NC0055786_Pretreatment Annual Report_20220228

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

d
r� a
CD
� ='w
0.
c
yC
b
A
g z
z otte
Ca n D te
b
nPO
0
CD
o
CDCD CD
Gn H
z
�d
o
CD
('
0-0
CD
CLCOD
�c
' �
COD
z
y CD
CD " �, •
� c o
CD CD o
x CD
° o
CD
b
CL� do
CD Cr
z 0 w
�
CD
GQ
I
� CL
CD I Q
0
� cn
c
�
n
G
CD [
o
C
C
BCD
CD
•J
O
o
., a
I r,-,
b
C
CD
o
o
•
arc
p
a
CD
a
CD
z
� o
II II H
� � b
cro'
H
n
o a�' CD
CD
CD
CA
0
0
CD
H
z�
z
Iu
0
0
c
CD

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

N
�
J
�
N
w
�
0
0
0
N
N
N
N
�
iN
N
to
41
w
N
41
w
N
N
N
N
O
O
O
O
N
cp
a
0
m q (D G N 3 Cif 0 0 7 0 7 c) N N-0 * ;1 W= (D.� > V1
.m3 3 _moo gym NCfDD Cd
n'mm-o0-MC21 ; Om(�m nmo.
N m N CD> SU Q a N n O O_^�.
C N D) fD n 7 O. O N (D
m N Q K? O Q A
_ N = t
O
O
O
O
O O
O
O
y
O
O
O
O
O O
O
O
^a
��
f

0
0 0
b o
o
o
0
0 0
0 0
0 0
0 0
4�. o
�0
o
o -r
c.n
all
loll
n
n
n
n
n n
n
n
0
0
0
0
0 0
0
0
0
0
0
0
0 0
0ll
0
0
0
0
0
0 0
0
0
0
0 0
0
0
0
0
0
0
0
0
0
0 0
0
0
0
0
0
0
0 0
0
0
00C,CC
0
0
0
0
0 0
0
0
0
0
0
0
0 0
0
0

0
0
0
0
0
0 0
0
O
O
�
w
won
� 000
O
O
O
O
O
o O
O
o
O
O
O
o
O
O O
0
00
00
o_ 00
0
O
o
O
o
_o
_o
N
O
N
N
O
cn
N N
n
O
O
O
O
O
O
O
O
W
W
A
A
O
00
N
oo
r
n '
0
0
0
0
0
0
0
0
.A
w
vi
cn
�.D
oo
�.
o'
0
0
0
0
0
0 0
0
Oh
J W
N
^'
O
al�
(O
ON1
G.
IIIIIIIIIIIIIIIIII
IIIIIIIIIIIIIIIIII
�II�I�I�III

n
n
n
n
1. n
n
n
n
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
ch
ch
ch
cn
ch
ch
ch
ch
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Vi
lh
CA
�.A
LA
U
CA
Ch
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
C:l

0
0
0
0
0
0
0
0
cN1i
N
O
N
.A
1
A
N
O
O
O
O
O
O
O
O
N
.-
N
N
p.
N
W
W
N
W
ONi
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
w
In
A
01
O
cn
A
A
A
N
�1
cn
0
0
0
0
0
0
0
0
00
00
0
0
00
0
0
00
00
W
N
VA
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
oo
w
N
t.A
O
O
O
O
O
O
O
O
�
O
O
O
O
O
O
O
O
O
O
Cl
O
O
O
O
O
O
N
O
N
—1
N

�
•u
o
o
o
�
Cl
O
O
O
O
O
0
�
N
00
toil
W
N
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
0
0
wN
Q
0
0
0�
O
v,
w
"o
4�-
O
O
90

� a
w
0',
# # # #
# # # #
# # # #
o
�
o
<
o C
o C
o,
< OR
Z z CD
y m
Z z a w
w y
Z z aCD
w in' O. O
u V=
V UQ
v v
W
li
W
W c -0
�o adQ�°Qrn
o �oQ �00
II II II II II II it
V V V V V V V
II II II II II II II
V V V V V V V
II II II II II II II
V V V V V V V
0
0
J
O
eD
w
tQ
N
O
fD
N
00
O
I
.'7
O
O
N
00
O
0
0
0
0
�
C
o
0
0
0
�
►�
N
N
O
Lh
LA
lJ�
tli
'-r
(D
I
r
0
0
0
0
O
O
O
C
N
O
O
O
OGo
o
O
N
O
O
O
O
cn
0
0
0
0
0
o
0
0
0
00
o
(LA\
Ln
w
m
R
�
O
0
0
0
0
��
o
o00
o
�o
O
000
0
LA
t-A
m
�
on
C
I
�
o
o
0 C
0CDm
�CD0o
� � �k m co y
v v v v v
r
X_
O �
O O O O
0 0 00
�w CD
r"
N N
v Z
k k CD
a
0
O
o �
0
o�
00 CDCD
C
m

B c 5
aa�
Boa
C.
0
°
o
o C
� O
-s
Syys y
V a
w
V V V
V V
°
o
�] O
O
OCOO60
�
4 �: O
,
zzr>
�w
v uq
i uQ CD
CD
0 0
\ \ [y
C
¢,
U
V V V U
U U V
u
O
00
?
N
p
�
O
O
O
00
O
00
N
o
.•v
�
C
o
o0
\
a
o
o
fl
ON
o
0
0
0
0
0
LJ
cc
00
RE

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

N
A
4�
4�,
4
l�
¢'
E.�
>
Vi
—
A
—
W
N
00
.-
�
Q\
-
Y,o
O
<
>
O
O
N
O
N
O
N
O
N
O
N
O
N
O
M
cD
l
m C@ 01 2 3* cn 8 O <p m 00 m O. v N- a * M W 2 m cn
N `m
7 3 nn �. c m m= m m„ N N F y o_ 0 cD p^
m� O m c m 3 E— 3_ a R f, N 0 m,� m
N
1
m fD K V+ N m m A 6 O' O m m— m - m r. N
N fp S' :3 0 m m- Q CD Q p j�
2.
N N 7 CL N f/i m
m CD
m N n a �= N 7
O
O
O
O
O
N
O
O
O
O
O
O
O
O_
O
j
N
O
O
d
•
00
v�i
O\
�l
00
Do
Q\
c.n
�O
cn
N
A
.A
00
?
0o
D
O
�
N
N
w
QCi
O
N
00
--1
cn
c
O
01
N
--
N
00
N
J
'
J
O
w
00
A
01
ui
O�
b1
Oo
\o
00
O�l
A
O
W
N
t.A
W
�o
O,
�i�a

0
0
0
0
0 0
0 0
0 0
I'lll'llllllllll'llllll�g
A
n
n
n
n
A
n
n
0
0
0
0
0
0
0
0
0
0
0
0
0
O
o
O
O
O
o
O
0
o
O
o
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
�j
t1i
t1i
�o
0
0
0
0
0
0
0
o
0
0
0
o
b
o
0
0
o
0
0
0
0
O
O
O
O
0
0
0
0
0
0
0
0
0
cr
O
O
O
N
A
N
N
N

n
0
0
0
0
0
0
LLLL
o
0
0
o
0
_o
0o
N
In
to
W
�1
ID
O
O
O
O
O
O
O
N
O
O
O
w
00
N
Vi
tIi
W
�l
�o
O
O
O
O
O
O
O
O
O
O
O
p
O_
O
O
O
C.
O
O
O
`D
Ch
O
O
O
O
O
O_
O
A
4P
O
O
N
O
A
A
cn
N
lt�
v
N
�1
n
O
0
O
0
O
o
O
0
O
0
O
0
O
o
r
ON
0W0
\0
W
N
A
O
04�,0
O
4�,
O
N
O
�J
O
O
O
N
O
O
G d
p' _
O
A
O
O
W
Vi
N
ONO
O
�

0
0
0
A
n
n
n
n
n
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
cn
cn
v,
v�
N
N
w
N
O
O
O
O
O
O
O
O
O
O
O
O
N
N
N
N
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
cn
N
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
.P
NO
A
n
n
n
n
n
n
n
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
o
O
O
O
O
O
O
O
O
O
00
CD
O
O
O
O
CDO
O
O
O
O
O
O
O
O
O
O
Cl
O
O
N
O
O
O
O
O
O
O
O
O
O
O
00
O
O
O
O
N
n
n C co CD

I;II��III�lI

O
Cr,
Crs
O
cs
N
00
n
n
•
1 1
0.022 0.022
0.024 0.024
0
0
W
0
0
‘.O
0
Cr,
0
0
C
0
0
•—
0
0
N
ISO
r
N
r
w
, 4
1
I 0.003
O
.0C
O
O
_
O
O
O
O
O
O
0.002
Used in Calculated
Calculation lbs/day
1
0.0032 1
0.0066
0.0053
0.0006
0.0004
0.0030
0.0006
O
O
O
O
0.0002
O
,O
N
-P
VO
O
Cn
O
Vi
,,O
O
Cn
V.
N
00
00
1
5.5458
_
A
--
-
�O
O
ON
J
Cn
O
CA
\O
-
O
LA
Ch
2.887
LA
-P
CA
00
1.94
O
ONO
0.3270
O
O
O
O
0.2520
0.0240
0.1352
O
c
cn
N
0.2889
0.6528
O
--1
O
.O
1
•
i
A
*`TrE=E�7c'iTC�:

41,
41,
0
CO
n
a
Chlorides
Used in Calculated
Calculation lbs/day
1
1
o o
o,
w
0
v,
a,
0.1471
0.6545
0.1471
0.6545
A
o'
ceD
CD
A

ri
Used in Calculated
Calculation lbs/day
'
n
■
1
r
Sodium
Used in Calculated
Calculation Ibs/day
•
21.04
67.4
21.04
CT
J
O
---1
.J
w
W
0.9732
7.9343

rn
W
rn
0'G
dAV TUOLU 1s 1
s a, m c 2 3= cnoo m oa�
D cg13 cCD CD
3 . c m m c m m 0,
. N v w CD K Q a N CD 7 CL (D - A 0 O
(0 T 7 a Q
N 91 co = (0 3 c 2. d a.0
C N O. CD (Q T= A W
ooFZ1W20•-• Fco
N d O (D O (D 7 ,O ,
w m �c .y+ a 0 (D v 'm
gn s-O (1,G (R N ,; O.
. n N O- 0 S
7 N (D(D N N N `<
(A j
r
-
i
0.0167
0.0208771
0.0207441
0.0205441
0.004722
0.0332171
0.026262
I 0.0061051
oN
O`
oN
J
c
0
ik
853.3
41.
LA
✓0
1520f 1520
640 640
784 784
t/,
356 356
61 61
754 754
-
0\
"O
W
w
-P
132.0 I
•
'-
N
rn
LA
110.72
w
••
w
.-•
00
1p.
147.93
--I
J
w
0000
w
00
0
N
00
440
270
420
Oo
0,
429
840
580
N
CO
E 4401
270
420
LA
00
CT.
429
840
580
22.29
1
O1
N
A
01
ONi
,-•
01
- LA
01
N
A
\O
W
C\
60' Sb 1
N
‘.O
w
A
soa
w
0
A0
(0
A
co0

00
00
N
,
■
3.241
10.81
01
O1
W
.A
01
01
W
D\
.
N
,---
J
k—
�O
i J
00
01
O1
W
W
01
C1
W P
-1 -
01
O
N
A
N
O
00
N
00
N O
O
0.90
o
.r
o
.r
W \O
—
\O
00
W
In
—1 00
LA
O
�1
N
1
r
A
IN N
I
All
I,
rr
D
X
cn
f
Used in Calculated
Calculation lbs/day
1
1
A
A
A
A
A
A
A
A
0
0
O
0
0
O
0
0
O
0
0
o
0
0
0
0
0
0
0
0
0
0
0
0
I 0.0005
o
0
O
CA
S000.0
I 0.0005
O
0
o
VI
I 0.0005
o
0
0
Vl
I 0.0005
0.0001 1
•0
r
0
U,O
O
0
O
0
O
0.0001
o.0000]
0.0001
0.0001
0.0001
0.0000
A
r"
r
0
Ca.
n
c

0
0
O
Q1
0
0
.-
0
0
T
0
0
O
u,
0
0_
W
0
0
N
00
0
0_
W
0.008
I
O
O
O
a1
110'0
O
O
-
O\
O
6
O
(h
O
O
-
W
O
O
N
00
0
O
-
w
0
O
0
00
O
O
o
(J
0.0031
0.0010
0.0019
O
O
O
J
0.0002
O
o
o
01
O
O
0
-
0.0022
0.0004
A
a
0
0
d
ril f 11 I 41 DI! I:BC
A
ACIO
A
t •
o
0
0.013
O
0
-.
0
o
w
o
o
a
w.
o
0.0271
C"
0
0
/
L0
0
o
(n
0
0
.--
w
0
0
o
(n
0
0
-
w
0
41.
0
0
�o
w
0
0
-
0.027
PER
Used in Calculated
Calculation lbs/day
0
0
-
�.
0
0
c
0
o
0
0
oN-
0
0
0.0005
0
0
0.0204
0.0076]
0.0014
A

a
0
_
00
A
A
A
A
A
A
A
I
'
0.005
0.005
0
0
Li,
0
0
u,
0
0
LA
0
0
oo
0
0
LA
0
o
l./,
0
0
N
0.0025
0
o
N
CA
0
c
N
V,
4
0
o
ON
V,
c>
0
00
0
0
N
LA
0
0
N
U
0.0003 I
O
O
0.0004
0.0004
0.0004
0.0001
0.0007
0.0018
0.0004
0.0001
A
A
A
A
A
A
A
A
A
r
0
0
0
LA
0.0002
O
0
0
N
0.0002
0.0002
0.0002
0.0002
0.0002
0.00025
O
O
co
O
O
O
co
O
co
O
O
O
O
O
co
co
O
O
O
O
O
O
O
O
co
O
0
0
0.00002 I
0.00002
0.00004
0.000021
0.00002
O
O
O
O
O
O
0.00003
0.00002
0.00002
0.00001
r
m

—
A
w
1
1
'QL
r-
O
r
-<
DENUM
Used in Calculated
Calculation lbs/day
-
-
A
1
A
A
A
CDD
CD
N
.i
0
O
.0
0
O
.-,
0
O
-
0
.0--'
w
_o
J
0
w
I
I'
O
O
0
Ul
O
O
IQ
`._,
O
O
CA
O
O
O
VI
O
O
O
Vr
C
O
W
O
O
.-.
�l
O
O
.--'
W
0.0014 I
0.0029
0.0009
0.0036
0.00091
0.0014
0.0002
0.0066
0.0007
0.0029
A
ao
Co
n
t. rn
r
Used in Calculated
Calculation lbs/day

A
A
A
A
. ,
-
m
i
-
0
0
0
0
0
0
0
0
0
0
o
0
0
b
0
0,r
0.0211
0.0081
O
b
O
y
0
b
0
O
to
0
b
0
o
Ji
0
o
0
o
w
o
b
0
O
LA
0
0
O
as
0
0
N
�-.
0
0
o
00
0
0
O
-1
O
O
O
-
O
O
N
o
O
O
O
O
O
O
O
O
O
O
O
O
---
O
O
O
o
O
O
O
O
_
-1
0.0046
0.0014
0.0004
r
_
.0
•
O
lV
‘.D
N
CO
0
QN
O
00
00
`vO ,
O
C
0
Oh
�+
W
N
N
N
00
..-,
W
Cn
-1
rr
,_,
N
i--,
O
N
.0
N
CO
o
0.,
O
00
00
.0
O
O\
O
O�
...
W
IV00
IV-1
N
,--
W
to
N
. --,
0.2145 1
0
N
00
t�.l
.
N
0.50281
O
N
w
0.0239
0.3662
0.47771
0.2344
O
O
�1
,--.
A
1
i
A
i
A
C)
0
0
z

CD
O
AD IT'
a.
n
Chlorides
Used in Calculated
Calculation lbs/day
1 _
I
00
O
0
00
00
O
O
v
00
O
O
0.3178
0
W
(!i
(11
-.1
00
0
?
0
-A
A
0
A
0
Q

Oh
5
(IP
Conductivity
Used in Calculated
Calculation lbs/day
±iiIP
I
Used in Calculated
Calculation lbs/day
1
3
VI
IP
N
C.II
J
IP
un
cm
N
tal
.A
N
00
N
N
2.18251
2.9226
A

n AD q
�' Q. w 0 = 0�
II II v v � AD
C�Cr,Y«a'C
CrCra �vvvvvvvvv
IMontni Dauy
e. r
* * * * * * * *
•< p \ C
o < o < <
o 6, o' O o•
o
�-- .-. O
n AO �* c7 ,-+ c i "s O
y) 00. o c<CD O 00 0< O
v'D�v')U,�aI KKo rnLi' v,�I 440
Z z Z r a x P Z Z z Z r Y x x w
Q w c c o c 7'' c¢ w o 0
v v v v 5•ac 3 -,, v v v v 0•0,, 2
II II II a W CD w I} II II 00 O
0 0 o a\ 0- It, �� '0 0 0',o Do �� CMG `LS
� C. -- O- Fro .°\i o ¢. N
VVVVVVVVV V V V V V V V V V
IMontniDai y IMontnlri Daly
O
000
0.0063
1 0.0144
00
st 6 mont is
I opper
Ilst 6 months 1
!Arsenic
00
[1st- 6 months 1
(IQ
R.
0
0
0
0
O
0
0'
0.0204
oo
t�
0.
0
2nd 6 months
00
2nd 6 months I
st 6 mont is
A2
eo
0
0000
O
—
o
0
—
00
st 6 mont is
I1 ati mium
0
000�
o0
w
0
00
c
0
—
5
BOD
2nd 6 mont is
0
0000
0
O
0
0
O
00
Fnd 6 mont is
O
000�
,.0
O
rn
00
N.
a
a
5
0
0
vo
O
O
O
O
0.0007
0.0003
00
st 6 months
L eatf
O
0
C.
O
0.0032 j
0.144
00
0`
G
Vs
C..nromium
N
N
00
00
st [, months
TSS
0
0
0
0
0.0005
r 0.0018
00
I2nd 6 months
0
O'
O
O
0.0023
0.0061
00
Lnd 6 mont is
74.02
162.34 I
CO
I,-
0
Cr
S
0
O
O,
0
0
1 0.00003
0.00002 _
00
O
O
f
A
Z
r
r
st 6 months
c
C
ii
o
IQ00
a1
0
CD
'P
Ifsi6months I
Ammonia
co
co
O
O
1 0.00002
1 0.00004
00
0
1
kind 6 mont is I
N
iw
00
0000
c
C.
_
o
01
0
CiP
CL ro
C g
mg
Ct7 ° .-.. �D
CD 11
cc CD 0 et
CD
AD A
0 0
-5 d
♦�i
IZOZ/OE/9 of

AlTP o
ror
Q.
(71
co
W-�0DcCo
a ii V ii
d V v v
0
.c1 c0Co
CDz^a
C7 0 8
�0O5r
a. =.
, w 0
0 CD
z
CD
c_
pa.a�
0 ro v V v
v c
p tvi 8 a'ai
cn Boa c��o 3
a.
erg
o <
H of -3 o
• 8 C
O• szo
O Vn
O O O
CID
zzzr
wti II (Pa cp
45
G 0
(IQ erq
o
✓ V V V V V V V V
0
* * * * * * * *
o
< o o <
.- o' -3 o H o' -I o.
o O �' o oio O• Y
O
O -t o -t O t O
.......�.\� � o���0���� 44
nnn n<X wnnno�
O 1iACD 7t
_ v �t i' ¢ G 5 O V VV V �y 2-, V VV V -•o•h
II II k IT) II II • 61'
Ch
Ch la 0000 554 OC T0\\ \o o\p•- a.. - F
... Nm ........�`.
up
II II II II II II II II II II II II II II II II
V V V V V V V V V V V V V V V V
Month! Dai y Month' Dai y
Y
YYYa
0
0
N
1 st 6 mont is
7
;
I st 6 mont is
-
0
0000
0
CA
Co
O
VI
00
w
O'
on
on
Nickel
Y
a
L _ 0.4340
0
O
CO
N
2nd 6 months
2nd 6 months
o
0
0
0
0
O
0.0066
00
St1lUOW. 9 pUT
zzzz:L1'
��aa�
N
st 6 months
st 6 months
CP
0
5
Selenium
zzzzi..,
a�aa�
N
2.9226
N
p.,
os
y
2nd 6 months
R
0r
5
0
En
st 6 mont i s
st 6 month s
zzzzo
aaa5>N
O
—
o
o
0
as
00
s , mon is 1
Silver
2nd 6 months
a.
o
1
9
N/A
0.0010
0.0046
00
2nd 6 months I
st 6 mont �s
i^
,v'.'
o.-
O
O
o
O
O
0.215 1
0.653
00
I st B months
N
.
n
I2nd 6 mont is I
Ga
0'
O
O
1
O
O
O
o
0.2492
0.5028
00
2nd6moniisI
Gr b
r
CD
VD
171 AD
•� t7 2
co 0 CD
O i0
• c
CD P A� �..�
mtz
Q" O O
.CD cc BZ
d d111
It
z
co
co

SIU INSPECTION FORM
Name Of Industry: LA
Address Of Industry:
. Z-.2714
pIndustry Repr septat�� C� t 2"7
w Title
4!=4-1,1‘.,SC24—
Title
P} OTW present 4-4 rftl -r
Date Of Inspection: 114 IC( 1 2O ( Time Of Inspection:
Purpose of Inspection: Annual Other (Describe)
`�
POTW to which IU discharges , NPDES # Z € C
Is SIU currently in SNC? t•La If yes, for what?
IUP # (Qp /'O
IUP Expirati n Date:
rsf3(/io.Zy
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES 4010
Raw materials used YES /ii%7
Manufacturing processes YES itW
Categorical, if applicable YES / NO
Production rate Y =-
Number of employees E p ► / NO go
Number of shifts YES 01C
Comments:
a----Y(3
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 f
2. A roduction areas diked, con
especially from spills or slugs?
oor drains in the production area? / NO Where do they go? 3
a . • _ . _ g,+� -
, or otherwise constructed in Mich a way as to prevent harm to the WWTP,
NO Comments:
3. Are there floor drains in the storage area?
/ NO Where do they go?
4. Are storage tanks and areas diked, cont , or otherwise constructed in such a way as to prevent rm to he
WWTP, especially from spills or slugs? /'YES NO Comments:
5. Are process and storage tanks and pipes labeled?
6. How are off -spec raw materials, and products dispose of?
7. When is the production area cleaned?
8. Is the wastewater from cleaning the production area disc 1i-d to the POTW? NO
9. What non -process wastewaters are discharged to POTW?
0 czici
-
Comments:
3)o N--Q 'C-A--42-1 *
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
Page 1

si tf INSPECTION CTION FORM
PART II - Plant Tour Section B - PRETREATMENT SYSTEM
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system?
NO Comments:
2. Are all units operational?
3. How often does operator/maintenance person c -ck system? 4-$r--p��
4. Is there an operator for each shift? YES / �6• j 54- s_
5. How and when is sludge disposed of?
6. Is thet a schediLle-
of r preventative maintenance? NO
Comments:
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 / r: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?
NO Comments:
4. Is there a calibration log for the flow meter? Ey� / NO Comments:
Comments:
c..Q... - `-4 if 11342_ l
PART III - EXIT INTERVIEW
Review monitoring records an.. er SIU records required by IUP.
l . Are files well organized? ♦ ./ NO Comments:
2. Are sample collection / chain -of -custody forms filled out properly? YES / NO Comments:
trt
3. Do resiets in files agree ith reports sent to POTW? YES / NO Cq meents:
u >r G ptt �jJ
4. Who h s authority t shut down odu do should a mill ot; slug discharge occur?
) Ji t4L OC i Crud (--
5. How does SIU inform employees of o to c 11 at OTW in case of spit slug?
If slug/spi plan is ready required by fOT ; eview procedures. u
6. Is SIU implementing slug/spill plan? NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? '/ 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
Page 2

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

Chapter: PAR Guidance File name: R 4i@iFatshvRQtisdep t ptt aRpstdti49Bk pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page
,fly;uour spauag,s
IQa Aug Pug s1I
•pasn sawn oaaZ JO 'ZQgZ
VI
0
CD
CD
0
0 <
n�
o'
0
of 9 0
0 ' °'
zzra
n oo <
.acrQa o
ii II n
v v v v v v v
0
". n
< o'
o' o
" n n o
ti
o < o\ o
zzry x a
n(,o <
v"' 7' a w c o o,
II V
II CI4 CD cn
�' c
3 o o
v vvvvvv
0
0
o
O
N
oo
st 6 months
!Copper
I st6 mont�s
:
n
a
0
C
7Q
a
'.
0
O
aoo
O.
0.087
2nd 6 months
a
O
m
v
a
O
(n
0
o
0
Q
N
VI
o
QQ
j
LA�
N
a
0
Cyanide [Lead
0
0
o
0
CA
0.0005
00
st 6 months
p.
a
406
O
00
st 6 months
C
C
0
0
QO
1 j
to
O
to
N
2nd 6 months I st 6 mont is
o
o
QO
O
to
O
g
to
00
N
y
p
537
875
°o
2n( 6 months
0
o
O
A
J
.
N
O0
0
0
0.0074
(Ji
oo
Chromium
Op
°o
si 6 months
-
ci
0
0
0.0032
o
0
00a
00
hJ
o.
0
0v,
•
0.0068
0.015
00
la
R.
a
0
a
o°°,
�o
00
12nd 6 months
st 6 months
et
n
C
tc
tc
st 6 months
c
L..)a'
a,
st 6 months
L mmonia -
2nd 6 months
2nd 6 months
43
oN
o0
Ind 6 months
IZ/I£/Zt oa

11 Xpinp pun ,flgtuow
103131nq Pun s
d
z[d
nn°r
II it v v v v
can v'• c. 07
T a, 0
0 5. F
0 w C7
?•D:'Zc g
6
oar
5
0'
04 <
.
0-3
0
5 - O
• o
nn0 <<
Q w
u u • 0 Era
CD
CT
II n u n
✓ v v v
0'
5
0
0
spuour 9 pu41
stI1uotu 91s 1
0'
0
0'
0
j
0
stpuour y is 1
stpuoIuy pui
* * * * * * * *
v
oq <
0-3 o'
n
o
• r)
0
o, n,>o
CD 0
47ao
t• .
zzrx
n 0 < .r
' p 0
II II 00(
CV\ 0 .o
✓ v v v v v v
I st6 months I?nd 6 months
'C
0
0.0124
o
.0o00
'
CD
—,
O
O
0.0094
b
00
00
_'nc [, months I st) months [. nd ( months
7
CD
st 6 mont is
r1
P
0
0
st 6 mont is
oio
0.0007 0.0005 0.2510
O
S
N
O
o
Ch
O
J
8 8 8 8
o
=
0
cn
r��rr
t-
a
0
_
C
t.D
a,
o
"IN
v
OO
p
Enj
o4
O
04
_
O
0
c.
t.,
O
o
cr,
1
A
L2nc 6 mont z s
O
O
O
LA
0
O
vD
s.O
CA co,
CD
' • , A• DS AD
to n eD
do im
• m
A e
• Q" O O
• v)1 1
d
5
c
1
it it CD
00
DD

N
O
0
O
rrr
i Z0Z/£Z/17-ZZ/t
i ZOZ/ZZ/t- I Z/t
10
9
i Z0Z/ZI/Z-I 1/Z
N
N
10
1 Z0Z/6/Z-8/Z
waicMB*.-o3°�Togm� niy�f Plco22�Sm
�20c7mammgEgg ''oa0�'°2(7 »m
"2133 3cnoan3 -aO f�yo�v�md�m
3 V m - o w m m P ri o Q a- a� a
r:>i N �`< sc g� m m aam a o S=
a a •N ? ? ^ y
1
n
■
a r
a
r
N
.�-.
?
.--
01
-7
J
O
to
O
w
v
.A
O
-
N
10
O
4, r-,
.P --Ar
01 .p.
=
0
O
O
405.88
♦
N
D1
v
v
O
LA
O
w
A
O
�1
N
10
O
f=
D1
,P
J
A
BOD
Used in Calculated
Calculation lbs/day
O
O
O
C'
O
L...
10
0
O
O
w
0o
oc
LAw
a,
-ac
�1 w
co w
�
494
0's
a
P
610.38
w
00
00
to w
01 10
�1 O
.,1 w
00 w
OP .
10
.A
Used in Calculated
Calculation lbs/day
252
678
0
0
O
O(
o
-
-
-
-
-
/
-
--
r—-
i
v
r r
I
L 46.8
Q\
.-,
w
J
=
N
v
43.40
I
.P
ON
be
O
.r
w
..-.1
bo
N
n
y
❑ 0
a;
o' a
0
g
O
Z
D
O
o
o
_ 0)
0
a
o $
a
SIX b-6ZOZ .o0•6jW 6uiadS'8 Pee pooMAlloH

Q =
CD N < j ea IDO
N N
N
N -' 33 Q o
c — .A.. co co5
coN -0 Q 5
T ac 0
(
D 5 co
A)
0 V
0
m
O
rn
O
0
roc
1 ZOZIZZ/17-1 Z/17
N
N
IN)
I Z0Z/I 1/Z-0I/Z
l Z0Z/0l/Z-6/Z
I ZOZ/
5
111
ccam�3cn3oc1m8mav vv��7oo2m��tn
m v, a c m- n < J o J m •' y o O m O m J m a
3mc, ��mmm=mmm•m�n°im.... 'm
fD N f0 N L n N 'z OJfD _ J --O Na�j Fi O a N ny.
a
mC-gJ�apa o O
_m n
' �4
• m a • 3 0 A p�
J - N
5
0
O
0
0
,
...
I
n
_
,
I
•
,
I
W
a
5
rro
r
D.m�CD
Mr
k,
,
,
aZ
o' . 0
0
n
��
��
�D)
rii-
a
o
a
.__,_
__
A
n
n
n
A
n
n
n n
0
0
0
0
0
0
0
0 Z
0
0
0
0
C.
0
0
o fo
.
0
0
0
0
0
0
0
0
0
0.0005
V
w
n
>
o
= ©.
0
0
0 0
o
a
C
0
o
o
cn
= o
= o
'A U
0
0
v,
0
0
U
0 0
0 0
cn U
0
0
cn
0
0°
cm
-°
g' S•
C
E
is
0.0000
4
C
0
col
c
P>
O
-
`< io
a
A
n
n
0
0
0
0
0
0
o
0
O
0
o
o
0
o
0.007
0.005 I
r.
r,
0.0150
0.0074
0.0074
O
0
LA
O
0
�,,,,
O
0
O
0
CD
0
0
N
CA
O
0
0
N
(Jr
0.007
CD
0
0
N
U
Used in Calculated
Calculation Ibs/day
O
O
O
N.)O_
d
L
•
i
Hollywood Bed & Spring Mfg.Co. 2021-1.xls

(D N N N O_
N CD
N
O W C yy
N O 3 0 a r1- (•)
Cca s A .-• C
n
N. A r0 i7o .^3
w
'O
(0 CO 7 CD 7
CP
W
0
V
N
N
6 month AvE
4/22-4/23/2021
14/21-4/22/2021
4/20-4/21 /2021
14/19-4/20/2021
12/11-2/12/2021
2/ 10-2/ 11 /2021
12/9-2/10/2021
N
- Sample Date
1 Hon) wood Bed & Spr
Sample Location:
N
O
N
cam23�m30�mnmaro Nvvf�7aD2�'5g)
NN N �1 -ern GOOOfD "" _OONOfD �`J N.O
c 3 m g .m m m FI E FI m i g R-o a m m- m
O y d d F. w 0 cD- O? A s.- O m N- N a pr n, N
N F N fD '< 7, C> -fin a)O O. - (p a O O
S _
a N a "!) "' J A N-
s _
0
O
0
O
DJ
0
N
D...)W
0
O
0
O
0
O
VA
0
0
A
0
o
�l
00
t"
0.2720
0.0814
I
0.082
0.097
0.0814
O
N
--1
N
O
O
00
co
O
O
N
O
O
N
U
Used in Calculated
Calculation lbs/day
0.027
0.044
O
O
O
O\
LA
d
C
0
1 a A.
A A
IIII1I1IIII1IIIIIIIII!:IuI
1 0.0025
Calculated
Ms/day
0.0000
0.0000
_
_
_
1
_ -
_
_
A
1
A
A
1
A A
A
A
0
O
N
0
O
o
0
O
o
0
O
o
0
O
co
0
O
0
0 0
O O
0 o
rra
0.0120
0.0047
0.0047
o
N
0.007
O
N
o
0
N
00
N
N
0
N
e. c
o w
O 0
0
m
o
o
p
0
d
C
0
5 E
. e
w w
<
SIX' 1.-20Z 'o0'641/1 6uudS13. pea poo,IloH

I Z0Z/£Z/b-ZZ/b
1 Z0Z/ZZ/b- I Z/b
.N-
N
I ZOZ/Z I/Z-1 I /Z
I Z0Z/1 I/Z-0I/Z
N
0
N
00
N
I,40,
N
r-�
CD
p«
N N N< N *, 0 ° G s O S 2-1.1 ti O (AD coN in
(C f n O Fj, C (j Dt (D a N (p C N N T1 N rp O. < N O 2 co
n u m 4 oc m y 4 s c n o m • a o m g N y M N ~ C n. O. m N y N .0
N
t"
0
0
5
r=
1
Used in Calculated
Calculation lbs/day
0.00000 I
CI
0
'
i
C7
0
C7
0
iiiiiiiiiiiiiiiom
IIuuIIIIIuuI1uuIIIuuIIIIIi
Calculated
lbs/day
A.
n
n
.
0
0
0
0
0
0
o
B
0
0
0
0
0
b
6 o
rtO
oo
oo
w "'
C"
r 0.0270
0.0124
-
z_
6. 0
0
0
0
0
0
0
c> a °=
n
0
0
06
0
0
0.
0
0
0
G a
m
00
-
00
r
0
0.0000
n
C7 1-1
5 E.
o
•-
`� �"c
SIX' i•- i.ZOZ 'o3.6in 6uiadS '8 peg pooMIlOH

N
I ZOZ/£Z/17-ZZ/b
I ZOZ/ZZ/b-I Zit
I Z0Z/ I Z/17-0Z/17
I ZOZ/0Z/17-6I/b
IZOZ/Zl/Z-ll/Z
IZOZ/I I/Z-0I/Z
N
00
DJ
N m O G R 1;, (� O< O O 3 N N p( �p O N O
co3mo 'm-mmmcmmT ' a 0..
m�kt°4=ao='a3 _�o owom,ead,9d
F ? ri o ^ (p m �'
Fro N m > N 3 N a ❑..00.. a�i
(D .0�. n _ m O �, y (D
O. w O. • Oj. g /c- N
v
r
A ■
■
1
1
\
1
1
1
Used in Calculated
Calculation lbs/day
O
O
O
A
A
A
A
A
A
A
A
d 1 1
0 0
o co
i
o
0
0
0
0
0
00
0 0
0
N
0
0
U
I ----
n
0
iv
N.),a
0 0
W
J
0.323
"iv
ocD
tJ
O
01
rr
C"
0.4700
0.2508
w
O
NN
pp
o
N
O
w
�p
O
w
W
(
O
.�
to
O
,_,
coO
N
CO
Used in Calculated
Calculation lbs/day
0.0000
4A
d
C
O
Hollywood Bed & Spring Mfg.Co. 2021-•1.xls

X
N
O
co
Erg
V
1Z0Z/ZZ/OI-IZ/0i
l ZOZ/ l Z/0I -OZ/0 i
N
O
N
I ZOZ/6I/01-81/01
CO
00
0
N-,
00
00
N-,
IZOZ/SZ/8-tZ/8
I Z0Z/tZ/8-£Z/8
awa aldt es
(commmmcaoc=0-p � Frioaa
J 2 O m N N- A O Q O fD N -" N D.O N
N� tl� O '< S C J J N J (D O. O. T n O O S
(3 w?CO 3 fD J C .O. Q? N D N N N y .O.
" N j?
O
e^�
m
1
0
-
-
A LA
-- 00
CT OA
LA
10
oo
r1
LA
w o0
O 0,
,-, Ln
A
N
10
N
W
v,
r
C1"
00
v
VI
O
O
536.88
f
A
O.
to CADO
00 \O
v
w 00
O /
A
N
Used in Calculated
Calculation lbs/day
235
O
o
O
4
C7
C
O
`
.�
-1F-___AT---
cn
O
O
01
01
00
O
1fl
J
C
w
V
T
0
LI
,..
LA
V
01
-.,
N
c
5
r
r
�1
01
O
00
co,
O
O
O
01
00
..+
O
--.1
01
---.1LA
01
01
Used in — Calculated
Calculation lbs/day
126
576
O
O
co
co,
co
i.'.)
O
r
,
1
I
I
G
40.6
1
w
01
--
Co
w
�1
01
O
A
O1
VI
,O
A
O
n
ric
42.53
A
O
Q1
w
01
A
18.8
w
J
N
40.6
59.9
46.4
60.3
O
O
O
_
SIX Z-2OZ -oj•6j1A1 6uudS'8 Pee PooMIIOH

IJ N -0 m 2
W j (11 O
• (D
j 8 IQ N On 3 Q
• N
A v CO
(O 2 (D
C N O
N cn � SM
COCD CO
CO
0
0
N
N
N
Column Averages =>
Maximum
1
0
a
10/21-10/22/2021
110/20-10/21/2021
110/19-10/20/2021
10/18-10/19/2021
8/26-8/27/2021
18/25-8/26/2021
18/24-8/25/2021
18/23-8/24/2021
Sample Date
1 Hollywood Bed & Sp
Sample Location:
N m
m�coo
m
n
N 0
N
'm
an d
m n
_ '4 to rT O. W N
m=5a0. 9'a. -O
O N 83 N• A O Q
N`G CC JNN N
a 3 g a ,. a
•3 g n d
O, o
*ate
O O
p,n(p
O N O, 2 .... W .0
a, 0. �m22
C (D n 01 a N
n O a.S
n m
m s.
Mfy,.Co.W
4
^�
C)
ivy
r
0o
Used in Calculated
Calculation lbs/day
O
0
'
AAAAAAAAA
_
•
0
O
0
.-.
0
O
0
.r
0
O
0
0
O
0
r-,
0
O
0
r
0
I o
0
r
0
o
0
0
O'•"
0
r
0.0005
O
C
0
(J1
w
r
CD
O
0
LA
o
0
0
0
t/.
0
0
0
0
to
1
0
0
0
0
to
0
0
0
0
to
0
0
0
0
to
0
0
0
0
to
0
0
0
0
U
0
0
0
0
to
n
e. c
C rn
w a
. 0•
0
n
e.
W =
< io
a
0
g
C
S
0
O
O
C
O
.—
I
i
•
(
o
o
0
ON
P
0
O
o
0
O1
o
0
0
v
o
0
0
to
0.0151
O
0
0
to
o
o
0
to
n
rr
r
0
0
.-
o
0
0
o
°Ur �°
0
0
o 0
al °O o
rn
c
.--
0
o
rn
0.007
0.0025
0
Q
to
0
o
LA
0.00251
Calculated
lbs/day
0.0012
C7
C
0
SIX.Z-I.Zo 6uiadS'8 pee poonn/(IIOH

rry
IZOZ/ZZ/OT
IZ0Z/6I/0I-81/OI
1 Z0Z/LZ/8-9Z/8
OD
Do
ZOZ/SZ/8-17Z/8
I ZOZ/l7Z/8-£Z/8
CID
co
co
3g.Cg2, omnN Nvv��CO20 cn
G1 7 F, G O O D CD .,1, • = y p 0^ O 2 O" N V
7,3
C' 0 o_ S n 3 f n 2- 0 m.� m m n a
A O O N ry n N
'G 'O 2-3
C R- O N S)5...2
O �' �' 0�.. a j j W
m= c= a_ 0 y m , "' m
0
0
CD
0
0
O
0
m
r
0
II
-
-
-
i
i
n
-
-
-
•
•
O
O
b
J
O
O
N,
C'
O.P.
0
O
0
o
00
0
0
U
0
o
A
C "
0.0870
O
OU
O
OU
0.04
Cr:
-
—
O
N
s.0
O
J
O
0
C\
-
O
CD
00
J
O
b
-JCD
r--
O
A
.-.
OPPER
Used in Calculated
Calculation lbs/day
O
O
O
01
U
d
O
O
*CO
A
O
ILA
—
n
n
n
n
n
A
r
n
Orr-
O
O
_.
'
r
.
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
O
00
O
0.0032
O
O
OW
I N
O
O
N
U
O
O
N
U
O
0
N
U
O
O
00
O
O
N
U
O
O
N
Ul
O
00
N
U
Calculated
lbs/day
o.0000 I
C
O
Hollywood Bed & Spring Mfg.Co. 2021-2.xls

Column Averages =>
Maximum
6 month Avg
110/21-10/22/2021
0
o
1,
O
N
O
0
‘0o
O
N
N
o
0/ 18-10/ 19/2021
11
/26-8/27/2021
00 o
LA
co
N
O\
N
O
N
8/24-8/25/2021
I8/23-8/24/2021
Sample Date
f Hollywood lied & Spring Mfg.Co.
Sample I.ocation:
N
-'
coi'=qpiii
O 6 N 3 f (A 3° F 2 O`3fD
N am N A
O A
N y a *L 7 m= j v= g)
O O. O N (Drynd= N O 4lni a~�N
N f y N `G • N
��
0
GI
C
0
w
d
71
0
r
n
r"'
M
4
d
C
O
d
C
O
Calculated
lbs/day
0.00000
d
C
0
GOw o
a E
p, w
a.
co
m
Z
C
A
A
A
A
A
k
I
�
l
0
'co
0
o
0
c
0
o
0
-,
0
0
0
o
r7
r"
o
0
O0
0
_
0.0094
00000000
`O
o
00
0
0
0
0
0
0
0
0
0-0 c.44
0
0
Z
0
[ C)
yam
0. 0 r
5 w
0-
o w
`< (o
a
0
o
o
0
C
0
•-
SIX Z-v'o •oO 6nW 6uiadS'8 pee poonn/II0H

Column Averages =>
Maximum
6 month Avg
10/21-10/22/2021
10/20-10/21 /2021
10/19-10/20/2021
110/18110/19/2021
[8/26-8/27/2021
8/25-8/26/2021
18/24-8/25/2021
8/23-8/24/2021
0
W
[ Hollywood Bed & Spr
tiample Location:
`c=3m
N N
a a
3 f to 3° 8 (3 'v N a a i A m 2 g- rn
°''d'2, FD. mm-n '-mix^a�mp2�
;° O -'(3 a°' 'y
,< O� s.C ^ b y (p Q a. d .. .. p O
". ^ o ,. m y
rf_
ffr
p
0
0
d
0
A
9
1
n
G
patelncleJ ui pasp
r
n
n
nJA
A
non
A
A
0
0
0
-
0
0
0
-
0
0
0
�-
0
0
0
-
0
0
0
-
0
0
0
--
0
0
0
0
0-
0
Cm
0.0005
, 0.0005
.
=
.-r;
V,
o
0,0
o
(1,
0
O
Vt
0 0
O O
O O
V, Li,
0 0
O O
O O
(./, to
0 0
o o
O O
U tJ,
-n
c
2 ;<
... I5.
0
'a
w
. c
m w
< co
co.
r-
o
o
o
0
d
C
0
-
A
.
2
♦ .O
0
N
�l
is.)
0
N
--
0
W
.O
.O
0
N
•A
0
W
0
a
0
N
-
0-
-
tN
-.l
r
O
W
.D
O
O
N
O
O
O
N
O
O
O
..-
.D
o
iv
J
is)
0
iv
-
0
W
.0
,O
0
iv
.
0
W
as
O,
0
[J
,_.
--,
0.137
Used in Calculated
Calculation lbs/day
0.0000
It
d
<
0_
Hollywcod Bed & Spring Mfg.Co. 2021-2.xls

121 HOLLYWOOD BED & SPRING MFG. CO., INC.
THE BEST BEDDING SUPPORT PRODUCTS SINCE 1925
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:
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.hollvwoodbed.com

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.
Certif ing Official:
Signature
Randy E Everhart
Date
Human Resources Manager
Printed Name and Title

SIU INSPECTION FORM
Name Of Industry: 440I 1 wOGE4 , 8-- srpriLl' IUP # (DO t
Address Of Industry: [ 61 (©cJO'lr L-Q1 n IUP Expiration Date:
-,c4n 24a9 Z 5131 /2,02y
It,AustryRAp r sentatives: Title �/
Ka 61 g L'r Prod,�,c ve, M4rv3 �^
POTW Representatives:
Egg 11+; NH
Date Of Inspection: LI r 2of ..1301 Time Of Inspection: _ 11 : ix ; _ _ aOpm
Purpose of Inspection: Annual y r Other Describe)
POTW to which IU discharges i IR, kI NPDES # Ai G A05 3 4 gG
Is SIU currently in SNC? N,o If yes, for what?
Title 1
l4,6e,�,,iso,p -
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 W NO 4/ �0� '°1
Number of shifts YES a
❑ 1
(1,eOuJf- t' 4,e _ b w�-�'�`qcf "4-4-84'1—
4r cuit, � •
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
Comments:
1. Are there floor drains in the production area? , / NO Where do they go?
`�V'zt._14� Gael;
2. Are pr uction areas iked, contained, or otherwise constructed in such a way asvent harm to the WWTP,
lib
11�
especially from spills or slugs? YES / NO Cos ents:
3. Are there floor drains in the storage area?
4. Are storage tanks and areas diked, con
WWTP, especially from spills or slugs?
Where do they go?
r otherwise constructed in such a way as to prevent harm to the
NO Comments:
5. Are process and storage tanks and pipes labeled? Y NO
6. How are off -spec raw materials, and products disposed of?
Auk
7. When is the production area cleaned? 00-,-.
8. Is the wastewater from cleaning the production area dischad to the POTW? / 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 t
YES 47 Comments: QOa
Ask the operator to describe pretreatment system.
1. Does operator seem knowledgable about the system?
2. Are all units operational? / NO
3. How often does operator/main enance
4. Is there an operator for each shift?
5. How and when is sludge disposed of?
check system?
NO
t,c1
6. Is there a schedule for preventative maintenance?
Comments:
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? YES O 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?
S / NO Comments:
4. Is there a calibration log for the flow meter?
/ NO Comments:
/
Comments: r ( q l 2.0 (
PART III - EXIT INTERVIEW
Review monitoring records an. SIU records required by IUP.
1. Are files well organized NO Comments:
2. Are sample collection / chain -of -custody forms filled out
? YES / NO Comments:
NI)9-
3. Do results in files agree with reports sent to POTW? YES / NO Comments:
ents:
4. Who has authority to sh t do piroduction should a sRill or slug discharge occur?
QAlu t P�fr t QG t erl+�. 144ftt,
55 How does SIU inform employees of whom to call at POTW in case of spill/slug?
If slug/spill plan is already required by POT eview procedures.
NO Comments:
6. Is SIU implementing slug/spill plan?
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed? ,/ NO
Comments, Required Or Recommen . ed Actions:
tk°f210 4Lgi— ; ( cam. L- f t,..0 124,3V i otel- 4 tom•
Signature Of Inspector(s)
Date: _111_,L2--/
Date: / 1/ 53/: (
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
Page 2

MATCOR METAL FABRICATIONS
IUP #0012

Chapter: PAR Guidance File name: PARGBfi raB ves[bnidateCl►a st91„stetkbn B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page of
0
c
0▪ n
VV
g
a• a,
tro
E.
w g
7:1z
< 0
•▪ a
n 3
N.
io =
CD
POTW must enter at least one of these
n
<
Q n
O
n - 0
n • 0. n On
AD
zr> E
<
• E.
G o�
crcl
1 ii tro
• II
04 o _d Fs:
✓ vvvvvv
* * * * * * * *
v 11 11 11 v
OD
p
ON
to
C..../°,
0
O,
'-,
1 St 6 months
j Copper
coD
0
ZZr
'Arsenic
1
1 st 6 months
O
O
O
is-)-fi
0.810
00
N
G.
Cr
0
A
N
G.
ON
00
h.
R
Q'
O
cn
O
O
a
pp
LA
o
Op
t,
N
1 st 6 months
m
r
O
O
0.0012
0.004
J
O
O
Cadmium
—
N
V'
w
0
v
0.
Q
0
CD
0.0025
Op
N
Ln
N
0
Ca.
O
m
O
O
0.0007
0.002
00
stl)uout 9 puz
11
44.4
00
00
t.:
¢I
0
En
O
O
O
p
OLA
p
OO-
1 st 6 months
Lead
O
O
O
Op''''
C...)LA
p
La
-.1
st 6 months
Chromium
00
O\
�
'E.:,
N
J
1 s 6 month s
'Ammonia
O
co
o
C
N
O
'
00
1J
a
a
o
O
0.0099
0.024 f
00
2nd 6 mont is i st 6 mont is
C
C
8 I 7
a
5
Op
0'
0
cn
f st 6 months
Mercury 1
O
w
o
2nd 6 months
N
G.
a
o©
0
5
O
o0
t
Q
O'
0
0
IZOZ/I£/ZI 01
F.1
C b
CD
O671 e�
O
AD AD
fi,DACD
112
• con
• o •
CD
Qfa. o, •�"O
5.�-,�
0 d
JZOZ/0£/9 01
b
Crl
b
co
co

Chapter: PAR Guidance File name: PARQb36 alkei vcsfbnideteC est$,$) t n B, pages 12, 13, 14 Blank IDSF Form, Copy and use in your PAR Number each set for each IUP pipe - Page
z�d
v v V v
00 a ° o
0 o E
o d
( Z (D c0
f • 0 r
0
• -0 B
rn
0
S II1UOAt 9 is]
stpuout 9 puz
s41u0111 91s
sworn 9 puz
* * * * * * * *
m
01
0
stpuout 9 puZ
s yluout 9 is
stpuout 9 puz
O
O
O
J
O
O
0
0
N
Co
O
O
0
00
cn
0
o.
0
a
uunivarac:
stpuout 9 is 1
stpuout 9 pub,
stpuout 9 is
o.
stjluoul 9 is
S[f1UOw 9 puz.
stpuout 9 is j 1
O
0
O
0
0
00
00
O
0
0
00
s ytuout g 1S l
O
O
O
0
v
0
O
O
00
staluout 9 pu7
stpuout 9 puz
O
O
O
N
W
O
s tlluout 91s l
O
O
O
w
O
O
00
0'
00
S141UOut 9 J)U
l• "r
on 11
omi et)
ADS AD
to 1—
O AD
° 2
p M-M
• 1.1
¢" O O(25

TZOZ/£Z/I7ZZ/1''
T ZOZ/ZZ/b- I Zit
IZOZ/IZ/h-0Z/tf
OO
ON
i ZOZ/SZ/£-bZ/£
I ZOZ/bZ/£-£Z/£
c.�
N
W
I ZOZ/6Z/ I -8Z/1
IZOZ/8Z/T-LZ/I:
I ZOZ/LZ/I -9Z/I
I ZOZ/9Z/I -SZ/I
.,y
c
d
w
i9
la
�5 N a 7 of• 5- T
E •
0' a • co k es
co
356.
0
0
:uoieao' aldutes
!0.009188
0.00584
O
I 0.00344 1
O
9
0.009188
0.007302
0.006349
0.006505
0.005684
0.002903
0.005354
i---
,
8O
LA
0
C
336.00
A
i
-.
_
40.4
to
o
a
r
A
Co 00
W
w
w
a
—
ul
N
a
40.4
CA
a
VI
00
BOB
Used in Calculated
Calculation lbs/day
S
T
-
7.60
V
u,
N
0\
JCO
O
A
a
O
�+
'7l
N,
�l
N
pp
O
N
N
'A
.:
222
N
W
_ C
1002.00
286.86
I
1
-3
FJ
-J
tJ
r
1
p
O
N
U
o
222
Used in Calculated
Calculation lbs/day
230 10.27
�1
O
'--
N
Vl
N
00
A
O
w
W
A
to
J
lA
O
N
O
LA
W
--.1
i
/
.F
Ak
_
Immil,
A
0
a
00
0
E...)
so
.
0
w
w
0
N
..
N
0
_
a
0
N
N
o
?
'L^
tr0
t?
0.39
O
w
O
:4
O
.;
-�
O
W
a
'
O
.
�.
C
-
C
IJ
-a
C
MMONIA
Used in Calculated
Calculation lbs/day
o
O
N
O
O
-
1
O
O
O
O
O
O
O
O
O
b
O
O
O
O
SIX'I,-LZOZ /Gewwns elea _mien

(0
P
ƒ
<= saggiany uuinlo3
P
@
00
I Z0Z/£Z/b-ZZIt
\
\
I Z0Z/9Z/£-SZ/£
I ZOZ/SZ/£17Z/£
I ZOZ/bZ/£-£Z/£
Z0Z/£Z/£-ZZ/£
ZOZ/6Z/I-8Z/I
Z0Z/8Z/I-LZ/1
Z0Z/LZ/1-9Z/I
Z0Z/9Z/1-SZ/ I
§
���E264ƒI+G§+2
{\§\[\&\Eƒ7 §)/glgg(
�=`;g®)g aaS I,o=
ags a m(Da Sag T,E12 R
» \'25i ) (m °
P
@
\
g
§
/
2
\
E
;,"_
\
k
7
\
\
\
\
£
ƒ
0
§
�
For
/
\
1
�
,
.
�
�/
�A
?
'
-
,
.
RSENIC
Used in Calculated
Calculation lbs/day
P
@
0.004
0.004
0.001
0.001
0.001
f
0.00087
0.00065
/
=
//.
iE;j
�
ADMIUM
Used in Calculated
Calculation lbs/day
0.0002
0.0001
P
\
0.0000
P
\
PPPP
\
$
$ $
}
~
/
^•
\
\
/
.
,
4,
,
o
k
>
P
8
p
2
,
P
c/
a
P
P
3\®
P
�
.
R
0
P
/
0.0423
-
.
.
1
I
.
P
%
.
04c
/I
r
c
;
,
>
P
§
P
2
,
o
\
0.0064
0.0018
P
/
0.0008
0.0005
0.0004
0.0015
0.0064
Calculated
lbs/day
0.0031
Matcor Data Summary 2021-1.xls

N
N
<= SO2U.I3AV umnloD
I Z0Z/£Z/17-ZZ/1
_N
Q
O
Cn
O
N
N
w
O
.N.�
w
N
O
1 Z0Z/8Z/I -LZ/ I
I Z0Z/LZ/I -9Z/ 1
I ZOZ/9Z/I -SZ/I
'b
al (p Q3d a `���
�N N A I� Sui� E.
(15.4
0
0
:uouluoo1 oidtuus
0
0.00584
O
p
I 0.00344 I
O
O
0.006099
0.009188
0.007302
0.006349
0.006505
0.005684
O
b
0.002903
0.005354
O
O
O
O
1
0
00
1
'.0
'D
G
A
0.089
O
01
CO01
O
IJ
N
O
W
J
0.297
O
N
W
0.124 I
W
00
001
O
i0
J
0
On
'--'
0.893
IQ
3.806
O
N
O
�
O
00
O
N
O
J
O
0.293
O
A
pw
T
O
O
-
O
bo
W
OPPER
Used in Calculated
Calculation lbs/day
0.1804
0.0350
0.0042
0.0251
0.0130
0.0192
0.0181
0.0155
0.0067
0.1804
0.0162
0.0471
O
O
W
�
����.
A
A
■
O
p
O
SZ00'0 100'0
CYANIDE
Used in Calculated
mg/L Calculation lbs/day
O
OO
Un
O
LA
I.
!
(
-
O
8
v.
..,..
0.00013 I
0.0001
0.0001
0
8
0
--
a
A
A
A
-
-
r
n
n
r
*
O
O
O
O
O
0
O
O
0
•I
O
O
O
LA
O
O
0
LA
O
g
W
O
8
N
ej
C-'
0
o
0
0.0031
f
I
I
r
,
1
O
8
U
O
8
to
0
8
J(
o
0
c
8
o
8
0
8
LEAD
Used in Calculated
Calculation lbs/day
0.00024 I
pO
O
pO
QUOO
0
O
0
O
O
0
pO
O
0
pO
O
O
Op
O
0
O
8
00
SIX.1.-1.Z0Z &Iewwns elea .loosen

<= sagnzand utunfOD
I Z0Z/£Z/17-ZZ/t1
1
I Z0Z/ZZ/P- I Z/t
I Z0Z/9Z/£-SZ/£
IZOZ/SZ/£-1 Z1£
1
N
N
N
I ZOZ/6Z/I -8Z/ I
I ZOZ/8Z/1-LZ/ I
I Z0Z/LZ/I -9Z/I
IZOZ/9Z/I SZ/I
Ny
A
he"'
t8a c f3 c (3 T
•
ET
ng LiSmS 2.58 w R.SIOR
3=1
O
8
00
9
8
O
O
8
.U-
O
1
QO
rL�
00
00
W
W
OI
U
oo
U
W
U
W
cn
4
O
r
•/
II
4111
.�
•
A
__
A
I
Used in Calculated
Calculation lbs/day
0.00000
V
rl
C
O
1
,
'
_
•
Y ID-
far
T
A
'
•
1
•
CM
•
1
1
f
1
LYBDENUM
Used in Calculated
Calculation lbs/day
O
—
0.069
O
O
O
O
N
O
OW
0O
O
LI
8
O
O
N
O
co
O
VD
C
J
O
O
IN
O
w
O
0
NICKEL
Used in Calculated
Calculation Ibs/day
0.00825
O
O
—
0.0009
0.0020
O
0
L...,W
0.0030
0.0082
O
8
O
o0
Matcor Data Summary 2021-1.xls

w
co
CO
V
I ZOZ/ZZ/b I Z/17
I ZOZ/I Z/17-0Z/
I Z0Z/9Z/£-5Z/£
IZOZ/SZ/£-IZ/£
I ZOZ/bZ/£-£Z/£
I Z0Z/£Z/£-ZZ/£
I ZOZ/6Z/I -8Z/ I
00
N
i ZOZ/LZ/I -9Z/I
I ZOZ/9Z/ I -5Z/I
Cn
B
`l0
7 g a< N O 7 (D N N (TO g`. y a
n_ 63. .�� o n o �s m 5-f6 83f �fir if3 ma<42_,• O4@2 aag oocmo
as1,772400,2
•
> a = Cl.
{1
Iw
O
8
00
00
n
0
O
O
Lit
O
8
O
O
8
NID
00
00
O
O
O
O
N
O
8
w
1/40
8
O
C!,
O
8
oo
O
8
Lsi
O
0
O
O
8
cn
m
r
0
,
-
I
Used in Calculated
mg/L Calculation lbs/day
I
0.00 1
-
_
,
.
n
A
r
.
-
r
O
0
O
O
O
O
N
-
O
O
00
I
O
O
ON
0.002 1
O
b
—
cm
0.00800
0.0028
40110•0
Zoo•o
O
pC
O
8
O
8 1
•
SILVER
Used in Calculated
Calculation lbs/day
0.00038
0.0001
0.0000
0.0001
0.0000
O
gO
?
O
oO
o
O
0O
O
O
.--�
O
O
O
O
O
2.8910
0.942 1
1,-
A
4,
0\
4,
A
-
N
O+
Co
00
0000
-1
-
N
W
N
\NO
r'
2.89100
O
G
—
O
0
O
C
O
N
—
9
—
N
x
00
-
d
N
W
a
00
N
O
0.0433
O
0.0225
0.0427
O
0.0275
O
9
O
0.0618
0.0228
0.0750
Calculated
lbs/day
w
O
Q
O
O
W
--ILA
O
LA
G\
-.11
(J.)
w
\p
0
LA
-.1
O
Matcor Data Summary 2021-1.xls

ƒ¥JEƒ
0 -C-,
q°03D
«%#2£
4_�®
N Du
3
co 3
co
co
f
co
0
\
ON
P
\
0
O
0
\
‘40
0
0
\
/
00
0
0 0
J}@�®°ƒƒA/7®�
%\[}K2
,/
!
®§7QDA m (®� i•§5$
g
@
k
@
\
\
0
\
\
0
0
j
I Z0Z/£Z/L-ZZ/L
0
g
0
2
/
\
g
$
/
I ZOZ/ I Z/L-0Z/L
A
\
\
f
0
0
P
CO
ON
CO
CD
O
§
0
AD
0
:
-
�\
......_.
_
I 15
x^
0
Em
_ A
(.0
>
88.5
88.4
G
15.4
88.50
t
0
\
&
88.5
88.4
7
/
G
CT
y
e
2
0{\\
VI
ON#
o
0
o
7\
o
Calculated
lbs/day
0.98
371.00 1
/
_
'
_
_
j
,
-
-
�n
_
»
-
/
-,
\
k
G
00
\
,
G
r
i
, ,
f
3
r
-
§
k
a
¥
\
TSS
Used in Calculated
Calculation lbs/day
/>
§
k
w%«
-
3
0
03
d
0
Co
o
o
In
0
4
_
|
►
\
—
)
| .
A
a
, —
-
-
0.124
0.15
0.412
,
I/
P
/
P
/
/
D
—
G
—
W
R
0.41
1
-
_
I
.
. i
,
@
-
P
—�/
f
P
c1-
P
o
»
k
�w
G
a
§
>
0.03
9
0
0
6£
0
P
5
0
8
0
8/
0
0
8
Calculated
lbs/day
SIx. -I.ZOZ kiewwns ewa aoo}eW

0)
2
C
5
<= saezany uutnloJ
0
OO
I ZOZ/OZ/OT -61/01
I ZOZ/6I/01 -8I/0I
I Z0Z/£Z/L-ZZ/L
I ZOZ/ZZ/L- I Z/L
TZOZ/IZ/L-0Z/L
IZOZ/0Z/L-61/L
10)
TJ
CD
O
a d
�j Q �p 7 7 Cp
N 7
fD ff 7d7 a to 7 A fi{ 4
:uoprooi aidmes
0
0
0.00701
_
-
_
_
I 0.006442 I
0.007957
0
0
0.006173
0.006404
0.006547
0.007300
L 0.00586
G�
TI
r
0
o.
d
n
5
as
r?
Used in Calculated
Calculation lbs/day
0
b
0
o
N
n
A
A
A
A
A
n
n
0.001
0
0
0
0
0
0
0.001
0
0
0
0
0
0
m
°�
4
0.0007
PoPPPPP
Cn
N
t1n
s
U
lA
CA
ADMIUM
Used in Calculated
Calculation lbs/day
0.0001
1
0.0000
O
b
00
0.0000
0.0001
0.0000
O
bO
O
O
pb
O
O
b
O
W
r
— -r
Ai
d
A
A
A
A
I
0.008
0.021
o
O
?
A
p
O
A
o
o
ZY,
o
O
lh
O
O
Cn
O
Cn
m
0.024
0.0099
l
y
(
O
g
0.021
o
O
b
-.
g
O
O
O
HROMIUM
Used in Calculated
Calculation lbs/day
0.0014
0
o
0
CS
1
0
0.0014 1
0
S-
0
f
0.0003 J
0
0
0
0
3
0
0
Matcor Data Summary 2021-2.xls

W
Column Averages =>
Maximum
110/21-10/22/2021
0
N
9
0
N
N
O
NJ
10/ 19-10/20/2021
I ZOZ/6I/0I -8I/0I
17/22-7/23/2021
7/21-7/22/2021
7/20-7/21/2021
7/19-7/20/2021
Sample Date
4
O
Sample Location:
253
0
dlanm v a.m0— m cn
D, a 7 d- N' 7
E.
- a g: '- 3
3
p
0
c,O
0
0
_ _
0.006442 1
O LA
vo
J
0.009367
0.006173
0.006404
1
O
J
0.007300 1
O
-n
-
-vir0,-
,
-
A
r
p
tm
o
�vt
0.236 !
0
N♦♦00
0
b
0
b
T
0
b
N
0
b
cti,
tg
o
oro
O
cn
CN
t
I.
O
v,
T
p
0O
O
w
a
O
a,
N
O
us
00
O
LA
O'
O
or
Na
O
LA
U
n
o C
m a
,-. .-•
o
n
Q m
F.
E.
Fa m
a
0
71
m
m
0.0538
0.0153
0.0538
0.0084
0.0184
0
0
0
w
0
p
O
0
La
o
o
' r
-
A
•
n
"' 1
O
b
0
o
.0
0
0
0
VNi
0
0I
U
r
9
S
cn
0
YANIDE
Used in Calculated
Calculation lbs/day
0.00013
0.0001
O
b
0
0
.r
o
b
0
0
.r
A
A
A
AO
r
A
A
A
A
O
O
`
pO
O
r
pO
O
O
0
O
O
O
O
O
O
o
O
s
0
O
p
Op
U
PP
p
LA
j
p
'..A
0.0025
PPPPP
op
CA
p
',A
f
IpN
V
p
LA
OU
LAO
LEAD
Used in Calculated
Calculation lbs/day
0.00020 1
o
OO
0
pO
O
0.0002 I
O
p
O
N
O
p
O
o
O
0.0002
0.0001
0
0
—
Matcor Data Summary 2021-2.xls

n
O
c
p
N N m N O '"
p N.)A c P
A
R P.)0 3 0 CD
cn
• coco .. 0) v
cO is-m c
v co 33
co K N to
co
N
1 Z0Z/ZZ/OI - I Z/01
IZOZ/IZ/01-0Z/0I
I ZOZ/OZ/Ol -61 /01
O
O
O
.N+
OO
scs.r mv:8 ,48- d" g %tea
N � m '0 N �'G
7 �p jggj C C $N H O
N _:
ou 2 � 3 m� Q� v a •CS_
�wa , �. �^ mmnfir 3 cut
�Ny
^ty
K
O
0
O
0
_
.
0.006442 I
O
of
-
o
'
0.006173
0.006404
0.006547
0.007300
0.00586
0
0
o,
0
1
?
Used in Calculated
Calculation lbs/day
O
0
go
d
\
A
r
..
-
r
1
. 1
E
E
0
i
LYBDENUM
Used in Calculated
Calculation lbs/day
.1
-)
1'
n
0
0
N
0
0
.
0
0
v
p
0
VD
0
_o
-
0
o_
N
0
o_
W
1—
W
as
Era
C—
0.05900
0.0280
r .
APF
O
N
N
O
b
A
O
o
W-.1
•
O
O
'C
o
C
.
0
O
N
o
O
w
O
O
W
Used in Calculated
Calculation Ibs/day
0.00358
O
0
J
9
0
N
0.0030
0.0029
0.0036
0.0007
Op
00
J
pO
00
O
3.
01
Matcor Data Summary 2021-2.xls

N
N
0
IZOZ/iZ/Oi 0Z/0I
I ZOZ/OZ/0I -61 /0I
1 ZOZ/6I/01-81 /01
IZOZ/£Z/L-ZZ/L
IZOZ/ZZ/L-TZ/L
I ZOZ/0Z/L-6I/L
W
d
w
7 ICiI g g C Nuo T
a c. m 3 m >> a- a ow = s,
111.
N
0
O
:uowooj oidwes
Q
0
O
00
L 0.006442 _ I
O
OJ
1 0.009367
1 0.006173
0.006404
0.006547
SO
0.00586 1
/�
-11
J
0
V�--..y�y
V
00C
C
-
_
I
n
as
Used in Calculated
Calculation lbs/day
0
0
0
n
nnn
A
n
0
0
0.001
0
0
0
0
0 0
0 0
0
0
0
0
3
�1
0.00100 0.00007 1
0.0007 0.0000
o
§
52
0.001 0.0001
O
S2
§
tJi
O
52
§
U
O
§
CA
Oo
Q
§
lA
0
0
0
SILVER
Used in Calculated
Calculation lbs/day
0.0000
pO
00
0
pO
00
0
•pO
00
0
O
08
O
p0
O
p0
O
0
A
I 0.274
O
Q
A
o
O
0.108
O
O
MI
0.84600
0.3466
0.274
O
be
O
p.-
0.773
O
ON
O
OQo
I
O
.-
In '
O
._
Used in Calculated
Calculation lbs/day
O
OVI
ON
?
0.0210
0.0147 1
0.0320
0.0561
0.0398
O
N
O
p
O
VD
0.0070
0
A
SIX'Z-4ZOZ kiewwns ewea .too:eW

AIWCOR
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:
Print Name: Joe Edwards
Title: EH&S/Maintenance Supervisor
Date Signed: June 30, 2021

401WCOR
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:
rrc7-14,2a-c* -Az-a
Print Name: Joe Edwards
Title: EH&S/Maintenance Supervisor
Date Signed: December 1, 2021

SIU INSPECTION FORM
Name Of Industry:
Address Of Industry:
Industry Representative
H S MCA: (44211 c is
tA1-1-0-- lf.�'QLA l t'O41 IUP # ct]C) 2—
IUP Expiration Date:
s: Title
POTW Representatives: cLu
edr
Date Of Inspection: _ L) i 231
Title
Time Of Inspection:
Purpose of Inspection: Annual.f ,O er (Describe)
POTW to which IU discharges L e_vf tA/ V
Is SIU currently in SNC? If yes, for what?
NPDES #
Al oo 5-5 �
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMMENTS
Product YES/Q9_
Raw materials used YES /
Manufacturing processes YES /
Categorical, if applicable YE
Production rate
Number of employees
Number of shifts YES
Comments:
)°
t I ' 3 °
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
2. Are production areas diked, co
especially from spills or slugs?
Where do they go?
d, or otherwise constructed in such a way as to prevent harm to the WWTP,
/ NO Comments:
3. Are there floor drains in the storage area? YES
Where do they go?
4. Are storage tanks and areas diked, conta' . - or otherwise constructed in such a way as to prevent harm to the
WWTP, especially from spills or slugs? • / NO Comments:
5. Are process and storage tanks and pipes labeled? E 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 charged to the POTW?
9. What non -process wastewaters are discharged to POTW?
Comments:
YES
(19
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? NO Comments:
2. Are all units operational?
3. How often does operator/maintenance . ern check system?
4. Is there an operator for each shift?
5. How and when is sludge disposed of?
NO
NO
Lam 16 et,
6. Is there a schedule for preventative maintenance? ( EJ NO
Comments:
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?
NO Comments:
4. Is there a calibration log for the flow meter?
Comments:
0 Comments:
cue: i Is?, 124
PART III - EXIT INTERVIEW
Review monitoring records an. l er SIU records required by IUP.
1. Are files well organized? fin 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 di charge occur?
O W
/ rt C OI f V,t s
5. How does SJinform employees of om to a11 at POTW in case of pill/slug?
k
If slug/spill plan is already required by POview procedures.�j
6. Is SIU implementing slug/spill plan? NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed?
Comments, Required Or Recomme
NO
Actions:
Signature Of Inspector(s)
1lo
Date: 1?
Date: / - - 7- q 1
Title: SIU Inpsection Form
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 Date
Printed Name & Title
EXECUTIVE OFFICER:
Signature Date
Printed Name & Title

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 Date
Printed Name & Title
EXECUTIVE OFFICER:
6/.40'7
Signature
t,4•41 T, f, 0,6 r1eirfr NIm
Printed Name & Title
Date
02 409 at 412-/

SIU INSPECTION FORM
Name Of Industry: T r e i
Address Of Industry:
.2.420 Pro
i�%.�hQ N e— 24 Z
Industry Representatives: Title
joc To pp
POT Reprepntatives: n
Date Of Inspection• r 16 ��
IUP # 0 0 4 5
IUP Expiration Date:
5/3 / / 2A 24
Title
IA�Iv
Time Of Inspection:
Purpose of Inspection: A ual ✓ Other (Describe)
POTW to which IU discharges L . W i P(P NPDES #
Is SIU currently in SNC? 110 If yes, or what?
• P Unto
d 04 1444-L_
<91/pm
NC_ ooS54.8 6
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
YES / N
YES
S
PART II - PLANT TOUR - Visit all areas where wastewater is generated or where there are
drains to the POTW.
Plant Tour Section A - PRODUCTION AND STORAGE AREAS
1. Are there floor drains in the production area?
NO Where do they go?
2. Are production areas diked,
especially from spills or slugs?
cod, or otherwise constructed in such a way as to prevent harm to the WWTP,
/ NO Comments:
3. Are there floor drains in the storage area? YENO % Where do they go?
4. Are storage tanks and areas diked, contai
WWTP, especially from spills or slugs?
or otherwise constructed in such a way as to prevent harm to the
/ NO Comments:
5. Are process and storage tanks and pipes labeled? 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 arged to the POTW? YES
9. What non -process wastewaters are discharged to POTW?
Comments:
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? NO Comments:
2. Are all units operational? / NO
3. How often does operator/maintenanc
4. Is there an operator for each shift?
5. How and when is sludge disposed of?
—Mr*
on check system?
/ NO
6. Is there a s dule for preventative maintenance? / NO
s-0 P ee_dzal
Comments:
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 i O 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 er 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? aria
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 POT eview procedures.
6. Is SIU implementing slug/spill plan? / NO Comments:
Comments:
INSPECTION RESULTS
Slug/Spill Control Plan Needed?0 0
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

0
a PIE
Vn
1)
v
zsQ
V
Monthly Dai y
* * * * * * * *
S
< 04 C
<. 8
W 0 ..
n o O
'Era
o y 0 <
n .. C)• )
Osq
UP UP 0
0
O
; EL
a 0
✓ v v
CBD
OOQ 0 04 Q _ cD
co)
V V V V V V V V V
Monthlyl Dai y
5
• O z O < !
Vn r O
n 4 4 o
n' rm<nnno0.c5[4
ovvvvoa55
rn a tic trc,
b
✓ V V V V V V V V
o
n p Vv, 0
c Po C^i Y O
Month! y1 Dai y
cr
o
S..
Copper
T
O
o
'Arsenic
R
o
I
E
TQ
0.203
O
O
N
2nd 6 months
O
O
V7
O
O
C/1
N
[.7r^
Q'
a
c,
N
Iv
5
c
o
a-
n`
0
is.
st6 months
Ladmium
st 6 months
BOD
0.51000
O
LA
.--'
00
2nd 6 months
o
O
0'
0
p
L.)O
N
2nd 6 months
r
—
8,350
,--,
0
---.1
CD
N
D
gO,
a
0
5
st 6 months
—
r
t
11
st 6 months
Chromium'
w
a
O
5
TSS
O
Cr,—
N
O
O
N
stnuom 9 puZ
0.014
0.0012
N
2nd 6 months
is.)
Cn
2,290
N
2nd 6 months
_
st 6 months
4
ct
II
et
tc
_
.7'7
5
o
st b months
Ammonia
CD
O
0
'-'
N
NI
R.
T
p
c
5-
N.1.,
c.
0
p
0
5
24.15 1
28.5
N
Znd 6 months
01.
0'
0L
0
I I
V
r-�
O
O
C
In
co
o
CI
t"t
co
coo
0
co
ill
.- L) od
co on 7d
0\
E
t
N
O
RZOZ/0£/9 0l
C7
U]
ci)
n
0
O

>y
7 C� o.
5.e
o � '
O
t 0
O < 074
-. W
4 4
n znzo < x
n n a CClt
w C 0
iiIi~
7
llIloo w
II II II II II II II II
vvvvvvVVV
Monthly Dai y
oR < 04 <
o' °
o' y 4
Vrn
col t' -'
nnnn
II II II II
LAJ
V V V V
Monthly Dai y
* * * * * * * *
Monthly Dai y
0
Z
z
a
I I st 6 mont is
=
rcn cn
0
Nickel
2n( 6 mom is
0.
c.
O
v
o
0
W
0.047
IV
C.
O
syluout 9 Is
'
1st 6 months
.
1st o months rend 6 months 11 sE 6 months
Selenium I ISilver
2nd 6 mont , s
2nd 6 months
st 6 mont is
rwi
O
O
71
0,
0
m-
cn
r
st mom 9 puzl
r 0.0045 1
0.008
N
.2nd 6 months
st 6 months
st 6 mont is
st) mont is
Zinc
1
C
L
2nd 6 mom is ]
L 2.053
W
a'
N
0'
5
0
y
1-1
CD
CD mCip
'G A:
to 0 AD n
d Ooo
AD -
o
CD 1-t
CD Cit
AD n A,
0.1
A 0-QC
cn PI
CD
cp con 20
°
cn

9
0
co
pv
00
pO
O
oo
Jl
00
oo
lJ
O
8
7 N, (� < N 5..� Q i C CD Q CD N
a 7 N d. _ a C m (D C� C E� ('o T
5:1-- d f� N• 2 -(D- A Oor
N g 7 CC+ 3 C Lo OC Cr_91
VD 7a 00 2 N � F N
� y a co R lD ---- (n 0
N 5.
1U
10.012189 I
P
o
T
r
N
c)
Qcc
C
n
U
O
O
—
©
O
BOD
Used in Calculated
mg/L Calculation lbs/day
O
O
vo
O,
-p.
O
O.,
(n
A
N
-
N
-
T
f
N
O
2290,
Used in Calculated
Calculation lbs/day
1
N
CA
U.)
232.561

00
O
0
8
9
8
I8,0
N
Ch
O
0
O
8
W
aN
r
II
■
00
90
N N
O 00
A
b
N
gO
A
O
8
CIt
VI 1
r ■
•
•
O
A
n
0
O
0
00
o'
c
c.
0
w
O
8
00

O
g
N
O
L
0
0
0
0
•
A
O
n
n y
CD
DO
O
1
9
S
■
A
•
A
ro
o'
R.
•
i
Wf IINO IHO
0
-13
n
c oo
G_
a
Do w
c
CD
a

O
O
0
8
o.
O
8
0
8
0
T
Ilk
•
f
A
0
8
N
8
A
0
8
8
8
_
411.
T
4
A
o'
0
c
C.
0.

0
8
O
b
g5
0
1
oo
0
1
r
411
I
w
r1
r1
A
0
r
O
8
0
oo
oo
•
■
O
oo
CJ
e
CD
a
0
0
0
S
0
O
0
co
1

O
00
v,
•
r
O
A
ci
O'
C
CD
a.
7
•
•
•
•
• •
c
w
a
CD
Q-
7'
1

SIU INSPECTION FORM
Product
Raw materials used
Manufacturing processes
Categorical, if applicable
Production rate
Number of employees
Number of shifts
Comments:
Name Of Industry: E$' tAkoci Pra01A,L.ed-s f �-�-G IUP # C9D C -1
Address Of Industry: IUP Expiration Date:
•
Leg ‘Aft4'
In stry Represent tives:
rc c1 Le c_
W;Ili Am gay
POT Representatives:
vies)-L.
Title
ENS Tr) "49-c
Environmental 5pec%R[r5-t-
Title
1
re
Date Of Inspection: Ai 5 / a-1 Time Of Inspection: if 1 9 (E9pm
Purpose of Inspection: Annual Other (Describe) N 2 t,o l' r .A . R
POTW to which IU discharges R li` NPDES # IN. C.40 55 $�1.
Is SIU currently in SNC? Al 119— If yes, for what?
PART I - INITIAL INTERVIEW
Has anything changed since the last inspection or IUP application in the following:
COMME9 _ f i
YES/NO
YES / NO
YES / NO
YES / NO
YES / NO
YES / NO
YES / NO
54,4_+.5
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
Where do they go?
2. Are production areas diked, co
especially from spills or slugs?
ed, or otherwise constructed in such a way as to prevent harm to the WWTP,
/ NO Comments:
3. Are there floor drains in the storage area?
YE
Where do they go?
4. Are storage tanks and areas diked, con
WWTP, especially from spills or slugs?
or otherwise constructed in such a way as to prevent harm to the
/ NO Comments:
5. Are process and storage tanks and pipes labeled?
6. How are off -spec raw materials, and products disposs
/NO
of?
7. When is the production area cleaned? 6=4— SirYtt
8. Is the wastewater from cleaning the production area discharged to le POTW?
9. What non -process wastewaters are discharged to POTW?
Comments:
YES No
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? / NO Comments:
2. Are all units operational? ' YE / NO
3. How often does operator/m r enance
4. Is there an operator for each / NO
�5. How and when is sludge dispos d oetc
6. Is there a schedule for preventative maintenance?
Comments:
•
n check system? (
/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? ( / NO If yes, name of lab. �-
�•
2. If industry completes sampling, ask the indus representative to describe samplingiirocedures. Comments:
3. Is flow measurement equipment operational?
/ NO Comments:
4. Is there a calibration log for the flow meter? YES / NO Comments:
Comments:
PART III - EXIT INTERVIEW
Review monitoring records an• SIU records required by IUP.
1. Are files well organized' / NO Comments: a
2. Are sample collection / chain -of -custody forms filled out properly? YES / NO Ce'tnments:
ISt 6--
3. Do results in files agree with reports sent to POTW? YES / NO Comments:
W
4. Who has authority to shut down production should a spill or slug discharge occur?
5. How does SIU inform emplo es of w om to call at POTW in case of spill/slug? �n.Q•� M�
If slug/spill plan is already required by POTS review procedures.
6. Is SIU implementing slug/spill plan? �' / NO Comments:
Comments:
INSPECTION RESULT
Slug/Spill Control Plan Need d? Y / NO
Comments, Required Or Recommen ed Actions:
Signature Of Inspector(s) Date:
Title: SIU Inpsection Form
File name: COMP.INSP App 7-D
Revision data: August 1, 1994
z/
Page 2

/ k
rcri
/
\
Percent MAI-IL still available (%) _>
Percent Allow. Ind. (MAIL) still available (%) =>
<_ (itsp/s9I)13a[ 'IIdIH
7 2
§=
[ \
//�/�
! v 0 v
<=Mo1d pallluuad SaGdN
0.3250
%
a
b
}
•
'
3.2580
3.2420
6.5000
.$
A
$
1102
74.0 %
4704
—
f 15682
22036
\
}
/
\
7
CO
0
Column Totals =>
"Egger Wood Products, LLC 7
'Tier Rack
,Matcor Metal Fabrication 1
'Hollywood Bed & Spring MFG. CO., LLCJ
IShutz Container Services
IASCO Power Technologies
INDUSTRY NAMES
(please list alphabeticly)
f
/
co
01
ILRWWTP
Headworks last approved:
Allocation Table updated:
Permits last modified:
0014
/
a
/
w
0028 1
9
3
I 0038 I
Industry
Permit
number
2
\
\
/
\
c
\
R
-
«
\
/
-
$
§
§
§
\ \
&
§
\
§
1) Applicable Values should be entered in the Heavy Bordered cells
2) Formulas are discussed in the Comprehensive Guidance, Chap
3) HWAand AT worksheets in this workbook are linked. Pollutant
worksheetare automatically entered from the HWAspreadsheet
-
§
\
\
/
}
\
}
\
j
\
\
\
§
\
§
,
7
\
$
)
$
{
r
2
)
05/31/24
$
)
0.1640
_
/
0
b
Q5
\
\
G
\
$
\
Q
K
?
ƒ
FLOW
Permit Limits
. Rest ofworksheetis protected,
ter 6, Section C.
Names, MAHLs, Basis, and Uncon
This includes pollutantnames in c
a
/
a
/
%
/)
/
/
Q
or
4
Conc. Load
mg/1 Ibs/day
BOD
Permit Limits
password is "2'.
trollable load in this AT
olumns AT through BK.
�
600.48
.
.
0
a
/
\

SOOZ aagweAoN:paslnab
<= (icEp/sgI)1HVIH auaond S
Percent MAHL still available (%) =>
Percent Allow. Ind. (MAIL) still available (%) =>
<= (xEp/sqI) tj31'IIb'IR
• Er Es:
Au Au ▪ Au a a a Au
✓ V V V
CN
0000
00
CN
v
v
co
Ca
00 �] 0\ U A W
tin
0
0
Column Totals =>
`Egger Wood Products, LLC 1
^
Au
n
PC'
Matcor Metal Fabrication
Hollywood Bed & Spring MFG. CO., LLC1
Shutz Container Services
IASCO Power Technologies
Industry
INDUSTRY NAMES Permit
(Please list alrhabetldy) number
O
ton
to
(n
"Ni
CO
a)
LRWWTP
Headworks last approved:
Allocation Table updated:
Permits last modified:
S
A
§
U
S
N
g
00
0010
S
00
o
N
O
N
O)
N
o
67
N
0
8
S
,
4
Conc. Load
mg/1 lbs/day
TSS
Permit Limits
O
40.03
algel uoi}eooliv
0
0
0
0
Z
a)
3
fD
00
0
0)
V)
C
13
0
rP
m
a
D
cp
O
N
O
N
O
XC
y
fD
fD
e-t
co):
• N
• N
N
O O
CD

SOOZ aagtuanoN:paslnab
<= (,fep/sul) 'J-IdIII luaozad S
Percent MAHL still available (%) =>
Percent Allow. Ind. (MAIL) still available (%) =>
>
O
o w
_0
CD b 0 0
o
CD ADa. o ▪ ,-
_ n
o � � c
~ o
�, • a a
Crcrcrc-aeci
-
a00a0
P AD AD AD W ▪ y
•< V
✓ V V V V
VI
00
00
37.8 %
268.89
96 %
278.89
10.01
f 432.611
i-L.
—
0.0229
00
J
4)
^
a
0.4025
0.0012
0.4037
0.0541
0.4578
O
50.5 %
o
0
•
0
0
0.0324
0.1921
O
0
O
J
O
00
N
.D
C
w
cn
N
O
N
rn
0.3866
t
a
0
w
.r
0000
O
0000
N
O
W
58 %
2.0244
1.4488
w
J
A
N
J
W
0
N
A
�
0
N
f0
pts wea.IlS
0
3
rQ+
0
CO - 0% In A W N
0
Col
Egger Wood Products, LLC
Fier Rack 1
Matcor Metal Fabrication 1
Hollywood Bed & Spring MFG. CO., LLCI
Shutz Container Services
ASCO Power Technologies
INDUSTRY NAMES
(plcase list alphabeticly)
Z
n
0
0
VI
V
CO
I LRWWTP
Headworks last approved:
Allocation Table updated:
Permits last modified:
0014 1
cn
s
N
s
0000
S
O
1 0038 l
Industry
Permit
number
oo�
W
-.
N
_
0)
N
0)
N
O
g
G
453.
.--.
O
25.001
Conc. Load
mg/1 lbs/day
L Ammonia
Permit Limits
9
O
,
8
W
t O
A
Q' 0
..0 a
Arsenic
Permit Limits
O
s
N
9
p
O
N
O
s
0.070
1 0.070
0.070
01
s
O
O
P
a
�, r
R w
a
Cadmium
Permit Limits
O
w
SO
N
0
�
O
0
O
0
is
.
O
0
w
O
S
--A...
O
_
J
_
J
_
J
_
J
o0
n
Y r
N
aC G
Chromium
Permit Limits
N
CS8
0
N
O
N
A
O
lJ
ham.+
O
[J
°LI'
'-`
0
O
oO
N)
22s
C
A
P�+
O
N
O
N
s
O
Conc. Load
mg/1 lbs/day
Copper
Permit Limits
C
0
0.293
O
‘.0
0.345
1.3.285
O
o0
D
0
0
rt
o'
7
Cr
O
0
3
O
z
(D
03
0
0
V)
V)
C
0.
d
e-F
1
O
N
O
O
N
K
O
CD
O
▪ N
al
(o
(D N
O O
co 3

7J 2
m .<
C' D
CD
O -Di
Z
0
(D
3
a—
fD
O
0
cn
CD
4
<_ (XEP/sqI) 'II3yI�I
b
CD o
0
Z D
a o
E tw ▪ cr.
4 5 o
Fir a p
Y a c. cr
Y as
0, • ,
? Q o- . ▪ 6 td
co 0
• P. Q. a • a a 4.
▪ I10 ▪ AD AD Y?
V V V V V V
00
0
w
rn
00
00
2
0
F
• 40 00 J U In • W N r-+ C G�
O
0
o
Egger Wood Products, LLC
Tier Rack
Matcor Metal Fabrication1
Hollywood Bed & Spring MFG. CO., LLCI
Shutz Container Services
IASCO Power Technologies
Industry
z
0
0
cn
c71
\I
CO
rn
ILRWWTP
Headworks last approved:
Allocation Table updated:
Permits last modified:
fumn Totals =>
0014 1
cn
_
O
N
0028
_
0038
0
J
N
T
0
N
N
—
0
0")G
_,
01
N
O
r
v
A
g
a
§
§
r
i 0
CD
n
1
v
0
0
0
N
•
a
A)
Cyanide
Permit Limits
o
o
0
8
0
S
0
00
o
algel uolieaoliv

SOOZ aagwanoN:paslna�
CD
CD
<_ (Cep/sql) II -I
Percent MAHL still available (%) =>
'-C
o 0 o
O ^'
✓ V V V V V
0.0823
zPPP
Co
24.3 %
A
Lrk
0
'•-•�
o
?
W
v
0.004280
O
0.000530
O
0.017034
0.085593
uo
U
C*
vo
tJ
0O
00
o
00.
0.9905
2
0.9905
0.1514
---`
o
8
0.1447
47.9 %
£'£S
00
N
N
\Ul
0
0.2947
2.8939
Lit
-
N
CD.
7 (0
O co
O
�D 00 O\ U .4. W
n
0
0
Column Totals =>
'ier Rack
Egger Wood Products, LLC
Matcor Metal Fabrication 1
Hollywood Bed & Spring MFG. CO., LLCI
1 INDUSTRY NAMES
(please list alphabeticly)
ASCO Power Technologies
Shutz Container Services
z
n
O
O
Co
to
V
CO
61
LRWWTP
8§
A
In
8
N
0028 1
8
O
8
Oo
g 0
0-
H
o
o
Q
81�a
O
w
O
.
O
?
O
W
5 n
g
n
Lead
Permit Limits
O
U
cA
CJ
O
O
-
O
-
o
OJ
O
0
O •
A
°
w a
'`
—w
`
.
C
pp
O
to
r O
5 n
n
a
N
5 A
z: n
r a
9 -I
(0.5
8
Y.)
`
{_i
n
a. A5 A
Molybdenum
Permit Limits
O
C
� O
a i
`. p•'
INickel
Permit Limits
N
A
O
p
00
o
-
w
0
-
w
0
VNi
O
0 o
00 U
O O
awl uopeoolIV
0
W
0
N
O)
O
0
3
O
CD
CO
cn
C
a
cD
a
Q.
O
O
c
cn
cp
f-F
t:I

SOU JagwoAoN:pasiAaj
D
D
H
GI
co
<_ (pep/sqi) IH
Percent MAHL still available (%) =>
Percent Allow. Ind. (MAIL) still available (%) =>
<_ (Aep/sgi) uai 'IIVY�I
O
O
a
0
o go• Rao
5 p
0. ti Q'
Q • ' F Q
�y-.' • .3
C r1- O
cn
a 01
q t—'c
a- o-crEn con crn
w I. • w m
✓ 11 11 V
0.0317
8
O
O
O
00
O
o
0.6341
8
8
4,0
A
00
00
0
N
01
0
CO
0
O
col
V
3
N
2
VI
3
QN
n C�
\D 00 A L N - 8 "G
Z
O 0
Co;
Egger Wood Products, LLC
!Tier Rack
IMatcor Metal Fabrication
[Hollywood Bed & Spring MFG. CO., LLij
5hutz Container Services 1
IASCO Power Technologies
Industry
z
n
O
O
(11
Ul
V
CO
01
LRWWTP
8
J,
r
§
vA
I
8
N
r
0028
8
O
8
00
r
pQ
O
pQ
O
§
§
§
§
.7
GS 0
R
�~
O
g
Conc. Load
mg/1 lbs/day
Selenium
Permit Limits
PPPP
gg_
O�
8
B o
5 r
w a
Silver
Permit Limits 1I
O
coS
o
0.034
0.034
O
p
?
:pal;lpow ;se! s;ltwad
:paiepdn algel uolleoolIV
:panoadde Ise! s)IJompeaH
0
0)
Ol
0
algel uolleoollb'
O
0
0
0
CD
ID
CO
0
cn
cn
Q
a)
A"F
CD
Q
D
D
O
CD
0a
rn
rn
0
0
N
X
O
1
N
CD
CD
3
O
� N
• N
(p
O O
▪ 3

SOOZ JagwanoN:pas!Aaa
<_ (SUp/sgl)'IRVI's 111aoJad 5
Percent MAHL still available (%) =>
Percent Allow. Ind. (MAIL) still available (%) =>
<= (,pep/sqi) Sal "IIVYN
a • a a a y
V
V 11 11 V
- 38.7 %
W_
10.5548
2.3847
N
14.3573
27.2968
00
Is
#VALUE!
J
I #VALUE!
O
8
11.9528
;__.IT
8
p
38.49
O
38.49
200.57
239.06
s
s
8
#VALUE!
#VALUE!
0
I
5. N
O' z
5
z
0
v
CA)
N
00
o J rn v O A w t� —❑
O
Column Totals => 1
Egger Wood Products, LLC I
'Tier Rack
Matcor Metal Fabrication
•
Hollywood Bed & Spring MFG. CO., LLt
Shutz Container Services
IASCO Power Technologies
INDUSTRY NAMES
(please list alphaheticly)
z
n
O
O
Ul
V
m
m
ILRWWTP
Headworks last approved:
Allocation Table updated:
Permits last modified:
8§
A
VI
8
N
8
oo
8
O
0038
Industry
Permit
number
o
W
\
N
O
6\l
N
o
N
0
g
O
g
O
g
O
!
O
��
O
L woo
O
J10
V1
oo
...-
0A
oo
..
A
oo
A
00
`Li
2.385
1
• 1
O
O
O
N
O
O
A
..
LAA
O
5
� o
-- o
a
Total Nitrogen
Permit Limits
o
8
o
n
V
y
a
Total Phos.
Permit Limits
O
8
.
Conc. Load
mg/1 lbs/day
c
Permit Limits
—.
1
w
-
--
-
r
algei uo!leaolly
O
a
O
O
z
01
3
CD
co
0
cn
cn
Q
a)
rh
CD
Q
D
D
O
CD
O
0
03
N
0
0
X
N
XC
O
-T
N
CD
CD
N
co N
c
• N
V O
O