07 2.32928
10.982699
CADMIUM
Used in Calculated
< mg/L Calculation lbs/day
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
pq
9.00E-05
0.0001
0.0005 0.0001
0.0001

CHROMIUM
Used in Calculated
< mg/L Calculation lbs/day
0.008
0.008
0.0004
0.013
0.013
0.0022
0.028
0.028
0.0061
0.013
0.013
0.0036
0.005
0.005
0.0002
0.016
0.016
0.0027
0.011
0.011
0.0019
0.006
0.006
0.0010
0.0031
0.0015
0.0125 0.0023
0.0061
COPPER
Used in Calculated
< mg/L Calculation lbs/day
0.027
0.027
0.0014
0.044
0.044
0.0076
0.093
0.093
0.0204
0.04
0.04
0.0111
0.013
0.013
0.0005
<
0.01
0.005
0.0009
<
0.013
0.01
0.013
0.005
0.0022
0.0009
0.0101
0.0011
0.0300 0.0056
0.0204

Used in Calculated
Calculation lbs/day
Used in Calculated
< mg/L Calculation lbs/day
<
0.005
0.0025
0.0001
<
0.005
0.0025
0.0004
0.008
0.008
0.0018
<
0.005
0.0025
0.0007
<
0.005
0.0025
0.0001
<
0.005
0.0025
0.0004
<
0.005
0.0025
0.0004
<
0.005
0.0025
0.0004
0.0008
0.0003
MERCURY
Used in Calculated
< mg/L Calculation lbs/day
<
0.0002
0.0001
0.00001
<
0.0002
0.0001
0.00002
<
0.0002
0.0001
0.00002
<
0.0002
0.0001
0.00003
<
0.0002
0.0001
0.00000
<
0.0002
0.0001
0.00002
<
0.0002
0.0001
0.00002
<
0.0005
0.00025
0.00004
0.00002
0.00002
0.0032 0.0005 P
00012 0.00002
0.00 0.0018 0.00004

Used in Calculated
< mg/L Calculation lbs/day
0.013
0.017
0.013
0.017
0.0007
0.0029
<
<
0.03
0.01
0.01
0.03
0.005
0.005
0.0066
0.0014
0.0002
<
0.01
0.005
0.0009
0.021
0.021
0.0036
<
0.01
0.005
0.0009
0.0029
0.0014
0.0126 0.0021
0.0066

Used in Calculated
< mg/L I Calculation lbs/day
0.007
0.007
0.0004
0.008
0.008
0.0014
0.021
0.021
0.0046
0.006
0.006
0.0017
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
<
0.001
0.0005
0.0001
0.0020
0.0001
0.0055 0.0010
0.0046
Used in Calculated
< mg/L Calculation lbs/day
1.121
1.121
0.0571
1.357
1.357
0.2344
2.181
2.181
0.4777
1.322
1.322
0.3662
0.606
0.606
0.0239
0.889
0.889
0.1523
2.906
2.906
0.5028
1.02
1.029
0.1792
0.2838
0.2145
1.4264 0.2492
0.5028

Total Phosphorus
Used in Calculated
.440
0.55040

Conductivity
.Calculation
Sodium
Used in Calculated
lbs/day
_
TN
Used in Calculated
. ay
� � 11

Pretreatment Annual Report (PAR) Control Authority, Industry
Town Name => City of Lexington Namel Shutz Containeriervices
Industrial Data Summary Form (IDSF) WWTP Name => LRWWTP IUP #
Use separate forms for each industry/pipe NPDES # => NCO055786 Pipe # 1
Enter BDL values as < (value) 1 st 6 months, dates => l 1 21 to 6/30/2021
2nd 6 months, dates => to 12/31/2021
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations,(chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) => _ra
% violations,(chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
otal # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or _ Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) => _CO
% violations,(chronic SNC is >= 66%) => s
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or _ Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
% violations,(chronic SNC is >= 66%) => s
% TRC violations, (SNC is >= 33 %) => s_
Flow, mgd
BOD
TSS
Ammonia
Ist6months
2nd6mon is
s monr is
2ncl 6 mon s
s Mon s
2nd (i mon s
s mon is
Ind b months
8
8
8
8
8
8
4
8
379.0
264.65
128
162.34
0.890
10.98
177.8
99.50
52.9
74.02
0.526
2.33
0
0
0
0
0
0
0
0
Arsenic
ac mium
1L.111romium
st 6 months
2nd 6 mont s
st montis
n Monts
TsT 7 montis
n montis
777s montis
2nd 6 month s
8
8
8
8
0.0001
0.0001
0.144
0.0061
0.0001
0.0001
0.0032
0,0023
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Copper
-yan>< a
Leau
Iviercury
st 6 months
2nd6montlis
Ist6months
2nd 6 months
st mont s
n i mont i s
st montis
2nd 6 months
8
8
8
8
8
8
0.0144
0.0204
0.0003
0.0018
0.00002
0.00004
0.0063
0.006
0.0007
0.0005
0.00003
0.00002
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
BDL => Below Detection Limit mg/I => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, t itr, or 6-month & if BDL , 1/213DL, or zero values used. TRC => Technical Review Criteria WWTP => wastewater treatment plant
Chapter: PAR Gui ante File name: pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page o

Pri treatment Annual Report (PAR)
Indu atrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _> o
% vio'ations,(chronic SNC is >= 66%) _> Z
% TRC violations, (SNC is >= 33 %) _> �O
Total # of samples =>
* Maximum =>
* or Minimum =>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _> o
% vio'ations,(chronic SNC is >= 66%) _> w
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _> o
% viol ations,(chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Industry Name I S51117 Container Services
IUP # 10
Pipe # 1
Nickel
Selenium
Silver
Zinc
sl 0 months
n mon s
s months
n mon s
s n s n s mon mo
s months
n months
8
8
8 8
8
8
0.0075
0.0066
0.0066 0.0046
0.653
0.5028
0.0025
0.0021
0.0021 0.0010
0.215
0.2492
0
0
N/A N/A
0
0
0
0
N/A N/A
0
0
0
0
N/A N/A
0
0
0
0
N/A N/A
0
0
P11
st mont s_
ndmont a s
st mont a s
2 n moat i s
st mmont s
2nd 6 mont I s
st mont s
2nd 6 months'
N/A
st mont s
2nd6montlis
I st 6 mont i s
2 nc 6 mont 1 s
Ist6monflis
2nd 6 mont s
st mmont is
2nd 6 months'
2
2
2
2
0.655
0.5500
7.93
2.9226
0.401
0.4340
4.45
2.5525
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
BDL => Below Detection Limit mg/I => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Otr, or 6-month & if BDL , 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP => wastewater treatment plant
Chapter: PAR Guidance File name: PPLBotlfo&MmkRedi'ai� offlh ¢trgLWtctWAB, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

SIU INSPECTION FORM
Name Of Industry: vl A,4 I IUP # eap po
Address Of Industry: IUP Expirat' n Date:
y
Indu�Repr septatives: ., — — Title
POT\y .present tives: Title
U►
Date Of Inspection: I 2,0 ( Time Of Inspection: 2% py� w4e
Purpose of Inspection: Annual Other (Describe)
POTW to which IU discharges NPDES # _A( r
Is SIU currently in SNC? � If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
r ()AAAa RT.TTC
Product
YES
Raw materials used
YES
Manufacturing processes
YES
Categorical, if applicable
YES / NO
Production rate
Y
Number of employees
/ NO
Number of shifts YES
O
:fir o
Comments: o.2 ~�
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
l . Are there Boor drains in the
2. A&.production areas diked,
especially from spills or slugs?
/ NO _ Where
T, or otherwise constructed in
NO Comments:
3. Are there floor drains in the storage area?
4. Are storage tanks and areas diked, cont
WWTP, especially from spills or slugs? /r
they go?
a way as to prevent harm to the WWTP,
NO Where do they go?
)r otherwise constructed in such a way as to prevent rm to the
NO Comments:
5. Are process and storage tanks and pipes labeled?
6. How are off -spec raw materials, and products dis
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production area disc}!
9. What non -process wastewaters are discharged to POTW?
Comments:
Title: SIU Inpsection Form
Filename: COMP.INSP App 7-D
Revision data: August 1, 1994
to the POTW?
Page 1

si U il. SPEMON jFORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? OYESNO Comments:
2. Are ali LL its operadonail? YE NO
3. How often does operator/maintenance person c ck system? —$ t
4. Is there an operator for each shift? YES / O"�
5. How and when is sludge disposed of?
D, A. — .. _,1 sr rr
6. Is theft a
Comments:
preventative maintenance?
orl
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.)
I. Does an outside lab complete sampling? YES / 0 If yes, name of lab. _
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3. Is flow measurement equipment operational?
�`E NO
Comments:
4. Is there a calibration log for the flow meter?
E / NO
Comments:
Comments: CA— �� 2
PART III - EXIT INTERVIEW
Review monitoring records and —other SIU records required by IUP.
1. Are files well organized? YE / NO Comments:
2. Are sample collection / cham-of-custody forms filled out properly? YES / NO Comments:
ff
3. Do results in files agree y+ith reports sent to POTW? YES/NO Comments-
f. - -
4. Who his authority tq shut down
5. - How does SIU inform
If slug/spiWplan isCrready required by i
6. Is SIU implementing slug/spill plan?
Comments:
o� slug discharge occur?
to c ll at VOTW in case of
eview procedures.
NO Comments:
INSPECTION RESULTS ,��
Slug/Spill Control Plan Needed? ( YF,SRV NO
Comments, Required Or Recommen ed Actions:
Signature Of Inspector(s)
i ate: Diu tnpsection Form
Filename: COMP.INSP App 7-D
Revision data: August 1, 1994
Date:
Date: 2ozJ
Page 2

Hollywood Bed & Spring Mfg. Co.
I U P #0028

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations,(chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Control Authority,
Town Name =>
City of Lexington
WWTP Name =>
Lexington Regional WWTP
NPDES # _>
NC0055786
l st 6 months, dates =>
O1/01/21 to 06/30/21
2nd 6 months, dates =>
07/01/21 to 12/31/21
Industry
Naml HollywoodSpring Mfg.Co.
IUP # W28
Pipe # 01
OW, mg
mmonia
st 6 months
2ml 0 months
I st 6 months
2nd 6 months
I st 6 months
2nd 6 months
TstMonirs
Ind 11 months
8
8
8
8
4
8
770
875
1390
976
61.6
60
406 1
537
610
586
43.4
43
Arsenic
Cadmium
Chromium
uOu
st 6 months
n mon s
st mont s
n Mont s
st t months
_n months
st months
n months
8
8
8
8
0.0005
0.0005
0.015
0.015
0.0005
0.0005
0.0074
0.0068
0%
0%
0%
0%
0%
1 0%
1 0%
0%
Copper
Cyanide Lead
Mercury
st 6 months
2nd 6 months
I st 6 months
2nd 6 months Tst 6 months
2nd 6 months
I st 6 mon s
!2nd 6 months
8
8
2
2 8
8
0.272
0.087
0.0025
0.0025 0.012
0.008
0.081
0.056
0.0025
0.0025 0.0047
0.0032
0%
0%
0%
0% 0%
0%
0%
0%
0%
0% 1 0%
0%
BDL => Below Detection Limit mg/1=> milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Av,g period could be month. Qtr. or 6-month & if BDL. 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP => wastewater treatment plant
*Reflects monthly and daily limits and half BDL
Chapter: PAR Guidance File name: iQftjUfiFmWRQkisdcp flhtepftgtistdodRgA pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or 6 mth Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/0 _>
* or Maximum (lb/d) _>
* or Average (mg/1) _>
* or Average Loading (lb/d) _>
% violations, (chronic SNC is >= 66%) _>
% TRC violations, (SNC is >= 33 %) _>
Industry Name Hollywood Bed & Spring Mfg.Co.
IUP # 0028
Pipe # 01
1NICKet
, e emum
wiver
me
st 0 months _n mOnt S
st) mon 1S
7 months Wn
S monl S _n p mon[ S
St ) months
710 months
8 8
8 8
8
8
0.027 0.018
0.002 0.0005
0.47
0.399
0.0124 0.0094
0.0007 0.0005
0.25 t0
0.250
0% 0%
0% 0%
0%
0%
0% 0%
0% 0%
1 0%
0%
st 6 months
�n mon is
st 6 months
2nd 6 months
Ist6months
2nd6montlis
Ist6months
2nd 6 months
st 6 months
2nd 6 months
Ist6months
2nc mont s
Ist6months
2nc mont s
Ist6months
2nd 6 months
BDL => Below Detection Limit mg/l => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Av--, veriod could be month, Qtr, or 6-month & if BDL 1/2BDL. or zero values used. TRC => Technical Review Criteria WWTP => wastewater treatment plant
*Reflects monthly and daily limits and half BDL
Chapter: PAR Guidance File name: lit JMj1MEnsbvRWk]cn &t' tept0mqustdtid@B4 pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of

Hollywood Bed & Spring Mfg.Co. 2021-1.xls
Column Averages => #DIV/0!
Maximum 1 0
Hollywood Bed & Spring Mfg.Co. 2021-1.xls
data summary
Page 1 of 14 pages
2/2112022, 12:47 PM
Revision: August 1999
3n,
e�
Calculated
ay
LE
1 11
1 11
610.38
1390.00 0.00
AMMONIA
UseCalculated
Calculation 'o..

Hollywood Bed & Spring Mfg.Co. 2021-1.xls
ARSENIC
Column Averages =>
Maximum 0
Hollywood Bed & Spring Mfg.Co. 2021-1.xls
data summary
Page 2 of 14 pages
2/21/2022, 12:47 PM
Revision: August 1999
<
<
<
<
<
<
<
<
<
CADMIUM
mg/L
0.001
0.001
0.001
0.001
0.001
0.001
0.001
0.001
Used in Calculated
Calculation lbs/day
0.0005
0.0005
0.0005
0.0005
0.0005
0.0005
0.0005
0.0005
0.0005
#DIV/0!
0.0005
0.0000
<
CHROMIUM
mgiL
Used in Calculated
Calculation Ibs/day
<
0.005
0.0025
0.007
0.007
<
<
0.005
0.005
0.009
0.0025
0.0025
0.009
0.01
0.011
0.01
0.011
0.015
0.015
0.0074
0.0074
#DIV/0!
0.0150
0.0012

Hollywood Bed & Spring Mfg.Co. 2021-1.xis
um1 le Location:
•70.004
• - - -
Used in Calculated
Calculation lbs/day
loli wood Bed & Sp rin
Mfg.Co.
MGD
Sample Date
8-2/9/2021
Spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells
Rest of
worksheet is
protected,
password is
„T.
2) For below
detection data,
enter "<" in "<"
column, and
enter detection
level in Influen
or Effluent
mg/l columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 1/2
value entered.
10.083
0.025
0.021
0.272
0.082
0.097
0.027
0.044
0.025
0.021
0.083
0.272
0.082
0.097
0.0814
9-2/10/2021
10-2/11/2021
11-2/12/2021
19-4/20/2021
20-4/21/2021
21-4/22/2021
22-4/23/2021
month Avg)
Column Averages => #DIV/O! 0.0814 #DIV/O!
Maximum 0 0.2720 0.0065
Hollywood Bed & Spring Mfg.Co. 2021-1.xls
data summary
Page 3 of 14 pages
2/21/2022, 12:47 PM
Revision: August 1999
<
<
<
<
<
<
m L
0.005
0.005
0.005
0.005
0.006
0.005
0.007
0.012
7inCalculted
0.0025
0.0025
0.006
0.0025
0.007
0.012
0.0047
0.0047
#DIV/O!
0.0120
0.0000

Hollywood Bed & Spring Mfg.Co. 2021-1.xis
Column Averages => #DIV/0!
Maximum 1 0
Hollywood Bed & Spring Mfg.Co. 2021-1.xls
data summary
Page 4 of 14 pages
2121/2022, 12:47 PM
Revision: August 1999
#DIV/0!
0.00000
MOLYBDENUM
■■�■ ay
■���
LN
LE
LN
��■■�■
N
■■�
L���
LE
N ■ Nl
In
--
■�■Usedin
NICKEL
Calculated
Calculation lbs/day
■
1 1
11 -
11
111
Q�
1 11
■
1 1 :
t 1 :
■
11
11
■
11
11 :
■
11
11
-
I 1 1
1 1111

Hollywood Bed & Spring Mfg.Co. 2021 1.xls
Location:
MGD
-2/9/2021
Spreadsheet
Instructions:
1) Data
entered only
-2/10/2021
0 2/11/2021
Heavy
Bordered cel
Rest of
worksheet is
protected,
password is
„2„
1-2/12/2021
9-4/20/2021
0-4/21/2021
i nYYl/)nY l
;/2021 2) For below
detection data
Av enter "<"in "<'
column, and
enter detection
level in Influen
or Effluent
mg/1 columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 112
value entered.
Column Averages => #DIV/0!
Maximum 0
Hollywood Bed & Spring Mfg.Co. 2021-1.xls
data summary
Page 5 of 14 pages
2/21/2022, 12:47 PM
Revision: August 1999
0.001
0.001
0.001
0.001
0.001
0-
0.001
0.001
195� 0
Ua:d in Calculated
Calc,ilation lbs/day
0.(005
0.(005
0.(005
0.(005
0.(005
0.)02
0.( I
0.(I
0.( I
0.(007 #DIV/0!
0.(020 1 0.0000
ZINC
CalculatedUsed in
Calculation lbs/day
L�
!,
1 1' •
1 1
1 1' •
®-
-
L
I.
.---
-
-
--
--
1 1:
• � 1
1 � 11
1 1111

Hollywood Bed & Spring Mfg.Co. 2021-2.xls
Sam le Location:
•
Hollywood Bed & Sp rin Mf .Co.
MGD
Sample Date
8/23-8/24/2021
Spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells
Rest of
worksheet is
protected,
password is
2 .
2) For below
detection data,
enter "<" in "<"
column, and
enter detection
level in Influent
or Effluent
mgll columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 112
value entered.
8/24-8/25/2021
8/25-8/26/2021
8/26-8/27/2021
10/18-10/19/2021
10/19-10/20/2021
10/20-10/21/2021
10/2 1 -10/22/202 1
6 month Avg
Column Averages =>
Maximum
#DIV/0!
0
Hollywood Bed & Spring Mfg.Co. 2021-2.xls
data summary
Page 1 of 14 pages
2121/2022, 12:54 PM
Revision: August 1999
Used in
Calculated
< /L
I Calculation
lbs/day
235
235
429
429
865
865
301
301
875
875
594
594
580
580
416
416
536.88 4DIV/0!
875.00 0.00
586.00
976.00 0.00
42.53
60.30 1 0.00

Hollywood Bed & Spring Mfg.Co. 2021-2.xls
�aln ale Location: I
20170JI111111111111
Holk wood Bed & Sp ring Mfi;.Co.
MGD
Sam le Date
8/23-8/24/2021
Spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells
Rest of
worksheet is
protected,
password is
2
2) For below
detection data,
enter "<" in "<"
column, and
enter detection
level in Influent
or Effluent
mgA columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 1/2
value entered.
8/24-8/25/2021
8/25-8/26/2021
8/26-8/27/2021
10/18-10/19/2021
10/19-10/20/2021
10/20-10/21/2021
10/21-10/22/2021
6 month Avg
Column Averages =>
Maximum
#DIV/0!
0
Hollywood Bed & Spring Mfg.Co. 2021-2.xls
data summary
Page 2 of 14 pages
2/21/2022, 12:54 PM
Revision: August 1999
0.00
0.0005 #DIV/0!
0.0005 0.0000
<
CHROMIUM
mi %L
Used in Calculated
Calculation lbs/day
<
0.005
0.005
0.0025
0.005
0.015
0.015
<
0.005
0.0025
0.007
0.007
0.0061
0.006
0.011
0.01
0.0061
0.006
0.0068
0.0068
#DIV/o!
0.0150
0.0012

Hollywood Bed & Spring Mfg.Co. 2021-2.xls
Sample Locatiom-1
9 1191TITM
Holl wood Bed & Sp rin = Mfe.Co.
MGD
Sample Date
8/23-8/24/2021
spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells
Rest of
worksheet is
protected,
password is
2
2) For below
detection data,
enter °<" in "<"
column, and
enter detection
level in Influen
or Effluent
mg/l columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 1/2
value entered.
8/24-8/25/2021
8/25-8/26/2021
8/26-8/27/2021
10/18-10/19/2021
10/19-10/20/2021
10/20-10/21/2021
10/21-10/22/2021
6 month AvQ
Column Averages =>
Maximum
#DIV/0!
0
Hollywood Bed & Spring Mfg.Co. 2021-2.xls
data summary
Page 3 of 14 pages
212112022, 12:54 PM
Revision: August 1999
Used in Calculated
< m /L
I Calculation lbs/day
0.041
0.041
0.051
0.051
0.087
0.087
0.064
0.064
0.07
0.07
0.029
0.029
0.071
0.071
0.04
0.04
0.0566
{ 0.0566 #DIV/0!
0.0870 0.0065
,ulated
/day <
1.0000
Used in Calculated
;/L
Calculation lbs/day
0.005
0.0025
0.005
0.0025
0.005
0.0025
0.005
0.0025
0.008
0.008
0.005
0.0025
0.005
0.0025
0.005
0.0025
0.0032
0.0032 #DIV/0!
0.0080 0.0000

Hollywood Bed & Spring Mfg Co. 202-1-2.As
Sam le Location:
Hollywood Bed & Sp rin Mfg. Co.
MGD
Sample Date
8/23-8/24/2021
Spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells
Rest of
worksheet is
protected,
password is
2
2) For below
detection data,
'<" in "<.
column, and
enter detection
level in Influen
or Effluent
mg/l columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 1/2
value entered.
8/24-8/25/2021
8/25-8/26/2021
8/26-8/27/2021
10/18-10/19/2021
10/19-10/20/2021
10/20-10/21/2021
10/21-10/22/2021
6 month Avgenter
Column Averages =>
Maximum
#DIV/0!
0
Hollywood Bed & Spring Mfg.Co. 2021-2.xls
data summary
Page 4 of 14 pages
2/21/2022, 12:54 PM
Revision: August 1999
#DIV/0!
0.00000
Used in Calculated
Calculation lbs/day
<
<
<
<
<
m /L
0.01.01
0.013
0.018
0.014
0.01
0.01
0.01
0.01
7Usueldn Calculated
ion lbs/day
0.013
0.018
0.014
0.005
0.005
0.005
0.005
0.0094
0.0094
#DIV/0!
0.0180
0.0000

Hollywcod Bed & Spring Mfg.Co. 2021-2.xls
tiara le Location:
Hollywood Bed & Sprint Mfc.Co.
MGD
Sample Date
8/23-8/24/2021
Spreadsheet
Instructions:
1) Data
entered only in
Heavy
Bordered cells
Rest of
worksheet is
protected,
password is
2 .
2) For below
detection data,
enter "< in "<"
column, and
enter detection
level in Influen
or Effluent
mg/l columns.
Spreadsheet
will auto-
matically
calculate
averages and
removal rates
using 112
value entered.
8/24-8/25/2021
8/25-8/26/2021
8/26-8/27/2021
10/18-10/19/2021
10/19-10/20/2021
10/20-10/21 /2021
10/21-10/22/2021
6 month Av
Column Averages =>
Maximum
#DIV/0!
0
Hollywood Bed & Spring Mfg.Co. 2021-2.xls
data summary
Page 5 of 14 pages
2/21/2022, 12:54 PM
Revision: August 1999
Used in Calculated
0.0005 #DIV/0!
0.0005 0.0000
m ' L
Used in Calculated
Calculation lbs/day
0.137
0.137
O—. 2-111
0.211
0.366
0.214
0.399
0.211
0.272
0.19
0.366
0.214
0.399
0.211
0.272
0.19
0.2500
0.2500
#DIV/0!
0.3990
0.0000

HOLLYWOOD BED & SPRING MFG. CO., INC.
THE BEST BEDDING SUPPORT PRODUCTS SINCE 1925
Total Toxic Organics Certification Statement
Based on my inquiry of the person or persons directly responsible for managing
compliance with the permit limitation for total toxic organics (TTO),1 certify
that, to the best of my knowledge, no dumping of concentrated toxic organics
into the wastewaters has occurred since filing of the last monitoring report. I
further certify that this facility is implementing the toxic organic management
plan submitted to the Control Authority.
Certifying Official:
r i2-q-2/ —
�� 6
Signature Date
Dan Harpole VP of Operations
Printed Name and Title
5959 Corvette Street • Commerce, CA 90040 • [phone] • Fax [phone]
161 Proctor Lane, Lexington, NC 27292 • [phone] - Fax[phone]
www.hollywoodbed.co

Total Toxic Organics Certification Statement
Based on my inquiry of the person or persons directly
responsible for managing compliance with pretreatment
standard for TTO's, I certify that to the best of my
knowledge and belief, this facility, Hollywood Bed Mfg.
Co. Inc., Proctor, does not store, use,' or discharge to the
sanitary sewer system any toxic organic chemicals.
Certifying Official_
Sig6ature
/,.1;7 Zoal
Date
Randy E Everhart Human Resources Manager
Printed Name and Title

SIU INSPECTION FORM
Name Of Industry:
Address Of Industry:
I ustry r sentatives:
A
IUP # q00 ,2
IUP Expiration Date:
POTW Representatives: Title
Date Of Inspection:Time Of Inspection: _ 11 :: F _ _ avpm
Purpose of Inspection: Annual `44 — Other Describe)
POTW to which IU discharges NPDES # Al C- 00 5,�7 8�
Is SIU currently in SNC? _ N D If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product
YES /
Raw materials used
YES /
Manufacturing processes
YES
Categorical, if applicable
YES / NO
Production rate
YE
Number of employees
NO
_
Number of shifts YES
/ O
/ 1
Comments: to
1" i e1A.)
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? YE / NO, Where do they go?
2. Are pr uction areas iked, contained, or otherwise constructed in such away as46 prevent harm to the WWTP,
especially from spills or slugs? YES / NO Co ents: "'0"1 4io-
3. Are there floor drains in the storage area? O Where do they go? _
4. Are storage tanks and areas diked, conr otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? ES NO Comments:
oments:
5. Are process and storage tanks and pipes labeled? QjPNO
6. How are off -spec raw materials, and products disposed of?
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production area dischai4d to the POTW? YE / NO
9. What non -process wastewaters are discharged to POTW?
Comments:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system. ��"�
1. Does operator seem knowledgable about the system? YES Comments: NO QOa
2. Are all units operational? ftgj / NO cc�l
3. How often does operator/mam enance check system?
4. Is there an operator for each shift? NO
5. How and when is sludge disposed of?
6. Is there a schedule for preventative maintenance? ES NO
C
Comments: O, c
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES If yes, name of lab.
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3.
Is flow measurement equipment operational? ,
Y S / NO
Comments:
4.
Is there a calibration log for the flow meter?OD
/ NO
Comments:
Comments: c>1r 5 11 q l /
2D 2, (
PART III - EXIT INTERVIEW
Review monitoring records an SIU records required by IUP.
1. Are files well organized E NO Comments: OIe.T Tom-•
2. Are sample collection / chain -of -custody forms filled out r e ? YES / NO Comments:
i)9--
3. Do results in files agree with reports sent to POTW? YES / NO Comments:
4. Who has authority to shut do�yn production should a spill o ; slug discharge occur?
ho%w does SIU inform em loyees of whom to call at POTW in case of spill/slug?
If slug/spill plan is already required by POV
TV�,'�eview procedures.
6. Is SIU implementing slug/spill plan? NO Comments:
Comments:
INSPECTION RESULTS ����
Slug/Spill Control Plan Needed? (YES/ NO
Comments, Required Or Recommen ed Actions:
Signature Of Inspector(s)
�- -to �4
i , _I
Date: Il L , ] I
Date:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 2

MATCOR METAL FABRICATIONS
IU P #0012

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations,(chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Control Authority,
Town Name => Lexington
WWTP Name => LRWWTP
NPDES # => NCO055786
1st 6 months, dates => 1/1/2021 to 6/30/2021
2nd 6 months, dates => 7/1/ 021 to 12/31/2021
Industry
Name Matcor Metal Fabrication
IUP # 12
Pipe # 1
it ow, mga
DUO
I nO Ammonia
st 6 months
2nd 6 mont s
st mont s
2nd 6 months
s mon s
2nd 0 monthsTs-1 Mon s
2n months
10
8
7
8
7
8 7
8
336
88.5
1002
371 0.39
0
125.26
44.4
286.86
91.19 0.23
0
Arsenic
amiu
romium
UOD
st months
n months'
ontm2n
months
n montis
ont s
8
7
8
04
0.002
0.135
0.024
0.0012
0.0007
0.0423
0.0099
0
0
0
0
0
0
0
0
opper
Uyanicle
ea
Mercury
st months
n months
st mont is
2n 6 months
st 6 mont s
n mont s
st mon s
n months
11
8
2
2
7
8
3.806
0.810
0.0025
0.0025
0.005
0.025
0.765
0.251
0.0025
0.0025
0.0250
EO.O031
0
0
0
0
00
0
0
0
0
BDL => Below Detection Limit mg/I => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit Ib/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg, period could be month, Qtr, or 6-month & if BDL, 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP => wastewater treatment plant
Chapter: PAR Guidance File name: PAR.(I&S radbeEsives[bnidateCAago t91 sLVQ&n B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe -Page of

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum =>
* or Minimum =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Industry Name Matcor Metal Fabrication
IUP # 12
Pipe # 1
�'�
IdaiiTi[•i'iTiTiiii�
IR3[• .iiTiTfliT.�
iR+i'fli [•• i�"iT•Ti[ii'�
• •
I�G iTiT•Tiii�
1�[. iTiTiiill�
liiili[.iiT•Ti11i�
1 '
11 '
--
1 11:
111
:'1
11:�•
00-
0000
WRIMEM M=
U.E• ®
M�'i�i [.�
UMMEMO
iE M1 i M
UM •�
OWEEM
If.EM'iTiSi B
�ii1'iC. ii'ST•TM
H .SiiTiTi
ME=
EMMEM
IeiitiGTi=
IMOM M
Sti[.TEM
BDL => Below Detection Limit mg/1 => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four rows, Please indicate how averages were calculated SNC => Significant Non -Compliance mgd => million gallons per day
Avg period could be month, Qtr. or 6-month & if BDL , 1/2BDL, or zero values used. TRC => Technical Review Criteria WWTP => wastewater treatment plant
Chapter: PAR Guidance File name: PARQ06ftdrWvcsGWdeteCAsg enl%,sEgg6n B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe -Page of

Matcor Data Summary 2021-1.xls
Column Averages => 0.00584
Maximum 0.009188
Matcor Data Summary 2021-1.x1s
data summary
Page 1 of 18 pages
2/22/2022, 3:27 PM
Revision: August 1999
ems■BOb
ay
■
1�
1.
11
WM
. 11
11
eie■Used
TSS
h) Calculated
L�
AMMONIA
Usin ed
Calculation lbs/day
11

Matcor Data Summary 2021-1.xls
Column Averages => 0.00584
Maximum 0.009188
Matcor Data Summary 2021-1.x1s
data summary
Page 2 of 18 pages
2/22/2022, 3:27 PM
Revision: August 1999
e�
■
■
CADMIUM
.l,:Calculated
1 111: � 1 1111
1 111• 1 1 1 1111
■
�■
1 11
111�
®
111�
1 1111
1111
1 11
1 11
�
1 1
1 1111
1 1111
■
Z
0
■
NONE
NEON
SEEN
--
■NONE��
1 11
1 11
1 111
off, 11
<
CHROMIUM
mg/L
0.069
Used in Calculated
Calculation lbs/day
0.069 0.0031
0.017
0.017
0.0004
0.031
0.135
0.031
0.135
0.0015
0.0064
0.01
0.01
0.0005
0.029
0.029
0.0008
0.005
0.005
0.0002
0.0423
0.0018
0.135
0.0064

Matcor Data Summary 2021-1.xls
Column Averages => 0.00584
Maximum 0.009188
Matcor Data Summary 2021-1.xls
data summary
Page 3 of 18 pages
2122/2022, 3:27 PM
Revision: August 1999
<
mg/L
COPPER
Used in Calculated
Calculation lbs/day
0.893
0.893
0.0399
0.671
0.671
0.0162
0.977
0.977
0.0471
3.806
3.906
0.1804
0.124
0.124
0.0067
0.293
0.293
0.0155
0.297
0.327
0.297
0.327
0.0181
0.0251
mow
0.272
0.272
0.0130
0.668
0.668
0.0192
0.089
0.089
0.0042
0.7652
0.0350
3.806
0.1804
e�ated
CYANIDE
ay
1 11
1 11
1 111
LE
-
--
1 11
11
1 111
L
-
--
0.0025 0.0001
0.0025 1 0.00013
Used in Calcu lated
latedT<mrg/L
Calculation lbs/day
<
0.002
0.003
0.001
0.003
0.0000
0.0001
0.005
0.005
0.0002
0.005
0.005
0.0000
<
<
<
0.005
0.005
0.005
0.0025
0.0025
0.0025
0.0001
0.0001
0.0001
0.0031
0.0001
0.00500
0.00024

Matcor Data Summary 2021-1.xls
Sample Location:
•
Matcor
MGD
Sample Date
1/25-1/26/2021
Spreadsheet
Instructions:
1) Data entered
only in Heavy
Bordered cells.
Rest of workshee
is proud'
password is '7".
2) For below
detection data,
enter ". ' in "<'
column, and en
detection level in
mgA columuend
ns.
mgA c lu ns.
Spreadsheetwill
auto-matically
calculate
averages and
removal rates
using 12value
entored.
0.005354
1/26-1/27/2021
0.002903
1/27-1/28/2021
0.005779
1/28-1/29/2021
0.005684
3/22-3/23/2021
0.006505
3/23-3/24/2021
0.006349
3/24-3/25/2021
0.007302
3/25-3/26/2021
0.009188
/19-4/20/2021
0.006099
/20-4/21/2021
1/22-4/23/2021
0.005751
/21-4/22/2021
0.00344
0.005669
Column Averages =>
Maximum
0.00584
0.009188
Matcor Data Summary 2021-1.xls
data summary
Page 4 of 18 pages
2/22/2022, 3:27 PM
Revision: August 1999
MOLYBDENUM
e�Used'W Calculated
■
<
mg/L
0.107
Used in Calculated
Calculation lbs/day
0.107 1 0.0048
0.053
0.053
0.0013
0.062
0.174
0.062
0.174
0.0030
0.0082
0.027
0.027
0.0013
0.069
0.069
0.0020
0.018
0.018
0.0009
0.0729
0.0031
0.17400
0.00825

Matcor Data Summary 2021-1.xls
SELENIUM
e�Used in Calculated
IN
- �-
INNONE
--
INNONE
��
M---
•NONE
--
• NONE
�-
■NEEN��
■NONE��
01 - --
■NONENEEN
��
-
• - --
• SEEN
--
0---
zNONE
��
■NONE��
■NONE��
■ NONE
��
■ NONE
��
�NENN��
■NONE��
Column Averages => 0.00584
Maximum 0.009188
Matcor Data Summary 2021-1.xls
data summary
Page 5 of 18 pages
2/22/2022, 3:27 PM
Revision: August 1999
<
mg/L
Used in Calculated
C alculationss lbs/day
<
0.001
0.0005
0.0000
0.002
0.002
0.0000
0.006
0.006
0.0003
0.008
0.008
0.0004
<
<
0.002
0.001
0.001
0.002
0.0005
0.0005
0.0001
0.0000
0.0000
0.0028
0.0001
0.00800
0.00038
<
mg/L
Used in Calculated
Calculation lbs/day
1.679
1 1.679
0.0750
0.942
0.942
0.0228
1.282
1.282
0.0618
2.8910
0.193
2.891
0.193
0.1370
0.0105
0.452
0.452
0.0239
0.451
0.451
0.0275
0.617
0.617
0.0473
0.47
0.47
0.0225
1.488
1.488
- 0.0427
0.118
0.118
0.0056
0.9621
0.0433
2.89100
0.13705

Matcor Data Summary 2021-2.xls
Sample Location:
21101TITM
Matcor
MGD
Sample Date
7/19-7/20/2021
Spreadsheet
Instructions:
1) Data entered
only in Heavy
Bordered cells.
Rest of worksheei
is protected,
password is'T.
2) For below
detection data,
enter ".' in ". '
drolumen ter
tion le in
detecon leen
Influentor mgA columns.
Spreadsheetwill
auto-matically
calculate
averages and
removal rates
using 12 value
entered.
0.00586
7/20-7/21/2021
0.007300
7/21-7/22/2021
0.006547
7/22-7/23/2021
0.006404
10/18-10/19/2021
0.006173
10/19-10/20/2021
0.009367
10/20-10/21/2021
0.007957
10/21-10/22/2021
0.006442
Column Averages =>
Maximum
0.00701
0.009367
Matcor Data Summary 2021-2.xls
data summary
Page 1 of 18 pages
2/22/2022, 3:26 PM
Revision: August 1999
<7mg7/LIC�alculation
Used in Calculated
lbs/day
20
15
20
15
0.98
0.91
15.4
15.4
0.84
15
88.4
88.5
85
15
88.4
88.5
85
0.80
4.55
6.91
5.64
27.9
27.9
1.50
44.40
88.50
1 2.77
1 6.91
<
mg/L
Used in Calculated
Calculation lbs/day
14.7
14.7
0.72
8.8
8.9
0.54
8
8
0.44
mom
15
15
0.80
156
105
371
156
105
371
8.03
8.20
24.62
51
51
2.74
91.19
371.00
5.76
24.62
<
mg/L
Used in Calculated
Calculation lbs/day
0.132
0.132
0.01
< 1
0.1
0.05
0.00
0.123
0.123
0.01
<
0.1
0.05
0.00
0.412
0.412
0.02
0.412
0.412
0.03
0.15
0.124
0.15
0.124
0.01
0.01
0.18
0.41
0.01
0.03

Matcor Data Summary 2021-2.xls
Sample Location:
•
Matcor
MGD
Sample Date
7/19-7/20/2021
Spreadsheet
Instructions:
1) Data entered
only in Heavy
Bordered cells.
Restof workshee
is prowcted,
password is'2".
2) For below
detection data,
enter "<"in"<"
column, and en
detection level inn
Influent or Effluen-
mgA columns.
Spreadsheet will
automatically
calculate
averages and
removal rates
using 12 value
entered.
0.00586
7/20-7/21/2021
0.007300
7/21-7/22/2021
0.006547
7/22-7/23/2021
0.006404
10/18-10/19/2021
0.006173
10/19-10/20/2021
0.009367
10/20-10/21/2021
0.007957
10/21-10/22/2021
0.006442
Column Averages =>
Maximum
0.00701
0.009367
Matcor Data Summary 2021-2.xis
data summary
Page 2 of 18 pages
2/22/2022, 3:26 PM
Revision: August 1999
0.00
<
mg/l
CADMIUM
Used in Calculated
Calculation lbs/day
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0000
<
0.001
0.0005
0.0000
<
0.001
0.002
0.0005
0.002
0.0000
0.0001
<
0.001
0.0005
0.0000
0.0007
0.002
0.0000
0.0001
<
CHROMIUM
mg/L
Used in Calculated
Calculation lbs/day
<
0.005
0.0025
0,0001
<
0.005
0.0025
0.0002
<
0.005
0.0025
0.0001
0.005
0.005
0.0003
0.024
0.014
0,021
0.024
0.014
0.021
0.0012
0.0011
0.0014
0.008
0.008
0.0004
0.0099
0.0006
0.024
0.0014

Matcor Data Summary 2021-2.xls
Sample Location: -71
Matcor
MGD
Sample Date
7/19-7/20/2021
Spreadsheet
Instructions:
1) Data entered
only in Heavy
Bordered cells.
R est of workshee
is
passswordsword is "2". s
2) For below
detection data,
enter 'V'in 'V'
column, and enter0.007957
detection level in
ffluery
Influentor rrgA columns.
Spreadsheetwill
autwmatically
calculate
averages and
removal rates
using 12 value
entered.
0.00586
7/20-7/21/2021J
0.0 77300
7/21-7/22/2021
0.006547
7/22-7/23/2021
0.006404
10/18-10/19/2021
0.006173
10/19-10/20/2021
0.009367
10/20-10/21/2021
10/21-10/22/2021
0.006442
Column Averages =>
Maximum
0.00701
0.009367
Matcor Data Summary 2021-2.xls
data summary
Page 3 of 18 pages
2/22/2022, 3:26 PM
Revision: August 1999
T<r7n,g/L
0.055
0.062
0.056
0.068
0.562
Used in Calculated
Calculation Ibs/day
0.055 0.0027
0.062 0.0038
0.056 0.0031
0.068 0.0036
0.562 0.0289
0.236
0.236
0.0184
0.81
0.81
0.0538
0.156
0.156
0.0084
0.2506
0.0153
0.81
0.0538
0.0025 0.0001
0.0025 0.00013
<
mg/1-
Used in Calculated
Calculation lbs/day
<
0.005
0.0025
0.0001
<
0.005
0.0025
0.0002
<
0.005
0.0025
0.0001
<
<
0.005
0.005
0.0025
0.0025
0.0001
0.0001
<
<
<
0.005
0.005
0.005
0.0025
0.0025
0.0025
0,0002
0.0002
0.0001
0.0025
0.0001
0.00250
0.00020

Matcor Data Summary 2021-2.xls
Sample Location:
Matcor
MGD
Sample Date
7/19-7/20/2021
Spreadsheet
Instructions:
1) Data entered
only in Heavy
Bordered cells.
Restof workshee
is protected,
password is "2".
2) For below
detection data,
enter ". ' in "<"
column, and en
detection level inn
ffluen
Influentor mgA columns.
Spreadsheetwill
autD-rnatically
calculate
averages and
removal rates
using 12value
entered.
0.00586
7/20-7/21/2021
0.007300
7/21-7/22/2021
0.006547
7/22-7/23/2021
0.006404
10/18-10/19/2021
0.006173
10/ 19-10/20/2021
0.009367
10/20-10/21/2021
0.007957
10/21-10/22/2021
0.006442
Column Averages =>
Maximum
0.00701
0.009367
Matcor Data Summary 2021-2.xls
data summary
Page 4 of 18 pages
2/22/2022, 3:26 PM
Revision: August 1999
#DIV/0!
0.00000
<
mg/L
0.013
Used in Calculated
Calculation Ibs/day
0.013 0.0006
0.013
0.012
0.014
0.059
0.013
0.012
0.014
0.059
0.0008
0.0007
0.0007
0.0030
0.037
0.037
0.0029
0.054
0.054
0.0036
0.022
0.022
0.0012
0.0280
0.0017
0.05900
0.00358

Matcor Data Summary 2021-2.xls
Sample Location:
•
Matcor
MGD
Sample Date
7/19-7/20/2021
Spreadsheet
Instructions:
1) Data entered
only in Heavy
Bordered cells.
Rest of workshe
is p��
password is T'.
2) For below
detection data,
enter "1' in "<"
column, and en
detection level inn
Iniluentnifluen
mgA columns.
Spreadsheetwill
auto-matically
calculate
averages and
removal rates
using 12value
entered.
0.00586
7/20-7/21/2021
0.007300
7/21-7/22/2021
0.006547
7/22-7/23/2021
10/18-10/19/2021
0.006173
10/ 19-10/20/2021
0.009367
10/20-10/21/2021
0.007957
10/21-10/22/2021
0.006442
Column Averages =>
Maximum
0.00701
0.009367
Matcor Data Summary 2021-2.xls
data summary
Page 5 of 18 pages
2/22/2022, 3:26 PM
Revision: August 1999
<
mg/L
70.001
Used it) h Calculated
Calculation lbs/day
0.001
0.0000
<
0.001
0.001
0.001
0.0005
0.0001
0.0000
<
<
<
0.001
0.001
0.001
0.0005
0.0005 j
0.0005
0.0000
0.0000
0.0000
0.001
0.001
0.0001
<
0.001
0.0005
0.0000
0.0007
0.0000
0.00100
0.00007
<
mg/L
0.131
Used in Calculated
Calculation lbs/day
0.131 0.0064
0.115
0.108
0.115
0.108
0.0070
0.0059
0.116
0.116
0.0062
0.773
0.41
0.773
0.41
0.0398
0.0320
0.846
0.846
0.0561
0.274
0.274
0.0147
0.3466
0.0210
0.84600
0.05614

MP1322t:_M
METAL FABRICATION
835 Salem Road
Post Office Box 729
Welcome, NC 27374
Phone: [phone]
June 30, 2021
City of Lexington
Ms: Eglantina Minerali
Pretreatment Program Coordinator
28 W. Center Street
Lexington, NC 27292
"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."
"Based upon my inquiry of the person or persons directly responsible for managing compliance
with the permit limitation for Total Toxic Organics (TTO), I certify that, to the best of my
knowledge, no dumping of concentrated toxic organics into the wastewater has occurred since
filing of the last monitoring report. I further certify that this facility is implementing the Toxic
Organic Management plan submitted to the Control Authority".
Signed: 4�zz
Print Name: Joe Edwards
Title: EH&S/Maintenance Supervisor
Date Signed: June 30, 2021

AlMl=
METAL FABRICATION
835 Salem Road
Post Office Box 729
Welcome, NC 27374
Phone: [phone]
December 1, 2021
City of Lexington
Ms. Eglantina Minerali
Pretreatment Program Coordinator
28 W. Center Street
Lexington, NC 27292
"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."
"Based upon my inquiry of the person or persons directly responsible for managing compliance
with the permit limitation for Total Toxic Organics (TTO), I certify that, to the best of my
knowledge, no dumping of concentrated toxic organics into the wastewater has occurred since
filing of the last monitoring report. I further certify that this facility is implementing the Toxic
Organic Management plan submitted to the Control Authority".
Signed:
Print Name: Joe Edwards
Title: EH&S/Maintenance Supervisor
Date Signed: December 1, 2021

SIU INSPECTION FORM
Name Of Industry: 0SQ-i-0O3L- P4t)-at.L_A'� no'ka ( IUP # 'Q0.LZ—
Address Of Industry: IUP Expiration Date:
5
Industry Representatives: QA Title
&= F� s �M� poiHCQ
POTW Representatives: Title '
i
Date Of Inspection: Time Of Inspection:"rYJ
Purpose of Inspection: Annual O er (Describe)
POTW to which IU discharges NPDES # 1/ C 00 3
Is SIU currently in SNC? /SI-n If yes, for what? _
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product
Raw materials used
Manufacturing processes
Categorical, if applicable
Production rate
Number of employees
Number of shifts YES(
Comments:
YES/
YES/
YES /
r � A
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? YES (V Where do they go?
2. Are production areas diked, co d, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? / NO Comments:
3. Are there floor drains in the storage area? YES O Where do they go?
4. Are storage tanks and areas diked, cont�aor otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? (!Y y NO Comments:
5. Are process and storage tanks and pipes labeled? NO
6. How are off -spec raw materials, and products disposed of?
7.
8.
9.
When is the production area cleaned?
Is the wastewater from cleaning the production area Mcharged to the POTW? YES O
What non -process wastewaters are discharged to POTW?
Comments:
Title: SIU Inpsection Forth
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? VEYNO Comments:
2. Are all units operational? E / NO
3. How often does operator/maintenance psEKn check system? S �...
4. Is there an operator for each shift? NO
5. How and when is sludge disposed of?
6. Is there a schedule for preventative maintenance? ( ES
' NO
Comments: U, Q C f + 2
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES NO If yes, name of lab.
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3. Is flow measurement equipment operational? Y� W NO Comments:
4. Is there a calibration log for the flow meter? ES O Comments:
Comments:
PART III - EXIT INTERVIEW
Review monitoring records an er SIU records required by IUP.
1. Are files well organized? ES NO Comments:
2. Are sample collection / chain -of -custody forms filled out properly? YES / NO Comments:
Iv I fin
3. Do results in files agree with reports sent to POTW? YES / NO Comments:
4. Who has authority to shut down production should a spill or slug di charge occur?
to n q- C Oo r
5. How does StU inform employees of om to tall at POTW in case of pill/slug9
If slug/spill plan is already required by PO view procedures.
6. Is SIU implementing slug/spill plan? ES) NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? ES NO
Comments, Required Or Recomme Actions:
Signature Of Inspector(
Title: SIU Inpsection Forth
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 2

TIER RACK
I U #0045

NAME OF FACILITY: TIER -RACK
Business Address: 200 Prospect Drive, Lexington, NC 27292
Discharge Address (if different from above):
TOTAL TOXIC ORGANICS CERTIFICATION STATEMENT
Based on my inquiry of the person or person directly responsible for managing compliance with
pretreatment standard for TTOs, I certify that to the best of my knowledge and belief, this
facility does not store, use, or discharge to the sanitary sewer system any toxic organic
chemicals.
CERTIFYING OFFICAL:
Signature
Printed Name & Title
EXECUTIVE OFFICER:
Ag
Signature
Printed Name & Title
Date
Date

NAME OF FACILITY: TIER -RACK
4 Business Address: 200 Prospect Drive, Lexington, NC 27292
Discharge Address (if different from above):
TOTAL. TOXIC ORGANICS CERTIFICATION STATEMENT
Based on my inquiry of the person or person directly responsible for managing compliance with
pretreatment standard for TTOs, I certify that to the best of my knowledge and belief, this
facility does not store, use, or discharge to the sanitary sewer system any toxic organic
chemicals.
CERTIFYING OFFICAL:
Signature
Printed Name & Title
EXECUTIVE OFFICER:
Signature
Printed Name & Title
Date
Date

SIU INSPECTION FORM
Name Of Industry: IUP # D O '15
Address Of Industry: r0 IUP Expira ion Date:
e- ` 7
Industry Representatives: Title
ves:
Date Of Inspection: 12-116
Purpose of Inspection: Anhual
POTW to which IU discharges
Title
Y �O�
Time Of Inspection: it _3Q —O►Ipm
Other (Describe)
Is SIU currently in SNC? wM If
what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES
t
Raw materials used YES
Manufacturing processes YES
Categorical, if applicable YES / N
Production rate YES
Number of employees S O
Number of shifts YES40
Comments: !�
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? (ONO Where do they go?
2. Are production areas diked, co I d, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? YE / NO Comments: _
3. Are there floor drains in the storage area? YE NO Where do they go?
4. Are storage tanks and areas diked, contaiD4 or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? 1 NO Comments:
5. Are process and storage tanks and pipes labeled? kony, �1 NO
6. How are off -spec raw materials, and products disposed of?
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production area dis
9. What non -process wastewaters are discharged to POTW?
Comments:
to the POTW? YES
Title: SIU lnpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? (0 NO Comments:
2. Are all units operational? / NO
3. How often does operator/maintenanc on check system?
4. Is there an operator for each shift? / NO
5. How and when is sludge disposed of? AV PALIra�30
6. Is there a sWedule for preventative maintenance? YE / NO
Comments: 9-0 M (Mdxjd
PART II - Plant Tour Section C - SAMPLING POINTS) AND FLOW MEASUREMENT
(Collect a sample if desired.)
1. Does an outside lab complete sampling? YES If yes, name of lab.
2. If industry completes sampling, ask the industry representative to describe sampling procedures. Comments:
3. Is flow measurement equipment operational? YES / NO Comments:
4. Is there a calibration log for the flow meter? YES / NO Comments:
Comments:
PART III - EXIT INTERVIEW
Review monitoring records and okr SIU records required by IUP.
1. Are files well organized?/ NO Comments:
2. Are sample collection / chain -of -custody forms filled out properly? YES / NO Comments:
3. Do results in files agree with reports sent to POTW? YES / NO Comments:
4. Who has authority to shut down production should a spill or slug discharge occur?
5. How does SIU inform employees of whom to call at POTW in case of spill/slug?
If slug/spill plan is already required by PO review procedures.
6. Is SIU implementing slug/spill plan? / NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? YES O
Comments, Required Or Recommen e Actions:
Signature Of Inspector(s)
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 2

Egger Wood Products, LLC
I U P #0014

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations,(chronic SNC is >= 66%) => ,
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66°Io) =>
% TRC violations, (SNC is >= 33 %) _>
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) => ,
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 660k) =>
% TRC violations, (SNC is >= 33 %) => M
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) => ,
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66%) => t
% TRC violations, (SNC is >= 33 %) => 2
Control Authority,
Town Name => City of Lexington
WWTP Name =>
NPDES # =>
1st 6 months, dates => 1/1/2021 to 6/30/2021
2nd 6 months, dates => 7/1/ 0 1 to 12/31/2021
Industry
Namel Egger Wood Products, LLC
IUP # 14
Pipe # 1
1 11
1 1
1 11
EXIMM"
i��'=
KCHIMM
fdii�i[� � MRO=f►MTiiitiiii
ROKME„®NiiUMGTiii�1•
1 '1
1 111
1 1
1 111
1 1
1 111
1 1.
1
BDL => Below Detection Limit mg/1=> milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
four r %[Ciea /iidbalml mir5e'" i ll��aves[dnideteCAa�ast91 s�VA. B, pages 12, iW4V �l�l&OU. �8�'a1so se in your PAR Nudmo aino b'r 89Et.tl4 $V Page of
Avg Eriod could be month, Qtr, or 6-month & i i 1/2BDL, or zero values used. Tkt: => Technical Review ama WWTP => wastewater treatment plant

Pretreatment Annual Report (PAR)
Industrial Data Summary Form (IDSF)
Use separate forms for each industry/pipe
Enter BDL values as < (value)
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66%) => z
% TRC violations, (SNC is >= 33 %) =>
Total # of samples =>
* Maximum =>
* or Minimum =>
% violations, (chronic SNC is >= 66%) => ,,
% TRC violations, (SNC is >= 33 %) =>
% violations,(chronic SNC is >= 66%) => z
% TRC violations, (SNC is >= 33 %) => M'
Total # of samples =>
* Maximum (mg/1) =>
* or Maximum (lb/d) =>
* or Average (mg/1) =>
* or Average Loading (lb/d) =>
% violations, (chronic SNC is >= 66%) => ,
% TRC violations, (SNC is >= 33 %) => o
% violations,(chronic SNC is >= 66%) =>
% TRC violations, (SNC is >= 33 %) =>
Industry Name r Egger Wood Products, LLC
IUP #
Pipe # 1
10EEOM
r r t
iFr�t�im
gags=
UMME®
tmaEam
r�:r,,,
tME .7'=
11 Tit.TM
. •
l�r�
i►•�'iTir�
.
fe M123 M
BDL => Below Detection Limit mg/1 => milligrams per liter
* POTW must enter at least one of these IUP => Industrial User Permit lb/d => pounds per day
` iR� vcsi�nideleCA t91 sl f;t0n B, pages 12S fie& WiitO ft L- Wreuse in your PAR NH&:? a lil &aRgjW -Palm of
Avg period could be month Qtr, or 6-month &if B L , 1/2BDL, or zero va ues used. F Y R� _> Technical Review Criteria WWTP => wastewater treatment plant

olumn Averages => 0.01218
Maximum 0.012189
Used in Calculated
Calculation lbs/day
. 1
.111
.1• '�
111 848.29
10700.00 1 :. .

AMMONIA m ARSENIC CADMIUM

CHROMIUM
COPPER
1 11'
1 11' 1 111'
CYANIDE

LEAD MERCURY m MOLYBDENUM
- - -- - - -- - -
�� 1 1 I � � 1111 1111 11111 --
1 1 1 1 1 11 1 � 1 111 1 111 1 1111 --
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -

NICKEL SELENIUM SILVER
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -

ZINC OIL & GREASE
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
- - -- - - -- - -
Chlorides

SIU INSPECTION FORM
Name Of Industry: s3jRf=6 ' Vl% Pro�e.�-S 1, �-�-G IUP # :( —
Address Of Industry: IUP Expiration Date:
Industry l�eprese It tives: Title
eA N S /Y! Ayu 9 ✓`
r
VV•l ;am a _ Snv;fohMc►?to�( 5ecieftlyt-
POTW Representatives: ` Title `
w Q, L AOLI/ 1_
Date Of Inspection: Time Of Inspection: �pm
Purpose of Inspection: Annual Other (Describe) t o
POTW to which IU discharges J 9 U` N41 rp PDES # C $
Is SIU currently in SNC? If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMME TS f�
l
Product
YES / NO CAL
Raw materials used
YES / NO I.
Manufacturing processes
YES / NO
Categorical, if applicable
YES / NO
Production rate
YES / NO
Number of employees
YES / NO 3 S�
Number of shifts YES / NO -
Comments:
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area? YES (!�q Where do they go?
2. Are production areas diked, co�'�ed, or otherwise constructed in such a way as to prevent harm to the WWTP,
especially from spills or slugs? (1YE�/ NO Comment
3. Are there floor drains in the storage area?
Where do they go?
4. Are storage tanks and areas diked, conpAieq, or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? YE / NO Comments:
5. Are process and storage tanks and pipes labeled?
6. How are off -spec raw materials, and products dis
y51/NO
of?
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production area discharged to'die POTW? YES NO
9. What non -process wastewaters are discharged to POTW?
Comments:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994 Page 1

SIU INSPECTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system? YE / NO Comments:
2. Are all units operational? YE / NO
3. How often does operator/raenance n check system? 't",
4. Is there an operator for each shift? / NO
5. How and when is sludge dispos d ofJ
6. Is there a schedule for preventative maintenance? YE / NO
Comments: Zvi o 9 _ A S
PART II - Plant Tour Section C - SAMPLING POINT(S) AND FLOW MEASUREMENT
(Collect a sample if desired.) � ���f
1. Does an outside lab complete sampling? YE / NO If yes, name of lab. '� Q ��""'��
2. If industry completes sampling, ask the indus representative to describe sampling rocedures. Comments:
3. Is flow measurement equipment operational? (/' Yl�A / NO Comments:
4. Is there a calibration log for the flow meter? /( Y$S)/ NO Comments:
Comments:
PART III - EXIT INTERVIEW
Review monitoring records anSIU records required by IUP.
1. Are files well organized9 YE / NO Comments:
2. Are sample collection / cham-of-custody forms filled out properly' YES / NO ments:
3. Do results in files agree with reports sent to POTW? YES / NO Comments:
4. Who has authority to shut down production should a spill or slug discharge occur?
5. How does SIU inform emploes of whom to call at POTW in case of spill/slug?
If slug/spill plan is already required by POTW, review procedures.
6. Is SIU implementing slug/spill plan? '�J;� / NO Comments:
Comments:
INSPECTION RESULT
Slug/Spill Control Plan Need d? Y / NO
Comments, Required Or Recommen ed Actions:
Signature Of Inspector(s)
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
Date:
Page 2

POTW=
NPDES#=
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name: BODTSS Updated- HWA AT—Approved_06162020.x1sx, Worksheet S1vi:2RP/2022, 2:40 PM
Page 1 of 9
Allocation Table
Headworks last approved: 06/16/20
Allocation Table updated: 02/16/21
Permits last modified: O1 /31 /21
LRWWTP
NCO055786
Industry
INDUSTRY NAMES Permit Pipe
(please list alphabetidy) number number
1) Applicable Values should be entered in the Heavy Bordered cells. Restof worksheetis protected, password is "2".
2) Formulas are discussed in the Comprehensive Guidance, Chapter 6, Section C.
3) HWA and AT worksheets in this workbook are linked. PollutantNames, MAHLs, Basis, and Uncontrollable load in this AT
worksheetare automatically entered from the HWA spreadsheet This includes pollutantnames in columns AT through BK.
FLOW BOD
Type Renewal Modification Date Permit Limits Permit Limits
of Effective Effective Permit Conc. Load
Industry Date Date Expires MGD gal/day mg/1 lbs/day
ASCO Power Technologies
0038
0001
433
05/31/19
05/31/24
0.01
12,
Shutz Container Services
0010
0001
05/31/19
01/31/21
05/31/24
0.04
50,00[
1050
Hollywood Bed & Spring MFG. CO., LLC
0028
0001
433
05/31/19
02/05/21
05/31/24
0.04
20,i
Matcor Metal Fabrication
0012
0001
433
05/31/19
05/31/24
0.017
17,f.
Tier Rack
0045
1 0001
433
05/31/19
05/31/24
0.017
17,
Egger Wood Products, LLC
0014
0001
429
03/16/21
03/16/26
0.048
48,(X)O
15000
600.48
Column
Totals =>
0.1640
164,000
165
Basis=>
MAHL from HWA (lbs/day) =>
Uncontrollable Loading (lbs/day) =>
Total Allowable for Industry (MAIL) (lbs/day) =>
Total Permitted to Industry (lbs/day) =>
MAIL left (Ibs/day) =>
Percent Allow. Ind. (MAIL) still available (%) =>
Percent MAHL still available (%) =>
5 Percent MAHL (Ibs/day) =>
HWA.AT
Revised:November 2005
NPDES Permitted
NPDES Design
1
95.0 % 74.0
47.6 % 21.3
1

POTW
NPDES#
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name : BODTSS Updated- HWA AT—Approved_06162020.x1sx, Worksheet FfAfl`6:2RP/2022, 2:40 PM
Page 2 of 9
Allocation Table
Headworks last approved: 06/16/20
Allocation Table updated: 02/16/21
Permits last modified: O1 /31 /21
LRW WTP
NCO055786
Industry
INDUSTRY NAMES Permit
cn— list alphabetldyi number
Pipe
number
TSS
Permit Limits
Cone. Load
mg/1 lbs/day
ASCO Power Technologies
0038
0001
Shutz Container Services
0010
0001
Hollywood Bed & Spring MFG. CO., L
0028
0001
Matcor Metal Fabrication
0012
0001
Tier Rack
0045
0001
Egger Wood Products, LLC
0014
0001
1001
40.03
Column
Totals =>
40
Basis=>
Design
MARL from HWA (lbs/day) =>
131
Uncontrollable Loading (lbs/day) =>
l K
Total Allowable for Industry (MAIL) (lbs/day) =>
-5(
Total Permitted to Industry (lbs/day) =>
MAIL left (lbs/day) =>
5(
Percent Allow. Ind. (MAIL) still available (%) =>
101
Percent MAHL still available (%) =>
5 Percent MAHL (lbs/day) =>
H WA.AT
Revised: November 2005

POTW=
NPDES#-
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name: BODTSS Updated- HWA AT-Approved_06162020.x1sx, Worksheet r' r6:2AN/2022, 2:40 PM
Page 3 of 9
Allocation Table
Headworks last approved: 06/16/20
Allocation Table updated: 02/16/21
Permits last modified: O1 /31 /21
LRWWTP
NC0055786
Industry
INDUSTRY NAMES Permit Pipe
(Pk -list elphebe wly) number number
Ammonia
Permit Limits
Arsenic
Permit Limits
Cadmium
Permit Limits
Chromium
Permit Limits
Copper
Permit Limits
Conc. Load
mg/1 lbs/day
Conc. Load
mg/1 lbs/day
Conc. Load
mg/1 Ibs/day
Conc. Load
mg/1 lbs/day
Conc. Load
mg/1 lbs/day
ASCO Power Technologies
0038
0001
0.07
0.007
1.71
0.171
2.07
0.207
Shutz Container Services
0010
0001
0.023
1.1
0.285
Hollywood Bed & Spring MFG. CO., L
0028
0001
0.07(
0.012
1.71
0.285
2.07
0.345
Matcor Metal Fabrication
0012
0001
0.07
0.01(
1.71
0.242
2.07
0.293
Tier Rack
0045
0001
0.07(
0.01
1.71
0.242
2.07
0.293
Egger Wood Products, LLC
0014
0001
25.
10.01
0.003
0.0012
0.003
0.0012
0.05
0.02
0.061
0.0244
Column
Totals =>
10
0.00121
1
0.063
2.101
1.449
Basis=>
MAHL from HWA (Ibs/day) =>
Uncontrollable Loading (Ibs/day) =>
Total Allowable for Industry (MAIL) (Ibs/day) =>
Total Permitted to Industry (lbs/day) =>
MAIL left (Ibs/day) =>
Percent Allow. Ind. (MAIL) still available (%) =>
Percent MAHL still available (%) =>
5 Percent MAHL (lbs/dav) =>
HWA.AT
Revised: November 2005
Class A,
Class A,
Design
Mon. Avg.
Stream Std
Stream Std
Mon. Avg.
711.51
0.4578
0.1921
5.6478
7.6966
432.61
0.0541
0.0324
0.3866
4.2234
278.89
0.4037
0.1597
5.2611
3.4732
10.01
0.0012
0.0627
2.1013
1.4488
268.89
0.4025
0.0970
3.1599
2.0244
96 %
100 %
60.7 %
60.1 %
58 %
37.8 %
26.3 %
0.3

POTW=
NPDES#=:
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name : BODTSS Updated- HWA AT—Approved_06162020.x1sx, Worksheet fjAflqj:2RP/2022, 2:40 PM
Page 4 of 9
Allocation Table
Headworks last approved:
Allocation Table updated:
Permits last modified:
LRWWTP
NC0055786
INDUSTRY NAMES
(pl-- list alphebaicly)
06/16/20
02/16/21
O1 /31 /21
Industry
Permit Pipe
number number
Cyanide
Permit Limits
Conc. Load
mg/I lbs/day
ASCO Power Technologies
0038
0001
0.65
0.065
Shutz Container Services
0010
0001
Hollywood Bed & Spring MFG. CO., LL
0028
0001
0.6
0.108
Matcor Metal Fabrication
0012
0001
0.65
0.092
Tier Rack
0045
0001
0.6
0.092
Egger Wood Products, LLC
0014
0001
0.015
0.0060
Column
Totals =>
0.364
Basis=>
Stream Std
MAHL from HWA (lbs/day) =>
1.022,
Uncontrollable Loading (lbs/day) =>
0,067E
Total Allowable for Industry (MAIL) (lbs/day) =>
0.9551
Total Permitted to Industry (lbs/day) =>
0.363E
MAIL left (lbs/day) =>
0.591;
Percent Allow. Ind. (MAIL) still available (%) =>
61.9
Percent MAUL still available (%) =>
57.8
5 Percent MAHL (lbs/day) =>
HWA.AT
Revised: November 2005

POTW=
NPDES#=
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name : BODTSS Updated- HWA AT Approved_06162020.x1sx, Worksheet rfcivR16:20/2022, 2:40 PM
Page 5 of 9
Allocation Table
Headworks last approved: 06/16/20
Allocation Table updated: 02/16/21
Permits last modified: O1 /31 /21
LRWWTP
NC0055786
INDUSTRY NAMES
(please list alphabeticly)
ASCO Power Technologies
Industry
Permit
number
0038
Pipe
number
0001
Lead
Permit Limits
Mercury
Permit Limits
Molybdenum
Permit Limits
Nickel
Permit Limits
Conc. Load
mg/I lbs/day
0.43( 0.043
Conc. Load
mg/1 _ Ibs/day
Conc. Load
mg/1 lbs/day
Conc. Load
mg/l lbs/day
1.50( 0.150
Shutz Container Services
0010
0001
0.5
0.00041
0.380
Hollywood Bed & Spring MFG. CO.,
LL
0028
0001
0.4
0.072
1.5
0.250
Matcor Metal Fabrication
0012
0001
0.43
0.061
1.5(
0.213
Tier Rack
0045
0001
0.43(
0.061
LN
0.213
Egger Wood Products, LLC
0014
0001
0.04
0.0196
0.0003(
0.0001'
0.021
0.008
Column Totals =>
0.756
0.00053
0-2M
1.214
Class A,
Class A, Mon.
Sludge
Sludge
Basis=>
Mon. Avg.
Avg.
Ceiling
Ceiling
MAHL from HWA (lbs/day) =>
1.6459
0.085593
1.1419
2.8935
Uncontrollable Loading (lbs/day) =>
0.6462
0.017034
0.1514
0.2947
Total Allowable for Industry (MAIL) (lbs/day) =>
0.9997
0.068559
0.9905
2.5992
Total Permitted to Industry (lbs/day) =>
0.7563
0.000530
0.0000
1.2141
MAIL left (lbs/day) =>
0.2434
0.068029
0.9905
1.3851
Percent Allow. Ind. (MAIL) still available (%) =>
24.3 %
99.2 %
100 %
53.3 %
Percent MAHL still available (%) =>
14.8 %
79.5 %
86.7 %
47.9 %
5 Percent MAHL (lbs/day) =>
0.0823
0.004280
0.0571
0.1447
HWA.AT
Revised: November 2005

POTW=
NPDES#—
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name: BODTSS Updated- HWA AT_Approved_06162020.x1sx, Worksheet R ffi&2,P/2022, 2:40 PM
Page 6 of 9
Allocation Table
Headworks last approved:
Allocation Table updated:
Permits last modified:
LRWWTP
NCO055786
INDUSTRY NAMES
(please list alphabeticly)
06/16/20
02/16/21
01 /31 /21
Industry
Permit Pipe
number number
Selenium
Permit Limits
Silver
Permit Limits
Conc. Load
mg/1 lbs/day
Conc. Load
mg/1 lbs/day
ASCO Power Technologies
0038
0001
0.2
0.024
Shutz Container Services
0010
0001
Hollywood Bed & Spring MFG. CO., LL
0028
0001
0.2
0.040
Matcor Metal Fabrication
0012
0001
0.2
0.034
Tier Rack
0045
0001
0.2
0.034
Egger Wood Products, LLC
0014
0001
0.0011
0.000
Column
Totals =>
0.0000
0.133
Basis=>
MAHL from HWA (ibs/day) =>
Uncontrollable Loading (lbs/day) =>
Total Allowable for Industry (MAIL) (lbs/day) =>
Total Permitted to Industry (lbs/day) =>
MAIL left (lbs/day) =>
Percent Allow. Ind. (MAIL) still available (%) =>
Percent MAHL still available (%) =>
5 Percent MARL (lbs/dav) =>
HWA.AT
Revised: November 2005
Stream Std Stream Std
0.6341 0.0152
0.0541 0.119C
0.5800-0.1038
0.0000 0.1325
100 % 228
91.5 %
0.031

POTW=:
NPDES#=:
IUP
Count
1
2
3
4
5
6
7
8
9
10
Workbook Name: BODTSS Updated- HWA AT_Approved_06162020.x1sx, Worksheet F49Mi6:2XP/2022, 2:40 PM
Page 7 of 9
Allocation Table
Headworks last approved:
Allocation Table updated:
Permits last modified:
06/16/20
02/16/21
O1 /31 /21
LRWWTP
NCO055786
Industry
INDUSTRY NAMES Permit
(Please list alphaheticly) number
Pipe
number
Zinc
Permit Limits
Total Nitrogen
Permit Limits
Total Phos.
Permit Limits
c
Permit Limits
4
Permit
Cone. Load
mg/I lbs/day
Conc. Load
mg/1 lbs/day
Conc. Load
mg/1 lbs/day
Conc. Load
mg/1 lbs/day
Conc.
mg/1
ASCO Power Technologies
0038
0001
1.48(
0.148
Shutz Container Services
0010
0001
1.51]I
Hollywood Bed & Spring MFG. CO., LLC
0028
0001
1.4
0.247
Matcor Metal Fabrication
0012
0001
1.48(
0.210
Tier Rack
0045
0001
1.48(
0.21
Egger Wood Products, LLC
0014
0001
0.175
0.0701
Z
Column Totals =>
2.385
0.00
0.00
0.0000
AS/Nit/TF
Basis=>
inhibition
NPDES
MAHL from HWA (lbs/day) =>
27.2968
239.06
Uncontrollable Loading (lbs/day) =>
14.3573
200.57
Total Allowable for Industry (MAIL) (lbs/day) =>
12.9395
38.49
Total Permitted to Industry (lbs/day) =>
2.3847
0.00
0.00 0.000C
MAIL left (lbs/day) =>
10.5548
38.49
Percent Allow. Ind. (MAIL) still available (%) =>
81.6 %
#VALUE!
100.0 % #VALUE!
Percent MAHL still available (%) =>
38.7 %
#VALUE!
16.1 % #VALUE!
5 Percent MAHL (lbs/day) =>
1.3648
11.9528
HWA.AT
Revised: November 2005