NC0031836_Renewal (Application)_20220920 (3)

3
ROY COOPER 1 t_A-_
Governor
ELIZABETH S.BISER ',. u r•I
Secretory
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
September 20, 2022
City of Statesville
Attn: Ken Galloway, ORC
PO Box 1111
Statesville, NC 28687-1111
Subject: Permit Renewal
Application No. NC0031836
Fourth Creek WWTP
Iredell County
Dear Applicant:
The Water Quality Permitting Section acknowledges the September 20, 2022, receipt of your permit renewal application
and supporting documentation. Your application will be assigned to a permit writer within the Section's NPDES WW
permitting branch. Per G.S. 150B-3 your current permit does not expire until permit decision on the application is made.
Continuation of the current permit is contingent on timely and sufficient application for renewal of the current permit. The
permit writer will contact you if additional information is required to complete your permit renewal. Please respond in a
timely manner to requests for additional information necessary to allow a complete review of the application and renewal
of the permit.
Information regarding the status of your renewal application can be found online using the Department of Environmental
Quality's Environmental Application Tracker at:
https://deq.nc.gov/permits-regulations/permit-guidance/environmental-application-tracker
If you have any additional questions about the permit, please contact the primary reviewer of the application using the
links available within the Application Tracker.
Sincerely,
XfielQVI6
Wren Thedford 1
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
D_E Q North Carolina Department of Environmental Quality I Division of Water Resources
Mooresville Regional Office 610 East Center Avenue,Suite 301 Moorcsvllk.North Carolina 28115
V 704.663.1699

September 15, 2022
Division of Water Resources
Water Quality Permitting Section—NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617 �P'` ]cD
R� EN
L+
SEP 16 2022
Permit Renewal Application
Fourth Creek Wastewater Treatment Plant NCDE�DW�NpD�S
NPDES Permit No. NC0031836
To Whom it may concern:
Enclosed you will find an original and two copies of the Permit Renewal Application EPA form 2A
with Table A,Table B,Table C,Table E,Table F, Process Flow Schematic and Topographic vicinity map.
The City of Statesville is requesting the permit renewal for the Fourth Creek WWTP under permit
NC0031836. The continued operation of the Fourth Creek WWTP consists of the following:
> Influent Pump Station
> Perforated panel bar screens (2)
> Extended aeration basins (2) with mechanical aerators (6 per basin)
> RAS and WAS pumps (2 each)
> Secondary wet well
> Secondary Clarifiers (3)
> Hypochlorite disinfection
> Sodium Bisulfite de-chlorination
> Aerobic digester with mechanical aerators (3)
> 2 meter/3 belt filter press
> Alkaline sludge stabilization
We do not have the second species toxicity tests completed yet, but I will forward those results when
we get them.
Should you require more information, or further action is required, please contact me at 704-878-3438.
Sincerely,
Ken Galloway
Plant Supervisor, Fourth Creek WWTP

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
Form U.S.Environmental Protection Agency
2A \=/EPA Application for NPDES Permit to Discharge Wastewater
IDES NEW AND EXISTING PUBLICLY OWNED TREATMENT WORKS
CTION 1.BASIC APPLICATION INFORMATION FOR ALL APPLICANTS(40 CFR 122.21(j)(1)and(9))
1.1 Facility name
City of Statesville 4th Creek
Mailing address(street or P.O.box)
PO Box 1111
City or town State ZIP code
Statesville NC 28687
Contact name(first and last) Title Phone number Email address
Andy Smith Operations Manager [phone]
Location address(street,route number,or other specific identifier) ❑ Same as mailing address
U-
693 Bell Farm Road
City or town State ZIP code
Statesville NC 28625
1.2 Is this application for a facility that has yet to commence discharge?
❑ Yes 4 See instructions on data submission ❑✓ No
requirements for new dischargers.
1.3 Is applicant different from entity listed under Item 1.1 above?
❑ Yes ❑✓ No 9 SKIP to Item 1.4.
Applicant name
Applicant address(street or P.O. box)
0
0o City or town State ZIP code
Contact name(first and last) Title Phone number Email address
0
1.4 Is the applicant the facility's owner,operator,or both?(Check only one response.)
❑ Owner ❑✓ Operator ❑ Both
1.5 To which entity should the NPDES permitting authority send correspondence?(Check only one response.)
❑✓ Facility ❑ Applicant ❑ Facility and applicant
(they are one and the same)
1.6 Indicate below any existing environmental permits.(Check all that apply and print or type the corresponding permit
number for each.)
Existing Environmental Permits
✓❑ NPDES(discharges to surface ❑ RCRA(hazardous waste) ❑ UIC(underground injection
water) control)
NC0031836
0 ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
w
a)
N ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section ❑✓ Other(specify)
404)
Land App WQ0014543
EPA Form 3510-2A(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
1.7 Provide the collection system information requested below for the treatment works.
Municipality Population Collection System Type
Served Served (indicate percentage) Ownership Status
100 %separate sanitary sewer El Own El Maintain
v Cit of 25000 0
CO y /o combined storm and sanitary sewer El Own 0 Maintain
Statesville ❑ Unknown El Own 0 Maintain
Cl) %separate sanitary sewer ❑ Own ❑ Maintain
•1 %combined storm and sanitary sewer ❑ Own ❑ Maintain
0 Unknown ❑ Own ❑ Maintain
a %separate sanitary sewer ❑ Own ❑ Maintain
_ %combined storm and sanitary sewer 0 Own El Maintain
co El Unknown ❑ Own ❑ Maintain
E %separate sanitary sewer 0 Own 0 Maintain
cn %combined storm and sanitary sewer El Own ❑ Maintain
C ❑ Unknown ❑ Own ❑ Maintain
Total
a Population 25000
c� Served
Separate Sanitary Sewer System Combined Storm and
Sanitary Sewer
Total percentage of each type of sewer line(in miles) 1Do o�0 0 /°
1.8 Is the treatment works located in Indian Country?
o 0 Yes ❑✓ No
U
c 1.9 Does the facility discharge to a receiving water that flows through Indian Country?
c ❑ Yes ❑✓ No
1.10 Provide design and actual flow rates in the designated spaces. Design Flow Rate
6 mgd
75
Annual Average Flow Rates(Actual)
. IR Two Years Ago Last Year This Year
-o re .
CO 3.72 mgd 3.29 mgd 3.26 mgd
ii) `L Maximum Daily Flow Rates(Actual)
o Two Years Ago Last Year This Year
11.03 mgd 10.50 mgd 6.82 mgd
u, 1.11 Provide the total number of effluent discharge points to waters of the United States by type.
o Total Number of Effluent Discharge Points by Type
a - Constructed
Combined Sewer
2 a Treated Effluent Untreated Effluent Overflows Bypasses Emergency
- - Overflows
U
N
0 1 0 0 0 0
EPA Form 3510-2A(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
Outfalls Other Than to Waters of the United States
1.12 Does the POTW discharge wastewater to basins, ponds, or other surface impoundments that do not have outlets for
discharge to waters of the United States?
❑ Yes 0 No 4 SKIP to Item 1.14.
1.13 Provide the location of each surface impoundment and associated discharge information in the table below.
Surface Impoundment Location and Discharge Data
Average Daily Volume Continuous or Intermittent
Location Discharged to Surface (check one)
Impoundment
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd ❑ Intermittent
❑ Continuous
gpd 0 Intermittent
2 1.14 Is wastewater applied to land?
❑ Yes ❑✓ No SKIP to Item 1.16.
0 1.15 Provide the land application site and discharge data requested below.
Land Application Site and Discharge Data
8 Location Size Average Daily Volume
Continuous or
a, Applied Intermittent
(check one)
❑ Continuous
o acres gpd ❑ Intermittent
acres d 0 Continuous
5 gp ❑ Intermittent
-a acres d El Continuous
`° gp ❑ Intermittent
- 1.16 Is effluent transported to another facility for treatment prior to discharge?
5 ❑ Yes ❑ No 4 SKIP to Item 1.21.
0
1.17 Describe the means by which the effluent is transported(e.g.,tank truck,pipe).
1.18 Is the effluent transported by a party other than the applicant?
❑ Yes ❑ No -9 SKIP to Item 1.20.
1.19 Provide information on the transporter below.
Transporter Data
Entity name Mailing address(street or P.O.box)
City or town State ZIP code
Contact name(first and last) Title
Phone number
Email address
EPA Form 3510-2A(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
1.20 In the table below,indicate the name,address,contact information, NPDES number,and average daily flow rate of the
receiving facility.
Receiving Facility Data
Facility name Mailing address(street or P.O. box)
City or town State ZIP code
0
Contact name(first and last) Title
0
iro Phone number Email address
aNPDES number of receiving facility(if any) 0 None Average daily flow rate mgd
1.21 Is the wastewater disposed of in a manner other than those already mentioned in Items 1.14 through 1.21 that do not
have outlets to waters of the United States(e.g.,underground percolation,underground injection)?
(73 ❑ Yes ❑✓ No - SKIP to Item 1.23.
t
0 1.22 Provide information in the table below on these other disposal methods.
Information on Other Disposal Methods
o Disposal Location of Size of Annual Average Continuous or Intermittent
Method Disposal Site Disposal Site Daily Discharge (check one)
Description Volume
acresgpd 0 Continuous
0 Intermittent
0 Continuous
acres gpd 0 Intermittent
acresgpd ❑ Continuous
❑ Intermittent
1.23 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(n)?(Check all that apply.
U N Consult with your NPDES permitting authority to determine what information needs to be submitted and when.)
C ❑ Discharges into marine waters(CWA ❑ Water quality related effluent limitation(CWA Section
Section 301(h)) 302(b)(2))
❑✓ Not applicable
1.24 Are any operational or maintenance aspects(related to wastewater treatment and effluent quality)of the treatment works
the responsibility of a contractor?
❑ Yes ❑✓ No 4SKIP to Section 2.
1.25 Provide location and contact information for each contractor in addition to a description of the contractor's operational
and maintenance responsibilities.
Contractor Information
Contractor 1 Contractor 2 Contractor 3
o Contractor name
(company name)
Mailing address
(street or P.O.box)
City,state,and ZIP
code
Contact name(first and
0 last)
Phone number
Email address
Operational and
maintenance
responsibilities of
contractor
EPA Form 3510-2A(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek
OMB No.2040-0004
SECTION 2.ADDITIONAL INFORMATION(40 CFR 122.21(j)(1)and(2))
o Outfalls to Waters of the United States
2.1 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
o ❑✓ Yes ❑ No 4 SKIP to Section 3.
0 2.2 Provide the treatment works'current average daily volume of inflow Average Daily Volume of Inflow and Infiltration,
'@ and infiltration. 15,000 gpd
Indicate the steps the facility is taking to minimize inflow and infiltration.
Water and Sewer Maintenance continues to camera lines to look for cracks and blockages.
0
2 2.3 Have you attached a topographic map to this application that contains all the required information?(See instructions for
R CL specific requirements.)
- Co
o �
F ❑✓ Yes ❑ No
E 2.4 Have you attached a process flow diagram or schematic to this application that contains all the required information?
o E (See instructions for specific requirements.)
u
o ❑✓ Yes ❑ No
2.5 Are improvements to the facility scheduled?
✓❑ Yes ❑ No 4 SKIP to Section 3.
Briefly list and describe the scheduled improvements.
1. Updating power distribution throughout the plant.
m
E
2. Replacing standby generator.
0
3.
C)
U,
4.
2.6 Provide scheduled or actual dates of completion for improvements.
Scheduled or Actual Dates of Completion for Improvements
Affected Attainment of
2 Scheduled Outfalls Begin End Begin Operational
Improvement Construction Construction Discharge
(list outfall Level
(from above) (MM/DD/YYYY) (MM/DD/YYYY) (MM/DD/YYYY)
(MM/DD/YYYY)
)
1. 1 09/01/2022 09/01/2023
2.
3.
4.
2.7 Have appropriate permits/clearances concerning other federal/state requirements been obtained?Briefly explain your
response.
❑ Yes ❑ No ❑✓ None required or applicable
Explanation:
EPA Form 3510-2A(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
SECTION 3.INFORMATION ON EFFLUENT DISCHARGES(40 CFR 122.21(j)(3)to(5))
3.1 Provide the following information for each outfall.(Attach additional sheets if you have more than three outfalls.)
Outfall Number 1 Outfall Number Outfall Number
State North Carolina
County Iredell
0 City or town Statesville
0
0 Distance from shore 3 ft. ft. ft.
Depth below surface N/A ft. ft. ft.
Average daily flow rate 3.35 mgd mgd mgd
Latitude 80° 47' 15" N
Longitude 35° 46' 36"
3.2 Do any of the outfalls described under Item 3.1 have seasonal or periodic discharges?
❑ Yes ❑✓ No 4 SKIP to Item 3.4.
3.3 If so,provide the following information for each applicable outfall.
Outfall Number Outfall Number Outfall Number
Number of times per year
discharge occurs
Average duration of each
discharge(specify units)
oAverage flow of each mgd mgd mgd
v, discharge
Months in which discharge
occurs
3.4 Are any of the ouffalls listed under Item 3.1 equipped with a diffuser?
❑ Yes ❑✓ No 4 SKIP to Item 3.6.
3.5 Briefly describe the diffuser type at each applicable outfall.
Ci
T Outfall Number Outfall Number Outfall Number
U,
N
vi 3.6 Does the treatment works discharge or plan to discharge wastewater to waters of the United States from one or more
discharge points?
❑✓ Yes ❑ No 4SKIP to Section 6.
EPA Form 3510-2A(Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
3.7 Provide the receiving water and related information(if known)for each outfall.
Outfall Number . Outfall Number Outfall Number
Receiving water name Fourth Creek
Name of watershed,river,
0 or stream system South Yadkin
4- U.S.Soil Conservation
I Zs
Service 14-digit watershed 030401020400400
o code
tz
Name of state Yadkin Pee Dee
a)
management/river basin
} U.S. Geological Survey
.0 8-digit hydrologic 03040102
cc cataloging unit code
Critical low flow(acute) cfs cfs cfs
Critical low flow(chronic) cfs cfs cfs
Total hardness at critical mg/L of mg/L of mg/L of
low flow CaCO3 CaCO3 CaCO3
3.8 Provide the following information describing the treatment provided for discharges from each outfall.
Outfall Number Outfall Number Outfall Number
Highest Level of ❑ Primary ❑ Primary ❑ Primary
Treatment(check all that 0 Equivalent to 0 Equivalent to 0 Equivalent to
apply per outfall) secondary secondary secondary
0 Secondary 0 Secondary 0 Secondary
0 Advanced 0 Advanced 0 Advanced
0 Other(specify) 0 Other(specify) 0 Other(specify)
c
0
.- Design Removal Rates by
.v Outfall
cp
o BOD5 or CBOD5 >90
d TSS >90 % %
0 Not applicable 0 Not applicable 0 Not applicable
Phosphorus % % %
0 Not applicable 0 Not applicable ❑ Not applicable
Nitrogen % o I
a k /o
Other(specify) 0 Not applicable 0 Not applicable 0 Not applicable
%
EPA Form 3510-2A(Revised 3-19) Page 7

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
3.9 Describe the type of disinfection used for the effluent from each outfall in the table below. If disinfection varies by
season,describe below.
-a Sodium Hypochlorite
a)
C
0
Outfall Number 1 Outfall Number Outfall Number
0
fl- Disinfection type
Sodium Hypochlorite
U)
m
0
Seasons used All
Dechlorination used? El Not applicable ❑ Not applicable ❑ Not applicable
❑✓ Yes ❑ Yes ❑ Yes
El No El No El No
3.10 Have you completed monitoring for all Table A parameters and attached the results to the application package?
✓❑ Yes ❑ No
3.11 Have you conducted any WET tests during the 4.5 years prior to the date of the application on any of the facility's
discharges or on any receiving water near the discharge points?
❑✓ Yes El No 4 SKIP to Item 3.13.
3.12 Indicate the number of acute and chronic WET tests conducted since the last permit reissuance of the facility's
discharges by outfall number or of the receiving water near the discharge points.
Outfall Number 1 Outfall Number Outfall Number
Acute Chronic Acute Chronic Acute Chronic
Number of tests of discharge
water 24
Number of tests of receiving
water
3.13 Does the treatment works have a design flow greater than or equal to 0.1 mgd?
❑✓ Yes El No 4 SKIP to Item 3.16.
o 3.14 Does the POTW use chlorine for disinfection, use chlorine elsewhere in the treatment process, or otherwise have
reasonable potential to discharge chlorine in its effluent?
❑✓ Yes - Complete Table B,including chlorine. ❑ No+ Complete Table B,omitting chlorine.
3.15 Have you completed monitoring for all applicable Table B pollutants and attached the results to this application
package?
❑✓ Yes ❑ No
3.16 Does one or more of the following conditions apply?
• The facility has a design flow greater than or equal to 1 mgd.
• The POTW has an approved pretreatment program or is required to develop such a program.
• The NPDES permitting authority has informed the POTW that it must sample for the parameters in Table C, must
sample other additional parameters(Table D),or submit the results of WET tests for acute or chronic toxicity for
each of its discharge outfalls(Table E).
❑ Yes 3 Complete Tables C, D,and E as ❑ No 4 SKIP to Section 4.
applicable.
3.17 Have you completed monitoring for all applicable Table C pollutants and attached the results to this application
package?
❑✓ Yes ❑ No
3.18 Have you completed monitoring for all applicable Table D pollutants required by your NPDES permitting authority and
attached the results to this application package?
❑✓ Yes ❑ No additional sampling required by NPDES
permitting authority.
EPA Form 3510-2A(Revised 3-19) Page 8

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05119
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
3.19 Has the POTW conducted either(1)minimum of four quarterly WET tests for one year preceding this permit application
or(2)at least four annual WET tests in the past 4.5 years?
El Yes ❑ No+ Complete tests and Table E and SKIP to
Item 3.26.
3.20 Have you previously submitted the results of the above tests to your NPDES permitting authority?
❑✓ Yes ❑ No 4 Provide results in Table E and SKIP to
Item 3.26.
3.21 Indicate the dates the data were submitted to your NPDES permitting authority and provide a summary of the results.
Date(s)Submitted Summary of Results
(MM/DD/YYYY)
a
a)
-c
3.22 Regardless of how you provided your WET testing data to the NPDES permitting authority,did any of the tests result in
o toxicity?
0' p Yes ❑ No -3 SKIP to Item 3.26.
e, 3.23 Describe the cause(s)of the toxicity:
c Unknown cause.
m
3.24 Has the treatment works conducted a toxicity reduction evaluation?
❑ Yes ❑✓ No- SKIP to Item 3.26.
3.25 Provide details of any toxicity reduction evaluations conducted.
3.26 Have you completed Table E for all applicable outfalls and attached the results to the application package?
❑✓ Yes ❑ Not applicable because previously submitted
information to the NPDES .ermittin. authorit .
SECTION 4.INDUSTRIAL DISCHARGES AND HAZARDOUS WASTES(40 CFR 122.210)(6)and(7))
4.1 Does the POTW receive discharges from SlUs or NSCIUs?
p Yes ❑ No +SKIP to Item 4.7.
4.2 Indicate the number of SIUs and NSCIUs that discharge to the POTW.
Number of SIUs Number of NSCIUs
N 4
- 4.3 Does the POTW have an approved pretreatment program?
_ ❑✓ Yes ❑ No
g 4.4 Have you submitted either of the following to the NPDES permitting authority that contains information substantially
identical to that required in Table F:(1)a pretreatment program annual report submitted within one year of the
� application or(2)a pretreatment program?
N ❑✓ Yes ❑ No 3 SKIP to Item 4.6.
4.5 Identify the title and date of the annual report or pretreatment program referenced in Item 4.4.SKIP to Item 4.7.
4/1/22 Pretreatment Annual report 04/01/2022
4.6 Have you completed and attached Table F to this application package?
p Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 9

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
4.7 Does the POTW receive,or has it been notified that it will receive, by truck, rail, or dedicated pipe,any wastes that are
regulated as RCRA hazardous wastes pursuant to 40 CFR 261?
❑ Yes ✓❑ No+SKIP to Item 4.9.
4.8 If yes, provide the following information:
Annual
Hazardous Waste Waste Transport Method Amount of Units
Number (check all that apply) Waste
Received
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
0
❑ Truck ❑ Rail
❑ Dedicated pipe ❑ Other(specify)
0
a
N ❑ Truck ❑ Rail
_ ❑ Dedicated pipe ❑ Other(specify)
Er
4.9 Does the POTW receive,or has it been notified that it will receive,wastewaters that originate from remedial activities,
including those undertaken pursuant to CERCLA and Sections 3004(7)or 3008(h)of RCRA?
❑ Yes ❑✓ No-)SKIP to Section 5.
4.10 Does the POTW receive(or expect to receive)less than 15 kilograms per month of non-acute hazardous wastes as
specified in 40 CFR 261.30(d)and 261.33(e)?
❑ Yes 4 SKIP to Section 5. ❑ No
4.11 Have you reported the following information in an attachment to this application: identification and description of the
site(s)or facility(ies)at which the wastewater originates;the identities of the wastewater's hazardous constituents;and
the extent of treatment,if any,the wastewater receives or will receive before entering the POTW?
❑ Yes ❑ No
SECTION 5.COMBINED SEWER OVERFLOWS(40 CFR 122.210)(8))
5.1 Does the treatment works have a combined sewer system?
a) ❑ Yes ❑✓ No 4SKIP to Section 6.
a 5.2 Have you attached a CSO system map to this application?(See instructions for map requirements.)
Yes ❑ No
5.3 Have you attached a CSO system diagram to this application?(See instructions for diagram requirements.)
`n ❑ Yes ❑ No
EPA Form 3510-2A(Revised 3-19) Page 10

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
5.4 For each CSO outfall,provide the following information.(Attach additional sheets as necessary.)
CSO Outfall Number CSO Outfall Number CSO Outfall Number
City or town
0
Pc.
- State and ZIP code
0
u)
o County
6
0
Latitude ° °
o'
u) Longitude "'
U
Distance from shore ft. ft. ft.
Depth below surface ft. ft. ft.
5.5 Did the POTW monitor any of the following items in the past year for its CSO outfalls?
CSO Outfall Number CSO Outfall Number CSO Outfall Number
Rainfall 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
a)
0 CSO flow volume 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
CSO pollutant
0
concentrations El Yes 0 No ❑ Yes 0 No 0 Yes El No
c.' Receiving water quality ❑ Yes 0 No 0 Yes 0 No 0 Yes 0 No
CSO frequency 0 Yes 0 No 0 Yes 0 No 0 Yes 0 No
Number of storm events 0 Yes 0 No 0 Yes ❑No 0 Yes 0 No
5.6 Provide the following information for each of your CSO outfalls.
CSO Outfall Number CSO Outfall Number CSO Outfall Number
cu Number of CSO events in events events events
N the past year
R
a
c Average duration per hours hours hours
event 0 Actual or 0 Estimated 0 Actual or 0 Estimated 0 Actual or 0 Estimated
cu
"' million gallons million gallons million gallons
o Average volume per event
co
❑Actual or❑ Estimated 0 Actual or 0 Estimated 0 Actual or 0 Estimated
Minimum rainfall causing inches of rainfall inches of rainfall inches of rainfall
a CSO event in last year ❑Actual or 0 Estimated ❑Actual or 0 Estimated 0 Actual or 0 Estimated
EPA Form 3510-2A(Revised 3-19) Page 11

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
5.7 Provide the information in the table below for each of your CSO outfalls.
CSO Outfall Number CSO Outfall Number CSO Outfall Number
Receiving water name
Name of watershed/
stream system
U.S. Soil Conservation ❑ Unknown ❑ Unknown ❑Unknown
Service 14-digit
watershed code
(if known)
Name of state
management/river basin
o U.S.Geological Survey ❑ Unknown 0 Unknown ❑ Unknown
8-Digit Hydrologic Unit
Code(if known)
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
exam Iles)
CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22 a and(d))
6. ( ) ( 1)
6.1 In Column 1 below,mark the sections of Form 2A that you have completed and are submitting with your application.For
each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority.Note that not
all applicants are required to provide attachments.
Column 1 Column 2
❑ Section 1: Basic Application ❑ w/variance request(s) ❑ w/additional attachments
Information for All Applicants
❑ Section 2:Additional ❑✓ wl topographic map ❑✓ w/process flow diagram
Information
❑ wl additional attachments
❑✓ w/Table A ❑✓ w/Table D
❑ Section 3: Information on ❑ w/Table B ❑✓ w/Table E
Effluent Discharges
❑✓ w/Table C ❑ w/additional attachments
Section 4: Industrial ❑ w/SIU and NSCIU attachments ❑✓ w/Table F
❑✓ Discharges and Hazardous
o Wastes ❑ w/additional attachments
Section 5: Combined Sewer El w/CSO map ❑ wl additional attachments
❑ Overflows ❑ wl CSO system diagram
Section 6: Checklist and
❑✓ ✓❑ wl attachments
Certification Statement
N
Y 6.2 Certification Statement
U
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted.Based on my inquiry of the person or persons who manage the system,or those persons directly responsible
for gathering the information, the information submitted is, to the best of my knowledge and belief,true,accurate, and
complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name(print or type first and last name) Official title
Kenneth Galloway 4th Creek Plant Supervisor
Signature Date signed
EPA Form 3510-2A(Revised 3-19) Page 12

EPA Identification Number
NPDES Permit Number
NC0031836
Facility Name
City of Statesville 4th Creek
Form Approved 03/05/19
OMB No. 2040-0004
CSO Receiving Waters
5.7
Provide the information in the table below for each of your CSO outfalls.
CSO Outfall Number
CSO Outfall Number_
CSO WWI Number . -
Receiving water name
Name of watershed/
stream system
U.S. Soil Conservation
Service 14-digit
watershed code
(if known)
0 Unknown
0 Unknown
0 Unknown
Name of state
management/river basin
U.S. Geological Survey
8-Digit Hydrologic Unit
Code (if known)
0 Unknown
❑ Unknown
❑ Unknown
Description of known
water quality impacts on
receiving stream by CSO
(see instructions for
exam Iles
SECTION
6. CHECKLIST
AND CERTIFICATION STATEMENT (40 CFR 122.22(a) and (d))
submi
the permitting
tang with your application. For
authority. Note that not
Checklist and Certification Statement
6,1
In Column 1 below, mark the sections of Form 2A that you have completed and are
each section, specify In Column 2 any attachments that you are enclosing to alert
all applicants are required to provide attachments,
Column 1
Column 2
Section
1: Basic Application
for All Applicants
❑ w/ variance request(s) ❑ wi additional attachments
0
Information
Section
2: Additional
✓ w/ topographic
map
attachments
GI
wl process flow diagram
✓
Information
■ wi additional
3: Information on
Discharges
✓ w/ Table
A
B
C
I7
w/ Table D
Cl wi Table
✓ Section
I•/
w/ Table E
Effluent
✓ wl Table
■
wl additional attachments
Section 4: Industrial
[Z] Discharges and Hazardous
Wastes
■ wl SIU
and NSCIU attachments
attachments
12 w/ Table F
❑ w/ additional
❑ Section 5: Combined Sewer
Overflows
❑ wl CSO map ❑ wi additional attachments
0 w/ CSO system diagram
6: Checklist and
Statement
✓ Section
✓ w/ attachments
Certification
6,2
Certification Statement
l 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 (here are significant penalties for submitting false information, including the possibility of fine
and imprisonment for knowing violations.
Name (print or type first and last name)
Kenneth Galloway
Official title
4th Creek Plant Supervisor
Signature
Date signed
q Zf'" a L
EPA Form 3510-2A (Revised 3-19)
Page 12

A Identification Number NPDES Permit Number Fa ne Outfall Number Form d 03/05/19
NC0031836 City of Stat 4th Creek 1 C 2040-0004
TABLE A.EFFLUENT PARAMETERS FOR ALL POTWS -
Maximum Daily Discharge Average Daily Discharge
Pollutant Number of Analytical ML or MDL
Value Units Value Units Method1 (include units)
Sam•Ies
Biochemical oxygen demand
El2 mg/I
or❑CBOD5 31.3 mg/I 4.41 mg/I 830 SM 52106 2016 ❑ML
resort one 0 MDL
Fecal coliform >6000 #/100 ml 6.67 #/100 ml 830 SM922D-2015 1 m g/I 0 ML
El MDL
Design flow rate 12.1 MGD 3.32 MGD 1215 f a f
pHr i s t
pH(minimum) 6.5a
I r l' I i i
pH(maximum) 8.7 pH
i 1 ; t ; i
a
Temperature(winter) 25 c 13.6 c 830 I
Temperature(summer) 26 c 21.2 c 830 t i 1
t.I
Total suspended solids(TSS) 40.8 mg/I 2.35 mg/I 830 SM 2540D-2015 2.5 mg/I 0 ML
MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 13

This page intentionally left blank.

dentification Number NPDES Permit Number Faci a Outfall Number Forrr ad 03/05/19
NC0031836 City of State 1th Creek 1 t 2040-0004
TABLE B.EFFLUENT PARAMETERS FOR ALL POTWS WITH A FLOW EQUAL TO OR GREATER THAN 0.1 MGD
Maximum Daily Discharge Average Daily Discharge
Pollutant Number of Analytical ML or MDL
Value Units Value Units Method1 (include units)
Samples
Ammonia(as N) 13.6 mg/I 1.42 mg/I 830 EPA 350.1 0.1 mg/I ❑ML
Chlorine o MDL
(total residual,TRC)2 <20 ug/I <20 ug/I 830 SM 4500CIG 2011 20 ❑ML
ug/I0MDL
Dissolved oxygen 12.5 mg/I 9.11 mg/I 830 SM 4500DG-2016 o ML
0 MDL
Nitrate/nitrite 6.58 mg/I 2.11 mg/I 4 EPA353.2 0.10 mg/I 00 ML
MDL
Kjeldahl nitrogen 17.9 mg/I 5.48 mg/I 4 EPA 351.1 0.20 mg/I 00 ML
MDL
Oil and grease 10.3 mg/I 1.05 mg/I 22 EPA 16646 5 mg/I ❑O MDL
Phosphorus 5.22 mg/I 0.151 mg/I 173 EPA200.7 20 ugl 0 ML
MDL
Total dissolved solids 222 mg/I 187.75 mg/I 4 SM2540C 10 mg/I ❑ML
0 MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
2 Facilities that do not use chlorine for disinfection,do not use chlorine elsewhere in the treatment process,and have no reasonable potential to discharge chlorine in their effluent are not
required to report data for chlorine.
EPA Form 3510-2A(Revised 3-19) Page 15

This page intentionally left blank.

-- dentification Number NPDES Permit Number Faci" . a Outfall Number Form .d 03/05/19
NC0031836 City of State 4th Creek 1 ( 2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
PollutantAnalytical ML or MDL
Number of Method1 (include Value Units Value Units units)
Samples
Metals,Cyanide,and Total Phenols
Hardness(as CaCO3) 59 mg/I 43.5 mg/I 18 SM2340C 1 mg/I 0o ML
MDL
Antimony,total recoverable <25 ug/I <25 ug/I 4 EPA 200.7 25 ug/I 00 ML
MDL
Arsenic,total recoverable 2.5 ug/I 0.11 ug/I 22 EPA 200.7 10 ug/I 0 ML
MDL
Beryllium,total recoverable <5 ug/1 <5 ug/I 4 EPA 200.7 5 ug/I O0 ML
MDL
Cadmium,total recoverable <2 ug/I <2 ug/I 22 EPA 200.7 2 ug/I O0 ML
MDL _
Chromium,total recoverable 39 ug/I 2 ug/I 22 EPA 200.7 5 ug/I ❑O0 ML
MDL
Copper,total recoverable 36 ug/I 4.85 ug/I 62 EPA 200.7 2 ug/I ❑O0 ML
MDL
Lead,total recoverable <10 ug/I <10 ug/I 22 EPA 200.7 10 ug/I 0 MML
DL
Mercury,total recoverable 54 ng/I 5.27 ng/I 17 EPA 245.1 2 ng/I 00 ML
MDL
Nickel,total recoverable 78 ug/I 10.25 ug/I 22 EPA 200.7 10 ug/I 0 MML
DL
Selenium,total recoverable 10 ug/I 0.454 ug/I 22 EPA 200.7 10 ug/I 00 ML
MDL
Silver,total recoverable 5 ug/I 0.227 ug/I 22 EPA 200.7 5 ug/I ❑O0 ML
MDL
Thallium,total recoverable <40 ug/I <40 ug/I 4 EPA 200.7 20 ug/I 0 ML
O MDL
Zinc,total recoverable 79 ug/I 47.91 ug/I 22 EPA 200.7 10 ug/I 0 ML
MDL
Cyanide 6 ug/I 0.272 ug/I 22 EPA 335.4 5 ug/I 0 MML
DL
Total phenolic compounds 16 ug/I 9.25 ug/I 4 EPA 420.1 10 ug/I 0 ML
MDL
Volatile Organic Compounds
o ML
Acrolein <50 ug/I <50 ug/I 4 EPA 624.1 50 ug/I 0 MDL
0 ML
Acrylonitrile <10 ug/I <10 ug/I 4 EPA 624.1 10 ug/I ❑O MDL
0 ML
Benzene <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I ❑O MDL
0 ML
Bromoform <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I 0 MDL
Page 17
EPA Form 3510-2A(Revised 3-19)

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0031836 City of Statesville 4th Creek 1
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
I=1 ML
Carbon tetrachloride <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I 0 MDL
0 ML
Chlorobenzene <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I 0 MDL
0 ML
Chlorodibromomethane <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I ❑MDL
ML
Chloroethane <5 ug/I <5 ug/I 4 EPA 624.1 5 ug/I 0 MDL
ML
2-chloroethylvinyl ether <5 ug/I <5 ug/I 4 EPA 624.1 5 ugh 0 MDL
0 ML
Chloroform 1.86 ug/1 1.19 ugh! 4 EPA 624.1 1 ug/I 0 MDL
0 ML
Dichlorobromomethane <1 ug/I <1 ugh' 4 EPA 624.1 1 ug/I El MDL _
ID ML
1,1-dichloroethane <1 ug/I <1 ug/1 4 EPA 624.1 1 ug/I 0 MDL _
0 ML
1,2-dichloroethane <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I 0 MDL
ML
trans-1,2-dichloroethylene <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I 0 MDL
0 ML
1,1-dichloroethylene <1 ug/I <1 ug/1 4 EPA 624.1 1 ug/I MDL
0 ML
1,2-dichloropropane <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I 0 MDL
0 ML
1,3-dichloropropylene <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I 0 MDL
0 ML
Ethylbenzene <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I 0 MDL
ML
Methyl bromide <5 ug/I <5 ug/I 4 EPA 624.1 5 ugh 0 MDL
0 ML
Methyl chloride <5 ug/I <5 ug/I 4 EPA 624.1 5 ug/I MDL
0 ML
Methylene chloride <1 ug/I <1 ugh 4 EPA 624.1 1 ug/I 0 MDL
0 ML
1,1,2,2-tetrachloroethane <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I 0 MDL
0 ML
Tetrachloroethylene <1 ug/I <1 ug/1 4 EPA 624.1 1 ug/I 0 MDL
ML
Toluene 6.2 ug/1 1.55 ug/I 4 EPA 624.1 1 ug/I 0 MDL
0 ML
1,1,1-trichloroethane <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I 0 MDL -
El ML
1,1,2-trichloroethane <1 ug/I <1 ug/Ip 4 EPA 624.1 1 ug/I 0 MDL
EPA Form 3510-2A(Revised 3-19) Page 18

dentification Number NPDES Permit Number Faci 3 Outfall Number Form :d 03/05/19
NC0031836 City of State lth Creek 1 ( 2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant ---___ Analytical ML or MDL
Value Units Value Units Number of Method1 (include units)
Samples
Trichloroethylene <1 ug/I <1 ug/I 4 EPA 624.1 1 ug/I ©ML
MDL
Vinyl chloride <5 ug/I <5 ug/I 4 EPA 624.1 5 ug/I El ML
0 MDL
Acid-Extractable Compounds
o ML
p-chloro-m-cresol <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 MDL
El ML
2-chlorophenol <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 MDL
2,4-dichlorophenol <10 ugh! <10 ug/I 4 EPA 625.1 10 ug/I 00 ML
MDL
2,4-dimethylphenol <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I ©0 ML
MDL
4,6-dinitro-o-cresol <50 ug/I <50 ug/I 4 EPA 625.1 50 ug/I ©MML
DL
0 ML
2,4-dinitrophenol <50 ug/I <50 ug/I 4 EPA 625.1 50 ug/I MDL
0 ML
2-nitrophenol <10 ug/I _ <10 ug/I 4 EPA 625.1 10 ugh MDL
0 ML
4-nitrophenol <50 ug/1 <50 ug/I 4 EPA 625.1 50 ug/I MDL
Pentachlorophenol <50 ug/I <50 ug/I 4 EPA 625.1 50 ug/I 00 ML
MDL
ML
Phenol <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 MDL
0 ML
2,4,6-trichlorophenol <io ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 MDL
Base-Neutral Compounds
o ML
Acenaphthene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 MDL
Acenaphthylene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I ©MML
DL
0 ML
Anthracene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 2 MDL
0 ML
Benzidine <50 ug/I <50 ug/I 4 EPA 625.1 50 ug/I 0 MDL
Benzo(a)anthracene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 2 MML
DL
ML
Benzo(a)pyrene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 MDL
ML
3,4-benzofluoranthene <10 ug/I <10 ug/1 4 EPA 625.1 10 ug/I 0 MDL
EPA Form 3510-2A(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
0MB No,2040-0004
NC0031836 City of Statesville 4th Creek 1
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge Analytical ML or MDL
Pollutant Number of Method1 (include units)
Value Units Value Units Samples
iii ML
Benzo(ghi)perylene <10 ugh' <10 ugh' 4 EPA 625.1 10 ughi 0 MDL
0 ML
Benzo(k)fluoranthene <10 ug/I <10 ug/I 4 EPA 625.1 10 ugh! ❑O MDL
ML
Bis(2-chloroethoxy)methane <10 ugh! <10 ugh! 4 EPA 625.1 10 ugh 0 MDL
0 ML
Bis(2-chloroethyl)ether <10 ugh <10 ug/I 4 EPA 625.1 10 ug/I p MDL
ML
Bis(2-chloroisopropyl)ether <10 ug/I <10 ugh' 4 EPA 625.1 10 ug/I 0 MDL
0 ML
Bis(2-ethylhexyl)phthalate 11.1 ug/I 2.775 ug/I 4 EPA 625.1 10 ug/I 0 MDL
ML
4-bromophenyl phenyl ether <10 ug/I <10 ugh! 4 EPA 625.1 10 ug/I 0 MDL
0 ML
Butyl benzyl phthalate <10 ug/I <10 ugh' 4 EPA 625.1 10 ugh O MDL
0 ML
2-chloronaphthalene <10 ug/I <10 ugh' 4 EPA 625.1 10 ugh! ❑✓ MDL
0 ML
4-chlorophenyl phenyl ether <10 ugh! <10 ug/I 4 EPA 625.1 10 ug/I 0 MDL
ML
Chrysene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I ©MDL
ML
di-n-butyl phthalate <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 MDL0 ML
_
di-n-octyl phthalate <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I ❑O MDL
ML
Dibenzo(a,h)anthracene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I m MDL0 ML
1,2-dichlorobenzene <10 ugh <10 ugh 4 EPA 625.1 10 ugh ❑O MDL
0 ML
1,3-dichlorobenzene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I MDL
ML
1,4-dichlorobenzene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I ©MDL
ML
3,3-dichlorobenzidine <50 ugh <50 ug/I 4 EPA 625.1 50 ug/I ©MDL
ML
Diethyl phthalate <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I ©MDL
ML
Dimethyl phthalate <10 ug/I <10 ugh' 4 EPA 625.1 10 ug/I ©MDL _
ML
2,4-dinitrotoluene <10 ugh' <10 ugh' 4 EPA 625.1 10 ug/I ©MDL
0 ML
2,6-dinitrotoluene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I ©MDL
EPA Form 3510-2A(Revised 3-19) Page 20

dentification Number NPDES Permit Number Faci e Outfall Number Forrr ed 03/05/19
NC0031836 City of State 1th Creek 1 ( ,2040-0004
TABLE C.EFFLUENT PARAMETERS FOR SELECTED POTWS
Maximum Daily Discharge Average Daily Discharge
Pollutant — — Analytical ML or MDL
Value Units Value Units Number of Method1 (include units)
Samples
1,2-diphenylhydrazine <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I LI ML
0 MDL
Fluoranthene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 ML
MDL
0 ML
Fluorene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 MDL
Hexachlorobenzene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 00 ML
MDL
Hexachlorobutadiene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 00 ML
MDL
Hexachlorocyclo-pentadiene <50 ug/1 <50 ug/I 4 EPA 625.1 50 ug/I 0 MML
DL
Hexachloroethane <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 ML
MDL
Indeno(1,2,3-cd)pyrene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 00 ML
MDL
0 ML
Isophorone <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 MDL
0 ML
Naphthalene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I ❑O MDL
Nitrobenzene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 MML
DL
N-nitrosodi-n-propylamine <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 ML
MDL
N-nitrosodimethylamine <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 MML
DL
N-nitrosodiphenylamine <10 _ ug/I _ <10 ug/I 4 EPA 625.1 10 ug/I 0 ML
MDL
Phenanthrene <10 ug/1 <10 ug/1 4 EPA 625.1 10 ug/I 00 ML
MDL
ML
Pyrene <10 ug/I <10 ug/I 4 EPA 625.1 10 ug/I 0 MDL
1,2,4-trichlorobenzene <10 ug/I <10 ug/I 4 EPA 625.1 10 ugh 0 ML
MDL
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR Chapter I, Subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19) Page 21

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Fac ie Outfall Number
Form Ap 3/05/19
NC0031836 City of Stat 4th Creek OME i0-0004
TABLE D.ADDITIONAL POLLUTANTS AS REQUIRED BY NPDES PERMITTING AUTHORITY
Maximum DailyDischarge
PollutantAverage Daily Dischar e
(list) Value Units Value Number of Analytical ML or MDL
•
Units Samples Methods (include units)
❑ No additional sampling is required by NPDES permitting authority.
o ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
❑ML
❑MDL
I Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or required
under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2A(Revised 3-19)
Page 23

This page intentionally left blank.

PA Identification Number NPDES Permit Number Facil Outfall Number Form App r05/19
NC0031836 City of Statesville 4th Creek 1 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Information.
Test Number 1 Test Number 2 Test Number 3
Test species Ceriodaphnia Ceriodaphnia Ceriodaphnia
Age at initiation of test <24 <24 <24 —
Outfall number 1 1
1
Date sample collected 01/09/2019 04/10/2019 07/16/2019
Date test started 01/09/2019 04/10/2019 07/17/2019
Duration 7 days 7 days 7 days
Toxicity Test Methods
Test method number 1002.0 1002.0 1002.0
Manual title Short Term Methods for Estimating the Chronic Short Term Methods for Estimating the Chrop Short Term Methods for Estimating the Chrop
Edition number and year of publication 4th Edition 2002 4th Edition 2002 4th Edition 2002
Page number(s) 141-189 141-189 141-189
Sample Type
Check one: ❑ Grab ❑ Grab 0 Grab
✓❑ 24-hour composite ❑✓ 24-hour composite ❑✓ 24-hour composite
Sample Location
Check one: ❑ Before Disinfection ❑ Before Disinfection 0 Before disinfection
0 After Disinfection 0 After Disinfection ❑After disinfection
✓❑ After Dechlorination ❑✓ After Dechlorination ❑✓ After dechlorination
Point in Treatment Process
Describe the point in the treatment process
at which the sample was collected for each Effluent Effluent Effluent
test.
Toxicity Type —
Indicate for each test whether the test was 0 Acute 0 Acute 0 Acute
performed to asses acute or chronic toxicity,
or both.(Check one response.) ❑✓ Chronic ❑✓ Chronic 0 Chronic
0 Both ❑ Both ❑ Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek 1 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
■ Test Number 1 Test Number 2 Test Number 3
Test Type
Indicate the type of test performed.(Check one 0 Static 0 Static ❑ Static
response.) r
0 Static-renewal Static-renewal vl_(Static-renewal
❑ Flow-through 0 Flow-through 0 Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check 0 Laboratory water 0 Laboratory water 0 Laboratory water
one response.)
❑✓ Receiving water 0 Receiving water ✓❑ Receiving water
If laboratory water,specify type.
If receiving water,specify source. Lake Brandt Lake Brandt Lake Brandt
Type of Dilution Water
Indicate the type of dilution water. If salt ❑✓ Fresh water ❑✓ Fresh water ✓❑ Fresh water
water,specify"natural'or type of artificial
sea salts or brine used. ❑ Salt water(specify) 0 Salt water(specify) 0 Salt water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series. 45 45 45
Parameters Tested
Check the parameters tested. pH ❑ Ammonia pa pH ❑ Ammonia [E pH 0 Ammonia
0 Salinity I Dissolved oxygen 0 Salinity 0 Dissolved oxygen ❑ Salinity 0 Dissolved oxygen
❑✓ Temperature gi Temperature Temperature
Acute Test Results
Percent survival in 100%effluent % %
LC5o
95%confidence interval % %
Control percent survival % % %
EPA Form 3510-2A(Revised 3-19) Page 26

'A Identification Number NPDES Permit Number Facili Outfall Number Form Appr )5/19
NC0031836 City of Statesville 4th Creek 1 OMB P. . 0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 1 Test Number 2 Test Number 3
Acute Test Results Continued
Other(describe)
Chronic Test Results
NOEC >45 % >45 % >45 %
IC25
/o
Control percent survival 100 % 100 % 100 %
Other(describe)
Quality Control/Quality Assurance
Is reference toxicant data available? ✓❑ Yes ❑ No ❑✓ Yes ❑ No ❑✓ Yes 0 No
Was reference toxicant test within
acceptable bounds? El Yes ID No 0 Yes ❑ No ❑✓ Yes ❑ No
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(describe)
reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks
EPA Form 3510-2A(Revised 3-19) Page 27

'A Identification Number NPDES Permit Number Facili Outfall Number Form Appn 15/19
NC0031836 City of Statesville 4th Creek 1 OMB t`._.__._0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Information
Test Number 4 Test Number 5 Test Number 6
Test species Ceriodaphnia Ceriodaphnia Ceriodaphnia
Age at initiation of test <24 <24 <24
Outfall number 1 1 1
Date sample collected 10/16/2019 01/14/2020 04/14/2020
Date test started 10/19/2019 01/15/2020 04/15/2020
Duration 7 days 7 days 7 days
Toxicity Test Methods
Test method number 1002.0 1002.0 1002.0
Manual title Short Term Methods for Estimating the Chronli Short Term Methods for Estimating the Chro© Short Term Methods for Estimating the Chrop
Edition number and year of publication 4th Edition 2002 4th Edition 2002 4th Edition 2002
Page number(s) 141-189 141-189 141-189
Sample Type
Check one: ❑ Grab ❑ Grab 0 Grab
✓❑ 24-hour composite ❑✓ 24-hour composite ✓❑ 24-hour composite
Sample Location
Check one: 0 Before Disinfection ❑ Before Disinfection 0 Before disinfection
❑After Disinfection ❑After Disinfection ❑After disinfection
0 After Dechlorination ❑✓ After Dechlorination ✓❑ After dechlorination
Point in Treatment Process
Describe the point in the treatment process Effluent Effluent Effluent
at which the sample was collected for each
test.
Toxicity Type
Indicate for each test whether the test was 0 Acute ❑Acute 0 Acute
performed to asses acute or chronic toxicity,
or both.(Check one response.) ❑✓ Chronic 0 Chronic ❑✓ Chronic
0 Both ❑ Both 0 Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek 1 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 4 Test Number 5 Test Number 6
Test Type
Indicate the type of test performed.(Check one ❑ Static 0 S atic Cl3tatic
response.)
❑✓ Static-renewal Static-renewal LJ Static-renewal
0 Flow-through ❑ Flow-through 0 Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check ❑ Laboratory water ❑ Laboratory water ❑ Laboratory water
one response.)
❑✓ Receiving water ❑✓ Receiving water ❑✓ Receiving water
If laboratory water,specify type. .
If receiving water,specify source. Lake Brandt 1 Lake Brandt Lake Brandt
Type of Dilution Water
Indicate the type of dilution water. If salt ❑✓ Fresh water ❑✓ Fresh water ✓❑ Fresh water
water,specify"natural"or type of artificial
sea salts or brine used. CISalt water(specify) CISalt water(specify) CISalt water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all 45 45 45
concentrations in the test series.
Parameters Tested
Check the parameters tested. Lf pH ❑ Ammonia ❑ pH ❑ Ammonia ❑ pH ❑ Ammonia
❑(Salinity ❑✓ Dissolved oxygen ❑ Salinity 0 Dissolved oxygen ❑ Salinity ✓❑ Dissolved oxygen
Ell Temperature ❑ Temperature ` ❑ Temperature
Acute Test Results
Percent survival in 100%effluent % % %
LC50
95%confidence interval % % %
Control percent survival % % % I
EPA Form 3510-2A(Revised 3-19) Page 26

PA Identification Number NPDES Permit Number Faci Outfall Number Form Appi 05/19
NC0031836 City of Statesville 4th Creek 1 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 4 Test Number 5 Test Number 6
Acute Test Results Continued
Other(describe)
Chronic Test Results
NOEC >45 % >45 % >45 %
IC25
Control percent survival 100 % 10o % 100
Other(describe)
Quality Control/Quality Assurance
Is reference toxicant data available? ✓❑ Yes ❑ No ❑✓ Yes ❑ No ❑✓ Yes ❑ No
Was reference toxicant test within
acceptable bounds? E] Yes 0 No ❑✓ Yes ❑ No ❑✓ Yes 0 No
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(describe)
reference toxicant test run within 2 weeks I reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks
EPA Form 3510-2A(Revised 3-19) Page 27

'A Identification Number NPDES Permit Number Facilit Outfall Number Form Apprc 15/19
NC0031836 City of Statesville 4th Creek 1 OMB k 0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Information
Test Number 7 Test Numbers Test Number 9
—
Test species Ceriodaphnia Ceriodaphnia Ceriodaphnia
Age at initiation of test <24 <24 <24
Outfall number 1 1 1
Date sample collected 07/14/2020 10/13/2020 02/09/2021
Date test started 07/15/2020 10/14/2020 02/10/2021
Duration 7 days 7 days 7 days
Toxicity Test Methods
Test method number 1002.0 1002.0 1002.0
Manual title Short Term Methods for Estimating the Chronic Short Term Methods for Estimating the Chrop Short Term Methods for Estimating the Chro©
Edition number and year of publication 4th Edition 2002 4th Edition 2002 4th Edition 2002
Page number(s) 141-189 141-189 141-189
Sample Type
Check one: ❑ Grab ❑ Grab 0 Grab
✓❑ 24-hour composite ❑✓ 24-hour composite ✓❑ 24-hour composite
Sample Location
Check one: 0 Before Disinfection 0 Before Disinfection ❑ Before disinfection
❑After Disinfection 0 After Disinfection 0 After disinfection
❑✓ After Dechlorination ❑✓ After Dechlorination 0 After dechlorination
Point in Treatment Process
Describe the point in the treatment process Effluent Effluent Effluent
at which the sample was collected for each
test.
Toxicity Type
Indicate for each test whether the test was 1 ❑Acute 0 Acute 0 Acute
performed to asses acute or chronic toxicity, ✓❑ Chronic ❑✓ Chronic ❑✓ Chronic
or both.(Check one response.)
0 Both ❑ Both 0 Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek 1 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY s
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 7 Test Number 8 Test Number 9
Test Type
Indicate the type of test performed.(Check one ❑ Static ❑ Static ❑ Static
response.)
✓❑ Static-renewal Static-renewal Z Static-renewal
❑ Flow-through ❑ Flow-through ❑ Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check ❑ Laboratory water ❑ Laboratory water El Laboratory water
one response.)
❑✓ Receiving water ❑✓ Receiving water ❑✓ Receiving water
If laboratory water,specify type.
If receiving water,specify source. Lake Brandt Lake Brandt Lake Brandt
Type of Dilution Water
Indicate the type of dilution water.If salt ✓❑ Fresh water ❑✓ Fresh water ❑✓ Fresh water
water,specify"natural"or type of artificial
sea salts or brine used. CISalt water(specify) CISalt water(specify) ❑ Salt water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series. 45 45 11.25,22.5,45,67.5,90
Parameters Tested �,,�
Check the parameters tested. IJ pH ❑ Ammonia Er pH ❑ Ammonia L`7 pH ❑ Ammonia
❑ Salinity ❑✓ Dissolved oxygen ❑ I+nity ❑✓ Dissolved oxygen 0 Salinity ✓❑ Dissolved oxygen
Temperature Temperature aTemperature
Acute Test Results
Percent survival in 100%effluent
LC50
95%confidence interval % % %
Control percent survival % % 0/0
EPA Form 3510-2A(Revised 3-19) Page 26

PA Identification Number NPDES Permit Number Facil Outfall Number Form Appr 05/19
NC0031836 City of Statesville 4th Creek 1 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 7 Test Number 8 Test Number 9
Acute Test Results Continued
Other(describe)
Chronic Test Results
NOEC >45 % >45 % >90 %
IC25 • % %
Control percent survival 100 % 10o % 10o
Other(describe)
Quality Control/Quality Assurance
Is reference toxicant data available? ❑✓ Yes 0 No ❑✓ Yes 0 No ❑✓ Yes 0 No
Was reference toxicant test within
acceptable bounds? 0Yes El No ❑✓ Yes 0 No ❑✓ Yes 0 No
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(describe)
reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks
EPA Form 3510-2A(Revised 3-19) Page 27

PA Identification Number NPDES Permit Number Faci Outfall Number Form App (05/19
NC0031836 City of Statesville 4th Creek 1 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Information
Test Number 10 Test Number 11 il Test Number 12
Test species Ceriodaphnia Ceriodaphnia Ceriodaphnia
Age at initiation of test <24 <24 <24
Outfall number 1 1
1
Date sample collected 07/14/2020 10/13/2020 02/09/2021
Date test started 07/15/2020 10/14/2020 02/10/2021
Duration 7 days 7 days 7 days
Toxicity Test Methods
Test method number 1002.0 1002.0 1002.0
Manual title Short Term Methods for Estimating the Chronic Short Term Methods for Estimating the Chro© Short Term Methods for Estimating the Chrod
Edition number and year of publication 4th Edition 2002 4th Edition 2002 4th Edition 2002
Page number(s) 141-189 141-189 141-189
Sample Type
Check one: ❑ Grab 0 Grab 0 Grab
0 24-hour composite 0 24-hour composite 0 24-hour composite
Sample Location
Check one: 0 Before Disinfection 0 Before Disinfection 0 Before disinfection
❑After Disinfection ❑After Disinfection ❑After disinfection
0 After Dechlorination ❑✓ After Dechlorination ❑✓ After dechlorination
Point in Treatment Process
Describe the point in the treatment process Effluent Effluent Effluent
at which the sample was collected for each
test.
Toxicity Type
Indicate for each test whether the test was ❑Acute 0 Acute 0 Acute
performed to asses acute or chronic toxicity,
or both.(Check one response.) ❑✓ Chronic 0Chronic ❑✓ Chronic
0 Both ❑ Both ❑ Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0031836 City of Statesville 4th Creek 1
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 10 Test Number 11 Test Number 12
Test Type
Indicate the type of test performed.(Check one ❑ Static 0 Static 0 Static
response.)
❑✓ Static-renewal ❑✓ Static-renewal 0 Static-renewal
' ❑ Flow-through 0 Flow-through ❑ Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check ❑✓ Laboratory water 0 Laboratory water ✓❑ Laboratory water
one response.)
❑ Receiving water ❑✓ Receiving water ❑ Receiving water
If laboratory water,specify type. MHSF MHSF
If receiving water,specify source. Lake Brandt
Type of Dilution Water
Indicate the type of dilution water.If salt 0 Fresh water ❑✓ Fresh water 0 Fresh water
water,specify"natural"or type of artificial
sea salts or brine used. ElSalt water(specify) 1::: Salt water(specify) ❑ Salt water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series. 11.25,22.5,45,67.5,90 11.25,22.5,45,67.5,90 11.25,22.5,45,67.5,90
Parameters Tested
Check the parameters tested. [ pH ❑ Ammonia ©pH 0 Ammonia 'pH ❑ Ammonia
❑ inity. 0 Dissolved oxygen ,❑ SS linity ❑✓ Dissolved oxygen ❑ SS linity ❑✓ Dissolved oxygen
C� Temperature L�f Temperature 2 Temperature
Acute Test Results
Percent survival in 100%effluent % % %
LC5o
95%confidence interval % % %
Control percent survival % %
EPA Form 3510-2A(Revised 3-19) Page 26

PA Identification Number NPDES Permit Number Fact Outfall Number Form Appi 05/19
NC0031836 City of Statesville 4th Creek 1 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 10 Test Number 11 Test Number 12
Acute Test Results Continued
Other(describe)
Chronic Test Results
NOEC • >90 % >90 % >90 %
IC25 % % °
�o
Control percent survival 100 % 100 % 100 %
Other(describe)
Quality Control/Quality Assurance
Is reference toxicant data available? ✓❑ Yes ❑ No ❑✓ Yes 0 No ElYes ❑ No
Was reference toxicant test within
acceptable bounds? 0Yes ❑ No 0Yes ❑ No ❑✓ Yes ❑ No
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(describe)
reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks
EPA Form 3510-2A(Revised 3-19) Page 27

'A Identification Number NPDES Permit Number Facili Outfall Number Form Appr )5/19
NC0031836 City of Statesville 4th Creek 1 OMB No.zu4u-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Information
Test Number 13 Test Number 14 Test Number 1-'
Test species Ceriodaphnia Ceriodaphnia Ceriodaphnia
Age at initiationof - <24 <24 <24
Outfall number1 1 1
Date sample collected 04/13/2021 04/13/2021 05/11/2021
Date test started 04/14/2021 04/14/2021 05/12/2021
Duration 7 days 7 days 7 days
Toxicity Test Methods
Test method number 1002.0 1002.0 1002.0
Manual title Short Term Methods for Estimating the Chronic Short Term Methods for Estimating the Chrod Short Term Methods for Estimating the Chrop
Edition number and year of publication 4th Edition 2002 4th Edition 2002 4th Edition 2002
Page number(s) 141-189 141-189 141-189
Sample Type
Check one: 0 Grab ❑ Grab 0 Grab
✓❑ 24-hour composite ❑✓ 24-hour composite ❑✓ 24-hour composite
Sample Location
Check one: ❑ Before Disinfection ❑ Before Disinfection ❑ Before disinfection
0 After Disinfection ❑After Disinfection 0 After disinfection
✓❑ After Dechlorination ❑✓ After Dechlorination El After dechlorination
Point in Treatment Process
Describe the point in the treatment process Effluent Effluent Effluent
at which the sample was collected for each
test.
Toxicity Type
Indicate for each test whether the test was 0 Acute ❑Acute ❑Acute
performed to asses acute or chronic toxicity,
or both.(Check one response.) ❑✓ Chronic 0 Chronic ❑✓ Chronic
0 Both ❑ Both 0 Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek 1 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 13 Test Number 14 Test Number 15
Test Type
Indicate the type of test performed.(Check one ❑ Static 0 Static ❑ Static
response.)
0 Static-renewal 0 Static-renewal 0 Static-renewal
0 Flow-through ❑ Flow-through ❑ Flow-through
Source of Dilution Water
Indicate the source of dilution water.(check e11boratory water 0 Laboratory water 0 Laboratory water
one response.)
trg Receiving water ❑ Receiving water 0 Receiving water
If laboratory water,specify type. MHSF
If receiving water,specify source. Lake Brandt Lake Brandt
Type of Dilution Water
Indicate the type of dilution water. If salt 0 Fresh water 0 Fresh water 0 Fresh water
water,specify"natural"or type of artificial
sea salts or brine used. ElSalt water(specify) ElSalt water(specify) ElSalt water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series. 45 11.25,22.5,45,67.5,90 45
Parameters Tested ,_,/ _
Check the parameters tested. I� pH ❑ Ammonia epH ❑ Ammonia pH ❑ Ammonia
❑, S pity 0 Dissolved oxygen ,❑lr Salinity 0 Dissolved oxygen 0❑ S linity 0 Dissolved oxygen
L'Temperature Temperature L'�Temperature
Acute Test Results
Percent survival in 100%effluent % % %
LC50
95%confidence interval % % 9/0
Control percent survival % %
510-2A(Revised 3-19 EPA Form 3 ) Page 26

'A Identification Number NPDES Permit Number Facili Outfall Number Form Appr( )5/19
NC0031836 City of Statesville 4th Creek 1 OMB Nu.cu,0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 13 Test Number 14 Test Number 15
Acute Test Results Continued
Other(describe)
Chronic Test Results
NOEC >45 % >90 % >45 %
IC25
Control percent survival 100 % 100 % 100 %
Other(describe)
Quality ControllQuality Assurance
Is reference toxicant data available? ElYes ❑ No ElYes ❑ No ❑✓ Yes ❑ No
Was reference toxicant test within ✓❑ Yes ❑ No ❑✓ Yes ❑ No ❑✓ Yes ❑ No
acceptable bounds?
What date was reference toxicant test run
(MM/DDP YYY)?
Other(describe)
reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks
EPA Form 3510-2A(Revised 3-19) Page 27

—
'A Identification Number NPDES Permit Number Facilil Outfall Number Form Apr( 15/19
NC0031836 City of Statesville 4th Creek 1 OMB N_ __ 3004 1
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Information
Test Number 16 Test Number 17 Test Number 18
Test species Ceriodaphnia Ceriodaphnia Ceriodaphnia
Age at initiation of test <24 <24 <24
Outfall number 1 1 1
Date sample collected 07/13/2021 07/13/2021 08/10/2021
Date test started 07/14/2021 07/14/2021 08/11/2021
Duration 7 days 7 days 7 days
Toxicity Test Methods
Test method number 1002.0 1002.0 1002.0
Manual title Short Term Methods for Estimating the Chronic Short Term Methods for Estimating the Chro© Short Term Methods for Estimating the Chrod
Edition number and year of publication 4th Edition 2002 4th Edition 2002 4th Edition 2002
Page number(s) 141-189 141-189 141-189
Sample Type
Check one: ❑ Grab ❑ Grab ❑ Grab
El 24-hour composite El 24-hour composite El 24-hour composite
Sample Location
Check one: ❑ Before Disinfection ❑ Before Disinfection ❑ Before disinfection
❑After Disinfection ❑After Disinfection ❑After disinfection
El After Dechlorination El After Dechlorination El After dechlorination
Point in Treatment Process
Describe the point in the treatment process Effluent Effluent Effluent
at which the sample was collected for each
test.
Toxicity Type
Indicate for each test whether the test was 0 Acute ❑Acute 0 Acute
performed to asses acute or chronic toxicity, ILI Chronic El Chronic El Chronic
or both.(Check one response.)
❑ Both ❑ Both ❑ Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0031836 City of Statesville 4th Creek 1
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 16 Test Number 17 Test Number 18
Test Type
Indicate the type of test performed.(Check one ❑ Static ❑ Static ❑ Static
response.)
❑✓ Static-renewal ✓❑ Static-renewal ❑✓ Static-renewal
0 Flow-through 0 Flow-through ❑ Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check ❑✓ Laboratory water 0 Laboratory water El Laboratory water
one response.)
❑ Receiving water ✓❑ Receiving water ✓❑ Receiving water
If laboratory water,specify type. MHSF
If receiving water,specify source. Lake Brandt Lake Brandt
Type of Dilution Water
Indicate the type of dilution water. If salt ❑✓ Fresh water ❑✓ Fresh water ✓❑ Fresh water
water,specify"natural"or type of artificial
sea salts or brine used. CISalt water(specify) CISalt water(specify) 0 Salt water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series. 11.25,22.5,45,67.5,90 45 45
Parameters Tested
Check the parameters tested. EGH ❑ Ammonia ErpH ❑ Ammonia LI pH ❑ Ammonia
0)S4inity CI Dissolved oxygen ❑ SS linity 0 Dissolved oxygen ❑, S�ity 0 Dissolved oxygen
LE Temperature L+J Temperature Temperature
Acute Test Results
Percent survival in 100%effluent % % %
LCso
95%confidence interval % % %
Control percent survival % % %
EPA Form 3510-2A(Revised 3-19) Page 26

PA Identification Number NPDES Permit Number Facil Outfall Number Form Appr 05/19
NC0031836 City of Statesville 4th Creek 1 OMB I. .,,,,,,-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 16 Test Number 17 Test Number 18
Acute Test Results Continued
Other(describe)
Chronic Test Results -
NOEC >90 % >45 % >45
IC2s
/o
Control percent survival 100 % 100 % 100 %
Other(describe)
Quality Control/Quality Assurance
Is reference toxicant data available? ✓❑ Yes ❑ No ❑✓ Yes ❑ No ❑✓ Yes ❑ No
Was reference toxicant test within
acceptable bounds? El Yes El No ❑✓ Yes ❑ No ❑✓ Yes El No
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(describe)
reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks
EPA Form 3510-2A(Revised 3-19) Page 27

'A Identification Number NPDES Permit Number Facili Outfall Number Form Appr )5/19
NC0031836 City of Statesville 4th Creek 1 OMB L. -0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Information
i
Test Number 19 Test Number 20 ' Test Number 21
Test species Ceriodaphnia Ceriodaphnia Ceriodaphnia
Age at initiation of test <24 <24 <24
Outfall number 1 1 1
Date sample collected 10/12/2021 01/25/2022 02/22/2022
Date test started 10/13/2021 01/26/2022 02/23/2022
Duration 7 days 7 days 7 days
Toxicity Test Methods
Test method number 1002.0 1002.0 1002.0
Manual title Short Term Methods for Estimating the Chronic Short Term Methods for Estimating the Chrop Short Term Methods for Estimating the Chrop
Edition number and year of publication 4th Edition 2002 4th Edition 2002 4th Edition 2002
Page number(s) 141-189 141-189 141-189
Sample Type
Check one: 0 Grab 0 Grab ❑ Grab
0 24-hour composite 0 24-hour composite ❑✓ 24-hour composite
Sample Location
Check one: ❑ Before Disinfection 0 Before Disinfection ❑ Before disinfection
❑After Disinfection 0 After Disinfection 0 After disinfection
✓❑ After Dechlorination ❑✓ After Dechlorination ✓❑ After dechlorination
Point in Treatment Process
Describe the point in the treatment process Effluent Effluent Effluent
at which the sample was collected for each
test.
Toxicity Type
Indicate for each test whether the test was 0 Acute ElAcute 0 Acute
performed to asses acute or chronic toxicity,
or both.(Check one response.) ❑✓ Chronic 0 Chronic 0 Chronic
❑ Both ❑ Both ❑ Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
NC0031836 City of Statesville 4th Creek 1
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 19 Test Number 20 Test Number 21
Test Type
Indicate the type of test performed.(Check one ❑ Static 0 Static ❑ Static
response.)
❑✓ Static-renewal ❑✓ Static-renewal ❑✓ Static-renewal
0 Flow-through 0 Flow-through ❑ Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check 0 Laboratory water 0 Laboratory water 0 Laboratory water
one response.)
❑✓ Receiving water ❑✓ Receiving water ❑✓ Receiving water
If laboratory water,specify type.
If receiving water,specify source. Lake Brandt Lake Brandt Lake Brandt
Type of Dilution Water
Indicate the type of dilution water.If salt p Fresh water ❑✓ Fresh water ✓❑ Fresh water
water, specify"natural"or type of artificial
sea salts or brine used. 0 Salt water(specify) 0 Salt water(specify) ❑ Salt water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series. 45 45 55
Parameters Tested ,_.,/
Check the parameters tested. LE pH 0 Ammonia 1pH 0 Ammonia 0 pH ❑ Ammonia
❑ SalinityL�T❑ Dissolved oxygen ❑,Salinity ❑ Dissolved oxygen 0 SS inity El Dissolved oxygen
L�(Temperature Temperature l'Temperature
Acute Test Results
Percent survival in 100%effluent % % %
LC5o
95%confidence interval % % %
Control percent survival % %
EPA Form 3510-2A(Revised 3-19) Page 26

r PA Identification Number NPDES Permit Number Facil Outfall Number Form Appi 05/19
NC0031836 City of Statesville 4th Creek 1 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 19 Test Number 20 Test Number 21
Acute Test Results Continued
Other(describe)
Chronic Test Results
NOEC >45 % >45 °o >55 %
IC25
Control percent survival 10o % 10o % 10o %
Other(describe)
Quality ControllQuality Assurance
Is reference toxicant data available? ❑✓ Yes 0 No ❑✓ Yes ❑ No ❑✓ Yes ❑ No
Was reference toxicant test within ✓❑ Yes ElNo ❑ Yes
acceptable bounds? El No ElYes 0 No
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(describe)
reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks
EPA Form 3510-2A(Revised 3-19) Page 27

4 Identification Number NPDES Permit Number Facilit} Outfall Number Form Appro i/19
NC0031836 City of Statesville 4th Creek 1 OMB Ni.__ _ _004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results. I
Test Information
Test Number 22 Test Number 23 Test Number 24
Test species Ceriodaphnia Ceriodaphnia Ceriodaphnia
Age at initiation of test <24 <24 <24
Outfall number 1 1 1
Date sample collected 04/05/2022 07/14/2022 01/12/2021
Date test started 04/06/2022 07/13/2022 01/13/2021
Duration 7 days 7 days 7 days
Toxicity Test Methods
Test method number 1002.0 1002.0 1002.0
Manual title Short Term Methods for Estimating the Chronic Short Term Methods for Estimating the Chrop Short Term Methods for Estimating the Chrop
Edition number and year of publication 4th Edition 2002 4th Edition 2002 4th Edition 2002
Page number(s) 141-189 141-189 141-189
Sample Type
Check one: 0 Grab 0 Grab ❑ Grab
❑✓ 24-hour composite ❑✓ 24-hour composite ❑✓ 24-hour composite
Sample Location
Check one: ❑ Before Disinfection 0 Before Disinfection ❑ Before disinfection
0 After Disinfection ❑After Disinfection ❑After disinfection
❑✓ After Dechlorination ❑✓ After Dechlorination ✓❑ After dechlorination
Point in Treatment Process _
Describe the point in the treatment process Effluent Effluent
at which the sample was collected for each Effluent
test.
Toxicity Type
Indicate for each test whether the test was ❑Acute ❑Acute 0 Acute
performed to asses acute or chronic toxicity,
Or both.(Check one response.) ❑✓ Chronic ❑✓ Chronic ❑✓ Chronic
❑ Both 0 Both ❑ Both
EPA Form 3510-2A(Revised 3-19) Page 25

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek 1 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 22 Test Number 23 Test Number 24
Test Type
Indicate the type of test performed.(Check one ❑ Static ❑ Static ❑ Static
response.)
❑✓ Static-renewal ❑✓ Static-renewal ❑✓ Static-renewal
0 Flow-through ❑ Flow-through 0 Flow-through
Source of Dilution Water
Indicate the source of dilution water.(Check ❑ Laboratory water ❑ Laboratory water ❑ Laboratory water
one response.)
❑✓ Receiving water ✓❑ Receiving water ❑✓ Receiving water
If laboratory water,specify type.
If receiving water,specify source. Lake Brandt Lake Brandt Lake Brandt
Type of Dilution Water
Indicate the type of dilution water. If salt ❑✓ Fresh water ❑✓ Fresh water ❑✓ Fresh water
water,specify"natural"or type of artificial
sea salts or brine used. ❑ Salt water(specify) ❑ Salt water(specify) ❑ Salt water(specify)
Percentage Effluent Used
Specify the percentage effluent used for all
concentrations in the test series. 55 55 45
Parameters Tested ,_,�Check the parameters tested. Kid El Ammonia �pH 0 Ammonia L'J pH ❑ Ammonia
Vlinity IDDissolved oxygen ❑ linity ❑✓ Dissolved oxygen ❑ Inity 0Dissolved oxygen
mperature gr Temperature Temperature
Acute Test Results
Percent survival in 100%effluent % % %
LC50
95%confidence interval % %
Control percent survival % % o
/o
EPA Form 3510-2A(Revised 3-19) Page 26

:PA Identification Number NPDES Permit Number Faci Outfall Number Form App /05/19
NC0031836 City of Statesville 4th Creek 1 OMB No.2040-0004
TABLE E.EFFLUENT MONITORING FOR WHOLE EFFLUENT TOXICITY
The table provides response space for one whole effluent toxicity sample.Copy the table to report additional test results.
Test Number 22 Test Number 23 Test Number 24
Acute Test Results Continued
Other(describe)
Chronic Test Results
NOEC >55 % >5 5 % <45 %
I C 2 5
Control percent survival 100 % 100 % 100 %
Other(describe)
Quality Control/Quality Assurance
Is reference toxicant data available? ❑✓ Yes ❑ No ❑✓ Yes ❑ No ❑✓ Yes ❑ No
Was reference toxicant test within
acceptable bounds? El Yes El No ❑✓ Yes El No ❑✓ Yes ❑ No
What date was reference toxicant test run
(MM/DD/YYYY)?
Other(describe)
reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks reference toxicant test run within 2 weeks
EPA Form 3510-2A(Revised 3-19) Page 27

EPA Identification Number NPDES Permit Number Facility Name
Form API 3/05119
NC0031836 City of Statesville 4th Creek OME 0-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three Sills.Copy the table to report information for additional SIUs.
SIU 1 , SIU` 2 :f 3,
Name of SIU — SIU
Denso Manufacturing NC Inc Paumac Tubing LLC Pratt Industries
Mailing address(street or P.O.box)
470 Craeford Road 150 Intercraft Dr 185 Deer Ridge Dr
City,state,and ZIP code
Staesville,NC 28625 Statesville,NC 28625 Statesville,NC 28625
Description of all industrial processes that affect
Fabricate steel housings,sub-assemble Tube bending,end forming,cutting, Manufacture of corrugated sheet and
or contribute to the discharge.
housings,plastic injection molding, welding,powder coating. boxes from paper stock. Cutting,slotting,
sub-assemble gears,motors and plastic
printing,folding and gluing operations.
housing control modules.
List the principal products and raw materials that
Galvanized steel,copper,brass,aluminum, Steel tubing,metal stamping,welding wire, Corrugated sheets,boxes,paper,corn
affect or contribute to the SIU's discharge.
adhesives,solvents,powder coating,molding powder coating and paint. starch,borax,caustic soda,ink,glue,
materials,cleaners,thinners,wiring and plastic strapping and wrap.
computer chips.
Indicate the average daily volume of wastewater
discharged by the SIU. 13,857 gpd 6757 gpd 10,771 gpd
How much of the average daily volume is
attributable to process flow? 9700 gpd 5879 gpd 9671 gpd
How much of the average daily volume is
attributable to non-process flow? 4157 gpd 878 gpd flop gpd
Is the SIU subject to local limits? _
✓❑ Yes 0 No 0 Yes 0 No ✓❑ Yes 0 No
Is the SIU subject to categorical standards?
0 Yes ❑ No 0 Yes 0 No 0 Yes ❑ No
EPA Form 3510-2A(Revised 3-19)
Page 29

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
TABkx iF.INDUSTRIAL DISCHARGE INFORMATKIN
Response space is provided for three Sills.Copy the table to report information for additional Ms.
. • 4 vi,)1
. • t' '-?-v SIU TY1f,
Under what categories and subcategories is the
SIU subject? 40CFR 433 40CFR 433 40CFR 433
Has the POTW experienced problems(e.g.,
upsets,pass-through interferences)in the past 4.5 0 Yes 0 No El Yes No 0 Yes 0 No
years that are attributable to the SIU?
If yes,describe.
EPA Form 3510-2A(Revised 3-19) Page 30
' '

EPA Identification Number NPDES Permit Number
Facility Name Form Ag 1/05/19
NC0031836 City of Statesville 4th Creek OMB D-0004
TABLET.INDUSTRIAL DISCHARGEINFQRMATIbN
Response space is provided for three SIUs.Copy the table to report information for additional SIUs.
SIU 4tix
Name of SIU ,• ` six. S *r
Tube Speacialties
Mailing address(street or P.O.box)
1401 Industrial Dr
City,state,and ZIP code
Statesville,NC 28677
Description of all industrial processes that affect
Shape,form,powder coat tubes for trucking
or contribute to the discharge.
and automotive industry.
List the principal products and raw materials that
affect or contribute to the SIU's discharge. Aluminum,aluminized steel,steel tubing
powder coating material.
Indicate the average daily volume of wastewater _
discharged by the SIU. 4571 gpd gpd
gpd
How much of the average daily volume is
attributable to process flow? 4121 gpd gpd
gpd
How much of the average daily volume is
attributable to non-process flow? 450 gpd gpd
gpd
Is the SIU subject to local limits?
O Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
Is the SIU subject to categorical standards?
❑✓ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No
EPA Form 3510-2A(Revised 3-19)
Page 29

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
, .., .,.
1.1i.ABIE .INDUSTRIAL DISCHARGE INFORMATION ,
Response space is provided for three Sills.Copy the table to report information for additional Sills.
'• - ' ' •-•.--".•-•'-.:', .'" '•••• -, •---..;if•-•-•;-',,-• - .!--,•'-•,',-•••. --•'-',(;.' CC;'''4'.g'...' ,,!. ',.'1."i j''''' ' A .Y2'.".",,,.. . 4 ,,7';':-.;._*;: ,',' ;'"'i,';1•',. ..;-;...,.?, ;. , ,:"? -I'Vi•. ,, .%;-h' s, ,,...:: ,'....• i,,."!,..i.• ,-,.--i.“'.-g,I.,..t.::
SlIji,-7-.--;4',-iL.,;.,-i---;:-,-,-dt,',,-;,-;...-,,,1-.,-,-,. ,-,.:4,w.-,':, -: '71-rt'..2..-::-,J -;biuxy,:,-,',:-.iii..- ikiiii:. "4.,iiiii. : :::;;;:;:' ,7 ;,1'4;:..•';,,,':',,,-:...; :;:f:':.,;:?* i biutr,'6,fli.,-: ,--,,,,,,,:%611K.•,--.1.-L,,-/-•
• , •,--:. --.- '• •••• •— :•.,-, •,:•. : :.•-•:- •'•': , - ,,,.3 .,-,•.-,s ••,3...-'• ,,,,..•..7 - -,'„.,,•••• -,,:..i.• - ,,,,,,,:-:;•--::.-• , ,•,. ,..,•,,,:•,•' ,,„,....„..,77.77,4/••,••,,i -„i,•,./.-: :• •v„•-•-• - ,•v•-••,..•••,..,..vt.,--, -,7•-•:•:,:,;•• .1.--...--L..,—= ..7-..,;:, •-_,-,--,rfLig.,: .',;,,,41','!-•••
Under what categories and subcategories is the
40CFR 433
SIU subject?
Has the POTW experienced problems(e.g.,
upsets,pass-through interferences)in the past 4,5 0 Yes ID No 0 Yes ED No 0 Yes 0 No
years that are attributable to the SIU?
If yes,describe.
Page 30
EPA Form 3510-2A(Revised 3-19)
, , ,

EPA Identification Number NPDES Permit Number Facility Name
Form Ap, 3/05/19
NC0031836 City of Statesville 4th Creek OME 0-0004
TABLE F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three Sills.Copy the table to report information for additional Sills.
SIU 1 SIU 2 SIU 3
Name of SIU Denso Manufacturing NC Inc Paumac Tubing LLC Pratt Industries
Mailing address(street or P.O.box)
470 Craeford Road 150 Intercraft Dr 185 Deer Ridge Dr
City,state,and ZIP code
Staesville,NC 28625 Statesville,NC 28625 Statesville,NC 28625
Description of all industrial processes that affect
Fabricate steel housings,sub-assemble Tube bending,end forming,cutting, Manufacture of corrugated sheet and
or contribute to the discharge.
housings,plastic injection molding, welding,powder coating. boxes from paper stock. Cutting,slotting,
sub-assemble gears,motors and plastic printing,folding and gluing operations.
housing control modules.
List the principal products and raw materials that
Galvanized steel,copper,brass,aluminum, Steel tubing,metal stamping,welding wire, Corrugated sheets,boxes,paper,corn
affect or contribute to the SIU's discharge.
adhesives,solvents,powder coating,molding powder coating and paint. starch,borax,caustic soda,ink,glue,
materials,cleaners,thinners,wiring and plastic strapping and wrap.
computer chips.
Indicate the average daily volume of wastewater
discharged by the SIU. 13,857 gpd 6757 gpd 10,771 gpd
How much of the average daily volume is
attributable to process flow? 9700 gpd 5879 gpd 9671 gpd
How much of the average daily volume is
attributable to non-process flow? 4157 gpd 2.7a gpd sioo gpd
-Is the SIU subject to local limits?
0 Yes ❑ No ❑✓ Yes ❑ No 0 Yes 0 No
Is the SIU subject to categorical standards?
0 Yes ❑ No 0 Yes ❑ No 0 Yes 0 No
EPA Form 3510-2A(Revised 3-19)
Page 29

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
TABIEIF.INDUSTRIAL DISCHARGE INFORMATION .
Response space is provided for three SIUs.Copy the table to report information for additional Sills,
, • "`, ;
' . •• ;;',y fisTa
Under what categories and subcategories is the
40CFR 433 40CFR 433 40CFR 433
SIU subject?
Has the POTW experienced problems(e.g.,
upsets,pass-through interferences)in the past 4.5 0 Yes E:1 No 0 Yes El No El Yes 121 No
years that are attributable to the SIU?
If yes,describe.
EPA Form 3510-2A(Revised 3-19) Page 30

EPA Identification Number NPDES Permit Number
Facility Name Form API 3/05/19
NC0031836 City of Statesville 4th Creek OME 0-0004
F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs.Copy the table to report information for additional SIUs,
SIU 4 SIU SIU
Name of SIU —
Tube Speacialties
Mailing address(street or P.O.box)
1401 Industrial Dr
City,state,and ZIP code
Statesville,NC 28677
Description of all industrial processes that affect
Shape,form,powder coat tubes for trucking
or contribute to the discharge.
and automotive industry.
List the principal products and raw materials that
affect or contribute to the SIU's discharge. Aluminum,aluminized steel,steel tubing
powder coating material.
Indicate the average daily volume of wastewater _
discharged by the SIU. 4571 gpd gpd
gpd
How much of the average daily volume is
attributable to process flow? 4121 gpd gpd
gpd
How much of the average daily volume is
attributable to non-process flow? 45o gpd gpd gpd
Is the SIU subject to local limits?
❑✓ Yes 0 No 0 Yes 0 No 0 Yes 0 No
Is the SIU subject to categorical standards?
❑✓ Yes ❑ No 0 Yes 0 No 0 Yes 0 No
EPA Form 3510-2A(Revised 3-19)
Page 29

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0031836 City of Statesville 4th Creek OMB No.2040-0004
TABLE',F.INDUSTRIAL DISCHARGE INFORMATION
Response space is provided for three SIUs,Copy the table to report information for additional Sills.
,,, :•!.. ,., : ; ..,, . : . :i'.., , ....:, ., .,r''',.;1•:.,.', ,.$ ., iii-liP1'4:1''.'t0:11:,-. I'''' i.T44.-,:1',.:tl.';,:;:.'.r';-::,:-.;,i-;. . rSIU:V,..'i'-.-§:;;;I.: : .:;,,I:' ,.' '''ci.• ,I; '.e,::',;:7<i:::', *.1'.;;;• 1.1t-IUOlgg,.
Under what categories and subcategories is the
4OCFR 433
SIU subject?
Has the POTW experienced problems(e.g.,
upsets,pass-through interferences)in the past 4.5 0 Yes 1=1 No 0 Yes 0 No 0 Yes 0 No
years that are attributable to the SIU?
If yes,describe.
EPA Form 3510-2A(Revised 3-19) Page 30
.,

PLANT INFLUENT
COVERED
DECHLORINATION METERING SLUDGE
o MH BUILDING FLUME EFFLUENT STALIME STORAGE
SLUDGE
TREATMENT
BAR SCREENS 7
FACILITIES
CHLORINE LIME
► BASIN CONVEYOR SLUDGE
STORAGE
INFLUENT EN
PAD
PUMP STATION I
RAS
BELT
PRESS
CLARIFIERS
/
RAS
L
i. I f11
WET
WEL
1
SLUDGE FLOW
PUMP SPLITTER SLUDGE
STA. BOX i PUMPS
WAS 1
❑ ❑ ❑ ❑ I ■
AERATION AERATION AEROBIC
BASIN III BASIN SLUDGE
DIGESTER
❑ ❑ ❑ 0 1.
NO.1 NO.2
AERATORS
0 ❑ ❑
` AERATORS \ AERATORS / I
. L
*FLOW
DISTRIBUTION
BOX
FLOW SCHEMATIC & WATER BALANCE
FOURTH CREEK WASTEWATER TREATMENT PLANT
CITY OF STATESVILLE

/ / „ Fourth Creek ,.if
�/ Alit. -
Sta-Lime
'/ --.,, .......
- -v^!s., Processing /
' *5P4 1
• 0 es ,..
1W1/ . telt
.-,
,., , , .
[W t' . . . .,E kSaf, a
..0. w
\ , , .... .. .
i . , �_+ - 41,je" ---0 Fourth Creek WWTP ,
'' , " ' .
IF
•0�J fis i,r '
1 /_____,_____!..) .:',::::::7:' .;;.1,, /
4...
4,44** -
\ .
4' F
I \ s i .
l :..: 1r414111rig - `1„
Fourth Creek WWTP
Vicinity Map 7 .1 .:
a , ,
10)
600
1 irti
I !Feet '
Date:January 21,2015 .,r r a •% At
Dwg:2015SWR004 / ,,

i
JEffluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 07/26/22
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
Dratory rfo st: MERITECH LABS, INC.
Comments: Dilution water batch
x
i e o Ope in Response e C arge 574 also used. Hard 48mg/1. Cond
X NiPC2 170 umho/cm.
Si nature offff L oratory Supervisor * PASSED: -13.01% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -2.744
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -13.01
% Mortality Avg.Reprod.
# Young Produced 17 22 19 21 21 21 19 20 17 24 22 23
0.00 20.50
Control Control
Adult (L)ive (D)ead L L L L L L L LLLLL
0.00 23.17
Treatment 2 Treatment 2
Effluent %: 55%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
- 10.707% PASS FAIL
# Young Produced 26 24 22 27 22 21 20 25 26 19 24 22 % control orgs X
producing 3rd
brood Check One
"a••lt (L)ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 07/13/22
Control 8.02 8.08 8.46 7.75 7.98 7.73 Collection (Start) Date
Sample 1: 07/11/22 Sample 2: 07/13/22
Treatment 2 7.77 8.03 7.80 8.03 7.90 7.81 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 23.9 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness(mg/1) 48
Control 8.45 7.80 8.46 7.77 8.33 7.60
Spec. Cond. (pmhos) 168 388 384
Treatment 2 8.47 7.83 8.33 7.80 8.25 7.63
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.8 1.3
(Mortality expressed as %, combining replicates)
Note: Please
% % % % % % % % % % Concentration Complete This
Section Also
% % % % % % % % % % Mortality
start/end start/end
LC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit
% -- % Spearman Karber _ Other High
Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

m
Merited- c. (Lab # 027) .-
Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#:
Client: <� Gci---i"45i/f /le- � i-k- Pipe#: 01 County: 7---'70,1 f /; Date Start: - (t -2:1 Date End: 7,q .,�
NPDES#: NC O / '3 Date/Time of Culture Transfer: 7,-)0,-92 // : 1.' 4r Time Start: � VS-7Ya w, Time End: /6, ' e'j,
Dilution Water: Lake Brandt Date/Time Neonates born: L 0:)a1 to- N: ;t-,Nyj 1st Renewal Date: .-JS-A? Time: /6> : ' ,A '
Test Organism Source: Tray# 6 Age of Neonates at Test Start: a,75') hours j 2nd Renewal Date: 7, /;-%2 Time: C/: '1 L cn
Stirred/Aerated for D.O.: Y/© Randomized:OY/ N Culture Tray Temp: ' -'). � °C Analyst(s): MR,LV,KS,KL Reviewed by: 4"2--
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 11 2 ')/'Sample 1: / 2 Sample 2: 7` 1 .
#Young Produced 0 0 0 0 _ 0 0 0 0 0 0 0 0
Adults Live/Dead L _. Sample Information
Day#5 y/ Y7 1 3, 4, 5. 6 7 8, 9 10 +-�11 12, , '
, / ��// ,r 100% pH G/C? Duration
_1� L `1
#Young Produced � . `y,, ' I7 3/7 y/`/ '1' '/.' Sample 1 7, ((9 C 2-1 hours
Adults Live/Dead L- L L_ ice- L L— L_ L-- L t✓ `A..-- 'i Sample 2 7,51 - :1u,0 hours
t
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Transferred by: Fed
#Young Produced 10 in ;/) )0 1 _1 Batch # 3._ 5-72" Sample 1 Sample 2 Day 0 t '/-2\_L
Adults Live/Dead Transfer Dayc
Z�" C . I_ i ►Y c 0 2 5 � t Day 1 ��
Hardness
Total Produced j c2. VI
j P-1, J �� (mg/L) ��� �7 4 >, - Day 2�►�(7._ L
` l 1 I 1 > Spec.Cond. l� ,-,1 n r Day 3
° (umhos/cm) 1(�. 1(C 68 3 N Day 4 (%"i
Percent of Control producing third brood: 't1y/";/°
I- Chlorine t*"" Day 5 - 2--
(mg/L) . ,.+tk ' r,� L-,,i �(�i'.
ti ��
Test Sample Organism Reproduction Receipt Sample ` '"�.,,� �� � n{4 � Day6 .
�1
Effluent %: Temp.(°c) ,K' � ''' .cl /` / /✓
5� Terminated byyL�L
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 pH 1st Sample 2nd Sample 2nd Sample
#Young Produced 0 0 0 0 , 0 0 0 0 0 0 0 0 Control 8,C1 a_CC7 1,4C, '7i 2.163 279
Adults Live/Dead L 7,77 iR.03 .7 8C 8t0 j ?qtt; f
Day#5 1 3 4 5 6 . 7 8; 9 , 10 11 12 Sample t c
1 !/ 1 ,+ initial final initial final initial final
#Young Produced 4//0.c) 1 11 �j �l4 Viz V Yho V/l1 ['/ _3/ Li/ ,,;/7 D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/Dead / L L— L L (' ' ' r, .. ., c, r .,
L Z., t-- L. L Control tl,<C) /.-.n C,.,4(� 7,%'7 j> ?tEG
Day#7 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 1 2 / 1 q ( l 0 7 6 t a_ /7 7 ) /„?, Sample 8.('7 7,i39 P3 7tP(; t'.;'5 7(63
iAdults Live/Dead 7 ) _ L._ L.,-- 2---.. 1. 2- I____ nmal final initial final initial final
Temp. 1st Sample 2nd Sample 2nd Sample
Total Produced 2 g,, '�`J2\ 2l1 � ?(y 1 t 1 " Control 31a 9 7
rimments: Sample V,?, ., 6 '7 74 4 ,1 n.2
initial final initial final initial final

i
MERITECH, INC. (Lab # 027) Meritech Sample ID#: Ci I � r�Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville,N.C.27320
( Phone: [phone] Fax: [phone]
Laboratory Supervisor E-mail: mike.reed(aJmeritechlabs.com Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client:e 1/ f Of feS.I((-e, PO#:
Contact Person: N 7O'\r)SOr NPDES#: NC(f3 I $2,
Physical Address: to A Bo For m RA • Phone: 16
U� -547R-•34
Mailing Address: �V V.
. �0 x � � 1 p Pipe#: V 1
City: . -1-0,'1 e,S..).A.Q.,.. State: AJC, Zip:p�8Lpl(j 1�
County: red ,II E-mail: 10'Tlr, ,x-4 .S4O. >s l I\e �. ` le�
u SAMPLE INFORMATION— ) y� ' 1
Sample Site: 1� �J�i� l� ( 1-e`e--‘(,�'Q C'1'1- CJ ut-- G1..1 l
Sample Type: ❑ Grab X Composite #of containers: a
Sampling Time: Start Date: +� l ( I I a a Start Time:, I l Ali PM
End Date: --opt(a'AA, End Time: T(, PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE. Pack the sample cool letely with ice.
The sample must be<6.0°C upon receipt at Meritech***
Collector's Name: Print: Ae-141'l Z/s7-fik f}ri Signature:
TOXICITY TEST INFORMATION
Test Required: [Chronic(7 days) Test Organism: X Ceriodaphnia dubla (water flea)
❑ Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahla (mysid shrimp)
IWC: 5 5 % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday.***
Comments/Dilution(s):
SHIPPING INFORMATION
Relinquished C \c4U4Yi8._./ Date: 5--W/AA Time: //3. 6) PM
Received b • ��— Date: 7,,/. ,. Time: // 35 PM
Relinquished b : �—" Date: /oL/,..2-2.,Time: / AM Irc)
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM I
Received by: Date: Time: AM PM
Sample Temperature(°C): I
Method of Shipment: ❑UPS ❑Fed EX ❑ Meritech Pick-up ❑ Delivered ❑ Other
***Samples shipped on Friday must be Fed Ex and must be clearly labeled for Saturday Delivery,NO SIGNATURE REQUIRED***
SAMPLE RECEIVING (Meritech Use Only)
-.
Relinquished by: 1`-1ccU:S k ed.N1
Received by: i6v ..PA Date: --)` L'l Time: / ) AM ig'M
r ,-
' Sample Temperatures(°C): t t�, / I V f I I Sample Condition: N c'�
WHITE = Laboratory copy YELLOW= Client copy --401111m I

i\ MERITECH, INC. (Lab # 027) Meritech Sample ID#: 0 r EH `.:)--)1
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville,N.C.27320
Phone: [phone] Fax: [phone]
1~=' Laboratory Supervisor E-mail: mike.reed(a,meritechlabs.com Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: 1- v 1 a- . 6.2yes k`1 e PO#:
Contact Person: ro,rd���1,-,C,.S6 n NPDES#: NC On 3 183 ,
Physical Address: (I3 -ge ti( F r rr\ I .d. Phone: 11 a c1_$7 8-3y-g
1 Mailing Address: •0.Gak I I tI I Q Pipe#: Q 1
City: s �es��`I�1�. State: fu L. Zip: t90�8^�
County: t(-cde j I E-mail: . .\or nso im S .-e.,c t\le nc.
1 SAMPLE INFORMATION ��QQ
Sample Site: 1 i.J 1_3 " If:, I tce.f-ik-- V fit 11
Sample Type: ❑ Grab omposite \ #of containers: a
1
Sampling Time: Start Date: 11/'3 iaa Start Time: ____all() PM
End Date: N. J I Li ca a End Time PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE. Pack the sample cooler plete ith ice.
Q /4/
The sample must be<6.0°C upon receipt at Meritech***
Collector's Name: Print: f3p/t D 1$M,1 Ad Signature:
TOXICITY TEST INFORMATION
Test Required: V'Chronic(7 days) Test Organism: Ceriodaphnia dubia (water flea)
❑ Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: S5 % *** Friday Samples for Chronic Fathead test must be collected after 9:00 a.m. on Friday.***
Comments/Dilution(s):
- ' . SHIPPING INFORMATIO
I
Relinquished , K.G A--- Date: i c Time: ��e, C3 PM
Received by: Date: Time: _iefa_ O. PM
Relinquished by: Date: 2 - Time: ASS AM 0,
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment: ❑UPS ❑Fed EX ❑ Meritech Pick-up ❑ Delivered ❑ Other
***Samples shipped on Friday must be Fed Ex and must be clearly labeled for Saturday Delivery, NO SIGNATURE REQUIRED***
SAMPLE RECEIVING (Meritech Use Only)
��
Relinquished by: u iY V i',,(\lt,l,l J
Received by: �, nl , , Date: i , `2� Time: 19 AM J
Sample Temperatures(°C): l 13 / 1 i 3 / / Sample Condition: C.'6/
WHITE =Laboratory copy YELLOW=Client copy -.0111e I

►.
Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 07/26/22
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -13 .01% CONTROL 55% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 246 278
Mean # Neonates 20.500 23.167
Standard Deviation 2.195 2.552
Coefficient of Variation 10.707%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 19 -4.1667 13 C 21 0.5000
2 C 17 -3.5000 14 C 21 0.5000
3 C 17 -3 .5000 15 E 24 0.8333
4 E 20 -3.1667 16 E 24 0.8333
5 E 21 -2.1667 17 C 22 1.5000
6 C 19 -1.5000 18 C 22 1.5000
7 C 19 -1.5000 19 E 25 1.8333
8 E 22 -1.1667 20 C 23 2.5000
9 E 22 -1.1667 21 E 26 2.8333
10 E 22 -1.1667 22 E 26 2.8333
11 C 20 -0.5000 23 C 24 3.5000
12 C 21 0.5000 24 E 27 3.8333

' 1
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 3.8333 -4.1667 0.4493 8.0000
2 3.5000 -3 .5000 0.3098 7.0000
3 2.8333 -3.5000 0.2554 6.3333
4 2.8333 -3 .1667 0.2145 6.0000
5 2.5000 -2.1667 0.1807 4.6667
6 1.8333 -1.5000 0.1512 3.3333
7 1.5000 -1.5000 0.1245 3.0000
8 1.5000 -1.1667 0.0997 2.6667
9 0.8333 -1.1667 0.0764 2.0000
10 0.8333 -1.1667 0.0539 2.0000
11 0.5000 -0.5000 0.0321 1.0000
12 0.5000 0.5000 0.0107 0.0000
1
W = X 119.8338
124.6667
Calculated W = 0.961 Critical W = 0.884
0.961 Z 0.884
The reproduction data is normally distributed
evaluated at a 9915 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Efflu
ent variance 6.5152
F = _ = 1.35
Control variance 4.8182
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
1.35 s 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

EQUAL VARIANCE t TEST
20.5 - 23.2
t = _ -2.744
0.972
Degrees of freedom = 22
Critical t = 2.508
-2.744 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99W confidence interval.
Chronic Test PASSES

ZZ
. 'Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 04/13/22
'Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
rator Pe o g Test: MERITECH LABS, INC.
Comments:
X
'Signature of Op for in Responsible Charge
X (✓ ti��eef
Signature of Labdratory i,pervisor * PASSED: -5.62% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -1.362
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -5.62
% Mortality Avg.Reprod.
# Young Produced 20 21 26 21 22 22 23 24 20 20 22 26
0.00 22.25
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L - - -
0.00 23 .50
Treatment 2 Treatment 2
Effluent %: 55%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
9 .606% PASS FAIL
# Young Produced 25 23 25 25 25 22 20 22 19 25 24 27 % control orgs X
producing 3rd
brood Check One
- It (L)ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 04/06/22
Control 7.81 7.87 7.89 7.83 7.85 7.73 Collection (Start) Date
Sample 1: 04/04/22 Sample 2: 04/06/22
Treatment 2 7.71 7.97 7.59 8.00 7.57 7.93 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.0 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 24.2 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness(mg/1) 48
Control 6.96 6.61 6.88 7.97 8.30 8.13
Spec. Cond. (pmhos) 200 418 441
Treatment 2 6.94 6.60 6.63 8.01 8.32 8.10
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 2.1 1.1
(Mortality expressed as %, combining replicates)
Note: Please
% %o %0 % %o % %o % Concentration Complete This
% a %
Section Also
% % % % % % % % % % Mortality
start/end start/end
LC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit
% -- % Spearman Karber -- Other - High
- Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Meritech, Ir (Lab # 027)
Mini Chronic Pass/Fail I esi: Ceriodaphnia dubia Incubator#:
Client: 5�c.,+-es,,,i l lei Pipe#: jj County: -rfalo (1 Date Start: kr to, 'Y). Date End: q- /'r��
NPDES#: NCb 3183er, Date/Time of Culture Transfer:4 -o--� ILY,-4,7A Time Start: 10= _S /-�ft) Time End: 9.©t?,t pei
Dilution Water: Lake Brandt Date/Time Neonates born: .� ( l, t{J ,10 - 9 Lf t0 1st Renewal Date: 2 Time: /0; (2)
Test Organism Source: Tray# Le Age of eonates at Test Starter`D-'� hours 2nd Renewal Date: l'-/'/�- Time: •' ' C�,
Ran Stirred /Aerated for D.O.: Y/ domized:�Y/ N Culture Tray Temp: ).' {.L7 °C Analyst(s): MR,LV,KS,KL. Reviewed by: , L
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 Z
Sample 1: (('Lf"2.� Sample 2: ( C)
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0
Adults Live/Dead L , -- - - - - Sample Information
Day#5 1 2 3 4 5 6 7 8 9 10 117 12 100% pH G/C? Duration
#Young Produced 34 3/7 `tic 3/F 3/6Ltf �lA> 1/"( 3/7 3//r 1�� y Sample 1 7r 53 C 2 (ft0 hours
Adults Live/Dead / - '`�'
r Sample 2 7, 1(2 C 14ft Z hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Transferred by: Fed by:
#Young Produced I i I I 1 )- 1(., 1. i )- 1 t, 1 1 )0 c( I (Th ) .)) Batch # MIME
Sample 1 Sample 2 Day 0 (LLI,7
Adults Live/Dead 1-- V L— L-- L L I_, L._ Il L t Transfer Day 0 2 5 u: Pam. Day 1 4r°2-
Hardnessiti Day 2 ' Li/
Total Produced .3-() :d ?b ;Z t 1.-)-- )-a- "3-- �-1,, d-G )..c, �) ( (mg/L) �/� Enz-,,,i--,,,,: �
PT—
Spec.Cond. Day 3
C t� o/o (umhos/cm) ,7r) ME t8 ,`f( Day 4 W`
Percent of Control producing third brood: _
Chlorine n
Test Sample Organism Reproduction (mg/L) �: i <O t I <Q( ( Day 6
- Day 6 21,
Receiptm Sample :t- 1 _
Effluent%:
Temp.(°c) A f << Terminated by:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 pH 1st Sample 2ndC� Sample 2nd Sample
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control 7,81 7, -7 �.CJ 1 7,6 7,1�J 7,�3
Adults Live/ Dead L.... - _ I 7. !C 7 7 0�
Sample -1r7 ,0 1 8 ,) 7��? 7.�3
Day#5, 1 2 3 4 5 6 7 /8 9/ 10 �11 12. initial final initial final initial final
#Young Produced 3/f/) 3/( Lf/y LI/ 5l� ,y7 /7 �!1 3/n Y//� t! /q y4 D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/ Dead Z., L 2., & L 'L Li //
Control ���b C.bi ��( l �r -7 KY-3
(9r13
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 c'( L
#Young Produced I.> I 1 13 I�- ) )d- 10 I I t,6 1-3 1 1 /6 Sample c.7 -, 4,6Q /Oro3 1,QI? ft 2 2- ( ((Q
►Adults Live/ Dead `"- 1--- L- I.— L.._ I--- 1_ L L' f initial final initial final initial final
Temp. 1st Sample 2nd Sample 2nd Sample
`Total Produced ),<- ),3 AS- ? S J.j ).).- to a)•- 1 cil ,),--;" ),(.4- Control A.7 tm ; -/,j j i.7 X Y Yi.L-
Sample > �� rtlP.1/
Cor 9nts: 5
initial final initial fins , al fins
I

' I MERITECH, INC. (Lab # 027) Meritech Sample ID#: 6`t- 3����
411:0;\
y
642Bioassa Tamco RdSample,ReidsvilleChain,N.C.ofCustody 27320
Phone: [phone] Fax: [phone]
r
Laboratory Supervisor E-mail: mike.reedt meritechlabs.com Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: C‘4 of •S t-e s V) \ lc PO#:
Contact Person: ---b('('\_“-� J dhn NPDES#: NC U _ �x,
(.0 c3 Physical Address: t t t F c rc , Phone:.7OL{ 8 7 g .1 - y
Mailing Address: . 0. v. Mt QQ qq` Pipe#: 0 i
City: t_ ��Sl�t 1 I G State: /l)0_ , Zip:c o U
County: ire_cl e,I I E-mail: 1-h c hnsa n sinkes6 l le ne,1 ne4—
J SAMPLE INFORMATION
Sample Site: a,r e.�f\ . J - E-c)Li Er 0 (JVt_F�-i
Sample Type: ❑Grab (Composite #of containers:
Sampling Time: Start Date: Li)L) /as Start Timer V(iC010 PM
End Date: Li 13 J End Time: 0 I AM PM
*'*Triple rinse sample container with sample before filling completely with NO AIR SPACE. Pack the sample cooler completely with ice.
The
v sample mmust be<6.0°C upon receipt at Meritech***
Collector's Name: Print: ,6Rih t visW/h_4^) Signature:
TOXICITY TEST INFORMATION
Test Required: X hronic(7 days) Test Organism: V Ceriodaphnia dubia (water flea)
❑ Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IN/C; % **"Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday. ***
Comments/Dilution(s):
SHIPPING INFORMATION
bq , , 4?V9 AM Relinquished by: i Date: Time:Received by: Date: - _ Time: j vtr® A fa
Relinquished b • / /Date: C �------- Time: I/- 8 AM
Received by: Date: Time: AM M
Relinquished by: Date: Time: _ AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C): - '
Method of Shipment: ❑UPS ❑Fed EX ❑ Meritech Pick-up ❑ Delivered ❑ Other
***Samples shipped on Friday must be Fed Ex and must be clearly labeled for Saturday Delivery,NO SIGNATURE REQUIRED***
SAMPLE RECEIVING (Meritech Use Only)
Relinquished by: Ni tC e.._ ram.=h I,c1 l/2
Received A�(1C,fC\Cc Nn.'nL0e`'L Date: LI I S/2 2- Time: `rJ� AM EMM,
Sample Temperatures(°C): a• I /r� , 1 / / Sample Condition: 1...1 d
WHITE= Laboratory copy YELLOW=Client copy -.41111

I\ MERITECH, INC. (Lab # 027) Meritech Sample ID#: OA01 ✓) " �, ,
, Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville,N.C.27320
Phone: [phone] Fax: [phone]
A Laboratory Supervisor E-mail: mike.reedmeritechlabs.com Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client:C 1 � '(1 QS�I� \ 1 .Q., PO#:
Contact Person: . c� �J Ch n n NPDES#: NC n 0 2
Physical Address: /0 q,3 ppe I nr rn Rd Phone: 7 0 -) 7$
Mailing Address: (1). n , 9-1CX 11 + ' 1 Pipe#: 01
City: �� -�SLji` e, State: )U Q, Zip:j_,__ I
County: treCif.I I E-mail: biOhrenE c fr4- St)sUIPpP.116-
•
/�/} SAMPLE INFORMATION
Sample Site: L,T it .0 .KLI , u- r-P + L r-nu c n-i- OLci- -Pc -( I
Sample Type: ❑Grab 'Composite #of containers: a
Sampling Time: Start Date:_`1 0 )9ra Start Time &,)O AM PM
End Date: L/ /7 ja a End Time. 0 PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE. Pack the sample cooler completely with ice.
The sample must be<6.0°C upon receipt at Meritech***
Collector's Name: Print: , 'Ej/m,✓ /)/f r//.l,.9 Signature:
TOXICITY TEST INFORMATION
Test Required: Chronic(7 days) Test Organism: 'Ceriodaphnia dubia (water flea)
❑ Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: �� /o ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m. on Friday.***
Comments/Dilution(s):
SHIPPING INFORMATION
Relinquished by: • iZ.Or�• Date: --L 7-/ate Time: J M PM
Received by: Date: _7- 2. Z , Time: Leg) PM
i Relinquished by: ,v ='---- Date: LTL�7_ 3 1.- Time: _L��p AM A
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment: ❑UPS ❑Fed EX ❑ Meritech Pick-up ❑ Delivered ❑ Other
***Samples shipped on Friday must be Fed Ex and must be clearly labeled for Saturday Delivery,NO SIGNATURE REQUIRED***
� )SAMPLE RECEIVING (Meritech Use Only)
/
Relinquished by: 13) it i t? (2 r/ 1
Received by: ,(/1A -fsvt,j,lt) Date: Li'7'2 1 Time: 2 C(.1
Q AM ,
Sample Temperatures(°C): b.' ! / It I / / Sample Condition: 1 C cl
WHITE = Laboratory copy YELLOW=Client copy -14111

p
Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 04/13/22
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -5.62% CONTROL 55% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 267 282
Mean # Neonates 22.250 23.500
Standard Deviation 2.137 2.355
Coefficient of Variation 9.606%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 19 -4.5000 13 C 22 -0.2500
2 E 20 -3 .5000 14 E 24 0.5000
3 C 20 -2.2500 15 C 23 0.7500
4 C 20 -2.2500 16 E 25 1.5000
5 C 20 -2.2500 17 E 25 1.5000
6 E 22 -1.5000 18 E 25 1.5000
7 E 22 -1.5000 19 E 25 1.5000
8 C 21 -1.2500 20 E 25 1.5000
9 C 21 -1.2500 21 C 24 1.7500
10 E 23 -0.5000 22 E 27 3 .5000
11 C 22 -0.2500 23 C 26 3 .7500
12 C 22 -0.2500 24 C 26 3 .7500

1
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
f COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 3 .7500 -4.5000 0.4493 8.2500
2 3 .7500 -3.5000 0.3098 7.2500
3 3.5000 -2.2500 0.2554 5.7500
4 1.7500 -2.2500 0.2145 4.0000
5 1.5000 -2.2500 0.1807 3.7500
6 1.5000 -1.5000 0.1512 3 .0000
7 1.5000 -1.5000 0.1245 3 .0000
8 1.5000 -1.2500 0.0997 2.7500
9 1.5000 -1.2500 0.0764 2.7500
10 0.7500 -0.5000 0.0539 1.2500
11 0.5000 -0.2500 0.0321 0.7500
12 -0.2500 -0.2500 0.0107 0.0000
1
W = X 107.3249
111.2500
I Calculated W = 0.965 Critical W = 0.884
0.965 a 0.884
The reproduction data is normally distributed
evaluated at a 9996 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Effluent variance 5.5455
F = _ = 1.21
Control variance 4.5682
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
1.21 5 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

EQUAL VARIANCE t TEST
22.3 - 23.5
t = = -1.362
0.918
Degrees of freedom = 22
Critical t = 2.508
-1.362 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 990 confidence interval.
Chronic Test PASSES

Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 03/02/22
'Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NO0031836 Pipe#: 01 County: IREDELL
Dorator erforming Test: MERITECH LABS, INC.
Comments:
Sign re o Ope or in, Responsi e C arge
X Weee
Signature of Laboratory Supervisor * PASSED: -15.23% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -4.965
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -15.23
% Mortality Avg.Reprod.
# Young Produced 18 21 19 20 21 20 18 22 20 21 20 23
0.00 20.25
Control Control
Adult (L)ive (D)ead L L L L L L L LLLLL
0.00 23.33
Treatment 2 Treatment 2
Effluent %: 55%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
7.332% PASS FAIL
# Young Produced 22 22 23 23 23 26 23 27 22 23 23 23 % control orgs X
producing 3rd
brood Check One
•',ilt (L)ive (D)ead L L L L L L L L L L L L 100%
L -
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 02/23/22
Control 7.94 7.98 8.01 8.01 7.95 7.81 Collection (Start) Date
Sample 1: 02/21/22 Sample 2: 02/23/22
Treatment 2 7.62 7.95 7.63 7.97 7.52 7.74 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 23.9 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness(mg/1) 44
Control 8.19 7.86 8.14 7.90 8.05 8.04
Spec. Cond. (pmhos) 180 366 414
Treatment 2 8.30 7.88 7.96 7.71 8.06 8.00
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.3 1.0
(Mortality expressed as %, combining replicates)
Note: Please
% % % % % % % % % % Concentration Complete This
Section Also
a o 0 %%%%%% Mortality
% % 0 0 0 0 o a
- start/end start/end
LC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit _ -
% -- % Spearman Karber _ Other High
Conc.
pH D.O.
TO rganism Tested: Ceriodaphnia dubia Duration(hrs) : _
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

i Meritech, ..,,;. (Lab # 027)
Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#:
*0 Client:, �-r e'5,- I�P `771-\ Pipe#: ()i County: 7-. 4, /1 Date Start: -23-- Date End: 3•-Q�
NPDES#: NCB 3i-7�� Date/Time of Culture Transfer: . �;� /0- I Bair Time Start: 11:09Am Time End: CI ; f,,.. .jr,
Dilution Water: Lake Brandt Date/Time Neonates born: /t: =�;-),-,,- 14,*(' 1st Renewal Date: ,,"7,- Time:
Test Organism Source: Tray# Age of Neonates at Test Start: , ,73 hours 2nd Renewal Date: - ?% 7,71 Time: Ci:' '�,1.A
Stirred/Aerated for D.O.: Y/© Randomized:oY/ N Culture Tray Temp: : '-.M. °C Analyst(s): MR,LV,KS,KL Reviewed by: 1../
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Sample 1: c - /-2 Sample 2: 2-25-
Adults Live/Dead L Sample Information
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 100% pH G/C? Duration
#Young Produced `1(-3 J 6 -'2(? 4I 1 `fi4t L4(ej '-;f-3 -*, 3 fr, )/c j/7 y1 Sample 1 '7, 0 _ a 3, Cj hours
•
Adults Live/Dead u- Lam- L- L-- L- _ t i. p er
- L_ L - L-- i _ rL_ Sample 2 ') . '
<2i-/,, ('1) hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Transferred by: Fed
#Young Produced `7 to Cl g 2 -7 -7 le j G ' r J /() Batch# IEEE Sample Sample 2 Day 0 ,v+P G,
Adults Live/Dead L- L-- L-- t _ L_ L_ i_ I L 1.._ °� L Transfer Day 0 2 5 ,_. ' . Day 1
Hardness 1111112:11i,-7 .-id, r�(mg/L) Day2/�0..._ /'
Total Produced t 2 41 1 c1 ..O -.t , 12 • a D.C., Al ;.Ca 3
Spec.Cond. Day 3 /�
(umhos/cm) / 0 Mill j till Day 4
Percent of Control producing third brood: l c, % Chlorine771, X# Day5 s/ti�L
TTest Sample Organism Reproduction (mg/L) �U`` `� ( 7---
est iw _ r,.i �>C Day 6 r'�
° Temp.CC) b� 17,7 7 z 7, /, } i,L. Terminated b /1M
Effluent /o: 5 S y
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 pH 7,9 itist Sample 2nd Sample 2nd Sample
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control ?cl d U G 0 8,C( 7,95 '7. j ,
Adults Live/Dead - --7 V
Sample �t�Z 1��`� -7,?-7 7 �c.�2 �<7
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 (6-7
,
9 ,--� �L initial final initial final initial final
#Young Produced 31'u ')I'=i _N-? )I'i 31 rc5 911, 31 cl 5 6�� 3(7„, `l( ----; �l -3/ D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/Dead L- L__ t_ t.__ t_ L t__ L L tJ L i c? ` '
Control j, 1�(� 2,I�' 7c (' 05 OTC(
Day#7 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced t \ I D 1 1, 1 1 �, 11 i i 1 .12 ( 1 i). /,.,`'' Sample �i34 /•d 1 (-I(47,-1! ',(16 rr
initial final initial final initial final
Adults Live/Dead L_ 1,_ L L- L__ >---- 1 L_,_ i�..
— Temp. 1st Sample 2nd Sample 2nd Sample
' Total Produced ), X), )3 ; ).j ,Ale V 2) ?1 ),), 9 '1,3 -� Control 31-.S ')Attit 2,11:1 ril 1 :A1.7 ' ,j-
'mments: Sample 9t'i-11 a'k ) il,`j en 31.4 911`_6
initial final mina fins; initial final

. r / ` l n fix"
MERITECH, INC. (Lab #027) Meritech Sample ID#.• vd�.l��
Bioassay Sample Chain of Custody
- 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
`• Toxicity Supervisor email: [e-mail] Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client:C 1 O f S1- -eC .)t I l'e, PO#:
Contact Person: �('c and C'r\Sin NPDES#: NC OO 1 36-,
Address: Q. b , v �O i , i I Phone: ( O LI ;r7� a 3
City: 5+0d-e_s 0 ,1 l 112.. Pipe#:
County: r- cJ Q, I ( State: A) (1-1 Zip: a O (0R1
SAMPLE INFORMATION I
Sample Site: q-fn ef L — v l tort'
Sample Type: ❑Grab Composite #of containers: p
Sampling Time: Start Date: a/d it/G7 Q Start Time:U 4E11 PM
End Date:f a a /a a End Time: 0 I 0 PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler oletely with ice. The
sample must be<0.6°C upone receipt at Meritech***
y/ ___ ..._..._.-....
Collector's Name: Print: //`ram 'Pi 5/11014A Signature: - I
,� / TOXICITY TEST INFORMATION
/
Test Required: L 'Chronic(7 days) Test Organism: 1 Ceriodaphnia dubia (water flea)
❑-Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: 55 % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished by: / C��`"��� Date: ( J(3a Time: f/�jo PM
Received b . Date: Time: //pp C� PM
Relinquished by: — Date: , �/ z— Time: 3/5G, AM CD
Received by: Date: 777 Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING (Laboratory Use Only)
inquished by: (Vic k Wein le(,/
� J Received by: l v J t, Date: r) ' 22 22 Time: 3 20 AM P�NI
Sample Temperatures(°C): 1 i) / 1.3 / / Sample Condition: N JJ

•
40.
MERITECH, INC. (Lab #027) Meritech Sample ID#: ODD'-k ))�31
. A Bioassay Sample Chain of Custody kt 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedAmeritechlabs.com Web Site: www.meritechlabs.com
CLIENTIEc INFORMATION
Client: a; -n O [1 S+Q±W kyt 1'e, PO#:
Contact Person: \:-CL 1-Qh n SO fl NPDES#: NC I
Address: ( . Q. PI ore X I) ) I Phone: 0 7 Y 3
City: i'T6.1-es v,I I 'e Pipe#: 0
County: tre.Ci.Q.I I State: Ai Zip:l^0 2(O5 7
SAMPLE INFORMATIO
Sample Site: .1-4+ Cr-e W I,e_jc --fop © --- \lt
Sample Type: ❑Grab Composite #of containers: Q
Sampling Time: Start Date: OS ia.2 aa Start Time:apyPoNfa) PM
End Date: Q/ d 44I a,a End TimefibPM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print: /6.A //4"7 b/S.t/ 4- J Signature:
TOXICITY TEST INFORMATION
Test Required: YChronic(7 days) Test Organism: (>,Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: 5 5% ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished by,- r Date: tq J LI Time:
Received b : j Date ///J/F�J��^/Jj%� - Time: /1�� I PM
Relinquished by:;- Date: " Time: ...261) AM M�
r~-/
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING (Laboratory Use Only)
Relinquished by: RA.c IC MO ole (/
Received by: I(Y\— l Date: ) `2 Y'22- Time: 2 TO AM �M
Sample Temperatures(°C): (/9 / 1.0 / / Sample Condition: 1\t d
VCI I P\IAI- ,1:�.1........... Iii116=MMINIMMIIIIIMIMilil

• , f
Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 03/02/22
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -15.23% CONTROL 55% Effluent
## Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 243 280
Mean # Neonates 20.250 23 .333
Standard Deviation 1.485 1.557
Coefficient of Variation 7.332%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 C 18 -2.2500 13 E 23 -0.3333
2 C 18 -2.2500 14 C 20 -0.2500
3 E 22 -1.3333 15 C 20 -0.2500
4 E 22 -1.3333 16 C 20 -0.2500
5 E 22 -1.3333 17 C 20 -0.2500
6 C 19 -1.2500 18 C 21 0.7500
7 E 23 -0.3333 19 C 21 0.7500
8 E 23 -0.3333 20 C 21 0.7500
9 E 23 -0.3333 21 C 22 1.7500
10 E 23 -0.3333 22 E 26 2.6667
11 E 23 -0.3333 23 C 23 2.7500
12 E 23 -0.3333 24 E 27 3.6667

4
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 3.6667 -2.2500 0.4493 5.9167
2 2.7500 -2.2500 0.3098 5.0000
3 2.6667 -1.3333 0.2554 4.0000
4 1.7500 -1.3333 0.2145 3.0833
5 0.7500 -1.3333 0.1807 2.0833
6 0.7500 -1.2500 0.1512 2.0000
7 0.7500 -0.3333 0.1245 1.0833
8 -0.2500 -0.3333 0.0997 0.0833
9 -0.2500 -0.3333 0.0764 0.0833
10 -0.2500 -0.3333 0.0539 0.0833
11 -0.2500 -0.3333 0.0321 0.0833
12 -0.3333 -0.3333 0.0107 0.0000
1
W = X 45.2377
50.9167
Calculated W = 0.888 Critical W = 0.884
0.888 z 0.884
The reproduction data is normally distributed
evaluated at a 990 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Effluent variance 2.4242
F = _ = 1.10
Control variance 2.2045
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
1.10 s 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

EQUAL VARIANCE t TEST
20.3 - 23 .3
t = _ -4.965
0.621
Degrees of freedom = 22
Critical t = 2.508
-4.965 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99% confidence interval.
Chronic Test PASSES

Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 02/02/22
' (Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
orator erf rm' Test: MER LABS, INC.
Comments:
X
nat o Opera r r Response e C arge
X
SignatZLa or Supervisor * PASSED: -22.36% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -4.418
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -22.36
% Mortality Avg.Reprod.
# Young Produced 21 22 17 22 22 15 23 18 17 20 23 17
0.00 19.75
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 24.17
Treatment 2 Treatment 2
Effluent %: 45%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
14.178% PASS FAIL
# Young Produced 23 27 23 25 24 21 21 26 25 23 27 25 % control orgs X
producing 3rd
brood Check One
It (L)ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 01/26/22
Control 8.09 7.90 8.11 7.97 7.62 7.98 Collection (Start) Date
1:
Treatment 2 7.64 8.03 7.69 8.05 7.79 8.08 Sample Tp ype/Durur e/ ati Sample 2: 01/26/22
ation 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.0 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 23.9 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness(mg/1) 46
Control 8.35 7.92 8.18 8.11 8.01 8.20
Spec. Cond. (pmhos) 158 366 392
Treatment 2 8.50 7.88 8.27 7.93 8.40 8.07
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.0 1.1
(Mortality expressed as %, combining replicates) I
Note: Please
% % % % % % % % % % Concentration Complete This
Section Also
% % % % % % % % % % Mortality
start/end start/end
LC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit _
% -- % Spearman Karber _ Other High
Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Meritech, I (Lab # 027)
/� Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator F: j
Client: _�7 Gf�P5 vl'i�' -/ �k Pipe#: 6 1 County: .,/`e rt e 11 Date Start: 1 - ),[;Q J.). Date End: a "9-"
NPDES#: NC 663)tj / Date/Time of Culture Transfer:\'= .9- l f c7.Li �Atto Time Start: ) I:i CA Time End: 11 ,26f '►
Dilution Water: Lake Brandt Date/Time Neonates born: 4, j:-9-or-u :3/")f,,,,1st Renewal Date: 7-2,Z?- Time: 1/ ; ,7ANI
Test Organism Source: Tray# c— Age of eonates at Test Start:'a.'�, 9`. hours 2nd Renewal Date: i- 3/ - g Time: /O: YI. M
Stirred/Aerated for D.O.: Y/ N Randomized: Y/ N Culture Tray Temp: ��.,7 °C Analyst(s): MR,LV,KS,►L Reviewed by: fi1\---
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Sample 1: I--��-)-)- Sample 2: /' G -2
Adults Live/Dead - - - - ? Sample Information
Day#5 1 3 4 5, 6 7, 8. 9, 10„ 11. 12, 100% pH G/C? Duration
#Young Produced ti 7 y q 7 �I4 ilk / /-,, '4/(o �,/1 3/ - 0 Sample 1 7; t c- .)-`I.. 0 hours
Adults Live/Dead L- L— L-- L_ I-- L- t_ - i` g_ L L Sample 2 7,(q 3_ L% hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 t Transferred by: Fed by.
#YoungProduced (, q G Batch# a Sample 1 Sample 2
( `( ( log ! ll ( 7��l� Day 0
Adults Live/Dead L j_ ( (� L L Ci L . L— ,L- Z.i Transfer Day r 0 2 5 r'�� �`,,,,,,..„. :trz,„ Day 1 ,M 1'
Hardness o Day 2 /: Lt.
Total Produced ). ," 1-* �� � g-- _ (mg/L) 7 t
I� �7 �j �� 1� Spec.Cond. 366
f/ Day 3 1"�
° (umhos/cm) j —^, l�+VC� Day 4
Percent of Control producing third brood: J(,,�.) �o Chlorine '
(mg/L) •j .^ <�(� /c-�t( Day 5 ��Lli
Test Sample Organism Reproduction ` Day 6 02
Receipt Sample " ';Effluent%: Temp.(°C) . ' Wr:
�. 6
Terminated by:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 pH 1st Sample 2nd Sample 2nd Sample
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control 8-G9' 7,C(Q 1,?7 '7 7 (l
Adults Live/Dead 1 — _ � (q 03 769 6 S' 7 7 7 n•Qe
Day#5 1 2Sample t � � t �+
4, 5. 6. 7, 8 9 10 11 12/ initial final initial final initial final
`, "' / ) �/ ` � 1 !cr(_WSJ-2�L#Young Produced % y 10C 9/' 9/5 �/� tj/7'`/9 q1/�i /67y/ +i,% FI.2 D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/Dead L L L L_ L. L_ L. Lam- L_ 'L '� r
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Control 8,3) 7,5 2, 6,(� 6k(( �,,Cn 1 Up
#Young Produced ,•6 / 3 / 1 /i, 12 II) 1 / /a /3 u sample 30 7` 27 �.R3 c' C 7
initial final initial final initial final
Adults Live/Dead L L z_- Z--
/� Temp. 1st Sample 2nd Sample 2nd Sample
Total Produced 2-.5 7 ,25 1 �\ , �L ;3 ,-2 9-7 T� Control o r/ -I,j 1.7 )ti,`1 3 ;0 3
Cc ants: Sample 'al(,. �{-Y �y, ,i.C, ''tl a ,w.3
initial final initial final initial final

AMERITECH, INC. (Lab #027) Meritech SamplelD#: o(3S)3-��
. Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedt meritechlabs.com Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: h PO#:
Contact son: C �-0 j 1 e i NPDES#: NC
0Address: , , `4 o)C , 1 i 1 Phone: t' Li
City: ,5+CKAe-s.c \ 1\ _ Pipe#:
County: J-(.�,i- i State: /[_.l� Zip: A 8I0S
SAMPLE INFORMATION
Sample Site: t Cr -� Oc+o \ I
Sample Type: ❑Grab Cpmposite #of containers: a
Sampling Time: Start Date: I 1 a,.: , Start Time:2194<D PM
End Date: -OlEnd Time: PM
***Triple rinse sample container with ar5lebefore filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
c$Collector's Name: Print: 4iel}t./i bIS,{yy.iA-, -----"XSignature:
TOXICITY TEST INFORMATION
Test Required: Chronic(7 days) Test Organism: )Ceriodaphnla dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: I. % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORM TION
Relinquished by: Date: Time: /? AM M
Received by: Date: Time: /925-- AM
Relinquished b . �''_7 Date: Time: ,. r AM P
Received by: Date: Time: AM M
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING (Laboratory Use Only)
inquished by: I46 k al (V%
I Received by: Ian P/IAA,K, Date: ( ' . 5 (2') Time: 3 c 6 AM QM
Sample Temperatures(°C): I-Cl / I A / / Sample Condition: -:5 Ur
WHITE= Laboratory copy YELLOW=Client cony

MERITECH, INC. (Lab #027) Meritech Sample ID#: CI Il "
•
A Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
Toxicity Supervisor email: mike.reedameritechlabs.com Web Site: www.meritechlabs.com
]_ CLIENT INFORMATION
Client@d 1 1 ��� S €)- €Sc \\ \Q PO#:
Contact Person: `-( cl Cf�C1 NPDES#: NC 0031
Address: , .(r). . d 1. Phone:-TA 2-1 g _4-3
City: -)-i-0.7,1esv` e.._J Pipe* d '
County: --Tce__C,X.QA k State: KJ Zip: 3S 634
(`( ,p �1 SAMPLE INFORMATION `
Sample Site: - .r� : �Yl (_�_� \ \ �.� {1J�.1 1
Sample Type: ❑Grab ❑CCom osite #of containers:
,443,6
Sampling Time: Start Date: 1 I fA Start Time: 7+ PM
End Date: 1 / / a,,, End Time: �0 , AM PM
a -ps
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
ficCollector's Name: Print: 1 /a ()JJ /YJ49) Signature:el---
TOXICITY TEST INFORMATION
Test Required: Chronic(7 days) Test Organism: 1QI Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: � % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
L
SHIPPING INFORMATION 1 /�
Relinquished by���iE Dates / 29/az..Time: l I O AM 6
Received byP/ Date: __ Time: 7 A AP
Relin uished b : �— f t� A q y Date: Time: �PM
�
Received by: `� Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX A Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING (Laboratory Use Only)
fl
Relinquished by: /U-( ( a) A l'f ;
Received by: 'CPA,
j Jl 7 I �,V Date: `G Time: AM FM
Sample Temperatures(°C): l° I / L II / / Sample Condition: I_Cu4
1AILJITC — I -L.nro Mr., n,...., VCI I nut;— rr,..,e ,.......

Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 02/02/22
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -22.36% CONTROL 45% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 237 290
Mean # Neonates 19.750 24.167
Standard Deviation 2.800 2.038
Coefficient of Variation 14.178%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
•
1 C 15 -4.7500 13 E 25 0.8333
2 E 21 -3 .1667 14 E 25 0.8333
3 E 21 -3 .1667 15 E 25 0.8333
4 C 17 -2.7500 16 C 21 1.2500
5 C 17 -2.7500 17 E 26 1.8333
6 C 17 -2.7500 18 C 22 2.2500
7 C 18 -1.7500 19 C 22 2.2500
8 E 23 -1.1667 20 C 22 2.2500
9 E 23 -1.1667 21 E 27 2.8333
10 E 23 -1.1667 22 E 27 2.8333
11 E 24 -0.1667 23 C 23 3 .2500
12 C 20 0.2500 24 C 23 3 .2500

SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 3.2500 -4.7500 0.4493 8.0000
2 3 .2500 -3.1667 0.3098 6.4167
3 2.8333 -3 .1667 0.2554 6.0000
4 2.8333 -2.7500 0.2145 5.5833
5 2.2500 -2.7500 0.1807 5.0000
6 2.2500 -2.7500 0.1512 5.0000
7 2.2500 -1.7500 0.1245 4.0000
8 1.8333 -1.1667 0.0997 3.0000
9 1.2500 -1.1667 0.0764 2.4167
10 0.8333 -1.1667 0.0539 2.0000
11 0.8333 -0.1667 0.0321 1.0000
12 0.8333 0.2500 0.0107 0.5833
1
W = X 123.2031
131.9167
Calculated W = 0.934 Critical W = 0.884
0.934 a 0.884
The reproduction data is normally distributed
evaluated at a 9956- confidence interval.
Test Passes!
F test for Homogeneity of Variance
Control variance 7.8409
F = = = 1.89
Effluent variance 4.1515
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
1.89 s 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

9
o
EQUAL VARIANCE t TEST
19.8 - 24.2
t = _ -4.418
1.000
Degrees of freedom = 22
Critical t = 2.508
-4.418 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99% confidence interval.
Chronic Test PASSES

11
1
Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 10/21/21
t^"cility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
,rator Perfo ming Test: MERITECH LABS, INC.
Comments:
X
ig e o Op or in Responsi e C arge
Signature of Laborato?y Supervisor * PASSED: -10.45% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C, DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -4.551
Tabular t = 2.681
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -10.45
% Mortality Avg.Reprod.
# Young Produced 23 23 24 25 24 24 24 24 24 24 24 24
0.00 23.92
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 26.42
Treatment 2 Treatment 2
Effluent %: 45%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
2.153% PASS FAIL
# Young Produced 26 27 26 25 30 28 26 24 29 26 24 26 % control orgs X
i producing 3rd I
brood Check One
t .t (L)ive (D)ead L L L L L L L L L L L L 100%
L- 1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 10/13/21
Control 7.94 8.02 8.05 7.82 7.84 8.11 Collection (Start) Date
Sample 1: 10/11/21 Sample 2: 10/13/21
Treatment 2 7.87 7.99 7.90 7.73 7.63 8.03 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 23.9 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness(mg/1) 46
Control 7.20 7.25 7.81 7.31 8.03 7.71
Spec. Cond. (pmhos) 160 399 405
Treatment 2 7.45 7.06 7.68 7.17 7.76 7.04
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.8 1.4
(Mortality expressed as %, combining replicates) I
Note: Please
% % % % % % % % % % Concentration Complete This
Section Also
% % % % % % % % % % Mortality
start/end start/end
LC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit
% -- % Spearman Karber _ Other High
Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

1 Meritech, Ir (Lab # 027)
+ / Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator*:
Client: . G�25v ( (I� -! t/^ Pipe#: o f County: 1...t p'L ./( Date Start °
� � '� lC)-13--a( Date End: !/')����-;)
NPDES#: NC(7i- 7(3 ,l, Date/Time of Culture Transfer: 10 -1 l-? )(,:SL-•.4/0 Time Start: /0: )-g Time End: ( l L: J 747'\
Dilution Water: Lake Brandt Date/Time Neonates born: ,/ ) (D(.r- 6,'% 1 °,1 1st Renewal Date: 1(2 -/ .. i Time: 1 a- iP;
Test Organism Source: Tray# 4 Age of onates at Test Start?4( hours 2nd Renewal Date: /(7 --1 , , / Time: /e) /" ,,,,
7. �
Stirred/Aerated for D.O.: Y/ Randomized: Y/N Culture Tray Temp: ; k-{r °C Analyst(s): MR,LV,KS,KL Reviewed by: "A----
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
Sample 1: 0'7/-2 l Sample 2: 1(-%-- y' --A 1
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0
Adults Live/ Dead ' Sample Information
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 100% pH G/C? Duration
#Young Produced ` ( I 3f r( 3 f Gj It 0 f I In 4('I ,3((p 't/r1 Wm 4!(0 'lit, -t Sample 1 -1. 2,Li ;7i, e( hours
Adults Live/Dead L- (--- L J L- L- I.- L t' Lr I- )-- I<• Sample 2 ?,7 I^✓ c-- ),i-k,(} hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Transferred by: Fed by:
#Young Produced / 0 /i j, II ID 1 l II I ( i s j t) j i ,j Batch# S` f34 525 •�,5 Sample 1 Sample 2 Day 0 /'{'-- L I/
Adults Live/Dead ( it L__ L t___ \__._ ( Z L Transfer Day 0 2 5 Day 1 0 2,
Hardness ., Day 2 2---'(m9/L) M.,,,,.,
Total Produced �-3 -3 2- 2 O- u 74 �1 � � Day 3
� � � � Spec.Cond. J � 1
} (umhos/cm) /t O k i '� 1 6i 0 5 Day 4 r-t^
Percent of Control producing third brood: /L't\ % :-
Chlorine aY 't� ( Day 5 L-1--/
(mg/L) F 4 f `_
Test Sample Organism Reproduction Day6 /`iz-
Receipt Sample ° ;. . ":_-3''
Temp.(°C) ;3 T :_ /-z...7 ,\ Terminated by: (Kt-
Effluent%: 1.{ - "�
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 pH 1st Sample 2nd Sample 2nd Sample
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control ..-1 f 4 2-0a xi. 7,82 7,8V 6,1/
Adults Live/Dead ( -L — Sample �•n 1,1-1I-1 ? i0 773 63 (1.03
Day#5 1 2 3 4 5 6 7 8 9 10 11 �+12 initial final initial final initial final
#Young Produced u+i 8 3f _3(I( 3/?? 3111 ,412 3fi-0 ' `4)I0 1II 31 i c°-1I ///. D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/Dead L— L_ (-- L� lr Ls t-- I... L-- L_.
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Control 'l-a(; �1,a5 7,19i 7,31 �,�i3 1(7
#Young Produced 19 1)— /? C L/ /c it, / 3 // pi/j j t/ !c Sample -IL 1•ot0 .8 7 (7f 176 7,0/l
Adults Live/ Dead L__ L I-, L._ L L. c.r- L L- 1.-- L L .
initial final initial final initial final
Temp. 1st Sample 2nd Sample 2nd Sample
Total Produced ,�(, a7 '36 ? 1 ) ,'f �) pssq 7 , - - 4 A, ° Control v�U/•`i Z4,9 .`'(•f ALI 6 I N ? ,7� 6-
• C 'rents: Sample w, ', :2.4,1 .t(J ?11 tj - i,v� ?y-6,
initial final initial final initial final

MERITECH, INC. (Lab #027) Meritech Sample ID#: ��2I - ��
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedAmeritechlabs.com Web Site: www.meritechlabs.com
��`` K� CLIENT INFORMATION
Client: Q.( V-F S- �QSk i\1e - Li eft. PO#:
Contact Person:I a =C:)`C1Y1SC3C NPDES#: NC CC)p3 Maio
Address:
P (3 � l f f�l 1 Phone: 76 LI O 1Y 3 3g
City: ---y -e. v t` '� Pipe#: cot
County: -1—red QI / State:- AA!, - Zip:
�
l(/� SAMPLE INFORMATION- 1
Sample Site: €.p�1./,K 63 - l.1-r ? 4u Qr\+ 0(. C\-- 0 -\l
Sample Type: Ill Grab i4Composite #of containers:
Sampling Time: Start Date: 10 I I I I c: I Start Time: 1 /6 C) PM
End Date: 1 C)(l a (a 1 End Time: O t 0 PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
i
Collector's Name: Print: Ail/AL AS 14 •.-.-- v Signature: f--,-.2/
TOXICITY TEST INFORMATION
Test Required: Chronic(7 days) Test Organism: Ceriodaphnla dubia (water flea)
❑ Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
iwC: Lis % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION Relinquished b { 1.4,D i Date: t ' Time: / AM
Received by: Date: p Time: JZ AM iic
Relinquished by: Date: Time: :.7re—' AM 0
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING (Laboratory Use Only)
A
:linquished by: kj c k ,si i i ell
K-12 21 7(`
Received by: (1)/v1 Date: Time: 5 AM gm
Sample Temperatures(°C): I i / ( r6, / / Sample Condition: I. CY.A
WI-IITG - I ohnrn4nni rnnni VP! I CM/= (:lipnt r_nnv -41111.111111111==.11

MERITECH, INC. (Lab #027) Meritech Sample ID#:(O1tf2(' 1 I" ..
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
f Phone: [phone] Fax:[phone]
Toxicity Supervisor email: mike.reedAmeritechlabs.com Web Site: www.meritechlabs.com
c CLIENT INFORMATION,r
Client t . l-t,,SO‘k l`\e — —1 ' �. i Ceif PO#:
Contact Person: (''Q�N�.c'�4� JtAjh�sO'(� NPDES#: NCO
ibp i 8 ;�~�
Address: "X 1 1 ( \ Phone:-70�t O 7 g 13( 3 e
City: �\ C )\ \\4... Pipe#: O I
County: 1 CC...CI 12.1 I State: it) C Zip: , ' b g -/
p i SAMPLE INFORMATION } n` j
Sample Site: Ll+11 ��� ` U3 ...- L� U e I� a t�-\ VC.J-\ \
Sample Type: ❑Grab Composite #of containers: a
Sampling Time: Start Date: l 31)3i a 1 Start Time:�05Thl PM
End Date:)O/1 L1 / at End Time:°'(, Mil PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
%%
Collectors Name: Print: kIt`kLA$ j.�,tr.�-r!v Signature:
TOXICITY TEST INFORMATION
Test Required Chronic(7 days) Test Organism: 'Ceriodaphnia dubla (water flea)
❑ Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: 1-1�� % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m. on Friday***
Comments:
SHIPPING INFORMATION Relinquished by: - Ck -) Date: O ( (IL
Time: 9/4) AM
Received by: Date: Time: V____ AMRelinquished by: Date: ,� / Time: AM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ['Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
�� y, SAMPLE RECEIVING (Laboratory Use Only
Relinquished by: 1 Vt ((< l i Nit t IA
Received by: /G'ti P,'vv- ', Date: y q/0 n I`7 ; Time: AM PM
Sample Temperatures(°C): if If I i+ ! / / Sample Condition: £ C 0
WHITE= Laboratory copy YELLOW= Client copy -4IllbMMMMIMNMN

Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 10/21/21
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -10.45% CONTROL 45% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 287 317
Mean # Neonates 23.917 26.417
Standard Deviation 0.515 1.832
Coefficient of Variation 2.153%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 24 -2.4167 13 C 24 0.0833
2 E 24 -2.4167 14 C 24 0.0833
3 E 25 -1.4167 15 C 24 0.0833
4 C 23 -0.9167 16 C 24 0.0833
5 C 23 -0.9167 17 C 24 0.0833
6 E 26 -0.4167 18 C 24 0.0833
7 E 26 -0.4167 19 C 24 0.0833
8 E 26 -0.4167 20 E 27 0.5833
9 E 26 -0.4167 21 C 25 1.0833
10 E 26 -0.4167 22 E 28 1.5833
11 C 24 0.0833 23 E 29 2.5833
12 C 24 0.0833 24 E 30 3 .5833

•
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 3.5833 -2.4167 0.4493 6.0000
2 2.5833 -2.4167 0.3098 5.0000
3 1.5833 -1.4167 0.2554 3.0000
4 1.0833 -0.9167 0.2145 2.0000
5 0.5833 -0.9167 0.1807 1.5000
6 0.0833 -0.4167 0.1512 0.5000
7 0.0833 -0.4167 0.1245 0.5000
8 0.0833 -0.4167 0.0997 0.5000
9 0.0833 -0.4167 0.0764 0.5000
10 0.0833 -0.4167 0.0539 0.5000
11 0.0833 0.0833 0.0321 0.0000
12 0.0833 0.0833 0.0107 0.0000
1
W = X 35.5681
39.8333
Calculated W = 0.893 Critical W = 0 .884
0.893 a 0.884
The reproduction data is normally distributed
evaluated at a 995:5 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Effluent variance 3.3561
F = _ = 12 .66
Control variance 0.2652
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
12.66 > 5.32 =► The Test FAILS , the variance of the control group
and the variance of the effluent group are not homogeneous.

F %
UNEQUAL VARIANCE t TEST
23.9 - 26.4
t = _ -4.551
0.549
Modified degrees of freedom = 12
Critical t = 2.681
-4.551 < 2.681
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99% confidence interval.
Chronic Test PASSES

P" \ /1
dfluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 08/19/21
i
' cility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
)rato efform' Test: MERITECH LABS, INC.
Comments:
n
ig t of Opert in Responsible C arge
X W640.11:e I/A, 2N
Signature of aboratory Supervisor * PASSED: -2.91% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -0.652
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -2.91
% Mortality Avg.Reprod.
# Young Produced 25 24 24 22 25 22 25 22 19 21 23 23
0.00 22.92
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 23.58
Treatment 2 Treatment 2
Effluent %: 45% -
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
7.994% PASS FAIL
# Young Produced 20 22 27 22 26 18 24 21 24 28 26 25 % control orgs X
producing 3rd
brood Check One
L "-lt (L) ive (D)ead L L L L L L L L L L L L 100%
I 1st sample 1st sample 2nd sample Complete This For Either Test
I, pH Test Start Date: 08/11/21
Control 7.95 7.99 8.00 8.00 8.09 7.99 Collection (Start) Date
Sample 1: 08/09/21 Sample 2: 08/11/21
Treatment 2 7.82 8.11 7.84 8.04 7.80 8.01 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 23.5 hrs L A A
r d r d r d U M M
t t t Sample 2 X 23 .9 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness(mg/1) 48
Control 8.12 7.47 8.19 7.53 8.20 7.40
Spec. Cond. (pmhos) 162 394 414
Treatment 2 8.08 7.47 8.11 7.51 8.16 7.33
1 Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.3 1.1
(Mortality expressed as %, combining replicates)
Note: Please
% % % % % % % % % % Concentration Complete This
Section Also
% % % % % % % % % % Mortality
start/end start/end
ILC50 = % Method of Determination Control
95% Confidence Limits Moving Average _ Probit
% -- % Spearman Karber _ Other High
Conc.
pH D.O.
1 Tested:
Organism
g e ted: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Meritech, Inc. b # 027)
if
'.. L L / Mini Chronic Pass/Fail Test: Ceriodaphnia dubie Incubator#:
Client:, 7 Ci-1-7 5✓/ 4-) L( f Pipe#: n I County: ,",L re,is (\ Date Start: r.- II -)-‘ Date End: ; /c} -�
N13DES#: NCO(_13( 36, Date/Time of Culture Transfer: c - 0`�j / : .)9,1/V1 Time Start: /0` -2j j,, v"\ Time End: 7. `T..-I1ti
Dilution Water: Lake Brandt Date/Time Neonates born: '- •!'u,+ 1st Renewal Date: ' -(j- 2I Time: // :,,,A,,.,,,„
Test Organism Source: Tray# 1 Age of onates at Test Start:9 ,. i'; hours /2nd Renewal Date: w4' '//,..'; . ,al-1 Time: (it' (. 4t
Stirred/Aerated for D.O.: Y/ I Randomized: Y/ N Culture Tray Temp: 1 - C Analyst(s): MR,LV,KS,KL Reviewed by: 1.,._.-
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
Sample 1: `?,-C1 -4 1 Sample 2: V - 11 -- I
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0
Adults Live/Dead L-- ---- -----___ -- Sample Information
Day#5 3 5 . 6 7 8 9 10 11 1 100% pH G/C? Duration
#Young Produced 9/» �4c /io JD V 1; ( `tll� y//�, ' , `if .Y" 3-
fry Sample 1 7, 7 7 �- -)Z'.1. hours
Adults Live/Dead ), L L-- i_ j_,__ L____ t- L 1._ L_ L L Sample 2 /7,66 C_ Cj hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Transferred by: Fed by:
#Young Produced ( 2 ICI lb k it . 9 11 , g- C, 41 (.6 c Batch# f-2 ,,, (., ),� Semple 1 Sample 2 Day 0 Ps.„ ri/
Adults Live/Dead L i`- L--- L.-- L__ t . .. L.- L L 4._ L,_ Transfer Day 0 2 5( ;;¢ ..,' ' Day 1 it;k
A
Hardness -w
-� � Day 2 Mk, /-.�
Total Produced �-r 911 2.4 9-` , P-_ .` 9� (mg/L) G (�'— t -�^ 4r
v�I .'� 3 Spec.Cond. . r I 'I Day 3 1`.:,t._
(umhoslcm) 6 0) ) y `? 9 Day 4
Percent of Control producing third brood:,/ )& % ', f
Chlorine ^ /
4 0 / i`� Day 5 1. �4,
Test Sample Organism Reproduction Wig„ Day 6 /1 r
Receipt Sample '"-NA
o Temp.(°C) ___' $ � . ..'? ( . I Terminated by: tom,/
Effluent /o: q.
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 pH 1st Sample pp 2nd Sample 2nd Sample
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control 7.95 'izi O,00 8,0o qr 7,(1c1
Adults Live/Dead q (�
Sample 7,62 7f- II 7,89 8,0� 7.4P D r!)(
Day#5 1 3 4 5 7 9, 10, 11. 12 initial final initial ' final initial final
#Young Produced 17 Li 9 § l L/ii Li y/ y 4 57/9 c,/' qt., tut:. D.O. 1st Sample 2nd Sample ° /In�Sample
Adults Live/Dead L._ L.... L i~ L 'L r I._._ t_ IL Ll 'I— i-- Control SIr l 0 �3 8 2� '
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 ��, 7 �✓ ref C
#Young Produced /0 9 // i� ii `. , /(' /417 (l if Sample 6,O€j 7(11 6,11 7,51 8l/c 733
initial final initial final initial final
Adults Live/Dead [_ L L L l-- L. L._ L I lr
Temp. 1st Sample 2nd Sample 2nd Sample
Total Produced �r. 17 pa 94a I 0),7 3,1 S .3.4,-, ,4g Control a,ti,5 if,5 .L(,'') ;)1- ,7 )11,) :2I Z
Cc 'ents: Sample 'iA '1i7 PA. .j.) .i .-)Ye 111111
Initial final initial inal is final

MERITECH, INC. (Lab #027) Meritech Sample ID#: OS1" .1)
° A. .
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
If Toxicity Supervisor email: [e-mail] Web Site: www.meritechlabs.com
CLIENT INFORMATION
\ ' c �p -- 11 (Y r Y
Client: i 5 ._,1 `.SU4 �. ` A get L PO#: 22 r/_
Contact Person: c-�v, J Men NPDES#: NC CO 3 83 (0
Address: ,Q , I Phone: 7 d Lie 2 8 3 `t 3 ej
City: L\'eSCE1\ le. Pine#: OI
County: ..�(12 '1 State: Q. Zip: 6
�],Qr^� r �°} ` SAMPLE INFORMATION p',, I l
Sample Site: ! 4 l ___ ` Vim( + c 'I-� l Lit e9 ' -- 0 ci, PW-I
Sample Type: ❑Grab Composite #of containers:
Sampling Time: Start Date: 8 Q I I Start Time: ' M PM
1 End Date: I fO End Time: :3 AM PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler pletely with ice. The
sample musy+t be<0.6°C upone receipt at Meritech'**
--k%
j
Collector's Name: Print: �UCI 0v`- c r`�� ) Signature: 1 ` j
TOXICITY TEST INFORMATION
Test Required: Chronic(7 days) Test Organism: 1Ceriodaphnia dubia (water flea)
Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: 15 % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATIO Relinquished by: 1 Date: /. Time: /)-O AM PAi—�,
Received by: ,1' Date: 6C Time: /✓e-- AM
Relinquished by: .— Date: P-r Time: ,g , AM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
I� SAMPLE RECEIVING(Laboratory Use Only)
API h alinquished by: Th51 i I r y ,I
Received by: f� �' \ Date: f r LQ I I Time: ? `i g AM 1151
Sample Temperatures(°C): ,i . / 1I / / Sample Condition: ,(,V4,1.6
WHITE= Laboratory copy YELLOW=Client copy -44111■ rr

MERITECH, INC. (Lab #027) Meritech Sample ID#: L/ )`c) Z 1 plc—I.
Bioassay Sample Chain of Custody
' A 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
f
Toxicity Supervisor email: mike.reedmeritechlabs.com Web Site: www.meritechlabs.com
C CLIENT INFORMATION /� !/
Client:C.41-1—(A,..S..,C � , eS 1( 1 l '_"1.ze ��� PO#:Contact Person: • crjj„y, , AOhl\sOn NPDES#: NC OC)_ I e3 b
Address: D,n . 2')Q l I l Phone: `l C1i4 1 3 34 3 8
City: s *--es o'c\\ \ , Pipe#: 0 1
County: re ne t t State: AD l. Z Zip: c (Q `l
r SAMPLE INFORMATION (�
Sample Site: 1-r C e c '' iJ
Sample Type: D Grab X Composite #of containers:
Sampling Time: Start Date: 8 I Start Time: cl, c 5 tat PM
End Date: a End Time: (.Q a V mar PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
I )k t-
Collectors Name: Print: Q V O1, �f`h 4C`�-� Signatures_
: J\‘'' '"—.."----"---
TOXICITY TEST INFORMATION
Test Required' Chronic(7 days) Test Organism: 111Ceriodaphnia dubia (water flea)
(((0��`��`Acute(24-48 hours) 777❑"'Pimephales prornelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: 45 % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
; ).1 _
Relinquished b Z �- Date: 9-kTime: �5 AMReceived by: - Date: V % Time: r AM
` /�i _
Relinquished b : , -- Date: Time: A
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
/ SAMPLE RECEIVING(Laboratory Use Only)
Relinquished by: (J I`dk !�t/1;' It`1
Received by: lu J` Date: �� Time: 9AM gm
Sample Temperatures(°C): ( t I / 14 / / Sample Condition: L oxt
tiimmirlllip.-- WHITE= Laboratory copy YELLOW= Client copy -44prarissiiIm
i

' Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 08/19/21
' Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -2.91% CONTROL 45% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 275 283
Mean # Neonates 22.917 23.583
Standard Deviation 1.832 3.029
Coefficient of Variation 7.994%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 18 -5.5833 13 E 24 0.4167
2 C 19 -3 .9167 14 E 24 0.4167
3 E 20 -3 .5833 15 C 24 1.0833
4 E 21 -2.5833 16 C 24 1.0833
5 C 21 -1.9167 17 E 25 1.4167
6 E 22 -1.5833 18 C 25 2.0833
7 E 22 -1.5833 19 C 25 2.0833
8 C 22 -0.9167 20 C 25 2.0833
9 C 22 -0.9167 21 E 26 2.4167
10 C 22 -0.9167 22 E 26 2.4167
11 C 23 0.0833 23 E 27 3 .4167
12 C 23 0.0833 24 E 28 4.4167

r a
• SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 4.4167 -5.5833 0.4493 10.0000
2 3 .4167 -3.9167 0.3098 7.3334
3 2.4167 -3 .5833 0.2554 6.0000
4 2.4167 -2.5833 0.2145 5.0000
5 2.0833 -1.9167 0.1807 4.0000
6 2.0833 -1.5833 0.1512 3.6666
7 2.0833 -1.5833 0.1245 3 .6666
8 1.4167 -0.9167 0.0997 2.3334
9 1.0833 -0.9167 0.0764 2.0000
10 1.0833 -0.9167 0.0539 2.0000
11 0.4167 0.0833 0.0321 0.3334
12 0.4167 0.0833 0.0107 0.3334
1
W = X 134.8148
137.8333
Calculated W = 0.978 Critical W = 0.884
0.978 ? 0.884
The reproduction data is normally distributed
evaluated at a 99%- confidence interval.
Test Passes!
F test for Homogeneity of Variance
Effluent variance 9.1742
F = = = 2 .73
Control variance 3.3561
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
2.73 s 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

EQUAL VARIANCE t TEST
22.9 - 23 .6
t = _ -0.652
1.022
Degrees of freedom = 22
Critical t = 2.508
-0.652 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 996 confidence interval.
Chronic Test PASSES

/7
It
Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 07/22/21
dlity: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
] ry rming Test: MERITECH LABS, INC.
Comments:
Signature of Op or in Responsi e C arge
4„.._
Signature of L Zratory Supervisor * PASSED: -1.35% Reduction *
Work Order:
Environmental Sciences
Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -0.361
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -1.35
% Mortality Avg.Reprod.
# Young Produced 22 25 28 25 24 25 24 25 26 26 24 22
0.00 24.67
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 25.00
Treatment 2 Treatment 2
Effluent %: 45%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
6.769% PASS FAIL
4 Young Produced 28 25 25 27 23 22 20 28 29 24 26 23 % control orgs X
producing 3rd
j L brood Check One
t (L) ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 07/14/21
Control 8.23 8.10 8.15 7.95 7.90 7.79 Collection (Start) Date
Sample 1: 07/12/21 Sample 2: 07/14/21
Treatment 2 7.99 8.11 7.96 8.08 7.88 7.96 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.2 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness(mg/1) 48
Control 8.15 7.57 8.02 7.70 8.04 7.05
Spec. Cond. (pmhos) 165 365 384
Treatment 2 8.08 7.48 8.04 7.75 8.11 7.12
Chlorine(mg/1) <0.1 <0.1
' LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.0 1.7
(Mortality expressed as %, combining replicates) 1
Note: Please
%0 % % Concentration Complete This
% Si0% %o a o%
Section Also
% % % % % % % % % % Mortality
start/end start/end
ILC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit
% -- % Spearman Karber _ Other - High
- Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubiar- Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

1-
Meritech, (Lab # 027)
// /_ Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#:
--6 (�5�/1'l� � —7 /
Client: Pipe#: County: ,� r.1 . Date Start: / —( — ( Date End: '7- .7-}-:211
NPDES#: NC U(.3iF3(,, Date/Time of Culture Transfer:. •-L3 -.- )- ' M Time Start: it'3 5 Time End: L ' j( "
Dilution Water: Lake Brandt Date/Time Neonates born: A; - S: 1st Renewal Date:
/`rT "7 Ifcf '24 Time: /P,'0,3„,-,,,
Test Organism Source: Tray# Age of onates at Test Start: ?),M" hours 2nd Renewal Date: 7 t 1 r ) Time: /u t" „�'r2,.-,t.1
Stirred/Aerated for D.O.: Y/ Randomized: Y/ N Culture Tray Temp: t{ °C Analyst(s): MR,LV,KS,KL Reviewed by: fw�--
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced L 0 0 0 0 0 0 0 0 0 0 0 0 Sample 1: - a- \ Sample 2: --1
A�-�.�
Adults Live/Dead — Sample Information
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 100% pH G/C? Duration
#Young Produced a,) I 1 1)10 171 l t 511 5-11 -'I(fr, S u il(1 71 y+-• �� P 1 . �'1C d'`i.). hours
tt 1 Sample 1 C
Adults Live/Dead L L U, 1.-- U- t, - t_ t__ 1_ L.
Sample 2 rl •'277 C- ,�`'4 , U hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Transferred by: Fed by:
#Young Produced 9 /2, I LI 13 i p /3 /✓() /3 ) /,,_ 1 Batch# L'' � �,-z, Sample 1 Sample 2
Day 0 ilA, l-�=
Adults Live/Dead (_- L L t--- 1:— l___. L_ ,,•_ I- L. L i_ Transfer Day 0 2 5 4410 V. Day 1 \
Hardness L 5% A" Day 2 //�'n L-U
Total Produced `.�-3- -9g-DS-'.24 � -Lf . -96 r// ,2/1
2 2,.t (mg/�) �U ''� .,-�5 p
- ✓ ""y � ��� Spec.Cond. Day 3 l''�I"--
(umhos/cm) J�� I�,��`7 5 30
Day 4 Y.-Z.,
Percent of Control producing third brood: /G n)% ..m r
Chlorine Hai .
(mg/1.) firms_ -` : % j,1 40._k Day 5 ./`"1--�-/...
Test Sample Organism Reproduction
Receipt Sample s + "� Day 6 (,./'.-
Effluent%: L��j Temp.CC) are11 _ W
1 t Terminated by: ()IA
--
Effluent #2 1 2 3 4 5 6 7 8 9 10 11 12 pH 1st Sample end Sample end Sample
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control q-c#3 2,10 n lc 7,95 7,90 "i,76(
Adults Live/Dead C.:v f
Day#5 1 2 3 4 5 6 7 8 9 10 11 1� Sample � -( j.1k 1c1k9 548 7,68 --i_ti(2
t , (( ,�1 �7 f/ initial final initial final initial final
#Young Produced ill! 4I 1)-°1)IC 3)l C) 4I(1 &4 1I'3 9 I I( �►I I �I I i 7i i f/9 D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/Dead ' (._. L- L l,.- l._- L- L- L L L
Day#7 1 2 3 4 /5 6 7 8 9 10 11 12 Control ,)5 "j.�'1 ,rJ� 7/ 7G 1�.(�(f Cc.
#Young Produced /` 5 13 /9 ( 6) /6 ,- / 5 /7 ‘., fi) /0) Sample e-ts —7,4 9, (t;Ltk 7,7 61 8, (f "7.I a
Adults Live/ Dead L. L L (--- L. L (_ 1.-- ndlal final initial final initial final
r� Temp. 'a1st Sample-y 2nd Sample
- 2nd Sample
Total Produced v2,s' 9:s— ? 27 , ," rJ pi :2 -/ `� . .),'4 Control ,'1;a v�/, 7 4 )--�r2 1.)-1) s V .2
nments: Sample d'4.1_ AT-'2, ,7 j 12 7 a- ) 7
initia final initial final naai r..�i

! MERITECH, INC. (Lab #027) Meritech Samplelo#:C7/32(- •I6.3
•
Bioassay Sample Chain of Custody
r, 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reeditmeritechlabs.com Web Site: www.meritechlabs.com
C CLIENT INFO�RjM-A�TIONf
Client: ci.4.(..1 Of,s' ' �-Jo( tie— L7" '' q.1 e_e z PO#:
Contact Person: ('�rY` � hYl�)l'f �•� NPDES#: NC(J©311 Can
Address: P. O .O . I U I I Phone:`JO'8 7 8 343
L P
City: , ma e St t�'� Pipe#: co
County: -ir,d.Q..II State: C Zip: ag GE-7 `
SAMPLE INFORMATION /�
Sample Site: � are p l_1(p 1.43 (y� [-I�{ L I (,l ent 0 I I
Sample Type: ❑Grab Composite #of containers:
?)) ,.
Sampling Time: Start ate: /i3 Start Time: 4 _ 41010 PM
End date: / `71131 E!d Time: r"9'I—+- 0 PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler corn letelly with ice. The
sample mus a<0.6°C upone receipt at Meritech*** A
Collector's Name: Print: V.! Cis A t 1l` L a r-dt Signature:,c0 ' `�k-S--
TOXICITY TEST INFORMATION
T^st Required: hronic(7 days) Test Organism: 'Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) E Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: LI5% ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m. on Friday***
Comments:
SHIPPING INFORMATION_
Relinquished e Q("(-/ Date: a Time: 4,2De AM
Received by: Date: Time: 42.,Or...) AM
Relinquished by. a Date: Time: S3/5 AMdp
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
�f SAMPLE RECEIVING (Laboratory Use Only)
Inquished by: fir)'CI(' i-T:((n \,,
Received by: ')WI/ j✓1, ,r Date: ,` `?I Time: / •� AM PM
Sample Temperatures CC): I 't^ / .r• / / Sample Condition: J !_.'
WI-IITP = I ahnratnni rnnv VCI I nut/-rq:.,.-4 .........

MERITECH, INC. (Lab #027) Meritech SamplelD#: �� f
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
`— Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedftmeritechlabs.com Web Site: www.meritechlabs.com
�, 'l CLIENT INFORMATION
Client: I+U of,.5J-CeS V t I FP -41-h -{r .K PO#:
Contact Person: cc \ck --Yoh 1\S Or\ NPDES#: NC 00"3 ` 83
Address: P.0 .Q,c,./.. (` l I „ \ Phone: -701 878 3 438
City: �If o `\2_ 10Q,a z1- Pipe#: CD I
CountyT (Q,G EA ( State: /l/� Zip: a U t g-1
/�p �� y SAMPLE INFORMATION ,�
Sample Site: 944-10"�C e.Y. 3 L — 6 A_ I `�C ry+ 0 u+ c -1 1
Sample Type: ❑Grab XComposite '3 i #of containers:
Sampling Time: Start Date: rPA44 Start Time: " i 2 • PM
End Date: 1� 15 nd Time: I D 0 PM
J
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler corn le ely with ce. The
sample mu t be<0.6°C upone receipt at Meritech*** �-
A 1 :-F \ /
Collector's Name: Print::0:VC• ~ t r k C �)I Signature: -
TOXICITY TEST INFORMATION
Test Required: hronic(7 days) Test Organism: Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC:A �� % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION -
Relinquished b _____ •"___ u Date: L czq Time: ;7, , p AM 0.
Received by: Date: 7 Time: / �r? AM M7
Relinquished b . _i - Date: 7 l Time: _7Ul� rfvh AM CP�
Received by: Date: Time: AMC° PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING(Laboratory Use Only)
Relinquished by: /lir(k (inkksA
Received by: l Fv \ Date: 7-i C- 1 Time: / 03-
AM 1
7 r`\
Sample Temperatures(°C): / / / I t3 / / Sample Condition: '? 'Qci
WHITF = I ahnratnni r-r r , VFI I r1W= r'inn+ I'.,.11. '6

i
rt Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 07/22/21
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -1.35% CONTROL 45% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 296 300
Mean # Neonates 24.667 25.000
Standard Deviation 1.670 2.730
Coefficient of Variation 6.769%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 20 -5.0000 13 C 25 0.3333
2 E 22 -3 .0000 14 C 25 0.3333
3 C 22 -2.6667 15 C 25 0.3333
4 C 22 -2.6667 16 C 25 0.3333
5 E 23 -2.0000 17 E 26 1.0000
6 E 23 -2.0000 18 C 26 1.3333
7 E 24 -1.0000 19 C 26 1.3333
8 C 24 -0.6667 20 E 27 2.0000
9 C 24 -0.6667 21 E 28 3.0000
10 C 24 -0.6667 22 E 28 3.0000
11 E 25 0.0000 23 C 28 3.3333
12 E 25 0.0000 24 E 29 4.0000

b
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 4.0000 -5.0000 0.4493 9.0000
2 3.3333 -3 .0000 0.3098 6.3333
3 3 .0000 -2.6667 0.2554 5.6667
4 3.0000 -2.6667 0.2145 5.6667
5 2.0000 -2.0000 0.1807 4.0000
6 1.3333 -2.0000 0.1512 3 .3333
7 1.3333 -1.0000 0.1245 2.3333
8 1.0000 -0.6667 0.0997 1.6667
9 0.3333 -0.6667 0.0764 1.0000
10 0.3333 -0.6667 0.0539 1.0000
11 0.3333 0.0000 0.0321 0.3333
12 0.3333 0.0000 0.0107 0.3333
1
W = X 110.1779
112.6667
Calculated W = 0.978 Critical W = 0.884
0.978 a 0.884
The reproduction data is normally distributed
evaluated at a 9996 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Effluent variance 7.4545
F = _ = 2.67
Control variance 2.7879
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
2.67 s 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

EQUAL VARIANCE t TEST
24.7 - 25.0
t = _ -0.361
0.924
Degrees of freedom = 22
Critical t = 2.508
-0.361 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99% confidence interval.
Chronic Test PASSES

Pace Analytical Services,LLC •
e
IN ace Analytical 9800 KinceyAve. Suite 78
trtiww.patdabS.toA Huntersville,NC 280
[phone]
July 29, 2021
Brandy Johnson
City of Statesville
693 Bell Farm Road
Statesville, NC 28625
RE: Project: NC0031836 Toxicity 4th Creek
Pace Project No.: 92549152
Dear Brandy Johnson:
Enclosed are the analytical results for sample(s)received by the laboratory on July 13,2021. The results relate only to the
samples included in this report. Results reported herein conform to the applicable TNI/NELAC Standards and the
laboratory's Quality Manual,where applicable, unless otherwise noted in the body of the report.
Some analyses were subcontracted outside of the Pace Network.The test report from the external subcontractor is
Cached to this report in its entirety.
The test results provided in this final report were generated by each of the following laboratories within the Pace Network:
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
Sarah Graham
[e-mail]
[phone]
Project Manager
Enclosures
A• REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
�j� without the written consent of Pace Analytical Services,LLC. Page 1 of 12

Document Ivonrc. -- Page 1°#2 ;
Office Sample Condition Upon Receipt(SCUR) Issuing Authority:
icap-- Document No.: r
f-CAR-CS-033-Rev.07 Pace Carolinas Quality ,
Laboratory
ville receiving lEdenD GreenwoodAsheville❑ Eden[ G 0 Huntersvifle'� Raleigh Mechanicsville❑ Atlanta❑ !
Sample Condition Client Name: Project St4Wp##.: 92549152 i
Upon Receipt ` • Ci� — ... , . ..
{11111�1{1{I{11�1111�{ I
❑Commercial
Pace ❑Other: 92549132 ��--
N Seals Intact? Dyes F-�N° " F )
Custody Seal Present? ❑Yes No BaInitials Reccan Examining•6onten
Biological Tissue Frozen?
Packing Material: [�
Bubble Wrap . Bubble Bags (None 0 Other ❑Yoles ❑lT �/A
Thermometer: 3Wet Delue ❑None
IIR Gun 10: 92'j_ 064 Type of Ice:
cam/-, Correction Factor: Temp should be above freezing to 6'C
Cooler Temp: --�-- Add/Subtract(DC) ❑should out of tempezincriteria.Samples on Ice,coaling process
6 t'4 has begun •
Cooler Temp Corrected('C1: `•L
USDA Regulated Soil(. 'N/A,water sample)
Did samples originate in a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samplesori®nate from a foreign source(internationally,
• Including Hawaii and Puerto Rico)?Des ONO
ill
Yes ❑No Comments/Discrepancy:
Chain of Custody Present? 1!Yes ❑No ON/A 1.
Samples Arrived within Hold Time?
esNo ■N/A 2,
•
Short Hold.Tlme Analysis <72 hr.)?
Alves INC ON/A 3.
• Rush Turn Around Time Requested?
■Yes ►'.No ON/A 4.
es �No ON/A 5.
Sufficient Volume? Yes ON ON/A 6. •
Correct Containers Used? •
Eyes It.No ■N/A
-Pace Containers Used?
FA Yes ■No ■N/A 7.
Containers Intact?
Ives ■No [1 /A S.
Dissolved analysis:Sam•ies Field Filtered? es �No _ QN/A 4.
Sample Labels Match COC?
-Includes Date/Time/ID/Anal is Matrix: __-V_= r
'Yes II No 7 WA 10,
Headspace in VOA Vials(>5-6mm)? Dyes ONO it /A 11.
Trip Blank Present?
II Yes ONo F. /A
Tri• Blank Custody Seats Present? Field Data Required? ❑Yes ONO
COMMENTS/SAMALE DISCREPANCY
Lot ID of spt it containers:
CLIENT NOTIFICATION/RESOLUTION
Date/Time:
Person contacted: /� '] ,
Date: _ T of v
Project Manager SCURF Review:
Date:
Project Manager SRF Review: Page 2 of 12

Document Name: ww,ncut ___. -_. .
, ..(/. „ Sample Condition Upon Receipt(SCURj_
e 7 of
—� f1C8 (la lCc3 Document No.: Issuing Authority:
F•CAR-CS-033-Rev.07 Pace Carolinas Quality Office
"''`-ck mark top half of box if pH and/or dechlorination is Project# r`,{O ; 9249152 •. 1
ied and within the acceptance range for preservation PM: SMG Due Date: 08/03/21
samples.
Exceptions:VOA,Coliform,TOC,Oil and Grease,DRO/S015(water)DOC,LLHg CLIENT: 92-Ci tyofSt■ )
**gczttom_ha.1.f_af_bax_is_to_list_number_of_bo.ttles_—
c v, c- ` z z
o Y m z b M . ro
ZZ. Z 7�7 U z c — ro N-'-V-"��a�.� _ Q .tea- �- Z n -
�'�1_. n 7is v Y = � ,., � -1 Z• 9 d =
z c. m ... N a = a V p ` m = - M Z , ...„, t'„ T c c 0.
v m a 01 O O C —° ° c O E z O� 0 0 } b a m °
c ' a c N z Z o -o Q u ° ''A s -- r 2 E.
0 g✓ u a .°
> > u c u 2 . • r = lv s t E o z a S Y Y 'c _ E c
. u .S G % E - - E Jo E o p <O O ' w 6 n «, 4?� a ,n E
1 n m 3 c E t ¢ E ¢ n > > J a a E E . E E E
a c a �" a Q. a J E ¢ ¢ ¢ � �
E E v1 ppF E E - °1 :: D rn{,� E E oE a ' > ,, N N 0 g o p
Q L'1 Jt N 7 ey rlLL' N 71 N C ' 0 . 7 X Y N N S' Q 7 7 01
E c m 6 a a a a 6' - a a m ti M m as+ t; m < 6 v~i N , d t N g a
�7 ly t9 4 ¢ Q O j > ° 9 in w — m C D
6/ m � m m SO m m ei $ � C C 6 ¢
i \ k\\\ \. \,\.\'' . ,
... 2 \
\\:\ \' \ 1 \ • i 1
3 \ \
i
t *\\\.\
\\\\ L
5
\ 1 •
B \
\\\\1'.
9 \
• 10 — \ I \-\\
11 \ \ \\
12 ik. :\ \\-- \\
pH Adjustment Log for Preserved Samples
Sample ID r Type of Preservative pH upon receipt Date preservation adjusted Timea resery aatian Amount oof Preservative Lot II
ded
"'ate: Whenever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina D£I-INR Certification Office(i.e.
ut of hold,incorrect preservative,out of temp,incorrect containers.
Page 3 of 12

. .
ki.•
-- - "•
.. . • • •- ••• •-• •
. . .. . . ,.. . .
..... . . ., .. ....,-..tsictiltPts-Pwwil. ......„.„syluuci,.
vollialyvvi406.11511tov4.40:00:t4:4buiatui:q0iiii :ilogi,,.?0Vilddas:liliMin:1404.
.. flOilblegViod40.6.4501!tOlOW0*11014*0-41011v1644 i -411140as up00:14,40104-00Axtrn;0.***460$.1:AciT9'13140'6' 04:10*".5,10014:tii4400tumr10•00190.4.,*i
i#14$.1.0010:6.:p9w4q#44.4sinia P.1.F•4044*.A4FiPojo04 ,04,040-iptikituvocIsinpli*oicoatocitionp:Ani,4001:jdii.ret ,p9p94•4444Wexhio,paparo!ci Iti**diisit'a#Soilu#0.3*)
. ,. .
.......... _;..0iii-3-015ouif oragothiclitkirtitregovaL .. . sztrnsi.W.ridbkitikitnausOiiiie41..
...ittljiit5diterrr.L.cribik .....,..... .. . .
' - ............
.iiimi•: .,..slum,.:.„. um.: , • .•..,•,. ::., • ,... .......... .:. ..,.. .,-...
- • . . -: , . ........ . . ... ... ... . A f all.. :.,
11111011.11111111111111111111111.1111111 .... .• ..... .
... ., . .......... , ...
••• .
11111111111111111111111 - --- -'. - ... '-- Afillii_ . .
:. •
11111011111313FAIIIIII - f ' / IIINIIOIIIIIIIMIIIMIINNINOIMII' IMIllreAllt.01111M
1111•11 .. • • - .111111111111•11111111111: 61111111111011111111111111.11Mak.'
.qp.)4PF,3.4 •:. Pil•u ..L ; .;,..pi.24 .7 ,r...1.paApPril • . ... •.,,._:0 1,,,.,'MR'''.'..1.1 141:11.1:.. • We
- ?'
40640/0ffigns
...
.. ,:i0c: •••"!".':.,:: .., 1.7(7,3'.::..-.:..:..5'''.d,,;Imimium____. -
.40,.....5.,,..*,
•
Numumunonnimimimimamiliairit ,
. ,
,.
El 32I
. .. eimii.,..,,.:.,,..„3
p., a
• '" • "
•••'•::iii. • 1!"'41110014414V.Wag", •, __; ...°1'.„t,i°.•;... g..;,,,, .• ...........-7:ro., 77-!. ,--A 4,4.45mTwia.. ..::::.,:,. 'z'suAms .-7 ..,1.7-.nows
A . :..,,. -:, A_ ivg.pgagp.:Tik • '
!oio . -raw. •-.. ..: '149.Pc0.1.tiRpm*i§*r s, i
• .lwen tosatf4; re '
,C1 - •,, ' OilkoittrIA0-474,5i • Afiticiiu03) '• z .
'. 5. , . •i, i..,. • ‘ ••
,, .. .—.-. ••.
• . -,...:AirY.: 0.1......,• 1=1103 • , ; 11111111111101111111k1k3- -.qr. , .- - -4 FaCt-l-M • • ',.:1P1•IRS
Ass, '• . .... ,
— ,sppoppgliprwiso • . '
-...,. .., ...... ... ,..... . . .....,.... • - •. . ' •Lki-tl.a;Cliniki
• ' '••-- - ••••-
..E-0.tr.isa..i411=1 ult.13•4
-- --•- - ,._. ...... . ---•
•-'• - ••••• • . ... ..
. •!-Ictortv.45.1«&igiii461.tioNTI:4
iliviok:pluwto-iii44. :47.**40,?:110 :
itterilit:(vai* ****01fOrti-glirsta
_
1—• 41'" : ' • 2•' L_,I.. $ . IL:ri'• 1
WI e.41
..sq.41-74-Wiraaa"S41:*a[,..g.r.. NI ir•'''
-0 fall0D--Ili-- NAIDIS. In—. iit. 0 NINTED ,.
. _
CD .
04' ,
•
Ae''.- . •
. ....._
,--_,
.._ .
4- .

•
Document Name: uocument tcevlseo:uctooer L5,LULU
9aceAndyticat4 Sample Condition Upon Receipt(SCUR) Page 1 of 2
IDocument No.: Issuing Authority:
. , . 1_ (
F-CAR-CS-033-Rev.07 Pace Carolinas Quality Office
aboratory receiving samples:
hevilie❑ Eden(' Greenwood 0 Huntersvilie/ Raleigh❑ Mechanicsville❑ Atlanta❑ KernersvilleD
WO# : 92549152
Sample Condition Client Name' � r 1 •
Upon Receipt �,l- -�✓ , f et q:
C�-/'�r--lf-- t6A-46r.ol.e..
..._ .. PM: me Due Date: 08/03/21
Courier: Y c nilSpc Zrlipnt _ CLIENT: 92-CityefSta
❑Commercial Pace [Other:
Custody Seal Present? Oyes trio Seals Intact? ❑yesQfNo �
Cate/Initials.Fercon-Examiniag�ntentaFr1 i 7 4 2/
Packing Material: ❑Bubble Wrap ❑Bubble Bags Zone ❑ Other Biological Tissue F en?
Thermometer• Dyes ❑No N/A
Cur ID:IAZr et ❑Blue ❑None
92T064 Type of ice:
j ` Correction Factor:
Cooler Temp: r Add/Subtract °C) _(j,1 Temp should be above freezing to VC
Qsamplesout of temp criteria.Samples on ice,cooling process
Cooler Temp Corrected('Sje l? has begun
USDA Regulated Soil(JZ'N/A,water sample)
Old samples originate in a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(internationally,
[Dies ❑No including Hawat and Puerto Rico)?pees ❑No
Comments/Discrepancy:
Chain of Custody Present? . Yes DO ON/A 1.
Samples Arrived within Hold Time? - QNa ON/A 2.-
Short Hoid,Tlme Analysis(<72 hr.)? YesDN/o ❑N/A 3.
Rush Turn Around:rime Requested? ©Yes j6No .ON/A 4.
efficient Volume? jeres ❑No ON/A 5.
Correct Containers Used? s ❑No ON/A 6. , •
-Pace Containers Used? Tres ❑No ON/A
Containers Intact? "' ONo ON/A 7.
Dissolved analysis:Samples Field Fiiitered? Ilk, ONo I/A B.
Sample Labels Match CCC? Ai Yes ❑No QN/A 9.
-Includes Date/Time/ID/Analysis Matrix: ‘,1I
Headspace in VOA Vials(>5-6mm)? ❑Yes Q /A 10. • •
. Trip Blank Present? ales ZNo ON/A 11.
Trip Blank Custody Seals Present? Dyes ❑No N/A _ -
COMMENTS/SAMPLE DISCREPANCY Field Data Required? DYes ONO
. Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
•
Person contacted: Date/Time:
/ /
rroject Manager SCURF Review: Add Date: '"( .-L_\
Project Manager SRF Review:
.,41/ Date! Q -I 4 -\
Page 5 of 12

I r
0N 1-. O 1.0 CO '1 ITW. - W N 1-1C : / Iternk
a /�,�/✓ //�/'//� p ( / )( ) wan 3 `° m
BP4U-125 mL Plastic Un reserve N A G- ,4Or v 3 ".. ro
o p N N ca.
0 BP3U-250 rnL Plastic Unpreserveil(N/A)
o ft
T $PZU-S00 mL Plastic Unpreservef(N/A) Al 2 Q' 7C
m I r, I"' o oh
2 n 9 pPiU 1 liter Plastic Unpreserved dN/A) g 5 �, q,
m BP45-125 mL Plastic H2SO4(pH< )(G-) 7r -+.
4/7
o w i i BP3N-250 mL plastic HNO3(pH< ) A 0 n O
m x n
3 , �, BP42-12S mL Plastic ZN Acetate &NaOH(>9) "* c. -% a
P. _ / / C G/ 3 'O
0 0 0 / / / BP4C-125 mL Plastic NaOH (PH>IL2)(Cl-) N rt• gu
4 5 ff /// t 'u w 3
a o Y WGFU-Wide-mouthed Glass jar L npreserved 6 p Ott e
0 0 k o - . N
a —_ Q / / / / J / / AG1U-1liter Amber UnpreservedIN/A)(CI-) • o 3 m
• 13.
m C C J f / / /// /! ! / (P ) If w p Fa
H 3 a rt AG1H-1 liter Amber HCI H<2 (9 F
'5 3 =. „ g
ro m 3 AG3U-250 mL Amber UnpreservId(N/A)(ci-) o G11 D o 0 0
et O N = 731 0 :1 n
a t O / AG35-1 liter Amber H2504(pH<2) r O Y' m
`�° 3 I 3 W R
d n p AG3S-250 ml Amber H2504(pH.r2) °O Lir ,0 2
3
o a //t " / AG3A(DG3A)-250 ml.Amber NH4,[I(NJA){G-) V C 19
in
n• C _ y t)G9H 40 mL VOA Ha (N/A) I (ins
m ID
VG9T-40 mL VOA Na25203(N/A) n p
c n' to 3t
a VG9U 40 mL VOA Unp(N/A)
o
m DG9P-40 mL VOA H3PO4(N/A) g
o V n
c
VOAK(6 vials per kit)-503S kit(N1A) al D
z r ro
o �' V/GK(3 vials perkit)-VPH/Gas klt(N/A) N A
n
c - 0 E. -* <
d P. SPST-125 mL Sterile Plastic(N/A tab) N D
a 51-
K.
9- C
o rri a SPIT-250 mL Sterile Plastic (N/Ai-lab) ) e 2, 0
I 0
�° a /77 .
ri . V O CI
NJ
ro / I n pp
w /// BP3A-250 mL Plastic(NH2}2504(9.3.9.7) N
0
o AGOU-100 mLAmber Unpreserved vials(N/A)
o ,
-o VSGU-20 mi.Scintillation vials (NiA)
cn `° it -
o m
rn DG9U-40 mL Amber Unpreserved trials(N/A)
i
o
N

N
O
ETT
CHAIN OF CUSTODY RECORD N.
_
wxt
j
1Page of
PO Box 16414,Greenville,SC 29608-7414 1
[phone], [phone] Fax[phone] •
Shipping Address:4 Craftsman Ct.Greer,SC 29350
W W W.CTTCN V INONM ICNTAI.COM
Client:
o f1---L.�{� y+
/ 1 P 1 f S -4-eso i 1 ke Program Containers !Preservative Parameters
Facility: t', C Y Q. K -rip
State: Ili c. NPNPD>S it: /UC' 3 I�3 3( _„ChWhronic
�e,Tt t Or;tr a
t G = Acute Chronic 'rest Orannisnis
S
U GIQ
o O w°
a _
11 (Composite only) Grab or Composite) o r- o id ('
a ( P ) ¢ pp8 .0 T p a
Ix
Sign,and Print below 3 M t m e 2-HCL 1.112504 = "' w $ m ei E ,u > P<
the dotted line U _ o a=1iNo3 e+ `2 2 i 1g `' 12
t� -. E E (-3 rn c 4=Nspy .2 2 p o '� 2 ;7 u w o l; a
SAMPLE ID t7 ComposiueStintDate Time Snmpic Collection Dole Time Collected by CJ r.13 rn Z n q (7 > 5=Zvdic o u 3 � 4 > .' j _ [Pi a
1�, - f, 5=oumc '� U V U Ci w rn .'F. U F- 3 2 Chemical Analysis&other
y 6re
,- 1ue n+ C '`:-'-`- �'- j—) ► v� a X ( Y X X
- 11y1a,1 • 1-1151at
•
Special Instructions:
. Poss ) Ei .1 y 5 7o
Sample Custody Transfer Record Secure Receipt Sample
YDate Time Relinquished By/Org: ization Received By/Organization Area Temp°C Preserved?
1, al Off',brit 4 tiir,„)
/ {c. (43a & 1PPc_. _ I `v/ r
L 1
•
COMPOSITE'SAMPLING PROCEDURES TEMPERATURE MONITORING PROCEDURES HOLD TIME PROCEDURES
Composite samples must be collected over a 24 hour period. Sample temperature during collection and transport must be between For toxicity testing the sample must first be used within 36 hours
Time Proportior--' - nple each hour for 24 hours.Equal volt]]0.0 and 6.0°C.Samples must not be frozen.Use e ' in sealed bags. of sample collection(completio 1 of composite sample'
or at minimum ;every 4 hours over 24 hours. Sample may not be used after 7 t hours from sample c i.
Row Propot sr instructions in NPDES permit. .

ET
environment/.inc. (F64)B77.6942.FAX[phone]
•
P.O.Box 1t414, Greenv►le, 5C 2.9606 4 Craftsman Court,Grier,SC 29650
Ceriodaphnia dubia Survival and Reproduction Test
EPA-821-R-02-013 Method 1002
Client: CITY OF STATESVILLE
Facility:4TH CREEK
NPDES#:NC0031836
Test Date: 14-Jul-21
Laboratory Sample ID#:T59636
Test Reviewed and Approved By:
Robert W.Kelley,Ph.D. Patrick D.Timms
President QA/QC Officer
• (.TN.
.4FLOCIRAIY Certification#E87819 SCDHEC Certification#23104
Test results presented in this report conform to all requirements of
NELAC,conducted under NELAC Certification Number E87819
Florida Dept.of Health.Included results pertain only to provided samples. NCDENR Certification# 022
Page 8 of 12
Page 1 of 5

•
i Effluent Aquatic Toxicity Report Form/Phase II Chronic Ceriodaphnia
Facility: CITY OF STATESVILLE 4TH CREEKri
NPDES# NC0031836 Pipe# 001 County: Iredell
'
atory Performing Tes- ETT Environmental,Inc.. Comments:
4
Signature of O.R.C. Signature of Lab Supervisor
Test Start Date Time End Date Time
Info 07/14/21 2:10 07/21/21 10:19
Sample Information Sample 1 Sample 2 Control (Start (Renewal 1 'Renewal 2 (Start 'Renewal 1 'Renewal 2 '
Collection Start Date 07/12/21 07/14/21 Treatment 90% 90% 90% Control Control Control
Grab pH Init. 7.5 7.5 7.6 7.8 7.8 7.8
Composite(Duration) 24 hr 24 hr pH Final 8.2 8.2 8.3 8.0 8.0 8.3
Hardness(mg/L) 85.4 D.O.!nit 8.5 8.2 8.9 8.3 7.7 7.7
Spec.Cond.(umhos.cm) 356 368 321 D.O.Final 8.0 7.8 8.3 7.5 _ 7.7 8.4
Chlorine(mg/L) <.05 <.05 Temp!nit 25.0 24.7 25.2 24.7 24.5 24.6
Sample temp.at Receipt 3.0 1.4 Temp Final 25.9 25.7 25.2 25.9 25.7 25.2
Chronic Test Results
Final Cont Mort.% 0.0%
Organism# %Cont3rd Brood 100%
1 2 3 4 5 6 7 8 9 10 11 12 Mean Control Repro CV 9%
Control #Young 18 21 20 19 21 25 21 19 19 22 none none 20.5 48 Hour Mortality
(L)ive
(D)ead L LLLLLLLL L none none Control IWC
0of10 0of10
1 2 3 4 5 6 7 8 9 10 11 12 Mean Significant? No
^ffluent% #Young 20 16 22 18 23 19 21 23 18 25 none none 20.5 Final Mortality Sign.@
Adult ,.Red
(L)ive
3% (D)ead L LLLLLLLL L none none o.o% % or n0 COnC
Reproduction nalyses
1 2 3 4 5 6 7 8 9 10 Mean Repro LOEC= >90.00% NOEC= 90.0%
Effluent% #Young 25 18 20 20 20 18 18 20 18 21 19.8 Method: Steers Test
Adult %Red Normal Dist? no Method Kolmogorov
(L)ive
22.5% (D)ead L LLLLLLLL L 3.4% Statistic 1.182 Critical 0.895
Equal Var? NA Method
1 2 3 4 5 6 7 8 9 10 Mean Statistic Critical
Effluent% #Young 18 20 21 22 17 21 21 21 24 20 20.5 Non-Parametric Analysis(if applicable):
Adult 'i Red Method: Steel's Test
(L)ive
45.0% (D)ead L L L L L L L L _L L 0.0% Effuent% Rank Sum Critical
11.3% 105.50 75.00
1 2 3 4 5 6 7 8 9 10 Mean 22.5% 91.00 75.00
Effluent% #Young 17 18 19 18 21 17 19 19 17 0 16.5 45.0% 108.00 75.00
Adult %Red 67.5% 70.00 75.00
(L)ive
67.5% (D)ead L L L L L L L L _L L 19.5% 90.0% 89.00 75.00
Overall Analysis IC25= >90.00%
1 2 3 4 5 6 7 8 9 10 Mean Result=PASS/FAIL or
Effluent% #Young 17 17 19 19 21 19 21 22 19 19 19.3 Test LOEC: >90.00% NOEC= 90.0%
Adult %Red
(L)ive
90.0% (D)ead L LLLLLLLL L 5.9% Chronic Value= >90.00%
Environmental Sciences Branch *Should use highest test concentration or
L Division of Water Quality highest concentration with D.O.>5.0 mg/I 1
N.C.DENR %Reduction from Control Reproduction Mean
TO: 1621 Mail Service Center
Raleigh,NC 27699-1621 DWQ form AT-3 (8/91)Rev.11/95
Page 9 of 12
Page 2 of 5

•
Test Day 4
source re 1 2 3 4 5 6 7 8 0l a T59636
V4/-2 A 4 +4+1U 18 control Client CITY OF STATESVIL .
D1 7-2 B 4 +8+9 21 Sample ID 4TH CREEK
D7 7-2 C +2+6 12 20 NPDESI NC0031836
1.
H5 7-1 D +2+6 11 19 County 0
H3 7-1 E +3+6 12 21 Month 7
W1 7-2 F +4+7 14 25 Start&fed Date 14-Jul-21
MS 7-1 G +3+7 11 21 Start&fed Time 02:10 PM
06 7-1 H +4+6 9 19 Started&fed By AM
KK6 7-7 I +3+5 11 19 � Test Organism Ceriodaphnia dubia
116 7-7 J 4 +7+11 22 1 Neo.born date 13-Jul-21
A 4 +b+1U 4U Neo.born time 1715-2200
B +2+5 9 16 Test Type NCCD
C 5 +8+9 22 Dilution Water MHSF
D +3+5 10 18 Units for Conc.
11.25 E +3+8 12 23 %3rd BROOD
F +3+6 10 19 Test vessels 30m1
G +3+8 10 21 Test volume 15ml
H +4+7 12 23 Incubator# 1
1 - +3+6 9 18 Light 161t/8dk
J +4+8 13 25 20.5 Initial Temp C 25
A 4 +1U+11 2S Selenastrum 0.05 ml
B 4 +6+8 18 YAT 0.05 ml
C +2+5 13 20 Test method EPA 921-R-02-013:1002
D - _ +3+6 11 20
22,5 E +3+5 12 20
F +2+6 10 18
G +3+6 9 18
H +3+7 10 20
I +2+5 11 18 i.ommenls
J +3+5 13 21 19.8
A 3 +b+9 18
B 4 +7+9 20
C 3 +8+10 21' Control ird temp
D +4+9 9 22
44 E 3 +6+8 17
F +3+5 13 21
G +4+7 10 21
H +4+6 11 21' 67.5%REP J=FEMALE IS DEFORMED
I +4+8 12 20
J 4 +7+9 20 20.5
A .3 *S+y 1/
B +3+7 8 18
C - 4 +6+9 19
D +3+5 10 18
47.4 E +3+7 11 21
F +3+6 8 17
G +2+7 10 19
H +4+6 9 19'
I +4+5 8 17
J 0 0 0 16.5
A 4 +b+/ 1/
B +3+5 9 17
C +3+5 11 19
D +3+6 10 19
g E +3+6 12 21
F +4+5 10 19
G +3+7 11 21
H +3+8 11 22
I +4+6 9 19
J 3 +6+10 19 19.3
Renew AM AM End Date
Fed JC AM JG JZ AM JC 21-Jul-21
Time fed&renew 0748 AM 02:29 PM 08:40 AM 07:56 AM 10:41 AM 07:34 AM 10:19 AM I JC
Effluent New temp'C 24./ 2b.2 D=Dead N/A-Lost or not used
Old temp.'C 25.9 25./ 2b.2
Control New temp.'C 24.5 24.6
Page 10 of 12
Page 3 of 5

I, 1 r ,
CHAIN uF CUSTODY RECORD
PP: r
m6 n.w�c t6 o pSd` t'.•_ Page of • f
PO Box 16414,Greenville,SC 29606-7414
[phone], [phone] Fax:[phone]
Shipping Address:4 Craftsman Ct,Greer,SC 29650
W W W.5TTEN Vi R 0 NMENTA4.COM
BClient: n .
l j /_� p. �I-rke501 tl-e. Program Containers Preservative Parameters
Facility: Li..0-) C ,..0 l.��� fi
Whole L•rnuent Toxicity Q
State: N ai T\TPD1$ �Qa3 a co
Acute Chronic' Test Orgonisms tl
c U — o Lo
u (Composite only) (Grab or Composite) < y o al U U G c Z
r = C7
a a 1=HeSO4 H o ._ ._ I Fi 1
__ Sign,and Print below L.. c z.HCL r — _ ;o< s
the dotted line ^ cam' U o y s=rtNoa u y E E z --- '", u °l_ 0, 4
U• e� 5=Zn.4e u oto
SAMPLE ID CompositcStart Dnte Time Sample Coltcaion Date Time Collected by U Ca" on Z i= U > 6.Odtnr E E i� U Ci d ~U - 3 i Chemical Analysis L Other
r
� 0 i 1-1-- 4,,,b.i.)
•
Special Instructions:
- ....W _. l
P s s --Fa i 5 c/a .
Sample Custody Transfer Record Secure Receipt Sample
Date Time Relinquished By/Organization Received By/Organization Area Temp°C Preserved?
k3Jj5-- igtilk. k( C7i jeoht.5_007/ I I
• /Feld C o /Srr ( jf /2.� I I t.a I
I � 1 I I
COBIPOSITE SAMPLING PROCEDURES TEMPERATURE MONITORIArG PROCEDURES HOLD TIME PROCEDURES
Coo osite samples must be collected over a 24 hour period. Sample temperature during collection and transport must be between For toxicity resting the sample must first be used within 36 hours
Ting Proportional:1 sample each hour for 24 hours.Equal volts 0.0 and 6.0°C.Samples must not be frozen.Use water ice in sealed bags. of sample collection(completion of composite sample).
or krninimum 1 sample every 4 hours over 24 hours. Sample may not be used after 72 hours from sample collection.
Flow Proportional:As per instructions in INNPDES permit. 1

ETT . CHAIN OF CUSTODY RECORD
iiipSi in?tli a 7a Ymll' rzi
�._ ���� .�°�3�3. o� Pale or
PO Box 16414,Greenville,SC 29806-7414
[phone], [phone] Fax[phone] .
Shipping Address:4 Craftsman Ct,Greer,SC 29850
WWW.ETTENVIVIIRONMENTA6.COM Client: l.0,l d f S-f r-i1_( j< U i 1 1
�+ ,r Program Containers Preservative' Parameters
Facility: Li} �l e ��p .K c i. _ - -
State: 1 V ( NPDES#: rV e,OD 3 1 j 3 f hroni Gmucnt TON; Q
Ac°te Chronic Test Organisms
n'
e o 1r o y � r,
• (Composite only) (Grab or Composite) < o o = a' . o z
U — N - 3 v
U = `o - •E., 1-I-L'tSO4 = = :�. o ;n_
Sign,and Print below y E o v HCL 2 - - �n �' _ C =` v:
the dotted line c c U .q y E s.Hnlos u �_ `-' a - " ? = <
U _ 4.1.,b01i : O r Ei v r _ ? ` L ?,
C. 7 7+ (aO 2' ems] a •o r' - o lj 5=ZnAc :] U a
SAIVIPLEID - Composite Start Date Time Sample Conertion Marl Time Collected by U rn rn 4 E (J 7 6=odter < <,U�U U ❑ ti .a v4 U i— . Chemical Analysis&Other
C6
- 10en+ C- "mit•sue ":��-T, � r--(2X 0.{ X X
[ '‘d:{VgAl
Special Instructions:
0 S S ) Fo i I H 5 VO . ___ .
Sample Custody Transfer Record Secure Receipt Sample
Date Time Relinquished By/Organization Received By/Organization Area Temp°C Preserved?
I J5L 1 co -r_AA. , ,. ,,,._, - 6 -- I I
1 ( , lL la 11! 1)-ti�QL� o?1b I l
ea
I I
ea
t�
Cf9MPOS!TE SAMPLING PROCEDURES TEMPERATURE MONITORING PROCEDURES HOLD TIME PROCEDURES •
Cyhposite samples must be collected over a 24 hour period. Sample temperature during collection and transport must be between For toxicity testing the sample must first be used within 36 hours
Tie Proportional:I sample each hourfor24 hours.Equal volut 0.0 and 6.0°C.Samples must not be frozen.Use water ice in sealed bags. of sample collection(completion of composite sample).
or at minimum I sample every 4 hours over 24 hours. Sample may not be used after 72 hours from sample collection. `
Flow Proportional' tr instructions in NPDES permit. ..
w •

• !f---
Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 05/20/21
:ility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
L ate •erfoi.i Test: MERITECH LABS, INC.
j - Comments:
X - . �jG
1 e of Ope toyn Responsible Charge
X 2-- - ---
Signature Laboratory Supervisor * PASSED: -6.55% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -1.322
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -6.55
% Mortality Avg.Reprod.
# Young Produced 19 22 24 24 22 22 24 22 25 22 24 25
0.00 22.92
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 24.42
Treatment 2 Treatment 2
Effluent %: 45%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
7.548% PASS FAIL
# Young Produced 28 27 24 23 21 17 30 23 22 25 27 26 % control orgs X
producing 3rd
brood Check One
1 I . t (L)ive (D)ead L L L L L L L L L L L L 100%
I- 1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 05/12/21
Control 8.03 7.87 7.96 7.90 7.91 8.08 Collection (Start) Date
Sample 1: 05/10/21 Sample 2: 05/12/21
Treatment 2 7.76 7.90 7.76 7.98 7.82 8.07 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 23.8 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 23.9 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness(mg/1) 48
Control 8.25 7.46 8.01 7.57 7.93 7.55
Spec. Cond. (pmhos) 168 356 378
Treatment 2 8.33 7.59 7.85 7.56 8.00 7.51
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 2.0 1.1
(Mortality expressed as %, combining replicates) I
Note: Please
% % a Concentration Complete This
% % % % % % %
Section Also
Mortality
% % % % % % % % % %
start/end start/end
ILC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit
% -- % Spearman Karber - Other - High
Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubiar- Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Meritech, (Lab # 027) -�
/ / Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#:
Client: ST4-6-'t//1/(J f�. Pipe#: ()I County: /',v(I `i// Date Start: -17 ` - .-- �k Date End: ( -
NPDES#: NC(��i3j' Date/Time of Culture Transfer:5 )/ / lrrl t'-1 -r} Time Start: /5 /1/ea Time End:
sq.Dilution Water: Lake Brandt Date/Time Neonates born: d % )—i>f�.M - L f_r'J,p9:�f) 1st Renewal Date: 9-, 14,L1 Time: (0, ,)_Ai
vt
Test Organism Source: Tray# 1-1 Age of onates at Test Start: ,T,9• 7 hours/ 2nd Renewal Date: ..C.,--/`7,--2./ Time: /0, rA_�
Stirred/Aerated for D.O.: Y/ Randomized: Y/ N Culture Tra Temp: `� S °
Y C Analyst(s): MR,LV,KS,KL Reviewed by: r
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Sample 1: `7 -I b -Z Sample 2: .5- r!2-,�/
Adults Live/Dead 'L•-- ice--- L- L___ C_ t____ j__ (,. L_ ( 1 L_ Sample Information
Day#5 1, 2 3, 4 6 7 8 1 Q 1 ° 12 100% pH G/C? Duration
#Young Produced ly 5 is Li 0 `vo' E- (4 I L` g-- 4t�A/ LI f 7//r' l,/ Zy Sample 1 7, 'i 9 C. ,�3 .
l t P hours
,r
Adults Live/Dead L - L L_ t— LL I__ L____ 1 __ �- L.-- L- Sample 2 7, ",-)--7 ._ 3, t hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12
� Transferred by: Fed by:
r7
#Young Produced /l %C, i i C 0 1 e� Batch# Sample 1 Sample 2
1 / ,/ � ? Day 0 t i L I;
Adults Live/Dead L.. L. 2__- L__ L„=_ L, L� - t Transfer Day 0 2 5 '. 4 p,!; Day 1 ,A/A,
Hardness 1 M r•�"`� 5
. (mg/L) 1I' ) _7 14' , z " s::
Total Produced C Day 2 /"tom- 1 '1/
,,'?9?9 9-ti ;-)f I ,?•9 �-tj ,,2?- '4 7�. ; ll. I2
Spec.Cond. Day 3 �-
/ (umhoslcm) 16 7 ` ') �j'7'�y /f�
Percent of Control producing third brood:(i- % �� ' Day 4 ILL,
Chlorine . = '' : Day 5 - L
onoTest Sample Organism Reproduction z .W Day 6 Receipt Sample E ' taiL
Effluent%: Temp.(CC) �� , _ {,�' �, 0 1, ) Terminated by: 4'1__
pH 1st Sample 2nd Sample 2nd Sample
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control ( f O 3 7,87 n6 ,',t(O 1 t ,�6,
Adults Live/Dead L , L 1_,... j ,.,,, /, I, L- L- L_ 1 ,
Sample 7f 7(, 7 C1° 7.76 7,96 7 ,Q7
Day#5 1 2 3 4 5 6 7 8, 9 10 11 1
initial final initial final initial final
#Young Produced C- 7 ry y r1 , ,-2
-'1 / (r, % 1Y7 ?/7 �, )S D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/Dead L_ L L-- L- 1___ L, L_ L__ L___ i___ L
Day#7 ��1, 2 3 4 5 6 7 8 9 10 1 12 Control t9,25 7,�65 8,01 /(17 7,jf
#Young Produced /%!:2 '�// / / )/ 3. /141 /' ) 9 ///f1 JL Sampler,) C j, `7 C,t e ._Z,
Adults Live/Dead 1.... (. 1. ' initial final initial final initial final
Temp. _ 1st Sample 2nd Sample 2nd Sample
Total Produced ,j�S�' 2 ' 5 2 �j�i r
-� v`_� � � �( i � � �r� °��-� ��� ,��% Control ��,2� ,,,9 .)1+7 )11* ) • 1 �'7
• ments: '
Sample Rj-? )Hr,), '91.4. )/ .V 2y
initial finwl ..r..i _.

ili ,
MERITECH, INC. (Lab #027) Meritech Sample ID#: GS`\ I. -I'
Bioassay Sample Chain of Custody
A. 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: [e-mail] Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client:C. '\I t ,S+0,3-€.5 L . I 1 e, PO#:
Contact Person: C .1{\C-)1/4 —Soh� � t NPDES#: NC f 3 I b��
Address: P. 0 . J O' 1 (1 \ Phone: -7 0 4 ,t 7 g 3(-1: 8
City: 5tf):,A.e_sk_ \ve, Pipe#: dl
County: Ill Q.,,1 ( State: it)L Zip: Y`(`'a
SAMPLE INFORMATION
Sample Site: 0k) Q_,R.Q,K ) ( -0 L� ,1
Sample Type: ❑Grab Composite #of containers: cR
Sampling Time: Start Date: ,5 i / 0 /, / Start Time: AM PM
End Date: ,5 1 / i /O 1 End Time: al PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print: :et-AG L,op9rnit, Signature: Z,
TOXICITY TEST INFORMATION
Test Required: Chronic(7 days) Test Organism: 'Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: 145 % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished by: � 7 Date: , Jji / Time: 41 ./ all PM
Received by:[/ y __ Date: // Time: 7 W r PM
Relinquished by: Date: �j/ '//z/ Time: y,. AM .PM J
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED** I
SAMPLE RECEIVING(Laboratory Use Only}
luished by: M'Cis. ' u,f1 L v1
t Received by: f€yr 9`' ‘N, Date: -41-2,1 Time: P(0 AM �vl
Sample Temperatures(°C): 1-A /'2,6 / _ / Sample Condition: I J IA
WHITE= Laboratory cony YFI I lW= r:liont rnnv

I
• MERITECH, INC. (Lab #027) Meritech Sample ID#: CS(D1—�
• Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: [e-mail] Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: QV1-\1\ C ,54_63ec 6, \ \O' PO#:
Contact Person: r oh t"\„__ r\ NPDES#: NC On 3123 j
Address: Q • t0. B U ' HI I l Phone: b 4Q r9__4 3 9
City: 3t- —A e' SLl\ \\e., Pipe#: Ol 1g
County: t('2 di to I State: k' c__, Zip: 3& 10,3 --
SAMPLE LE INFORMATION
Sample Site: qAk) \ ,�(` IJ�Th (,}Th P'_ 0 Ldt 1.,.! I
Sample Type: ❑Grabcomposite #of containers:
Sampling Time: Start Date: I i G, Ia Start Time:77/ c9 0 PM
End Date: : , I /3 ) a\ I End Time: T(� 0 PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collectors Name: Print: /II L•cLA5 0441-0N Signature:
TOXICITY TEST INFORMATION
Test Required: , Chronic(7 days) Test Organism: eriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: L s-% ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
ai] SHIPPING INFORMATION
Relinquished •�� „_ J ri� 4 Date: r Time: ell PM
At-
Received by: �'�� � 6Date: �� / Time: C ! AM PM
i s/'
O
Relinquished by: Date: '�� lj . , Time: 3= � AM 6)
Received by: °� Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING (Laboratory Use Only)
3
Relinquished by: ,.C.i, / uS O I tt\J
i n
Received by: I G Jvv ,'I Date: ` '3_`I Time: 2.Q AM RI
Sample Temperatures(°C): ' a I i'I / / Sample Condition: L c 4
WHITE= Laboratory copy YELLOW= Client copy

Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 05/20/21
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -6.55% CONTROL 45% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 275 293
Mean # Neonates 22.917 24.417
Standard Deviation 1.730 3 .528
Coefficient of Variation 7.548%
' Exact
Fisher's Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 17 -7.4167 13 E 25 0.5833
2 C 19 -3.9167 14 C 24 1.0833
3 E 21 -3.4167 15 C 24 1.0833
4 E 22 -2.4167 16 C 24 1.0833
5 E 23 -1.4167 17 C 24 1.0833
6 E 23 -1.4167 18 E 26 1.5833
7 C 22 -0.9167 19 C 25 2.0833
8 C 22 -0.9167 20 C 25 2.0833
9 C 22 -0.9167 21 E 27 2.5833
10 C 22 -0.9167 22 E 27 2.5833
11 C 22 -0.9167 23 E 28 3.5833
1 12 E 24 -0.4167 24 E 30 5.5833

411
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 5.5833 -7.4167 0.4493 13.0000
2 3.5833 -3.9167 0.3098 7.5000
3 2.5833 -3 .4167 0.2554 6.0000
4 2.5833 -2.4167 0.2145 5.0000
5 2.0833 -1.4167 0.1807 3.5000
6 2.0833 -1.4167 0.1512 3.5000
7 1.5833 -0.9167 0.1245 2.5000
8 1.0833 -0.9167 0.0997 2.0000
9 1.0833 -0.9167 0.0764 2.0000
10 1.0833 -0.9167 0.0539 2.0000
11 1.0833 -0.9167 0.0321 2.0000
12 0.5833 -0.4167 0.0107 1.0000
1
W = X 163.2543
169.8333
Calculated W = 0.961 Critical W = 0.884
0.961 a 0.884
The reproduction data is normally distributed
evaluated at a 991; confidence interval.
Test Passes!
F test for Homogeneity of Variance
Effluent variance 12.4470
F = _ = 4.16
Control variance 2.9924
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
4.16 s 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

EQUAL VARIANCE t TEST
22.9 - 24.4
t = _ -1.322
1.134
Degrees of freedom = 22
Critical t = 2.508
-1.322 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 990 confidence interval.
Chronic Test PASSES

1
® Pace Analytical Services,LLC
ceAnalytical 9800 Klncey Ave. Suite 100
Huntersville,NC 28078 /
www.pacdabs.con
[phone]
r
May 03, 2021
Brandy Johnson
City of Statesville
693 Bell Farm Road
Statesville, NC 28625
RE: Project: NC0031836 Toxicity 4th Creek
Pace Project No.: 92532839
Dear Brandy Johnson:
Enclosed are the analytical results for sample(s)received by the laboratory on April 13,2021. The results relate only to the
samples included in this report. Results reported herein conform to the applicable TNI/NELAC Standards and the
laboratory's Quality Manual,where applicable, unless otherwise noted in the body of the report.
Some analyses were subcontracted outside of the Pace Network.The test report from the external subcontractor is
Med to this report in its entirety.
The test results provided in this final report were generated by each of the following laboratories within the Pace Network:
If you have any questions concerning this report,please feel free to contact me.
Sincerely,
A
et„.61
Sarah Graham
[e-mail]
[phone]
Project Manager
Enclosures
f . . - REPORT OF LABORATORY ANALYSIS
r This report shall not be reproduced,except in full,
/ without the written consent of Pace Analytical Services,LLC. Page 1 of 12
.�+'. ,`iy

• Document Name; Document Revised:October 28,2020 t .
aceAnalytical Sample Condition Upon Receipt(SCUR) Page 1 of 2
7Document No.: Issuing Authority:
_ F-CAR-CS-033-Rev.07 Pace Carolinas Quality Office s
Laboratory receiving samples:
,/--qmville ❑ Eden❑ Greenwood ❑ Huntersvi)le Raleigh MechanicsvilleD AtlantaD Kernersville❑
'c
Sample Condition Client Name: 1 • ' iO� . �������� -
- Upon Receipt - C 1�`y 06 G7'r Jdj(. Project#: w •
Courier: . ❑Fed Ex ['UPS ❑LISPS ['Clientquill11111111I1111111
El Commercial . "pace ❑Other
92532839
Custody Seal Present? ['Yes 'No Seats intact? Des "lo '///��Z/17
Date/Initials Person Examining Contents:
•
Packing Material: ❑Bubble Wrap ❑eubble Bags ]None ❑ Other Biological Tis ue Frozen?
Thermorr ter: C/2-7a \• e ['Yes ONo N/A
Ell �JWet ❑Blue ❑None
LJ IR Gun ID: Type of Ice:
Correction Factor:
Cooler Temp: I y Add/Subtract(°C) 0.0°C Temp should be above freezing to 6°C
[Samples out of temp criteria.Samples on ice,cooling process
Cooler Temp Corrected(°C): 7 has begun
USDA Regulated Soil(t,N/A,water sample)
Did samples•riginate in a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source nternationaily,
Dyes io including Hawaii and Puerto Rico)?['Yes No
Comments/Discrepancy:
•
Chain of Custody Present? .Yes ONO ON/A 1.
Samples Arrived within Hold Time? . Yes ❑No ON/A 2.
Short Hold Time Analysis(<72 hr.)? ayes ONo ❑N/A 3.
Rush Turn Around Time Requested? Dyes `QNo ❑N/A 4.
efficient Volume? Yes ❑No ❑N/A 5.
Correct Containers Used? "Yes ❑No ❑N/A 6.
-Pace Containers Used? 'yes ONo ❑N/A
Containers Intact? 'Oyes ONo ON/A 7.
Dissolved analysis;Samples Field Filtered? ❑Yes ❑No "QN/A 8.
Sample Labels Match COC? Yes ❑No ON/A 9.
-Includes Date/Time/ID/Analysis Matrix: 1.-13
Headspace in VOA Vials(>5-6mm)? ❑Yes brio �N/A 10.
Trip Blank Present? Oven ONo I�1N/A 11,
Trip Blank Custody Seals Present? Oyes ONo v�/A
COMMENTS/SAMPLE DISCREPANCY Field Data Required? Dyes ONo
•
•
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
PP,son contacted: Date/Time:
Project Manager SCURF Review: a+4 Date: tA--6-),1
Project Manager SRF Review: � 1 Date: 1-15--.v
Page 2 of 12

f _
Document Name: Document Revised:October 22,2020
I
aceAnalyticaJ* Sample Condition Upon Receipt(SCUR} Page 2 of 2
+- --' Document No.: Issuing Authority:
'i l f F-CAR-05.033-Rev.07 Pace Carolinas Quality Office
*Check mark top half of box if pH and/or dechlorination is Project
r--Tfied and within the acceptance range for preservation WO# 92532839
es. PM: SMG Due Date: 05/04/21
E.___,__.ens:VOA,Coliform,TOC,Oil and Grease,DR0/8015(water)DOC,LLlid CLIENT: 92—Ci tyofSta
**Bottom half of box is to list number of bottles
.. a U V i , Q
o a u :6-
r, Z z
Z z Z a 2 2 a m iv `�
2 N 2 N a 2 ry Z rD rit 'j A
d v �i v v °� n d N v v ,- I cc a Q .>
2 Z 2 a S v c� Z v s. x ¢ 2 x a '' Z 1
c1 ti ` N V O u S N N , 21 V o ` M Q ? M ' U L., N N a y 1
ia te. r7 v O Q fl 2 a. a a O R .o p Z a c .. Yn N P.
ry = Z 1p NJ z t' u D N 2 - vNi 0 to > f6 iO Z M o c
n - �, a c`, , a E x z Sr Y ar w ct S' =°
N C
2 N Ip N rC f4 fa 7 -0 C O Q Q g ` N
n. a a A a P. a a E E E ¢ E a N > O > 5 i' a vn H a Q .0 E
J r J a _I .� G Q J Q > > > >
E E E a E E E E 4 `a ° CD E d A ° J J
E —'
noS .. � oI v, -. oLarnqo 1 q z' ' N oS O cr-, N t1' ri N . . r1 ' N H N Q . a N1 ra 7 7 o2 N C ,3 'y ,y m v-i mu' A c T m 0 Q ,; t O M 2 ,3 az es ® m m '2,- 2". m m ¢ Q C Q C
> > E tJ a a 8
1 1 \_ .,\.,\,\,,\ \\ •
�
\ -
3 \
\ \ . I
4 \ \ \
\ 10 .
\:\ \\N
i " \\.
_ \
_ \
2 sk \
\\\\\
ill
9 '.\ \\\\\\\\,_
\
\\. \\\: .._ ._.
1014 \ _
_ _
,,. , .
i„ \\-\\, \._ \ \-\ _ 1
pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation Amount of Preservative Lot t$
adjusted added
Nr* INhanever there Is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DEHNR Certification Office(i.e.
C incorrect preservative,out of temp,incorrect containers.
Page 3 of 12

CV
w
CHAIN OF CUSTOD RRECORDETTL
Mare �u,Llq rrrE a of 2
PO Box 16414,Greenville,SC 29606-7414
[phone], [phone] Fax:[phone]
Shipping Address:4 Craftsman Ct,Greer,SC 29650
W W W.ETTENVVIRONMENTAL.COM
Client: 1.I (J J o\\
Program Containers rPreservative Parameters
Facility: t? F� Yr tyY Whole Mil uent To)cicity p
p.
J'F/�.. ,�1.
State- )6�, 'MDES#: ktjOC3%R,.-iln Acute Chronic Tcst Organisms ^....i"
i
Cl
T — O 4 fa
o (Composite only) (Grab or Composite) .e 9 d ' r. �` y
En Ci7
" V =� 1N3SAJ e Y r_
Sign,and Print below . t t e o �, 2-Ha. c z o t.0 v 5
c 5 3=HNO3 ,.. - m a F
6 ttte dotted line c E c w `-' 4 a 4=ria0H w o o b ' y ,e is a
N 0 y o 0 n 0 .0 s=znA° u v :^ Ti ' '" W t9 er
SAMPLE ID Compo,ileStnnDate Time SampleCelleetonDote Time Collected.y U rn Li) 2 x C C7 > G=Odmr - U U CU�� [.-2 rn V F Chemical Anal sfs&Other _�._
tfilYerecK
dye ` lia)1 1 Li113b 1 �, ; '�'*' ,.
•
•
Special Instructions: . ` Ste)
Sample Custody Transfer Record • Secure Receipt Sample
Date Time R nquished By/Org,anization Received By/Organization Area Temp°C Preserved?
^�-z c� i9c tree-- 14v?? l iW 5 x )- At-
COMPOSITE SAMPLING PROCEDURES TEMPERATURE MONITORING PROCEDURES •HOLD TIME PROCEDURES
Composite samples must be collected over a 24 hour period. Sample temperature during collection and transport-must be between For toxicity testing the Sam)le must first be ised within 36 hours
Time Proportional:I sample each hour for 24 hours.Equal volut 0.0 and 6.0°C.Samples must not be frozen.Use water ice in sealed bags. of sample collection(comp etion of composi e s ample).
or at minimum I: :every 4 hours over 24 hours. Sample may not be used aDer 72 hours fron- tartpl- -,llection.
Flow Proportional: per instructions in NPDES permit. -

•
uy,tsl'Celt rvQnfC. I VVUJf I cm r\Cv13cy.V1.ty UC1 Z-0,cuGll
Sample Condition Upon Receipt(SCUR) Page 1 of 2
7. °_,-"WeAnalytical t Document No.: Issuing Authority:
T F-CAR-CS-033-Rev.07 Pace Carolinas Quality Office •
Laboratory receiving samples:
Asheville E Eden❑ Greenwood ❑ Huntersville Raleigh❑ Mechanicsville❑ Atlanta❑ Kernersville❑
Condition Client 1V awe:t,/ o'c G -J i J l WO# 92532839
Upon Receipt �/ Project H:
Courier: ❑Fed Ex ` ❑UPS ❑USPS DClient 111111111111 1IIII III
EJ Commercial tQPace DOther: 92532839
Custody Seal Present? ❑Yes IS.11a Seals Intact? es EINo )1 /�Des
Person Examining Contents/` i
/ /.5/2 (...t
Packing Material: ❑Bubble Wrap ❑bubble Bagslone ❑ Other Biological Tis ue Frozen?
Thermo eter: J'//��/1 ❑Yes ❑No N/A
Gun1D: C72 tJ / Wet ❑Blue ❑None •
Type of Ice:
C) , Correction Factor:
Cooler Temp: Add/Subtract(°C) 0.OT Temp should be above freezing to 6°C
/ 1:Sarrples out of temp criteria.Samples an ice,cooling.nrocess
Cooler Temp Corrected(°C): has begun
USDA Regulated Soil('J N/A,water sample) • 1
Did samples originate in a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source livtnationally,
❑Yes Rio including Hawaii and Puerto Rico)?❑Yes No
IComments/Discrepancy: I
Chain of Custody Present? EYes [No QN/A 1. `
Samples Arrived within Hold Time? . S,Ies ❑No ❑N/A 2.
Short Hold Time Analysis(472 hr.)? "Yes ❑No EN/A 3.
•Rush Turn Around Time Requested? Eyes Nr_jNo ❑N/A 4.
lent Volume? Lys es ❑No ❑N/A 5.
Correct Containers Used? Yes ❑No ON/A 6.
_ -Pace Containers Used? des ❑No ON/A
Containers Intact? et ❑No ❑N/A 7.
Dissolved analysis:Samples Field Filtered? Dyes ❑No 'EWA 8.
Sample Labels Match COC? s ❑No ❑N/A 9.
Lej c7N
Indudes Date/Time/ID/Analysis Matrix:
•
Headspace in VOA Vials(>5.6mm)? DYes ❑NoV/A 10.
Trip Blank Present? ❑Yes ❑No ��jA 11.
Trip Blank Custody Seals Present? Dyes ❑No L dit J
COMMENTS/SAMPLE DISCREPANCY Field Data Required? Dyes ❑No
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
^-----contacted: Date/Time:
Project Manager SCURF Review: Date: _ —}b-Z \
0.t !!'' J
Project Manager SRF Review: ;I r Date: l- V �,
Page 5 of 12

Document Name: Document Revised:October 28,2020
•
b sample Condition Upon ReceiptiSCUR) Page 2 of 2
aCi9/{fl�lytiCa� Document No.: Issuing Authority:
F-CAR-CS-033-Rev.07 Pace Carolinas Quality Office t
*Check mark top half of box if pH and/or dechlorination is Project# WO#
: 92532839
yorified and within the acceptance range for preservation . 7
.iples. PM: SMG Due Date: 05/04/21
Exceptions:VOA,Coliform,TOC,Oil and Grease,0R0/8015(water)DOC,LLHg CLIENT: 92-C f tyof Sta •
**Bottom half of box is to list number of bottles
-- .
U .�A.. CO c U Q
_ a v z
o a ` :re 1- = z
z 2 2 ` p z N o Z z N z z R rn S m
mat d W Z v V a1! A a1 N V V C 1 1 S 3 Q
= r x T N e v x. x a 3 Y a e ? T
551 m st e °. Cl. CO a v N o. S z - a z 2 O m N is
EL, `1 el U N N x 2 1 y c m Q z .g V u NN. aNi CZ v.
a g Q _ , ` a G .O m S N i1 .> w
mmmg = . N 2 I' 7 x U N c 0. S �' t
u = u z u � ,y u t T. ¢t x � VD �' ar �„ u Ia
a .9 N .. a`, a, a t g' E S z 7 "S Y 3 ?+ = ,� '.. .� y A
ro V m a n m F2 a .o E .o o ¢ < Q Q i t a`r _ E c
- r J C. J Ja .a.1 c- Q a J / V N > > > > s & v) J a J N Q
I' o SE °' E -4 E E -S ;: «: p d E E E E E ! a E E ,p7F' o E E
.-1 N {/1 ei N N -' N rl "1 N .•, N Q v q' 'I v m N N rN N 0 N V
* 7 7 > > as z N O W 3 2 6 ,A or g z F- n d Y ne sl F ���IJJ 4 7 D 7.
m .I m m m M Cl m en a1 a t9 WI m o D
ag a a a 4 i 4 a a t7 t7 l? t7 t7 t7 I L7 t7 O a ii a c7 H It
m m m m m m m Cl 3 a a a a a < �' > > e > > N m a > 2
1 \ \ \ ,
';\.'.N':::::::, _
2 \
3 \
4 \
5 \ \
6 \ \• V •
7 ` \ \\
8 \
9 \ \\, \ .
•
\
10•\ \ _
11 \
12 \ \ _\ �_
. pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation Amount of Preservative Lot k
adjusted added
Note: Whenever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DEHNR Certification Office(i.e.
0 Mold,incorrect preservative,out of temp,incorrect containers.
Page 6 of 12

(V
O I
ETT CHAYN OF CUSTODY RECORD
n
s k1 'aur0 2 a � of
PO Box 16414,Greenville,SC 29606-7414
[phone], [phone] Fax[phone]
Shipping Address:4 Craftsman Ct,Greer,SC 29650
W W W.ETTQNVI RONMENTAL.O OH
Client: n
Q-_ 'k c- -e•s0 ( l i'e__, Program Containers Preservative Parameters
Facility:
{� P ly.�* Y',
.. •V~. ri�` : `-" '` \L /' Whole Effluent Toxicity
State: •Al t,, NPDES#: Mee CO3 1$_3(n °Acute Cbranie Test Organisms CO
p d]
a c _ (o a) t7
eel (Composite only) (Grab or Composite) r y2y a ° ] _o -o 0
'.HZ604 'a 3 m r
Sign,or d Print below 3 o o��A ...HCL c. a �, O.O. e -0 v r o to
the dotted line c E c V .`—' °, 3•HNo3 Ba. U = -o , c .. a o
E E •� o o o 4•NaOH .. . Q o _g m 2 m 0 o i--
SAMPLE ID ° 5.InAc 5 'C •— :sa w
Composite Start Date lime Sample Collection Date lime G�ollected by U to t'n 2 ii (7 > li=Other -< •E U U C.J au 4 rn 'X U i- .4 Chemical Analyis;Other
C ,+ `i1114p) `-l11sia1 *. , t :�rr ' av 991X X X
Special Instructions: O ---
L4� /o
Sample Custody Transfer Record Secure Receipt Sample
Date Time Rel• guished By/Organization Received By/Organization Area T..mp°C Pres ed?
'/ISI� r3D/ ..i. —% • _ ?;--- .1 >''
L1is i 21 `- , �'li(r_{ H&c, fr,5rz.t ivy . ,
COMPOSITE SAMPLING PROCEDURES TEMPERATURE MONITORING PROCEDURES HOLD TIME PROCEDURES
Composite samples rr••"`-^ollceted over a 24 hour period. Sample temperature during collection and transport r•""-'•'-•-between For toxicity testing the sample must first be ust d within 36 hours
Time Proportional:I: each hour for 24 hours.Equal volut 0.0 and 6.0°C.Samples must not be frozen.Use wal i sealed bags. of sample collection(completion of composite tan-p
or at minimum I•sa y 4 hours over 24 hours. Sample may not be used after 72 hours from srmp e ion.
Flpw Pr 'anal: instructions in NPDES permit

•
Et . 0E64)B77.6942.FAX(864)B77.6938
P.O.Box 1 E414,Greenvile, SC 29606 4 Craftsman Court, Graer,SC 29650
Ceriodaphnia dubia Survival and Reproduction Test
EPA-821-R-02-013 Method 1002
Client: CITY OF STATESVILLE
Facility:4TH CREEK
NPDES#:NC0031836
Teat Date: 14-Apr-21
Laboratory Sample ID#:T59002
Test Reviewed and Approved By:
Robert W.Kelley,Ph.D.
QA/QC Officer
ate...
•
•-••,•146/11A.4' Certification#E87819 SCDHEC Certification#23104
Test results presented in this report conform to all requirements of
NELAC,conducted under NELAC Certification Number E87819
Florida Dept.of Health.Included results pertain only to provided samples. NC DENR Certification# 022
Page 8 of 12
Page 1 of 5

•
Effluent Aquatic Toxicity Report Form/Phase II Chronic Ceriodaphnia
•
Facility: STATESVILLE 4TH CREEK NPDES# NC0031836 Pipe# 001 County: fredell
Latio erfor " st: ETT Environmental,Inc. Comments:
,L 4(4
re--Of O.R.C. Signature of Lab Supervisor
Test Start Date Time End Date Time
Info 04/14/21 2:15 04/21/21 1:22
Sample Information Sample 1 Sample 2 Control (Start (Renewal 1 !Renewal2 ,Start !Renewal 1 )Renewal2 +
Collection Start Date 04/12/21 04/14/21 Treatment 90% 90% 90% Control Control Control
Grab -_._. pH Init. 7.7 7.5 7.8 7.7 7.8 7.7
Composite(Duration) 24 hr 24 hr pH Flea: 7.9 8.3 8.2 8.0 8.2 8.2
Hardness(mg/L) 87.2 D.O.nit 7.8 8.9 7.6 7.9 7.9 7.8
Spec.Cond.(umhos.cm) 409 432 321 D.O.Final 7.8 7.8 7.9 7.8 7.6 8.1
Chlorine(mg/L) <0.05 <0.05 Temp Ind 25.0 24.7 24.9 24.7 24,6 24.5
Sample temp.at Receipt 2.4 0.6 Temp Final 252 24.8 25 0 25.2 24.8 25.0
6roc" est'esu1s
Final Cont Mort.% 0.0%
Organism# %Cent 3rd!rood 100%
1 2 3 4 5 6 7 8 9 10 11 12 Mean Control Repro CV 5%
Control #Young 24 23 22 23 24 25 23 22 25 23 none none 23.4 46 Hour Mortality
(L)ive
(D)ead L L L L L L L L L L none none Control IWC
0of10 0of10
1 2 3 4 5 6 7 8 9 10 11 12 Mean Significant? No
Effluent% #Young 25 23, 24 26 24 24 25 22 20 21 none none wee423 Final Mortality Sign.
Adult '4 Red
(L)ive
n (D)ead L L L LLL L L L L none none 0.0% % or Ifto cone'
Reproduction Analyses
1 2 3 4 5 6 7 8 9 10 Mean Repro LOEC= >90.00% r1o€c= 90.0%
Effluent% #Young 23 24 25 23 24 20 25 28 22 20 23.4 Method: Steel's Test
Adult %Red Normal Dist? no Method Kolmogorov
(L)ive
22.5% (D)ead L _1._ L L L L L L L L 0.0% Statistic 0.970 Critical 0.695
Equal Ver? NA Method
1 2 3 4 5 6 7 8 9 10 Mean Statistic Critical
Effluent% #Young 23 24 24 24 24 23 21 24 20 22 22.9 Non-Parametric Analysis (if applicable):
Adult %Red Method: Steel's Test
(L)ive
45.0% (D)ead L L L L L L L L L L 2.1% Efuent% Rank Sum Critical
11.3% 109.00 75.00
1 2 3 4 5 6 7 8 9 10 Mean 22.5% 106.00 75.00
Effluent% #Young 21 22 20 23 24 25 25 26 24 22 23.2 45.0% 99.00 75.00
Adult %Red 67.5% 103.00 75.00
(L)ive
67.5% (D)ead L L L L L _ L L L L L 0.9% 90.0% 76.00 75.00
Overall Analysis IC25= >90.00%
1 2 3 4 5 6 7 8 9 10 Mean Result= PASS/FAIL or
Effluent% #Young 22 20 20 24 23 21 22 23 21 23 21.9 Test LOEC: >90.00% NOEC= 90.0%
Adult %Red
(L)ive
90.0% (D)ead L L L L L L L L L L 6.4% Chronic Value= >90.00%
Environmental Sciences Branch *Should use highest test concentration or
N. - - Division of Water Quality highest concentration with D.O.>5.0 mg/I
N.C.DENR %Reduction from Control Reproduction Mean
TO: 1621 Mail Service Center
Raleigh, NC 27699-1621 DWQ form AT-3 (8/91)Rev. 11/95
Page 9 of 12
Page 2 of 5

•
Test Day °
source rep 1 2 3 4 5 6 7 8 oral Labe T59002
US 4-2 A. +4+8 12 24 control Client STATESVILLE
D5 4-2 B 5 +8+10 - 23 Sample ID 4TH CREEK
G34-1 C +4+7 11 22 NPOESit NC0031836
R10 4-1 D +4+7 12 23 County Iredell
T44-2 • E +4+7 13-- 24 INonth 4
GG1 11 F +4+8 13 25 Start&fed Date 14-Apr-21
H2 G +4+8 11 23 Start&fed Time 02:15 PM
M8. H +3+8 11 22 Started&fed By JC
V8 4-2 I +5+8 12 25 Test Organism Ceriodaphnia dubia
LL1 3-31 J +3+7 13 23 1 Neo.born date 13-Apr-21
A +4+6 13 2b Neo.born time 1645-2205
B +3+9 11 23 Test Type NCCD
C +3+8 13 24 Dilution Water MHSF4/9/21A
_
D +5+9 12 26 Units for Conc.
11.25 E +4+8 12 24 %3rd BROOD
F +4+7 13 24 Test vessels 30 ml
G +4+8 13 25 Test volume 15 ml
H +4+7 11 22 Incubator# 1
I +3+7 10 20 1 can Light 161t/8dk
J -+3+7 11 21 23.4 Initial Temp°C 25
A +4+/ 12 23 Selenastrum 0.05 ml
B +2+8 14 24 YAT 0.05 ml
C +4+8 13 25 Test method EPA821-R-02-013:1002
D +5+6 12 23
22.5 E +6+7 11 24
F +4+6 10 20
G 4 +11+10 25
H 5 +12+11 28
I +4+7 11 22 Comments
J +4+7 9 20 23.4
A +4+/ 12 23
B +3+8 13 24
C +4+8 12 24 Control ini temp
D 5 +8+11 24
Si E +4+7 13 24
F +5+6 12 23
G +4+7 10 21
H 4 +9+11 24
I +4+6 10 20 mean
J 4 +8+10 22 22.91
A +3+/ 11 21
B 4 +7+11 22
C +4+6 - 10 20
D +4+7 12 23
17.8 E +4+8 12 24
F +4+7 14 25
G +3+8 14 25
H +5+8 13 26
I +6+7 11 24 �CI3TT�
J +4+7 _ 11 22 23.2
A +3+b 13 22
B +3+7 10 20
C +2+7 11 20
D +4+7 13 24
(® E 4 +8+11 23
F +3+8 10 21.
G +4+7 11 22
H +5+7 11 23
I +5+6 10 21 J +4+7 12 23 21.9 21.9
enew JZ JC End Date
ad JG JZ JZ JG JC JC 21-A0r-21
"m ,:,e fed&renew 11:11 AM 02:59 PM 08:12 AM 08:56 AM 01:32 PM 08:02 AM .i..,.; 01:22 PM JC
Suent New temp.•C 24.1 24.9 D=Dead N/A-Lost or not used
Id temp.°C 25.2 24.6 25
ontrol New temp.'C 24.6 24.5
Page 10 of 12
Page 3 of 5

1
CHA.L . JF CUSTODY RECORD
Idtt ii,I�6. :. 5:0 r VI Lq.„4 r`u+' 'I i Paste of
PO Box 16414,Greenville,SC 29606-7414 ,.
[phone], [phone] Fax:[phone]
Shipping Address:4 Craftsman Ct,Greer,SC 29650
W W W.ETTENViRONMENTAL.COM
Client: / n 1 \
i D J .5-�-Cki—e 0., k'e, Program Containers Preservative Parameters
Facility: 1.•- tre).—.Vc. L'� I P
t \YholeLmu°nt Toxicity t Q
State: NPDES#: ke.j Ot13 1��+!n Acute Chronic Test Organisms
M
ci 0: 3
c U t_ o • , (1
(Composite only) (Grab or Composite) _ U
U Com osite ^ = U _ _ -5
o '8. z
U 2 0 o e) l -l?SO4 �y — .g _ o `7
_ Sign,and Punt below _ an 1.-.Ho., z 'o < ^ ' > rn
e) O U n' U U - _ <
the dotted line U .° s=Hr o3 - - _ = <
U o rp r: ;74-_ o Lui 3=ZnAe u o .; — r = >, - [zt J ?_,
SAMPLE ID composite Hate Time Semple Collection Time Collected y U rn Z E U > 6=other < < i U U U 0 t ' rr U _ i Chemical Analysis 8:Other •
rCreeK t.� 1 b5ic
1I ] 3N4r -r„, A X a51-- /' \A i 9 CO246c'
2
v _
i
t
i E
t
Special Instructions: �I 5(.3)0
Sample Custody Transfer Record Secure Receipt Sample
Date Time R91inquished By/Organization Received By/Organizati n Area Temp°C Preserved?
I/411 /// . -',.. 1 � �-
d.P / i--r- 1rcij2E loop T-
i
I I 1
COSIIPOSITE SAMPLING PROCEDURES TEMPERATURE MONITORING PROCEDURES HOLD TIME PROCEDURES
CocTliposite samples must be collected over a 24 hour period. Sample temperature during collection and transport must be between For toxicity testing the sample must first be used within 36 hours
Time Proportional: 1 sample each hour'for 24 hours.Equal voles 0.0 and 6.0°C.Samples must not be'frozen.Use water ice in sealed bags. of sample collection(completion of composite sample).
at or minimum 1 sample every 4 hours over 24 hours. Sample may not be used after 72 hours from sample collection.
Flow Proportional:As per instructions in NPDES permit.

M, xt .. , CHAIN (I)I+ CUSTIDY RECORD
of . l.:sr zmm, id II_° of elit Page of
PO Box 16414,Greenville,SC 29606-7414
[phone], [phone] Fax:[phone]
Shipping Address:4 Craftsman Ct,Greer,SC 29650
W W W.ETTEN V IRONMENTAL.COM
Client: `
C,\ Ci C S` } s0 1 \ Program Containers Preservative Parameters
Facility: t 4-( r.c ex 13 t� 1�' �_
`-i �i `, 1 n / Whole Effluent
State: '10 NPDLS#: N� CO3 1 S r, Aeute �Cbronic Test Orasnisms n
M '
Si _. O
U (Composite only) (Grob or Composite) o U _ V _� _ - , J
U o = 1=H?SO4 ry _ .S v`
Sign,and Print below 3 ca - ?=HCL = = z '— m _ _ E :n
the dotted line - U P a=HNo3 — z 2 •`2 7— r" .n 2 —
SAMPL)✓ID Composite Start Date Time Sample Collection Date Time Collected by c.1 ar cn ,-e i= •o > = b=pt`r < < U 0 r_i 0 = 2 =U :— :: c Chemical Analysis&Other
1-411-h el'+eCK c
i l✓i111,P 1 . `1)1�a °y--" - air �5L X x X 5�0oa6
to ?/
,
Special Instructions: H.570
Sample Custody Transfer Record Secure Receipt Sample
Date Time Rel. quished By/Organization Received By/Organization Area Temp°C Preserved?
//I5/i 1 /30 J ^^" tr—t r21 /7 a 1 1 Y 0'3 1 AY
gitc00( ID Fezt_ -x ,,,(3,j,-„,,d,„, .T- ,,,D,,2 --- 1 0,(.0 1
I 1
CMPOSITE SAMPLING PROCEDURES TEAIPERATURE MONITORING PROCEDURES HOLD TIME PROCEDURES
CVmposite samples must be collected over a 24 hour period. Sample temperature during collection and transport must be between For toxicity testing the sample must first be used within 36 hours
Time Proportional:1 sample each hour for 24 hours.Equal voles 0.0 and 6.0°C.Samples must not be frozen.Use water ice in sealed bags. of sample collection(completion of composite sample).
or t minimum I °^^,nle every 4 hours over 24 hours. Sample may not be used after 72 hours from sa^,^la''llection.
Flow Proportic per instructions in NPDES permit.

13
Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 04/22/21
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
atory,Pefforming Test: MERITECH LABS, INC.
/ Comments:
X
i naf rat in Responsible C arge
X
Signature of Laboratory Supervisor * PASSED: -24.35% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -3 .917
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -24.35
% Mortality Avg.Reprod.
# Young Produced 21 20 23 21 19 22 20 18 15 16 23 12
- 0.00 19.17
Control Control
Adult (L) ive (D)ead L L L L L L L L L L L L
0.00 23.83
Treatment 2 Treatment 2
Effluent %: 45%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
17.635% PASS FAIL
# Young Produced 28 23 20 26 20 26 25 24 23 25 23 23 % control orgs X
producing 3rd
brood Check One
t (L)ive (D)ead L L L L L L L L L L L L 91.7%
L
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 04/14/21
Control 7.85 7.77 7.80 7.98 7.93 7.89 Collection (Start) Date
Sample 1: 04/12/21 Sample 2: 04/14/21
Treatment 2 7.81 8.10 7.75 7.68 7.82 8.12 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 23.8 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 23.8 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness(mg/1) 44
Control 8.39 7.96 8.22 7.82 7.91 7.69
Spec. Cond. (pmhos) 145 407 430
Treatment 2 8.26 7.90 7.91 7.26 7.81 7.61
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt (°C) 1.0 1.1
(Mortality expressed as %, combining replicates) 1
Note: Please
0 %% % o 0 % % % % Concentration Complete This
Section Also
% % % % % % % % % % Mortality
start/end start/end
LC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit
% -- % Spearman Karber - Other High
- - Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Meritech, (Lab # 027)
/i Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#: ---)
Client: `� -5Ul//f? +/ ��` Pipe#: (-)J County: .. /-r'(-1r'/J Date Start: 6/' f 11--�1 Date End: +-( ?lb,-. 1
NPDES#: NC 6Y_.).3l?7.3(o Date/Time of Culture Transfer: 91'3-a] /t)- ,?`31T1n Time Start: /(."<<'>,},,` Time End: 71 ] I%"'I
Dilution Water: Lake Brandt Date/Time Neonates born: vJ 1-_101, M.-Lt'-05-p,o1st Renewal Date: L/-(6, - a ( Time: >'/),' '9,4,,,`
Test Organism Source: Tray# Age of onates at Test Start: c�`-� •• �_ hours 2nd Renewal Date: �/ J`� Time: t .'_C 7,qi-)
Stirred/Aerated for D.O.: Y/ Randomized:( / N Culture Tray Temp: z .t°C Analyst(s): MR,LV,KS,KL Reviewed by: /4L-- '
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0• 0 0 0 0 0 0 0 0 0 Sample 1: 1-/U4-,Z 1 Sample 2: _ 1-1- 1 �4-
Adults Live/Dead L Z— L- (,_ C.-- L- (_- L (__ C _ C_ (,..__ Sample Information
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 100% pH G/C? Duration
#Young Produced i(/(O 1117 til ' 73/? 3/f( L(//7-, c(k. ;'7%., ? (,: ,7ij >(;'; Sample 1 7,7 2. �- -3. �C' hours
, Adults Live/Dead ,_ f-_--, �.__- L _ L- 4_ 4_ L__ i1....__ c__ L. L L_ ' ._ Sample 2 7,56 c/-_ �, 7 hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 r_ 16 `( Transferred by: Fed by:
#YoungProduced ,G 1 0 i -4 Batch# Sample 1 Sample 2
I �� 7 (�. _ jC�(r 7 �J�j Day 0 ^'lf'� L,_/
Adults Live/Dead L-- t_ t___ L._ t-- L-- C_._ Z__ t+. t____ t &--- Transfer Day 0 2 5 • Day 1 ,/1i'�
Hardness 1� Day 2 /'1,_ ,A/
Total Produced 'DI ' (mg/L) I
� �-t � `� � �tJ ��'" �� ��� ��=�' /F� Sec.Cond. V l�� � � Day 3 /4�
L (mhos/cm) i(5--—7 1�j` L4 -1 3U Day 4 AA
Percent of Control producing third brood: 9/ 7% Chlorine "f 2( Day5 /'"`- 1-V
(m9/L) 4�%'.1 1 b.
Test Sample Organism Reproduction Day 6
Receipt Sample _ 1
Effluent%: LJ Temp.CC) . 1 1.1 Terminated by: i
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 pH 1st Sample 2nd Sample 2nd Sample
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control 1 rd 5's 7,77 I,8 O 7,!,P,, 7,7'3 7 21
Adults Live/Dead /, t_ (- [_. L- (___ L- L L-- L C.__ L__ T9 p 781 tt 8.10 7/ r 75 r! �, / 4 1 , -
Sample f ,�
Day#5, 1 2 3 4 5 6 7 8 9 10 11 12 nitial final initial final initial final
#Young Produced 11/ if/ 3 < 7 / l/ 4 T//l [/ / at (� �l SampleP
f -/j� /(,' /Y lY ///i / D.O. 1st Sample 2nd 2nd Sample
Adults Live/Dead 1. L__. L. 1 G.- 2___ L i__._ L-,
Control r, 7,96
,, �� 7 ,
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 n �((;� 1 "�. (;{
#Young Produced /.� 7 l 11 / 9 I LI /�C /0 0 l 1l / /, Sample 0tZ(; 7,`l VI (J �, ) --L IA
Adults Live/Dead L- ( /, �. L._ � L L nitial final nitial final ndial final
Temp. 1st Sample 2nd Sample 1 )ei,5-2nd Sample
fisTotal Produced • { , � ✓ • , 21� 0 ,�11,/f ,L,r, pi-r, '1') ,- j rt
�(1 �� �� �� f� �� r�� ✓�7 �� �i.a�~' o���`� Control ., �•� •'� �1�
�,
C ,ments: Sample RI ,: (ta ati� ; 42 I3 i1 ,
initial final initial final initial final

•
MERITECH, INC. (Lab #027) Meritech Sample ID#: G''Li 13'31"115"
' A.
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: [e-mail] Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: (+4 cf S e D 1 `W, PO#:
Contact Person: i
'('(7,y-No �ahRSotn NPDES#: NC DO S)P3(Q
Address: I). ?QC 1 ,\ 1 Phone: 7611 87 e 3 p
City: Fj Cx:KS0 i 112. Pipe#: 0 1
County: T:I -'Q\e,1\ State: N�i Zip: d, 1p o15
SAMPLE INFORMATIO
p q LCi f ce, O �.,1
Sample Site:
Sample Type: ❑Grab Composite #of containers:
Sampling Time: Start Date: / I Start Time: (_/8 0 PM
End Date: LI 3 End Time: 7: 7 ? PM
GLIf�c+eJJ O'i y-i`(--t L✓
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print: NIL1cLAS oou5-TON Signature: 17,
TOXICITY TEST INFORMATION
Test Required: hronic(7 days) Test Organism: TCeriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: q5 % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished by: ,'` - �j�..1� II e Date: L �1 I Time: AM Gli
Received by: 4i •� Date: "///.. r Time: :; ) AM
Relinquished by: - PPG- Date: y/�✓�c/ Time: A PM
Received by: , Date: Time: A PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
/� , SAMPLE RECEIVING (Laboratory Use Only)
squished by: /I.(\ ,/ Iily f`i{�A I
I 1 ` (,
Received by: L(w AN iQn Date: �"1 �i Time: AM Pill
Sample Temperatures(°C): \,Z I 'c0 / / Sample Condition: ,Ca
SON- WHITE = Laboratory copy YELLOW=Client copy llllllN

. A MERITECH, INC. (Lab #027) Meritech Sample ID#: C USA -AA
Bioassay Sample Chain of Custody
A 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: [e-mail] Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: �, 1 t O Sr eso.l l i-e PO#:
Contact Person: ' and Lj TToh n.S CiC NPDES#: NC 3 )63(:
Address: ip, (') any. if ] Phone: 7e)q/_;,7 3 y 3 F)
City: 3 -2S O ) 1 1 e Pipe#: O
County: C Cr P,( ( State: /V Zip: 2 G,A
��+ SAMPLE INFORMATION
L Sample Site: `J't E t 0 ( O A—CO `
Sample Type: ❑Grab Composite #of containers: .:=,
Sampling Time: Start Date: y'/LI I Start Time: 7_6 PM
End Date:U 115/`)1 End Time: 1 do
PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collectors Name: Print: Afte,, ,AS f f, n,v Signature: —�i'�%,il�
TOXICITY TEST INFORMATION
Test Required: (Chronic(7 days) Test Organism: SCeriodaphnia dubia (water flea)
El Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: 5 % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished by Date: ) Time: `Z/� AM "Received by: Date: / Time: /2/ ANI�
Relinquished by: .ate % Date: tea- Time: AM alp
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery, NO SIGNATURE REQUIRED**
(( SAMPLE RECEIVING (Laboratory Use Only)
Relinquished by: ,,,c I�(\ . 11`in(Y�
Received by: (C.r'�1/1 L\sr-v r Date: l( �' Time: AM PV
24
Sample Temperatures(°C): t / (t t / / Sample Condition: .`‘.
■ WHITE= Laboratory copy YELLOW=Client copy 411111111111101111INMII■

Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 04/22/21
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -24.35; CONTROL 4596 Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00%- 0.0096
# Neonates 230 286
Mean # Neonates 19.167 23 .833
Standard Deviation 3.380 2.368
Coefficient of Variation 17.6356
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
1 a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 C 12 -7.1667 13 C 20 0.8333
2 C 15 -4.1667 14 C 20 0.8333
3 E 20 -3 .8333 15 E 25 1.1667
4 E 20 -3.8333 16 E 25 1.1667
5 C 16 -3.1667 17 C 21 1.8333
6 C 18 -1.1667 18 C 21 1.8333
7 E 23 -0.8333 19 E 26 2.1667
8 E 23 -0.8333 20 E 26 2.1667
9 E 23 -0.8333 21 C 22 2.8333
10 E 23 -0.8333 22 C 23 3 .8333
11 C 19 -0.1667 23 C 23 3.8333
12 E 24 0.1667 24 E 28 4.1667

SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 4.1667 -7.1667 0.4493 11.3334
2 3.8333 -4.1667 0.3098 8.0000
3 3 .8333 -3.8333 0.2554 7.6666
4 2.8333 -3.8333 0.2145 6.6666
5 2.1667 -3.1667 0.1807 5.3334
6 2.1667 -1.1667 0.1512 3.3334
7 1.8333 -0.8333 0.1245 2.6666
8 1.8333 -0.8333 0.0997 2.6666
9 1.1667 -0.8333 0.0764 2.0000
10 1.1667 -0.8333 0.0539 2.0000
11 0.8333 -0.1667 0.0321 1.0000
12 0.8333 0.1667 0.0107 0.6666
1
W = X 177.5282
187.3333
Calculated W = 0.948 Critical W = 0.884
0.948 z 0.884
The reproduction data is normally distributed
evaluated at a 990 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Control variance 11.4242
F = _ = 2.04
Effluent variance 5.6061
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
2.04 s 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

EQUAL VARIANCE t TEST
19.2 - 23.8
t = = -3 .917
1.191
Degrees of freedom = 22
Critical t = 2.508
-3 .917 < 2.508
Test passed. There is not a significant difference in reproduction
g
between the Control and the effluent evaluated at a 99% confidence interval.
Chronic Test PASSES

I
Pace Analytical Services,LLC 12
®lOr
Kincey Ave. Suite 100
aceAnaly�ical 9800 r www.pacelabs.com Huntersville,NC 28078
[phone]
March 24, 2021
Brandy Johnson
City of Statesville
693 Bell Farm Road
Statesville, NC 28625
RE: Project: NC0031836 Toxicity 4th Creek
Pace Project No.: 92526400
Dear Brandy Johnson:
Enclosed are the analytical results for sample(s)received by the laboratory on March 09, 2021. The results relate only to
the samples included in this report. Results reported herein conform to the applicable TNI/NELAC Standards and the
laboratory's Quality Manual,where applicable, unless otherwise noted in the body of the report.
Some analyses were subcontracted outside of the Pace Network.The test report from the external subcontractor is
ached to this report in its entirety.
The test results provided in this final report were generated by each of the following laboratories within the Pace Network:
If you have any questions concerning this report, please feel free to contact me.
Sincerely,
1,
Sarah Graham
[e-mail]
[phone]
Project Manager
Enclosures
_`" REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
,q �Q without the written consent of Pace Analytical Services,LLC. Page 1 of 12
Bp.;'O

• Document Name: Document Revised:October 28,2020
M Sample Condition Upon Receipt(SCUR) Page 1 of 2 1 '
r aceARalytical -Document No.: Issuing Authority: A
i F-CAR-CS-033-Rev.07 Pace Carolinas Quality Office
Laboratory receiving samples:
Asheville❑ EdenD Greenwood ❑ Huntersville 2"Raleigh❑ Mechanicsville❑ Atlanta❑ Kernersville0
Sample Condition Ciient Name: _—_ ' _ {,`O# ; 92526440
Upon Receipt-- di C'",l J f_e,vI//� Project g W
7 ilfi,Ty
lIl iI111 Courier, Fed Ex ❑UPS ❑LISPS ❑Client li'l
❑Commercial ce ❑Other: 92 6400
925Z
Custody Seal Present? ❑Yes No Seals intact? ❑Yes [f No 7
Date/Initials Person Examining Contents: 4 3 li f
Packing Material: OBubble Wrap OBubble Bags alone ❑ Other Biological Tissue zen?
Thermometer: Dyes Din N/A
P Wet ❑elue ❑None
f Gun ID: � Type of Ice!
�/' Corr ction Factor:
Cooler Temp: t r Add/Subtract(°C) 0.0'C Temp should be above freezing to 6°C
Darn,.Darn,.out of temp criteria.Samples on ice,cooling process
Cooler temp Corrected(IC): Ili `]v has begun
USDA Regulated 5o11( water sample)
Did samples originate In a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(internationally,
[Des ENO including Hawaii and Puerto Rico)?Des ONo
Comments/Discrepancy:
Chain of Custody Present? Yes ONO ❑N/A 1.
Samples Arrived within Hold Time? . e ONo ON/A 2.
•
Short Hold Time Analysis(<72 hr.)? orYes ❑No ON/A• 3.
Rt,1 Two Aivullrt1RRW negde °eut L fTes EI: Ili f'
Sufficient-Volume? J�Yes ONo ON/A 5.
Correct Containers Used? ti ❑Na ❑N/A 6.
-Pace Containers Used? Zres ❑No ON/A
Containers Intact? es ❑No ❑N! 7.
Dissolved analysis:Samples Field Filtered? Oyes ❑No N/A 8.
Sample Labels Match COC? es ❑No ON/A 9.
-Includes Date/Time/ID/Analysis Matrix:
L✓ I
Headspace in VOA Vials(>5-6mm)? ❑Yes ONo JA i0.
Trip Blank Present? Oyes Drio ON/A 11.
Trip Blank Custody Seals Present? Dyes ❑No [i+slA
COMMENTS/SAMPLE DISCREPANCY Field Data Required? Dyes ❑No
Lot ID of split containers:
CLIENT NOTIFICATION/RESOLUTION
Person cut naLced: Dat./-7,,.L.
dA
Project Manager SCURF Review: Date: 1 D— r�A
44 ( A
Project Manager SRF Review: Date: `,10! Page 2 of 12

•
a. -
N 1~-• .WO W (p •V 01 A W N N
Item,/ •r. m
" n
. Z/VZVZ� �7 / BP4U-125 mL Plastic Unpreserved(N/A)(0-) 0a ft, I m „h
c BP3U-250 mL Plastic Unpreserved(N/A) 3 1 a N. 3
G
v . BP2U-500 mL Plastic Unpreserved(N/A) p * t
m • G 0 o 74, O \
ru BP1U-1 flier Plastic Unpreserved(N/A) i ?
< : / BP4S-125 ml Plastic H2SO4(pH<2)(CI-) x 5 :74 '
: .
o ,� BP3N-250 mL plastic HNO3(pH<2) O 1 p 1-1 n tr.
H d fa X �.
3 vBPOZ-125 mL Plastic 2N Acetate &NaOH(>9) '* o.. O: =4 a.
m•
c z7,
/ Cm n S
/ BP4C-125 m1 Plastic NaOH (pH 12){CI) a, rp,
.7/ CT a 0
r n' x WGFU-Wide-mouthed Glass jar Unpreserved C' tm
d / AG1U•1 titer Amber Unpreserved(N/A)(CI-) LT C o oP
Ctit,.. ow
0
w AG1H-1 liter Amber HCI(pH<2) m -.
a C AG3U-250 mL Amber Unpreserved(N/A)(CI-) 0D q q
EEEEEW/AlCUiio' C o `' n !?
V
IAw fZD DG9H-40 mL VOA I1CI (N/A) IS
~ _ O ill
•o Q. VG9i 40 mL VOA Na25203(N/A) R
K +� n -
VG9U-40 mL VOA Unp(N/A)
i 4 a 5
1- 3
•' o N OG9P-40 mL VOA H3PO4(N/A) r~fl0• • o
• VOAK(6 vials per kit)-5035 kit(N/A) ••I 3 �+` off,
t0 io
3 V/GK(3 vials per kit)-VPH/Gas kit(N/A) N a `^
o _ 1 o c• -0 C
0 A =w
SPST-125 mL Sterile Plastic(N/A-lab) Ni) �, ,s a
w p.
o. M SP2T-250 mL Sterile Plastic (N/A-lab) a �+ o 0 0
. o / d• to lCD IV •
^'-ro
C/Z G91 lu w 'c N
• rC./ BP3A-250 mL Plastic(NH2)2504(9.3-9.7) O ro •
n r
f
AGDU-100 mL Amber Unpreserved vials(N/A). O 0 o
W
°^ VSGU-20 mL Scintillation vials (N/A) WO
a - \
ra
rn DG9U-AO mLAmber Unpreserved vials(N/A)
(a
taL.
o ,
N

N
. O
•
a)
CHAMI OF CUSTODY RECORD .
ETT
Yr,'��,,__ G;t __. �.��_��x� .(" nI�' Page of
N4a ri.gn'i��a- ���16 5.A�.� ',a�i�k�1�A�')[Iif...
PO Box 16414,Greenville,SC 29606-7414
[phone], [phone] Fax:[phone]
Shipping Address:4 Craftsman Ct,Greer,SC 20650
.WWW.ETTENVtnlO NM ENTAL.0 CM
Client: . 1 pc
J
• 1. o ` le
Program Co miners Preservative Parameters
1/4
Facility: ''t t ( cn-ex. L-i_( ,,,c
Wink •
State- A) Q� NPDES#: /t1 t'�003 r 83�7 • vent° Chronic Test Organisms q
N n
cn co-i r U z
0 a iComposite only) (Crab or Componno) w C�• y ".i-. ¢ c
U VI a J , H2SO4 ez U r _ � $ 2
Si-thedOttaflbclow 3 r a=HN0:3 G 9' La '2 y o t-
L rile dotteiftine'` ° 4=t aox o o _ e a ts3 `' t
SAMPLE ID P CompositrStnrt mete Time Srmplc Collection mete Time Cellec d• y U y cn Z - c�,c ' ? .2 G=ZOlhcr `t �- U U U O r✓ - rn � U F Chemical Analysis&C they
a.�iSL• � � r►
+ !! f J ;A.
cle 3J$Jal 3191�j , ':� ��, n� T— sa` \ X
•
f •
•
•
_ _ r
Special Instructions: I • 1 l r R 5 a v L1 6,1-, s-�9� •
Sample Custody Transfer Record Secure Rcz:eipt Sample
Date T i ee # Relin uished By I Ornanization Received Oraapi ---�� Area Tel tp°C Preserved?
44
2/ /k5' "------ % . w 1 ..A . 4,-.-� Z
COMPOSITE SAMPLING PROCEDURES 'TEMPERATURE MONITORING PROCEDURES HOLD TIME PROCEDURES
Composite samples must be collected over a 24 hour period. Sample temperature during collection and transpor must be between For toxicity testing the sample must first be used within 36 hours
Time Proportional:1 sample each hour for 24 hours.Equal volt]]0.0 and 6.0°C.Samples must not be frozen.Use wiser ice hi sealed bags. of sample collection(completion of composite samp c).
or at minimum I sample every 4 hours over 24 hours. Sample may not be used afler 72.hours from sample collection.
Flow Proportional:As per instructions in NPl)ES permit. •

J ,� r Sample Condition Upon Receipt{SCUFF}
Page lot
• �r°aceAnalyticai • Document No..: Issuing Authority:
• •• F.CAR-CS-033-Rev.07 Pace Carolinas Quality Office
t oratory receiving samples:
. sheville 0 EdenD Greenwood D Huntersville 'elghD MeihanicsvilleO Atlanta❑ Kernersvi leD
Sample Condition Client Name: __ ___ `WO ; 9-2 526400
/� ord ect•ts.
- - - Upon fieceipt /S 1 _,4/ -C ---
-_._-_ Ex UPS
.. USPS '/T5� QlCllenk '
.---Courier::: OFed [ O
0 Cammerdai ' ce ❑Over.
•
Custody seal Present? yes c Seals intact? °YesritTlc7
3,�/2/ .
oate/Inittats Person Examining Contents, <
Packing Material: QBubble Wrap - Deubbie Bags None Q Qther - • Biological Tlssi n? .
OYes ❑Na /A•
Thermometer et atue ❑None
IR Gun D) �? Type of Ica:
Correction factor: - •
Cooler Temp: a / (� Tem should be above freezing to 6'C .
Add Subtract °C Q.0°C A
Qsamples out oftemp criteria.Samples an Ice,cooling process
•
Gooier Temp Corrected.(dC): / hashegun
USDA.Regulated Soli(al A,water sample) • • '
. Did samples originate In a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples alginate from a foreign source(Internationally,
• Oyes ❑No including I awall and Puerto Rica?Des Duo
Comments/Discrepancy:
Chain of Custody Present? QNo ON/A ' 1. -
•
Samples Arrived within Hold Time? - Yes Elmo - DN(A 2.
Short Hold Time
�Analysis(�C72 hr.)? es (�aoo�'I )NiA 3. • • ,
— R lTT law M.ot�co-cL _ d f r1 ill' JtA_4� _ .�
Sufficient Volume? es QNo DNA .S.
Correct Containers Used? es ❑No ON/A 6. -
•
Pace Containers Used? es ❑No ON/A
Containers Intact? as []Na. ❑N(A 7. •
Dissolved analysis:Samples field Filtered?• - ,Yews —•No /L i+a A . 8.
Sample Labels Match COC? rerlIno ON/A 9• -
•
-Includes Date/Time/ID/Analysis Matrix: , • �. • •
Headspace to VOA Vials(>5.6mm)? . DYes' ONe L. 1A 10.
Trip Blank Present? - QYes Ono ON/A' 11.
Trio Blank Custody Seals Present? rives ❑No ON/A T
• • • Reid Data Required? Dyes. ❑No•
COMMENTS/SAMPLE DISCREPANCY •- • -
Lot ID of it containers
. CLIENT NOTIFICATION/RESOLuiION • - •
• nate/rune'. _.
lV......_L.1641_e,
•
Data: '
Project Manager SCURF Review: - '
Date:
Project Manager BRE Review: •
•
Page 5 of 12

O i n,, r o 1O gi®ra u, -4 w .✓ .ILemN # n
r n m m *
s 1` - AM ES,. BP4lJ 125 mL Plaslit Unpreserved(N/A)(a) d ay ro c�u
a- cl-
o ■■■, BA3li-250 mL 1'1as2ic UnpreseMved(N/A) -
_ G O 43i
c,
! F.
- BP2U-500 mL Plastic Unpreserved(NIA) !u! _'
�.
ro ( o IW1U-1.Etter Ptastit Unpreserved(N/A) "r' a .7 0
n la .. ru fp
m AA," BP4S-125 rot,Plastic I12504(pH<2)(Cl-) : N; o m
2 r • KI�Ad' 8P3N-250mt.plasticHNO3(pH<2) al o n C
. O
BP4Z•1?5 mt Plastic Z JAcetate &NaOH(>9) a L'' a •
� nr •Q
�' . •a grirgalririgglir
, BP4C-1 S mL Plastic NaOH (pH 12)(CI-) l of a
a A 3
M a
. '1 : p wGKU 73 . -Wide-mouthed Glass jar Unpreserved O o A°
R ,I n S ID
•
o AGIU-1 titer Amber Unpreserved(N/A)(Cl-) O o p w
Q
rt.- U n 3
Ann ardijrAirAPPYAb1H-i •firer Amber HCI(pH c 2) U;I v al t2 4
T rr • N T el
_ t rD 3 r7
�' op AG3U?50 mLAmber Unprescrved(N/nJ(Cl-) a Z m y q a-
rD =
w ..+ o v C 21 g
A� ' r N c Qs
i t- AGiS-1.liter amber H25D4(PH<2) o
no
o O ; i .n 'Ca m G
i -ti. , AG35-250.m1_Amber H25C14(pH<2) . z
a Oxi
.41PairlarAAPaariii•didl IIMMr_r 0 0 .=
G a
•)- •V AG3A(DG3A}-250 nu,Amber NH4C1(t3/A)(Ct•) ! v n
I. LL ill
fD - DG9H-40 mL VOA HC 1(N/A) ' o n
—. G
�_ o 0.t i VG4T-4O mt VOA Na2S203(N/A) .' rt
. ." r IX w VG9U-40 mt VOA Unp(N/A) Tt'f, -
n ro tdfi9P-4A nit VOA H1P01(N/A) rrn . O. -
w S 1*
VAAtc(G•ttas per k:t)-sins kit(N/A) - C1 Ig
ID e. u
v/01((3.,ia..P.,r k;)-wHJta:kit(N/A) I CO o ' v
. .. IN:m m
SPST-125 m,_Sf¢rile Plastic(N/A-lab) r C' C N• /
• g v SP2T-AO. mI.SterilePlast (NIA-LW • °. ` o ,,
a w ,
aAm n O
! •
r° �� Air. $P3A-250 mL Ptastit(NH21 04(.9.3-93) � ` w °'RO`� a
� . AGOU-100 mL Amber Unpresesved vials(N/A} w O
p 5 • VSGU-20 mt Scintillation vials (N/A) t"r
• - I C?
ti OG9U-40 mLAml3er•Vnpreserved vials(N/A) �
co .
CD
oo
N

N
. . . _____ .. . __... .... . . .. ._ .._... . ..... ...._. ..
1`
L,,
,,0
ETC . CHAIN OF CUSTODY RECORD
a,- �n 'Sr .i-:•a Pa^e of
w ° :SS gkar„r.r; e
PO Box I6414 Gcoonvile•SC 29808-7414
[phone]. OW)891.2325 Faa(884)877 6238
Mlpoin Ackireamt 4 Craftsmn Ct,Greer,SC 29650
WWW_LTTCNMIRe N N EllTAL.COM
Client: •
t q-U111 l e"0.—"0.— , V. ie-50 ll% i(e rraoram C ntefners rreservattve Pacalnctors
Facility:I'1't . 56 kott:Emocnt Tn!ctritr q'=
State! n) NPD FS ih_ I R(--, AR EC Chromic Test 0•anicnis n
m
P. • Q
0 p
8 O
(Co apmite on ) Z' 2 z a u
only) (Grab G R „ !:::
V o v •
V .r; w I L�504 c _ �_5'rgn,endFrintbelow � oo a-ttct -I t rUlute dotted fire �'— �' rs w s-4woa 3. �, N •o s
V .14
`O O .-�. 4 'SC O a` m T L W
SAMPLE ID r7 ...pe.➢e SrMDaI; Ti sunpteeelka:.n D.rc _, Couedad try Ul in cn '' 3t t7 7 yo, U C? CJ CI C v CJ �• } .L Ctmmleal Analysis&•,,her
y-�h CfeeK .
III 1I111
_� 111 11111�111 11111111 !
.111 I1I$IRIIIIIIIIII II ■i
1,_u _ _ I Ut ____I
peoial Instructions::M 1�—1` ran e 1, 1 it -a Si ��. �r y 5 - 5_ �__ - - -- l
Sample Custody Transfer Record Secure R . Sample
Date Time Relin r nished B 10 •aniza• n Received B 1• •, iza.. Area TL. . ' Preserved?
1 raii ,........ ....m..-
iii im•msmimmmmimmm I
1 1 1 it
,. .
COMPOSITE SAMPLING PROCEDURES TEMPERATURE MONITORING PROCEDURES HOLD TIME PROCEDURES
Composite samples must be collected over a 24 hour period. Sample temperature during collection and trsnspo must be between For toxicity testing the sample must first be used wi rlur 36,ours
whoTime Proportional:1 sample each hour for 24 hours.Equal who0.0 and 6.0 C.Samples must not be frozen.Use ter ice in sealed hags. of sample collection(completion of composite sam e).
or at minis-nut ile every 4 hours ever 24 hours. Sample may not be used after 72 hours from sarnpl coil in.
Flow Proportt per instructions in NPDES permit
1

N
lit4Env lrttll:ineciti,Ina. (E$d)877.6942.FAX(864)$77=6938.
F O, Box 1€414,Greenville,SC 29605 4 Craftsman Court,Greer,SC 29650
Ceriodaphnia dubia Survival and Reproduction Test
EPA-821-R-02-013 Method 1002
Client: CITY OF STATESVILLE
Facility:4TH CREEK WWTP
NPDES#:NC0031836
Test Date: 10-Mar-21
Laboratory Sample ID#:T58724
Test Reviewed and Approved By:
Robert W.Kelley,Ph.D.
QA/QC Officer
0.CCl%
li
re:
. ,�
t , Certification#E87819
1,-P.:,
SCDHEC Certification#23104
Test results presented in this report conform to all requirements of
NELAC,conducted under NELAC Certification Number E87819
Florida Dept.of Health.Included results pertain only to provided samples. NCDENR Certification# 022
Page 8 of 12
Page 1 of 5

. . Effluent Aquatic Toxicity Report Form/Phase II Chronic Ceriodaphnia
Facility: CITY OF STATESVILLE 4TH CREEK WWTP NPDES# NC0031836 Pipe# 001 County: Iredell
'ory Pe orming ETT Environmental.Inc. Comments:
ey
ignat of O.R.C. Signature of Lab Supervisor
Test Start Date Time End Date Time
Info 03/10/21 3:45 03/17/21 2:20
Sample Information Sample 1 Sample 2 Control (Start (Renewal 1 'Renewal 2 (Start "Renewal 1 )Renewal2 j
Collection Start Date 03/08/21 03/10/21 Treatment 90% 90% 90% Control Control Control
Grab pH Init. 7.3 7.4 7.5 7.7 7.8 7.8
Composite(Duration) 24 hr 24 hr pH Final 8.0 8.2 8.1 7.9 8.0 8.0
Hardness(mg/L) 85.1 D.O.!nit 7.8 8.6 8.6 7.5 7.9 8.0
Spec.Cond.(umhos.cm) 371 421 310 D.O.Final 7.9 8.2 7.7 8.1 8.0 7.5
Chlorine(mg/L) 0.23 <0.05 Temp(nit 25.0 24.9 25.2 24.7 24.7 24.6
Sample temp.at Receipt 2.5 1.1 Temp Final 25.7 25.8 25.3 25.7 25.8 25.3
Chronic Test Results
Final Cont Mort.% 0.0%
Organism# Cont3rd Brood 100%
1 2 3 4 5 6 7 8 9 10 11 12 Mean Control Repro CV 8%
Control #Young 21 20 19 23 20 21 17 21 22 22 none none 20.6 48 Hour Mortality
(L)ive
(D)ead L LLLLLLLL L none none Control IWC
0of10 0of10
1 2 3 4 5 6 7 8 9 10 11 12 Nlean Significant? No
Effluent% #Young 21 24 21 22 20 20 22 22 21 20 none none 21.3 Final Mortality Sign.@
Adult %Red
(L)ive
% (Dead L LLLLLLLL L none none -3.4% % or no cone
Reproduction Analyses
1 1 2 3 4 5 6 7 8 9 10 Mean Repro LOEC= >90.00% NOEC= 90.0%
Effluent% #Young 22 22 22 24 9 21 18 21 19 19 19.7 Method: Steel's Test
Adult %Red Normal Dist? no Method Kolmogorov
(L)ive
22.5% (D)ead L LLLLLLLL L 4.4% Statistic 0.998 Critical 0.895
Equal Var? NA Method
1 2 3 4 5 6 7 8 9 10 Mean Statistic Critical
Effluent% #Young 23 17 22 21 21 22 21 20 20 21 20.8 Non-Parametric Analysis(if applicable):
Adult %Red Method: Steel's Test
(L)ive
45.0% (D)ead L LLLLLLLL L -1.o% Effuent% Rank Sum Critical
11.3% 114.50 75.00
1 2 3 4 5 6 7 8 9 10 Mean 22.5% 104.00 75.00
Effluent% #Young 21 21 21 22 22 19 18 23 19_ 16 20.2 45.0% 109.00 75.00
Adult %Red 67.5% 101.00 75.00
(L)ive
67.5% (D)ead L LLLLLLLL L 1.9% 90.0% 76.00 75.00
Overall Analysis IC25= >90.00%
1 2 3 4 5 6 7 8 9 10 Mean Result=PASS/FAIL or
Effluent% #Young 17 12 20 16 16 21 21 18 16 21 17.8 Test LOEC: >90.00% NOEC= 90.0%
Adult %Red
(L)ive
90.0% (D)ead L L L L _L L L L L _L 13.6% Chronic Value= >90.00%
Environmental Sciences Branch *Should use highest test concentration or
L Division of Water Quality highest concentration with D.O.>5.0 mg/I
N.C.DENR %Reduction from Control Reproduction Mean
TO: 1621 Mail Service Center
Raleigh, NC 27699-1621 DWQ form AT-3 (8/91)Rev. 11/95 Page 9 of 12
Page 2 of 5

Test Day
source rep 1 2 3 4 5 6 7 8 o'otal Labs T58724 ,
Fin 1-2o A +3+/ 11 21 control Client STATESVILLE
F42-26 B +3+6 11 20 Sample ID 4TH CREEK
J3 2-25 C +4+5 10 19 NPDES# NC0031836
X8 2-26 D +4+8 11 23 County Iredell
16 2-26 E 3 +6+11 20 Month 3
X72-26 F +3+8 10 21 Start&fed Date 10-Mar-21
D4 2-26 G 3 +6+8 17 Start&fed Time 03:45 PM
M1 2-25 H +4+7 10 21 Started&fed By AM
M4 2-25 I +3+8 11 22 Test Organism Ceriodaphnia dubia
N4 2-25 J +3+6 _ 13 22 2 .b Neo.born date 09-Mar-21
A +3+7 11 21 Neo.bom time 1715-2200
B 4 +9+11 24 Test Type NCCD
C +3+8 10 21 Dilution Water MHSF
D +4+8 10 22 Units for Conc. .a
11.25 E 4 +8+8 20 %3rdBROOD
F +3+7 10 20 Test vessels 30 ml
G 3: +8+11 22 Test volume 15 ml
H +3+8 11 22 Incubator# 1
I +4+7 10 21 e Ca Light 161V8dk
J 3 +7+10 20 21.3 Initial Temp°C 25
A +3+/ 12 LL Selenastrum 0.05 ml
B +3+7 12 22 YAT 0.05 ml
C +4+8 10 22 Test method EPA 521-R-02-013:1002
D +3+9 12 24
22.5 E 3 6 9
F +4+7 10 21
G 3 +6+9 18
H +3+7 11 21
+3+6 10 19 Comments
J +3+8 8 19 14 7
A +3+8 12 23
B +3+5 9 17
C +3+7 12 22 Control Ini temp IMONOMMOMMT
D +4+6 11 21
45 E 3 +8+10 21
F +4+6 12 22
G 3 +8+10 21
H +4+5 11 20
I +3+7 102 1CI> T1
J +4+6 111 21 20.8
A +4+1 10 LI
B +3+6 12 21
C +3+7 11 21
D +4+6 12 22
67.5 E 4 +3+10 22
F +3+5 11 19
G +3+5 10 18
H +4+6 13 23
I +3+6 10 19
J +3+5 8 16 20.2
A +3+5 9 1/
B 4 8 12
C - +3+8 9 20
D +3+6 7 16
90 E 3 +6+7 16
F +4+7 10 21
G 4 +7+10 21
H +3+7 8 18
I +2+5 9 16
J 3 +7+11 21 17.8
Renew AM AM End Date
Fed JC AM JC AM AM JG ound 1/-Mar-21
Time fed&renew 07:52 AM 02:39 PM 00:22 AM 07:45 AM 11:59 AM 04:10 PM 02:20 PM I AM
Effluent Newtemp'C 24.9 2b.1 D=Dead N/A-Lost or not used
Old temp.•C 15./ 2b.t5 25.3
Control New temp.'C 24.1 24.b
Page 10 of 12
Page 3 of 5

ts
T c..
..., CHAIN OF CTJST I DY RECORD a
Page of �
PO Box 16414,Greenville,SC 29606-7414
[phone], [phone] Fax:[phone]
Shipping Address:4 Craftsman Ct,Greer,SC 29650
www.ETfEN V IRONM ENTAL.CO M
Client:
r-u F es 0 1 i le Program Containers Preservative Parameters
Facility: Win° Cl� 11ni "� -s
L� 1 ' ' `--Q \ ..)L Whole Effluent Toxicity ae
State: ft} C_ NPDES 1: /il/ ..) ('7?a(.,,_ Acute Chronic Test Organisms
U
U (Composite only) (Grab or Composite) o U o U
o 1=H3504 � - V.. - •_U E ` •_
1 Sign,and Print below �' c x-Het = o o = - o N E
the dotted line v .� C 3=1-INo3 _ _ H a
a C o o - o 8 s=7Othe 0 0
I SAMPLE ID c) Composite Siert Date Time Sample Collection Done Time C� Collected 1)y U ct Z U > 6=Otte < 6 J 0 U CI E 7 in U i— 2 Chemical Analysis&Other
1 -e a - ��;rr4 S$qZ` AE -c 1 iker1.- al Si'a i�- 31931 1-. �otr,d,1cr�x
v i
a
m
oVI
Special Instructions:
Sample Custody Transfer Record Secure Receipt Sample
t Date Time Relinquished By/Organization Received By1,Or•trayi �y3.—_-_�� Area Temp°C Preserved?
31
/ .--C:......' .c1. I/ 46 . r ----_-_----- --
,5 ()121 1 TP�a JI1 Jr1 90 2. S
COMPOSITE SAMPLING PROCEDURES URES TEMPERATURE MONITORING PROCEDURES HOLD TIME PROCEDURES
URE•S
Composite samples must be collected over a 24 hour period. Sample temperature during collection and transport must be between For toxicity testing the sample must first be used within 36 hours
Time Proporth • - ample each hour'for 24 hours.Equal voles 0.0 and 6.0°C.Samples must not be frozen.Use m ' ' in sealed bags. of sample collection(completion of composite sample)
or at minimum le every 4 hours over 24 hours.
Flow Proporti per instructions in NPDES permit. Sample may not be used after 72 hours from sample c

...: il ir, 47-7
CHAIN OF CUSTODY RECORD "5
_ — 43:0 031. et 4I : ea
c
Page of c
PO Box 16414,Greenville,SC 29606-7414
[phone], [phone] Fax•.[phone]
Shipping Address:4 Craftsman Ct,Greer,SC 29650
W W W.ETTEN V IRONMENTAL.CO M
Client:
, 1 t G-' 3 a es. it 1 Program Containers Preservative Parameters
Facility: "1 i i'f (1 cscQ ,<_ •tz.e. Whole Effluent Toxicity i i
1 /
State: n) C.... NPDES N e,C(3 ! g L'., Acute Chronic Test Organisms -
1 <
.41 0
e (Composite only) (Grab or Composite) <c.Jo `o •G U v o a- -e z
fj 3. �2 .n 1-HS0a _ _ •C ^
Sign,and Print below - = m c 2-Ho_ = .4 _ m s g _ - -_ 5
the dotted line 3 c V •= H c sHNO3 M •0 •0 '_ 7, , • o 2 _ •o• L
U C o 0 . h G o A=1da0H _ .. c o V m j - ,? _7 L] r_i
SAMPLE ID U Composite Start Date Tim� di 0 o a 0 u 5=ZaAc 5 o ^ - z.
-
ep Jam plc Collection Dole Tirtr_- Collected by Urn rn Z R a 0 > r=Other 'E 4 U U ci ❑ i_: rn z U _ Chemical Analysis&Other
(�'1'h C�'ze,IC
. ►ut�I, G 13,) 31 i i J ) * i , d -D 194i of • 2 &
N
cg
to . - -
0
•
a
Special Instructions:
U. l-+--1 range ', Ili -a5) aD , q6, la4--, 5) go
Sample Custody Transfer Record Secure Receipt Sample
Date Time Relinquished By/Organize'on Received By/Organizat• rl Area Temp°C Preserved?
-51t al Ii -- II\Q - . _ ��,,, ,� �. I I I
COMPOSITE SAMPLING PROCEDURES TE.IIPER4TURE MONITORING PROCEDURES HOLD TIME PROCEDURES
Composite samples must be collected over a 24 hour period. Sample temperature during collection and transport must be between For toxicity testing the sample must first be used within 36 hours
Time Proportional:I sample each hour for 24 hours.Equal volin 0.0 and 6.0°C.Samples must not be frozen.Use water ice in sealed bags. of sample collection(completion of composite sample).
or at minimum I sample every 4 hours over 24 hours. Sample may not be used after 72 hours from sample collection.
Flow Proportional:As per instructions in NPDES pemtit

Document Name: Document Revised:October 28,2020
Sample Condition Upon Receipt(SCUR) Page 1 of 2
•; ace,-na,,icaa -Document No.: Issuing Authority:
I F-CAR-CS-033-Rev.07 Pace Carolinas Quality Office j
-,A^•Tory receiving samples: _ .
dile❑ Eden❑ Greenwood ❑ Huntersville❑Raleigh❑ Mechanicsville❑ Atlanta❑ KernersvilleD
Sample Condition Client Name: _ •
WO1f : 92526400 ��.
Upon Receipt-- ._/ Project b TT
p / IT.° "S 1 1/u l/e. i111 Courier: FeOlind Ex ❑ ❑LISPS ❑Client "11�l■ �
❑Commercial ce ❑Other: 11111111111 0
92526400
Custody Seal Present? Oyes No Seals Intact? ❑Yes ['Noy 7 � 7
Date/Initials Person Examining Contents:/{�t, .
4 3 )U I
Packing Material: ❑Bubble Wrap ❑Bubble Bags [None ❑ Other Biological Tissue zen?
Thermometer;• _ /� ❑ a Des ONo N/A
2 70 wet Blue Nane
�TR 6un ID: . Type of Ice:
Corr ction Factor:
Cooler Temp: Add/Subtract(°C) 0.0°C Temp should be above freezing to 6°C
�} ❑samples out of temp criteria.Samples on ice,cooling process
Cooler Temp Corrected(IC): _ / v has begun
USDA Regulated Soil(water sample)
Did samples originate In a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate(ram a foreign source(internationally,
Des ONo including Hawaii and Puerta Rica)?❑Yes ❑No
• Comments/Discrepancy:
•
Chain of Custody Present? Yes ©No ON/A 1.
Samples Arrived within Hold Time? . [�Y ONo ON/A 2.
Short Hold Time Analysis(<72 hr.)? Ileffes ❑No ON/A 3.
— I,Turn AtJtmd lime Itryutstett? Dyes rvu 1:1.0% 4,
iclent Volume? Yes ONo ON/A 5.
Correct Containers Used? L1Te [No ON/A 6. .
-Pace Containers Used? Yes ❑No ON/A
Containers Intact? es ONo ❑N/ 7.
Dissolved analysis:Samples Field Filtered? pies ONo N/A 8.
Sample Labels Match COC? es . ©No ON/A 9.
-Includes Date/Time/ID/Analysis Matrix: �_
Headspace in VOA Vials(>5-6mm)? Oyes [No /A 10. •
Trip Blank Present? Oyes aii7 —ON/A
/11.
Trip Blank Custody Seals Present? ❑ves ONo ❑+�trA
COMMENTS/SAMPLE DISCREPANCY Field Data Required? Dyes ❑No
Lot ID of split containers: •
CLIENT NOTIFICATION/RESOLUTION •
8--uif Luinduecf' BatfT;,,, .
•
Project Manager SCURF Review: c _ Date: ' —\D—().`
44 Project Manager SRF Review: Date: '-',),X

. 1
O _ r i- w 00e .4 m vl . w N M
N f+ 0 Itemil * n si @ *
I n
= v • BP4U-125 mL Plastic Unpreserved(N/A)(Cl.) CO o S • m
o m • r. es
a BP3U-250 mL Plastic Unpreserved(N/A) 0 La :^
a3 3
v m BP2U-500 mL Plastic Unpreserved(N/A) o
p _ rf.
BP1U-1 liter Plastic Unpreserved(N/A) H o ? iv
2 a. . 0, 3 • •� ca m
m / BP4S-125 mL Plastic H25O4(pH<2)(Cl-) x _, -�
o F. Md, '�,i, d' BP3N-250 mL plastic HNO3(pH<2) O o n Cr `.
a prpippro pporporopppm BP4Z-125 mL Plastic ZN Acetate &NaOH(>9) ^'1 EL =.. e
a
,..,
z C . ..
• '• ; gill BP4C-125 mL Plastic NaOH (pH 12){co-) s. rt nj
ao
C ro m 3
-p WGFU-Wide-mouthed Glass jar Unpreserved -` o =
CL
n '° x I p ra• 0
D AG1U-1 liter Amber Unpreserved(N/A)(Cl-} a- o p 0. Si
Q
O ,r rL
D o r. PP,PPPPPV
' AG1H-1IiterAmber HCI(pH<2) v. m 0 rD „ G
AG3U-250 mLAmber Unpreserved(N/A)(Cl-) D 0 .,-. Oao•
"r„ / A c
AG1S-1 liter Amber H2SO4(pH<2) r p• 7 v. 3iiiiiiiiiiii
s N Co z 0
AG3S-250 mL Amber H2SO4(pH<2) w ito 2 co Dz,
`• c' y p p 3
gg uK ' 'a
D
D 1111111
AG3A(OGA)-250 mL Amber NH4C (N/A)(C-) 0-7 " on VOGG9U9 -4040 mmLLVVOOAA HUI
3np(NN/AA)) C
tDj°
DJ
c) -d
Fr 0 111111.11111111111.1111111111 0G9P 40 mL VOA H3PO4(N/A) to O • a
Ti 2
�, ' + -02
III1. 1111 VOAIC(6 vials per kit)-SD35 kit(N/A) . ;o;. e
D •
>' V/aN(3 vlais per kit)-VPH/Gas kit(N/A) N v A
c• C
z ploppoppl 1 5P5T-125 mL Sterile Plastic(N/A-lab) •A N a O' i, fD
Vl
a 0 SP2T-250 mLSterile Plastic (N/A-lab) O1s a w l D o N •-
• �V
a. l ,t.K it
al
Oil l°01°01.10111111011141011111111 Add BP3A-250 mL Plastic(NH2)2504(9.3-9.7) A
0
AGOU-100 mL Amber Unpreserved vials(N/A), w 0
•
VSGU-20mL5cintiHation vials (N/A) p
-- \
N
• DG9U-40 mLAmber Unpreserved vials(N/A) u•
i.
p
. i

•
•
, .
. . .
, . •
ETT ci ,, OF CUSTODY lr RECORD
k,,Tfstal�'y+Fe°alTrrt a{ J • Pa°e of
PO Box 16414,Greenville,SC 29606-7414
[phone], (BOO)891-2325 Fax:[phone]
Shipping Address:4 Craftsman Ct,Greer,SC 29650
•W W W.ETTKN VIRONM ENTAL.COM
•
Client: .t1� ► C �1 �Q i i
1 `mot Qf ` 1� l�/t es 0 ! SQ Program Co stainers Preservative Parameters
Facility: + i 4 /���/� 1,
• '1lf\ es)-P O L p Whole Effluent Toxicity
p 'N�V) Q
State: ! ) NVPDES# eJ 0 31 S -j 6y Acute Chronic rest Organisms 0
c. ti
_ v r U o 93
(Composite only) (Grab or Composite) 6 iu (g " •-
U ?� I H2SO4 r cc z c 6 LI d c�i
Sign,'and,Print;below 3 K 'S m e z NCI_ G z v °" in E m _
!lie 8otred°tine''• F - � y g 4=Id OH w o a E  2 L g N
UO D " �I d 5=ZnAc 5 U ^ v T A^ w C.t -1
SAMPLE ID �? Composite Start Hole Time Sample Collection Bete lime Collec d y U cm Z 4h c.`C7 ' > 6.Other '� e- U 0 0 O is < 6i 'X U F Z Chemical Analysis&C they
•
Special Tnstrtictions:
{ f r o 1 4-1 ra ! f —
Sample Custody Transfer Record Secure Receipt Sample
Date Time Relinquished By/Organization Received By j„Or°ayi- ' Area Ter ip°C Preserved?
NliAt //0-,(?)6C01 ____------. ...t,-----._, '
�-K-2/ //6�' , /'', 4 'a4_.- 4r '/`2,—
COMPOSITE SAMPLING PROCEDURES TEMPERATURE MONITORING PROCEDURES HOLD TIME PROCEDURES
Composite samp)a°..,,,°t be collected over a 24 hour period. Sample temperature during collection and transpor must be between For toxicity testing the sample must first be used wiAtin 36 hours
Time Proportions tple each hour for 24 hours.Equal volul 0.0 and 6.0°C.Samples must not be frozen.Use 1a in sealed bags. of sample collection(completion of composite samp e).
or at minimum 1 every 4 hours over 24!tours. Sample may not be used after 721tours from sample c I.
Flow Proportion,per instructions in NPD£S permit. -

,� Sample Condition Upon Recelpt(SCUR) Page 1of 2
�f c?G@IQRc7Ij�lCal� , Document No.: l issuing Authority: t
' F-CAR-C3-0334ev.07 Pace Carolinas Ctuality Office -
Laboratory recelviKg samples:
. Asheville 0 Eden! Greenwood[J Huntersville�IeighD Mechanicsville[ AtlantaD Kernersv(IleD
s.mple.Condition CllentNaame�«_/� _ �'` _[�--_.,../- raject'r;:00# 925Z6400
— Upongi�•cei•pt r / �� 4G ,�✓ !'3s• ����, .
—Courier::' ' .: ` -QFed Ex/ [iUPS'' '-CUSPS ,•` QCllent
• ❑Comme>dai ce QOther. )
Custody Seal Present? ❑Yes o Seals Intact? Dyes Mo ?../2/
call/(nit a(s Persan Examining Cements. 3 /
eubbie Bags r�u N one' ❑ Qther . . Eialogice1 Tissue Fro n? .
Packing Material: ❑Bubble Wrap • ❑ Des QNo J/A
Thermom teULbo f.' et e(ue []Na a
IR Gun i0:l Type of lea:
Correction factor,
Cooler Temp: Add/Subtract(IC) 0.0°C - Temp should be above freezing to•6'C •
QS�mpfes out oftemp criteria.Samples an lee,cooling process
Cooler Temp Corrected.('t): - f '2) _• bashegun
USDA Regulated Soil(e0cwater sample) ' -
•
Did samples oiiginateIn a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples arigiitrtefrom a foreign source(Internationally,
' tjTes ONO . including tlawati and Puerto RicoJ?pies ONO
- Comments/Olscrepaner.
Chain of Custody Prasent? ❑No ON/A •, 1. -
Samples Arrived within Hold Toe?
Yta QNo QN/A 1.
- Short Hold Time Ana;Ysis(<72 hr.)? . es QNo N/A 3. .
nu d.Yu a r»ond Ti wan Qnennr+nel7 fy., n r•1Nle 4.
Sufficient Volume? es Ono ON/A S.
Correct Containers Used? es ONa ON/A 6. •
-Pace Containers Used? e s ONo ON/A
Containers intact? • • es QNa- ❑N/A 7• •
Dissolved analysis:Samples Field Filtered?' " QYes No (C3d A . a.• '
Sample labels Match COC? . es ON° ❑N/A 9. "
• -Includes Date/Time/ID/Analysis Matrix:. / •
.
Headspace in VOA Vials(h57Smm)? DYes. ❑No Ll/A 10. -
Trip Blank Present? _
Trip Blank Custody Seals Present? •_ Des ONO ON/A r
FieldOataReRWrad7 []Yes. ❑Na
COMMENTS/SAMPLE DISCREPANCY .
Lot 10 of contain sp{iters•
CLIENT NOTIFICATION/RESOLUTION
i
•
l'[, e.reeMSMair
_ .- Date:
Protect Manager SCURF Review:
Date:
• Project Manager SRF Review:

1 r
l I
� • Y . Y lD G. `.D 4t A W N I..hi,. 0 .Itemk v % u4 < *
I a - f BP4U-125 mL Plastic Unpreserved(N/A)(CI-) 0' a
'Be3U-250 mt.Plastic Unpresoved(N/A)
g y 3
• ., BP2►1-500 mL Plastic t)npreserved(NJA} n {
vi ro - — Ol o ,... G
ro a Rin1J-1 liter Plastlt Unpreserved(N/A) o ^ s ni
n -0
m of ._ `" °:
,r � BP4S•I25 mL RWstic H2SO4(pH<2)(=1-) x, -l �• �••
2 N D 'r. g "l
g •':'... gP3N-250 mt pt+rtic HNO3(P11<2) o n 0
A z//,' . ..iii
3 •, v �� � �r 8P4Z-1?$mt PlastiCZri Acetate E,NaOH{>9) _ 10 `<
z
o •�� illFrAl IIV - BP4C-125 ml Plastic NaOH (pH>12)(C-) . 3 d m nxi •
i m . wGFU.Wide-mouthed Glass Jar Unpreserved -^`11 =
^ •Q /• . AG1U-1 liter Amber unpre erved(N/A)(CI-) Q U up
a r 4 to r / / AG1H-1 Iiite.r Amber HCI(pH<2) •' 2 rt, 0 n
: ./ / f , ro m T
rn0 •
AG3U-25Omr-Amber Unprescrved(N/A)(C1-) o ra m • g.
g
• r ! AG1S-1 liter amber H2SO4(pH<2) ! ,— o ntr
1' o ♦ - t S' • ] N W ra 'O
a a AG3S-250-m9.Amber H2504(pH<2) . , '° is..1 z
.C. -' i n
'. c ACr3A(DG3A)-250 ml,Amber NH4C1(N/A)(CI•) ) ;,
m
rci - DG911-40 ml.VOA HCl(N/A) i. in
•= A m - VG9T-40 mt VOA Na2S2O3(N/A) rn.• 5 ?
r VG9il4O mL F-f L
VOA Unp(N/A) - r -0 l+�
..t ss. : 3 - 7K
. ii ,o D09P-40 ml.VOA H3PO4(WA) .w .,. rn O
]AIC(6.444 per kill-Sn35 kit(N/A)•
�'1 d .
l . 1 , . •( -. Alt
W .. hi
s w
V/GK(3�etais pros.kit)-VPH)Gas kit(WA} N o
CI
• SPT- 2 r_Sterile Plastic(N/A—lab) IV wa
• r•
of O /w Q N
0. .. 5P2T•250 n lSt rite Plastic(N/A— : �/w`� d o N
f w
_� ...."):1„.. 772..„.. 4:11 8P3A-250 mL Malt(NH2)2SO4(9.3-9J) et rO1 `^y
AGO-10O rnL Amber Unpreserved vials(N/A) 1• 0 �'
1 1 -- GI
s - • VSGU-20 mL Scintillation vials IN/A) 6
- DG U-40 mt.Ambu,Unpreserved vials(N/A) - �N-.
.

ao
•
.. _ .--. .. . .. . . . ____ ... . . .____... . . .. .. _......... . ..... ...._ ..
. ,
ETT • CHAIN OF CUSTODY RECORD
Pale of
PQ Box t6414,Greenville,SC 8 0 6-7414
(864)8774942.[phone] Fax[phone]
Shipping Arica-exec 4 Craftsman Ci,Greer,6C 29650
Www.CTTRMVIROMMCMALCOM{{'-�� -{��,,�nc f
Client: c ;+tk 0...F
�3_ 1 �x 1� f, l:� . . .
Program C stainers Preservattve Parameters
Facil
ity:Lk*" CcCQV, _WhaleEm°°°t Tonicity
CI
State: /) t NPDFS#: TO t00 18.�l'7 Acoto Cbrooie Test Orporues
v z
u (Composite only) (Grab or Composite) 1� P v a U lti• o a m C7
d Sign,end Print below 3 F `- If 2-Ht�, c ca ca -'-p in-� ',A = • <
Ls tine dotted title e.� c � u, E 1 13 v c ` .c F. ? > a o N o y . t
O o 0.o c p E
SAMPLE ID O co..paalssaK coo ri soepie covedra ago couectcd C.) m rn 2 ae hC) > .9 gm OA.. < Q V V C.i d t rn U =r 3 2 Chemical Analysis&ether .
e }
'11rr4- C 1 �. I 1n. ,»w, vrsAi.,t►� _ .
. . . /
Special Instructions:
•..-- 1 1+1ranee : 11,aSi , t51146) 40115129 •
•
Sample Custody Transfer Record Secure R%ceipt Sample
Date Time Relinquished By/Organize'on Received By 1 iza' Area Temp°C Preserved?
-5fikt 141 >1\gi-‘ IA,Dr-'-k____. "r'''.--....•,..--
COMPOSITE SAMPLING PROCEDURES TEMPERATURE MONITORING PROCEDURES HOLD TIME PROCEDURES
Composite samples must be collected aver a 24 hour period. Sample temperature during collection and transpo must be between For toxicity testing the sample must first be used wi-hin 36,ours
Time Proportional:1 sample each hour for 24 hours.Equal value 0.0 and 6.0°C.Samples must not be frozen.Use-: ice in sealed bags. of sample collection(completion of composite sample).
or at minimum 1 sample every 4 hours over 24 hours. Sample may not be used after 7Z hours Sam sample colic lin.
Flow Proportional:As per instructions in NPDES permit

J
I ,
® 9800 Kincey Ave.,Suite 100
aceAnalytical Huntersville,NC 28078
www.pacelabs.cam [phone]
SAMPLE ACKNOWLEDGMENT
Samples Submitted By: City of Statesville Pace Project Manager: Sarah Graham
Client Project ID: NC0031836 Toxicity 4th Creek Phone[phone]
Client PO#: [e-mail]
Pace Analytical Project ID: 92526400
Samples Received: March 9,2021 11:40 AM
Estimated Completion: March 30,2021
CC: Brandy Johnson
Comments: [1]Some analyses were subcontracted to an organization outside of the Pace Network.
Pace Analytical Date/Time
Customer Sample ID Lab ID Matrix Collected Method
4TH CREEK EFFLUENT 92526400001 Water 03/09/21 07:16 Environmental Impact Fee
MultiConcentration-11.25,22.5,45,67.5,
i
Please contact your project manager if you recognize any discrepancy in this form or have any questions about your project.
ifidentiality Statement:The Parties agree that they will take all reasonable precautions to prevent the unauthorized disclosure of any proprietary or
fidential information of each other and that they will not disclose such information except to those employees,subcontractors,or agents who have
expressly agreed to maintain confidentiality.
•
Thank you for choosing Pace Analytical Services, LLC.
03/10/2021 02:43 PM Page 1 of 1

Effluent Aquatic Toxicity Report Form I Phase II Chronic Ceriodaphnia it
Facility: Statesville - 4th Creek NPDES: # NCO() 31836 Pipe#: 01 County: Iredell
oratory Perfor ' g Test: Meritech, Inc. Comments:
x x 9'-771.-e
Signature of O.R. /Email/Phone Number Signature of Laboratory Supervisor
Sample Information Sample 1 Sample 2 Control rest Start Date End Date Start Time End Time
Collection Start Date
3/8/21 3/1 0/21 Information* 3/10/21 3/17/21 3:20 PM 11:18 AM
Start Renew 1 Renew 2 Start Renew 1 Renew 2
Grab
Treatment 90 % 90 % 90 % Control Control Control
Composite
(Duration) 24.1 23.9 pH Initial 7.39 7.76 7.77 7.86 8.10 8.13
Hardness(mg/I) f t, 42 44 pH Final 8.15 8.25 8.24 7.83 8.16 7.92
. om:.
D.O.Initial 8.26 7.93 8.00 8.27 8.00 8.21
Spec.Cond.(pmhos/cm) 395 425 146 154 D.O.Final 7.55 7.56 7.43 7.66 7.70 7.39
Chlorine(mg/I) <0.1 <0.1 - :1-'5:3* 3r1Q Temp.Initial 24.5 24.7 24.3 24.3 24.7 24.7
Sample temp.at receipt 1.1 °C 1.4 C rek Temp.Final 24.6 24.3 24.9 24.4 24.8 25.0
Organism# Chronic Test Results
1 2 3 4 5 6 7 8 9 10 11 12 Mean Final Control Mortality% 0
Control #Young 20 15 15 18 19 16 20 18 18 15 17.4 %Control 3rd brood 100
Adult L L L L LLL LLL At Control Control Repro CV 11.6
(L)ive(D)ead 48 Hour Mortality
Control IWC
1 2 3 4 5 6 7 8 9 10 11 12 Mean 0 of 10 0 of 10
Effluent% #Young 17 21 16 21 16 21 18 11 19 20 18.0 Significant? Y ON
Adult L L L L L L LLLL %Refit Final Mortality Significant @
11.25 (L)ive(D)ead •3.4 %�o or CNo Con
1 2 3 4 5 6 7 8 9 10 Mean
Reproduction Analysis:
Effluent% #Young 23 20 23 20 15 22 21 16 16 17 19.3 Repro.LOEC= >90 %; NOEC= 90
Adult %Red Method: Dunnett's Test
22.5 (L)ive(D)ead L L L L L L L L L L 1 o.s Normal Distrib? YES Method: Kolmogorov
Statistic: 0.7454 Critical: 1.035
1 2 3 4 5 6 7 8 9 10 Mean
Equal Variances? YES Method: Bartlett
Effluent% #Young 17 18 19 18 20 20 19 19 17 20 18.7 Statistic: 10.55 - Critical: 15.09
Adult %Red
45 (L)ive(D)ead L L L L L L L L L L -7 5 Non-Parametric Analysis(if applicable):
Method:
1 2 3 4 5 6 7 8 9 10 Mean Effluent% Rank Sum Critical Sum
Effluent% #Young 15 21 15 22 20 17 15 22 17 13 17.7
Adult %Red
67.5 (L)ive(meadL L L L L L L L L L .17
1 2 3 4 5 6 7 8 9 10 Mean
Overall Analysis:
Effluent% #Young 16 22 23 17 16 17 24 19 17 20 19.1 Result=PASS/FAIL or
Adult Red
L L L L L L L L L L . Test LOEC= >90 %; NOEC= 90 %
L J1I (L)ive(D)ead 9.8 >90 %Chronic Value=
ATT: Water Sciences Section * Should use highest test concentration or highest
MAIL Aquatic Toxicology Branch concentration with D.O.>5.0 mg/I
Division of Water Resources t Reduction from Control Reproduction Mean
TO: 1621 Mail Service Center
Raleigh,N.C.27699-1621 DWQ form AT-3 (8/91)Rev. 11/95

MEF I TECH, /NC_
A'� ENVIRQNMENTAL LABOAT RORIES
A b:vislon of Water Techno/ogy and Controls, /nc.
Multi-dilutional Ceriodaphnia dubia Chronic Definitive Test Data Sheet (Lab # 027)
Test Effluent Information:
Dilution Water:Lake Brandt
Client: 5-Kia/74'Si/! /lf
Hardness Conductivity
' NPDES#: NC003/o36, Batch# Transfer Day (mg/L CacO,) (umhos/cm)
4 C(qt 0 9- I kt6
ti 5.6 2 `'/i-1 /Sq
5 ,J f
1st Sample 2nd Sample
Collection Start Date 3-4'9-1 3-/O 2( Sample D.O. Adjustment:
Sample Type!Duration C_Akt.1 G/g3,W Stirred Aerated :None
Conductivity(umhos/cm) 3'CtS 5115
Residual Chlorine (mg/I) G U • I , `-O I (
Temperature (°C) f^ I /,L // Neonates:
100% pH 7. .),/'1 -7, 7 Tray#: (P-:
Transfer Date/Time: •- `)-.I / 't; 3 I4.
Incubator#: 3 - Born Date/Time: j / 9:-It yl-,n.- i 1 �
Temp. of Stock: •7 °C Age at Start of Test: 7 33 hours
Randomization: CD No
Test Start, Renewal, and End Dates/Times: Test Transferred by: Test Fed By:
Start Date: 3•/t):2/ Time:`3 44)00, Start: ((L_ Start: LV
Day 1: N''---
1st Renewal Date: 3 ' 0.r 9A Time: /. 11 71 Day 2: 1.-- Day 2: I--lit
Day 3: KS
2nd Renewal Date: 3 lc, Time: /9�rd/)✓y, Day 5: Day 4: /...„)z-
/ Day 5: 17
End Date: 3c 17( 9/ Time: /f:f fi'/4f) Terminated: ` Day 6: ,^r`-
Chemical and Physical Determinations:
Test Start 1st Renewal 2nd Renewal
Start End Start End Start End
Control "7-1 (e 1.$3 P, , Q 1 G h,/3 7.c 2
pH
High Conc. -7, 2,rt 2,l c 7. 7 6 F,)S• 7,77 (�,2 7
Control 9..),/ —1. .00 7.7G 2-( 7.37
D.O. Hi _
h Conc.
g �.�� j.`i`a 7, SI 3 7(76 240 7, 3
Temp. Control 34, '7 pi.`'( -O.? 1t3( r Sr M: 7 5 0
High Conc. ?,14 . c- a'°i,.(;' ')-1/.1 _ 94.3 rat4. "3 ?Al C

Meritech, Inc. (Lab # 027)
Ceriodaphnia dubia Chronic Multi-dilutional Reproduction
Client: Ct�PSL/i f l{? - 714- Start Date: `'"/`()- , / Start Time: -) 6
NPDES#: NCQ(�3) 3(�., End Date: '3. "')'7 ;Z,) End Time: l,,'/ /Iri
Analyst(s): MR, LV, KS, KL Reviewed by: 7--
Replicates
Day# 1 2 3 4 5 6 7 8 9 10 %3rd Brood
2 0 0 0 0 0 0 0 Q 0 C]
control ; 3/ ( 3 47 `.) "} � 3/ / ,'��/� 3�� 3 `�- 1 << Q '-j /;, Reproduction
Total ,,)U I; /S I tot l 'c> AO ip i __ IS / 7.'-a I
2 0 0 0 0 0 0 0 0 0
11, 5 % 5 ? ,
q 9 3/ 3 (- //b q r� `� 1,
(0u °� —1 `J7 —1 � `7 I
Total I7 o1c ( Ilu ,,tl Io d.i 1v I. I I ,1.0 % RED. •--14...`I
2 0 0 0 0 0 0 0 0 0
a 5% 5 y j, 77j 5 `I/9 . i 9 T/7 `l/` y�53 t.i/c-- `-HH�� /. " �y
`7 I ._7 y 61 °I -7 (.
Total a3 9\b a3 v \c <-.�--- al Ito Ito I-7 % RED. -jC,/
2 0 0 0 0, 0 0 O. 0 0 0
/--( % 5 L) 7 1 '' '/ti Vg >/� s18- Li/7 V7 9/6 Lr/rt
7 (.0 1 la 1 es � Cl "1 17
Total 1 -1 Ica I c"1 I$ a ,.- D Ici 1oi 1 - dQ % RED. <-.7.5-
2 0 0 0 0 0 , 0 0 0 ' 0 0
67,5% 5_y/6, -giv yg- 3 It.) -s7' 7/6, LI7 ` R 3/7 . .3/
7 s 2 i P S u -r' q 17 7
Total 15 ,,1 1 S a.)_ d D 11 i.s A D_ t--1 I 3 % RED. -I . 7
2 0 0 0 0 141© 3 /& /- yj7I / 5/)/
' , >/7 V/9
. Total 1 L2 )-).- A-5 11 I%p 1-`' R LA I,Ci I1 9-0 % RED. ,.

• MERITECH, INC. (Lab #027) Meritech Sample ID#: 0' I''') 1 —5
A
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedAmeritechlabs.com Web Site: www.meritechlabs.com
YY�� j� 1_CLIENT INFORMATION
/
Client I V C 5f 1 1e.s o( Cl Th brektK PO#: _
Contact Person: tf C ray
IJ Q v �Y�or) NPDES#: NC Qr �03 I p+P 33‘,
Address: �0;' Bo'-<. I 1}1 1 Phone: 70r(lt 8 7 Ci j Q`j8
City: 3 -C i e.5 t 11e Pipe#: 0 +
County: t^2c;E-El I State: /tD( Zip:a1��9� j� Ij ry .7-
SAMPLE(INFORMATION/� 1
Sample Site: �I't-1 1 C e e K. ( J 1. ! 't' I U rl - 0 al---c1 1 1
Sample Type: ❑Grab Composite #of containers: C� _
Sampling Time: Start Date: 3/ a li 3 l Start Time:7G Q et, PM
:, I
End Date 8 I 3 1 End Timer I W 413 PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collectors Name: Print: GJ 1 .EG r-t. L a r c Signature: 0%,:i ..--Trii(iL)
TOXICITY TEST INFORMATION
Test Required: V Chronic(7 days) Test Organism: , J Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWJ
)ia C:: /�3 % ***Friday Samples for)Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments: tf l I I r Q� ea) j ,Q;5, S , ' 6 . 6,i l 0
SHIPPING INFORMATION /
Relinquished by . N , � 'V� Date: <3 \q I \l Time: ,,� S�'"l AM M
Received by:_ /`d NziZ/.t 'fir Date: /o .-a--, \ Time: ,/ 53/ AM
Relinquished by: og //4,7 if_.t/iTic... Date: /, — � 'rr/ Time: .ot-o AM C 1
I
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ['Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery, NO SIGNATURE REQUIRED**
/ ; SAMPLE RECEIVING (Laboratory Use Only)
Relinquished by: II!! !v is C;,r`r
r'
(1r�
Received by: 1ti1 l V . Date: }_f✓ 1
` Time: tit AM GPM
Sample Temperatures(°C): l, 6 / It I / / Sample Condition: L\..7c;

• MERITECH, INC. (Lab #027) MeritechSamplelD#.0Sample 3 `Q
A-' Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
` Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedAmeritechlabs.com Web Site: www.meritechlabs.com
r5 C C CLIENT INFORMATION
Client:e 14-L\ StnieSOf UUe. -Lit ` aceeK PO#:
Contact Person: bl,GZ TLh'(\`O(\ NPDES#: NC 06 3` Y36
Address: p. 0, PI,) Mg I Phone: [phone](1 B
City: 1 . dip 1' �� Pipe#: 0
County: .L r .( I State: I„g Zip: r a0 4
(/L p `� j SAMPLE INFORMATION , L l
Sample Site: e IrL.,e L )( "E f�14 e�)l- 0W PF 1
Sample Type: ❑Grab 4� X Composite #of containers: cQ
Sampling Time: Start Date: 31 lc(A ) Start Time: f PM
End Date: 3 I 1 ( I a 1 End Time: )0 6 PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collectors Name: Print: gala-I.1 'D IS 14m l�"1 Signature:
TOXICITY TEST INFORMATION
It Required: X Chronic(7 days) Test Organism: Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (rnysid shrimp)
IWC: • --.) % ***Friday Samples for Chronic FatheadJ test must be collected after 9:00 a.m.on Friday***
Comments: I { ) ra r e e 1 C. + Q r `t 5 • it) : 5• -. ` _
SHIPPING INFORMATION
Relinquished b Date: 3 1'
Time: a 1100-M
Received by: - Date: Ara Time: PM
Relinquished by: Date: 13�//*/ Time: 3 AM 6__
Received by: Date: l////e91/, Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: _ AM PM
Sample Temperature(°C):
Method of Shipment❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery, NO SIGNATURE REQUIRED**
SAMPLE RECEIVING (Laboratory Use Only)
relinquished by: I t/1 Cr.- Nil
/e��.j ! q
Received by: (t-rn ,`I v �, Date: .�1 i_7I Time: U`�, AM ;Pla
Sample Temperatures(°C): (` i / i„i + / / Sample Condition: I. C 0
—

•
Title: statesville - 4th creek
—i_e: 4th Transform: NO TRANSFORMATION
Kolmogorov Test for Normality
D = 0 . 0950 (p-value > 0 . 100)
D* = 0 .7454
Critical D* = 1 . 035 (alpha = 0 . 01 , N = 60)
= 0 . 895 (alpha = 0 . 05 , N = 60)
Data PASS normality test (alpha = 0 . 01) . Continue analysis .

Title: statesville - 4th creek
4th Transform: NO TRANSFORMATION
Bartlett ' s Test for Homogeneity of Variance
Calculated B1 statistic = 10 . 5545 (p-value = 0 . 0610)
Data PASS Bi homogeneity test at 0 . 01 level. Continue analysis.
Critical B = 15. 0863 (alpha = 0 . 01, df = 5)
= 11. 0705 (alpha = 0 . 05, df = 5)

1
Title: statesville - 4th creek
F- '.e: 4th Transform: NO TRANSFORMATION
1 Summary Statistics on Data TABLE 1 of 2
GRP IDENTIFICATION N MIN MAX MEAN
1 control 10 15 . 0000 20 . 0000 17 .4000
2 11 .25 10 11. 0000 21 . 0000 18. 0000
3 22 . 5 10 15 . 0000 23 . 0000 19. 3000
4 45 10 17 . 0000 20 . 0000 18 . 7000
5 67 . 5 10 13 . 0000 22 . 0000 17 . 7000
6 90 10 16 . 0000 24 . 0000 19 . 1000
Title: statesville - 4th creek
File: 4th Transform: NO TRANSFORMATION
Summary Statistics on Data TABLE 2 of 2
GRP IDENTIFICATION VARIANCE SD SEM C.V. %
1 control 4 . 0444 2 . 0111 0 .6360 11 . 5579
2 11 .25 10 . 0000 3 . 1623 1 . 0000 17 . 5682
3 22 . 5 9 . 3444 3 . 0569 0 . 9667 15 . 8387
4 45 1 . 3444 1 . 1595 0 .3667 6 .2005
5 67 . 5 10 . 9000 3 . 3015 1 . 0440 18 . 6526
6 90 8 . 9889 2 . 9981 0 . 9481 15 . 6971

Title: statesville - 4th creek
4th Transform: NO TRANSFORMATION
ANOVA Table
SOURCE DF SS MS F
Between 5 30 .3333 6 . 0667 0 . 8157
Within (Error) 54 401 .6000 7.4370
Total 59 431. 9333
(p-value = 0 . 5438)
Critical F = 3 . 3769 (alpha = 0 . 01, df = 5, 54)
= 2 .3861 (alpha = 0 . 05, df = 5, 54)
Since F < Critical F FAIL TO REJECT Ho: All equal (alpha = 0 . 05)

.
. 1
Title: statesville - 4th creek
r`�.e: 4th Transform: NO TRANSFORMATION
Dunnett' s Test - TABLE 1 OF 2 Ho:Control<Treatment
TRANSFORMED MEAN CALCULATED IN SIG
GROUP IDENTIFICATION MEAN ORIGINAL UNITS T STAT 0 . 05
i control 17 .4000 17 .4000
2 11.25 18 . 0000 18 . 0000 -0 .4920
3 22 . 5 19 .3000 19 .3000 -1 . 5579
4 45 18 . 7000 18 . 7000 -1 . 0659
5 67 . 5 17 . 7000 17 . 7000 -0 .2460
6 90 19 . 1000 19 . 1000 -1 .3939
Dunnett critical value = 2 . 3100 (1 Tailed, alpha = 0 .05, df [used] = 5, 40)
(Actual df = 5, 54)
Title: statesville - 4th creek
File : 4th Transform: NO TRANSFORMATION
Dunnett ' s Test - TABLE 2 OF 2 Ho:Control<Treatment
NUM OF MIN SIG DIFF % OF DIFFERENCE
GROUP IDENTIFICATION REPS (IN ORIG. UNITS) CONTROL FROM CONTROL
1 control 10
2 11 .25 10 2 . 8173 16 . 2 -0 . 6000
3 22 . 5 10 2 . 8173 16 . 2 -1 . 9000
4 45 10 2 . 8173 16 . 2 -1. 3000
5 67 . 5 10 2 . 8173 16 . 2 -0 .3000
6 90 10 2 . 8173 16 .2 -1 . 7000

• ® Pace Analytical Services,LLC (
t:Pic'
°Analytical 98001GnceyAve. Suite 100
uiww.pacelab5.cam Huntersville,NC 28078
[phone]
February 25, 2021
Brandy Johnson
City of Statesville
693 Bell Farm Road
Statesville, NC 28625
RE: Project: NC0031836 Toxicity 4th Creek
Pace Project No.: 92521043
Dear Brandy Johnson:
Enclosed are the analytical results for sample(s)received by the laboratory on February 09,2021. The results relate only
to the samples included in this report. Results reported herein conform to the applicable TNI/NELAC Standards and the
laboratory's Quality Manual,where applicable, unless otherwise noted in the body of the report.
ma analyses were subcontracted outside of the Pace Network.The test report from the external subcontractor is
td to this report in its entirety.
The test results provided in this final report were generated by each of the following laboratories within the Pace Network:
If you have any questions concerning this report,please feel free to contact me.
Sincerely,
Sarah Graham
[e-mail]
[phone]
Project Manager
Enclosures
PCCRF'�
(1t REPORT OF LABORATORY ANALYSIS
This report shall not be reproduced,except in full,
without the written consent of Pace Analytical Services,LLC. Page 1 of 12
,_qQQ •-

•
s f wwrnrnuam uow
t re: ram e newseu:vctooer ta,tutu
A _Sample Condition Upon Receipt(SCUR) Page 1 of 2
PCeilnaicat •
. .
Document No:: Issuing Authority:
•
r
• F-CAR CS-D33-Rev.OT Pace Carolinas Quality Office
•
Laboratory receiving samples:
•
/ eville ❑ EdenD Greenwood 0 Huntersville I Raleighfl Mechanicsville° Atlanta❑ KernersvilleQ
Sample Condition Client Name: W 'V g2521043
Upon.Receipt . . •• C i' ••lac- 5 �, t._(e Project#:
Courier: °Fed Ex , CUPS °LISPS °Client 111111 if III III 11111 El
❑Commercial [Pace Other: •
92521043
:ustodySeal Present? . ales • QNo Seals Intact? Oyes No f
Date/Initials Person Examining-Contents:214 lUt. U
'atking Material': .- ❑Bubble Wrap ❑Bubble Bags ❑None El Other Biological Tissue Frozen? •
hermorneter: i •
99 W ❑et Blue ONone Dyes ❑No ]N/A
'" )Q iR Gun ID: 92T064 Type of ice: • .
2. k Correction Factor:
ooier Temp: s Add/Subtract(°C) -0,1 Temp should be above freezing to 5°C •
Z • Panicles out of temp criteria.Samples on ice,cooling process
'o'er Temp Corrected(CC): has begun
SDA Regulated Soil(°N/A,water sample) •
d samples originate in a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(Internationally,
°Yes _QNo including Hawaii and Puerto.Rico)?°Yes ONo
•
•Comments/blscre pancy:
Chain of Custody Present? ' l4es ONo ❑N/A 1.
Samples Arrived within Hold Time? Oyes. QNo ❑N/A 2.
Short Hold Time Analysis(<72 hr.)? (tYes. ONo ❑N/A 3.
Rirsb Tu• rn Around time Requested? • °Yes I (No ON/A 4, • • •
_ ,dent Volume? • JYe"s ONo ON/A, . 5..
Correct Containers Used? • Yes ❑Ivo riN/A 6.
-Pace Containers Used? g yes ONo ❑N/A
Containers Intact? Ures ❑No ON/A 7.
Dissolved analysis:Samples Field Filtered? Dyes ❑Na I N/A 8,
~Sample Labels Match COC? byes DNo ON/A 9. .
-Includes Date/Time/ID/Analysis Matrix: ,-3
Headspace in VOA Vials(>5-6mm)? Dyes ONo l jNv/A 10.
Trip Blank Present? DYes DNo EN/A 11. •
Trip Blank Custody Seals Present? • Dyes ONo ON/A •
)MMENTS/SAMPLE DISCREPANCY Field Data Required? Over ONO
•
•
• Lot ID of split containers:
NT NOTIFICATION/RESOLUTION ,
rr ontacted: - Date/Time:
roject Manager SCURF Review: . Date: 9'1—
reject Manager SRF Review: Dater .5-q^ a,.`
. . • Page 2 of 12

• ' UULUIIICfI I'/QfjiC. VVLVf 11c1141.G v1ic4•4../LLV.IC1 CU,LVLV
� aceAnalytieal a Sample Condition Upon Fleceipt(SCUR) Page 2 of 2
.Document No.: ' Issying Authority: •
i F-CAR-CS-033-Rev.07 - •Pace Carolinas Quality Office .
*Check mark top half of box if pH and/or dechforination is Project# W0# : 92521043
ffied and within the acceptance range for preservation . �+
• • PM: SMG Due Date: 03/02/21
Exc_,__._.._:VOA,Coliform,TOC,Oil and Grease,DR0/8015(water)DOC,LLHg CLIENT: 92-C i tyo f S to
**Bottom-half of box is to fist number of bottles
r ,
y
v a v ?• V y a7t ^ ? .....
v. ` .• • GA v
a a a '' n. 2 .. m ry y r Y. x ` ? �Y ` ` a 2•.
aU E 2 ,a rs c: . 2 v Z ¢ m• O -
si. a a v O O Q p '—° d c p O9, •a 0 ' ? m Z •Y C N 5 g
'> d
c c . c G N z m to a a N E z ,..„ Z e o y in Fi -1 x - c c a
• c x Z N z T c N x C O I,^ 5 = z ' a
u n U . = x t _7 i N c y a a ,,, i-
w ' 'C'i t+i u v v 'a+ N .'c. a` `a y .a F a Z « S - m m ...-7
ro .- 2 . ra S9 ro E.
E -fl EE o o ¢ ¢ o . '.4 y •t E a a a !a = a a c E E a E E O p O O a H H _, „
1: E E, c ,-I E .E 61 ` ` E < .� :Ls'. J j -' = y J -' -' E J"
e; E E $ p; a y E ¢ ntfl E E 5
fn o o _ fn O cn .t1 - o O QE E E I.
a, E o 0 o E E
MI N In .-I ,i N ,1 ,-1 N .-1 N ..., N Q g Q . v ..al N N "I N Q
A 3 3 > 3 A i N v =, 3 x z �4 IA < s A Z a W Y N a 3 3 3
aEi a a Z a a ar. a a t7 1? t7 4~7 t7• ' ' ' t7 G O w y' pN r—' C c w '
m m m m m m m m 3 ¢ ¢ ¢ a ¢ a o > > a > 3 h rn m ¢ > G
\ . \ •
\ . \\, -
- \ _ -
\ . . .. . . . . . • \ ,• .• .
- \ \ .
.\\ • . .
• \• •
\\,\, ,,, .
• \ .\ . •
\ • \ • •
- . - , N
\ \ \\ .
\ .
• \ • •
•
\ ._. \\\,\.. .. \ _ .
\ -\\ _ _
•
pH Adjustment Log for Preserved Samples .
Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation Amount of Preservative Lot it
adjusted added
•
_
t- `-- er there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DEHNR Certification Office(i.e.
t :orrect preservative,out of temp,incorrect containers.
•
Page 3 of 12

•
4
O
a'
ETT .
•
•
CHAIN OF CUSTODY RECORDal
. : •
•
ilC.4y�.I•,nl.gyp. G" e�� �-
I d{" a .;;x - :.._ Mithi'!� ''ram,.„
yLa"wt.. 17k K�.-
74 sPa°e of
t3 Box 16414,Greenville,SC 296e6-7414 1 - o
364)877-6942, [phone] Fax:(864)'877 693E '
;hipping Address:4 Craftsman Ct,Greer,SC 29660
/W W.CCTCNVtRCNM EN_rAL.CC M
aCility f y� � �'�F5' Program Containers Preservative' Parameters
itat'e: t•�� _N]abES#:.• ) _ •
Whole Effluent Toxicity
� -[QQ� ..�...� Acute Clt runic Test brgnn,sms Q
° (Composite only) _
y) (Grab _ o U 3
o . U y j
Q. N .. t3 ."_ o ,,„ .
Sign;and Print-below 3 c oa 1= 2 a
to the dotted line - N U , r s=Hmo3 = c a y
SAMPLE ID c? ` o :.o 4., .. r .1=Net7ti •� " a F P y a N
Composite Stnn Pete Time Semple Collection Dnte Time Collected by Cj Z C7 5=znAc 8 o -- T > j,_ W W ^
t-fiNe Ce•K ^� .,-;.... ; G=Oi,cr U V CU [] 04 z rn V = ?r Chemical y
rt i�'�l r t • %�� i r I• �} �j • �! i[ Analysis Cther
C T I L f e rl i� "y::t s•:.,;:.,,: fiP r, 2 v % /" It fe
/►--=-1
•
.
•
>peciailnstructions 2
Sample Custody Transfer Record
Secure Rc ccipt Sample
Patek Time Relinquished By/Organization Received By/Organization Area Temp°C Preserved?
:',J.C141'e1 f p, "V2+ ' C'i l t r(?et- •.;
•
COMPOSITE SAMPLING PROCEDURES r HOLD TIME PROCEDURES
- TEMPERATURE MONITORIAL PROCEDURES
Composite samples must be collected over a 24 hour period. Sample temperature during collection and transport must be between
Time Proportional:7` 9 ° p For toxicity testing the sample must first be used edtr.in 36 hours
p o1e each hour for 24 hours.Equal volnl 0.0 and 6.0 C.Samples must not be frozen.Use 1 cc in sealed bags. of sample collection(completion of composite sa:
tr at minimum I satk very 4 hours over 24 hours. Sample may not be used after 72 hours from samp,_I ,llcction_
Plow Proportional:As per instructions in NPIlFS nermit

Document Name: Uocument Revised:October 28,2020
• b Sample Condition Upon Receipt(SCUR) Page 1 of 2
' i'. ___,.•-• aceAna ical Document No.: Issuing Authority:
F-CAR-CS-033-Rev.07 Pace Carolinas Quality Office •
r
Laboratory receiving samples:
-'---•"le❑ Eden❑ Greenwood n Huntersville Raleigh❑ Mechanicsville❑ Atlantan Kernersville0
,
S . - ondition Client Name: •
Upon Receiptf..... t-eccIP;gject#:
Courier: ❑Fed Ex Ours DAPS ['Client
0 Commercial' ace . ❑other.
'ustody Seal present? . ❑Yes No Seals Intact? ❑Yes Egg; _' - k"'Lf '"l/..:
Date/Initials Person Examining-Contents:. .
kiting Material: .• ❑Bubble Wrap ❑Bubble Bags Pone 0 Other Biological Tissue Frozen?
iermometer�: - Dyes ❑No EiNiii
.p IA Gun ID: 92T064 O OBlue ❑None
Type of Ice:
Correction Factor:
'o'er Temp: _ /• Add/Subtract(°C) -0.1 Temp should be above freezing to 6°C
•
[{samples out of temp criteria.Samples on ice,cooling process
toter Temp Corrected(°C):•• . 5, 3 has begun
iDA Regulated Soil L " A,water sample)
d samples originate in a quarantine zone within the United States:CA,NY,or SC(check maps)? Did samples originate from a foreign source(internationally,
QYes ..❑No• . . .- including Hawaii and Puerto Rico)?Dyes QNo
Coinrrsents/Discrepancy:
•
Chain of Custody Present? • l ❑No ON/A 1. .
Samples Arrived within Hold Time? yes. [DNo .ON/A 2.
Short Hold Time Analysis(<72 hr.)? EffecT
• �DNaa ON/A 3.
_'` '+Ti,•n Around Time Requested? []yes fNo EN/A 4,
Su Volume?. es. ❑No ON/A . 5.• .
Correct Containers Used? 'Yes ❑No ON/A 6. .
•-Pace Containers Used? Yes ❑No ON/A •
•
Containers Intact? _ yes ❑No ❑N/A 7.
bissolved analysis:Samples Field Filtered? Oyes ❑No JA 8. •
Sample Labels Match COC? es ❑No ON/A 9. •
-includes Date/Time/ID/Analysis Matrix: • •
•
Headspace in VOA Vials L(>5-6mm)? ❑Yes DNo A 10.•
Trip Blank Present? Dyes (e ON/A 11. .
Trip Blank Custody Seals Present? ❑Yes ❑No N/A^
•
DMMENTS/SAMPLE DISCREPANCY Field Data Required? Dyes ❑No
. Lot ID of split containers:
:NT NOTIFICATION/RESOLUTION -
•
! cted: - Date/Time: .
'roject Manager SCURF Review: did • Date: 2 -12. -2) .
'roject Manager SRF Review: <140 Date:_ '21—j 2-2l .
•
Page 5 of 12

v UULUT,ICI,t Nd[IIC. Vb,U urcP I,nCYUDCU.LLtvvo LQ,LULU
' Sample Condition Upon Receipt(SCUR) Page 2 of 2
/ dC8At1c?jICr?� Document No.: Issuing Authority: •
• F-CAR-CS-033•Rev.07
*Check mark top half of box if pH and/or dechlorination is Project# wo# : 92521043
' ified and within the acceptance range for preservation PM: SMG Due Date: 03/02/21
tples. CLIENT: 92-Cf tyofSta •
Exceptions:VOA,Coliform,TOC,Oil and Grease,DRO/8015(water)DOC,LLHg
**Bottom-half of box is to list'number of bottles J.
•
$ _ a
a 2 u V z
a N. yi 2 o. c b a v v a c `z,. z z z z a d • '2
. � z ¢^
Is
m m a v O O < o .. .=a.. c O o .n mO `- — m x Y 11 i N . c2. } Et
c c N x z O 0 G •r, = N = < ? EN ? d 6 ; to L z ] O C
2 N 2 =, .. T t. .0 ry C ee a L. r7
. ..a .N u y u . .Y t a`, v .0 w` a E x 2 D .2 . Y O1 f. 2 3 "d
m P. e� •- ro 12 a r_"o Q 'n .fl E -1' N Q n< Q Q y y a^ E •. •
a F. c a_ F E < E N O p O d .� N a Q 'u E
J ,,,-'1 .0 _� c Q < -J < .� > > > > to a v, • ti <.
vEi o o °' E o t o • te E P' o e¢n E E E E ; g E E E o E E
pp ,Q o
• nN•1 N U�1 v-1 N ,..I ry rV .-4 N O et C 'C 1 •N-1 N N eN N C
A g > > 7 to i N V = 3 2 7 th Q x 7 6. a Y Y F F •Q 6 6 6
V. .•I " M .•I M n'S t71 Of Gt M < 8 N N m o o. Ql
a a a a a a t? Ft 0 t7 tx• t0 E g t7 t7 O p p, a 1.7 to 0
m m +n m ca m m m 3 a ¢ a ¢ a• a n > > o > h ,n to < > c
1 \ \ . I• .
\ . \ '
.R\\\\,' . " .
3 \ \ . - .
• • • - . • \ •\ • • • • • • • • • . . ..
. . \ \ N . . .
5 \ • , . '
' \ .\ -
I ` • \I . \ \ .
.0. \
,\ \ . .
'.\\\\\\\\\ _ _
.1 \ \
2 \ \ \ • \. .
pH Adjustment Log for Preserved Samples
Sample ID Type of Preservative pH upon receipt Date preservation adjusted Time preservation -Amount of Preservative Lot H
adjusted added
•
of hen ever there is a discrepancy affecting North Carolina compliance samples,a copy of this form will be sent to the North Carolina DEHNR Certification Office(i.e.
ut Jtd,incorrect preservative,out of temp,incorrect containers.
•
Page 6 of 12

• N
CET
,,i,
• YY��-- y��pT� •-��{ CUSTODY RECORD O
•
0
T
t iN ._ '�'�'. ._... 0 Page of
PO Box 16414,Greenville,SC 29606-7414
[phone], [phone] Fax:[phone]
Shipping Address:4 Craft?man Ct,Greer,SC 29650
W W W.E7-reN V I RO NM ENTAL.COM '
Client: ti —
�,�;,}( \ �J ti "S 't,� e. ..sk�\�,te_. Program Containers ' Preservative
Facili •
ty: ,':;:,1 : Parameters
"7 �yr
'�� 4� ' �• ` ` Whole Effluent Toxicity 4h
State: P.) 0,, `VPDES#: f 1201,On 2.,I 1 cent° Chronic Tcst Organisms
ci a .1
g (Composite only) (Crab or Composite) 4 R — ac C- z
ry i , 1�4I2SOA ten- m C • w W , r%J
I . 'St nViiik Purit%bblow itl n e7p ?aHCI, x R: •:G ,� SDI '
the dotted line c rJ .� 3�xNo3 •r z •� :n 'U c y G •
cMq a a=NaOli .2 2 o o a. N e ^ 2,2 - .
SAMPLE ID �? 6' : o o o 5.znn° 8' o ' T. ., ;=• w to Q m ompJosile5tnrl Date Time Semple Collection Date Time Collected by U 'al cn Z F 0 ? 6=O0,°c d, .` C) C,) CU 0 C 2, v7 w U F �r Chemical Analysis 8.Other
• fau n�- 111(yyy/!!! (1lJ f a . id 1 - ryw.K -R . rJ`I 1' `�� IN
•
•
•
•
Special Instructions:�'y /� �"��� / t �}
I " 1.f i, f-z �._� ',-:`1+.._•. , ' (t 1 f 1 (i� ,, s / q s- 6 ! r 5 f q(
•
Sample Custody Transfer Record ^l • "�l + • . Secure Receipt Sample
Date Time Relinquished B Organizatio � �`'� \� Received By/Organization A,Pea Temp°C Preserved?
4 " ‘z
in , p,,,,, z___
l , ,.. .... 4.-
COMPOSITE SAMPL.'NG PROCEDURES TEMPERATURE MONITORING PROCEDURES HOLD TINE PROCEDURES
Composite sampled mtaot be collected over a 24 hour period. Sample temperature during collection and transc t be between • For toxicity testing the sample must first be ust n 36 hours
Time Proportions pie each hour for 24 hours.Equal volut 0.0 and 6.0°C.Samples must not be frozen.Us( ice in sealed bags. . of sample collection(completion of cdmposite ).
or at minimum I every 4 hours over 24 hours. Sample may not be used after 72 hours from s _allection.
. Plow P,toportion a leer instructions in NPDES permit.

enu ronment�,(nc. (f84)977-6u42.FAX(864)877,6938
P.O.Box-16 414,Greenvilte, SC zst106 4 Craftsman Court, Gr80r,SC 29650
Ceriodaphnia dubia Survival and Reproduction Test
EPA-821-R-02-013 Method 1002
Client: CITY OF STATESVILLE
Facility:4TH CREEK WWTP
NPDES#:NC003I836
Test bate: 10-Feb-21
Laboratory Sample ID#:T58503
Test Reviewed and Approved By:
Robert W.Kelley,Ph.D.
QA/QC Officer
j = ,,,Certification#E87819
SC I)H E C Certification#23104
Test results presented in this report conform to all requirements of
NELAC,conducted under NELAC Certification Number E87819
Florida Dept.of Health.Included results pertain only to provided samples. N C I)E R Certification# 022
Page 8 of 12
Page 1 of 5

Effluent Aquatic Toxicity Report Form/Phase II Chronic Ceriodaphnia
Facility: CITY OF STATESVILLE 4TH CREEK WWTP NPDES# NC0031836 Pipe 001 County: Iredell
Laboratory Perfor g Test: ETT Environmental,Inc. - Comments:
r '---,i,F,e j._`.. .7.-
Sig.' 1-11 O. . Signature of Lab Supervisor
Test Start Date Time End Date Time
Info 02/10/21 3:30 02/17/21 1:19
Sample Information Sample 1 Sample 2 Control !Start 'Renewal 1 'Renewal 2 'Start (Renewal 1 Renewal 2 1
Collection Start Date 02/09/21 02/10/21 Treatment 90% 90% 90% Control Control Control
Grab pH Init. 7.1 _ 7.3 7.3 7.8 7.7 7.7
Composite(Duration) 24 hr 24 hr pH Final 8.2_ 8.4 8.2 8.2 8.3 8.1-
Hardness(mg/L) 85.7 D.O.Init 8.5_ 8.3 8.2 7.9 8.2 8.2
Spec.Cond.(umhos.cm) 288 317 308 D.O.Final 8.5_ 8.5 7.9 8.3 8.5 7.8
Chlorine(mg/L) <.05 <.05 ... .. Temp!nit 25.0_ 24.6 24.7 24.7 24.4 24.5
Sample temp.at Receipt 1.3 0.8 Temp Final 24.8 24.9 24.6 24.8 24.9 24.6
1 Chronic Test Results 1
Final Cont Mort.% 0.0%
Organism# %cont 3rd Brood 100%
.1 2 3 4 5 6 7 8 9 10 11 12 Mean Control Repro CV 9%
Control #Young 27 21 21 25 25 20 22 23 22 22 none none 22.8 48 Hour Mortality
(L)ive
(D)ead L LLLLLLLL L none none _ Control IWC
0of10 0of10
1 2 3 4 5 6 7 8 9 10 11 12 Mean Significant? No
fflt!ant% #Young 22 21 22 21 24 20 21 23 23 23 none none 22.0 Final Mortality Sign.@
Adult %Red
(L)ive
11 (D)ead L L L L L _L L L L L none none 3.5% % or no cone
--
Reproduction Analyses
1 2 3 4 5 6 7 8 9 10 Mean Repro LOEC= >90.00% NOEC= 90.0%
Effluent% #Young 23 20 20 21 25 20 20 21 23 21 21.4 Method: t Test w/Bonferroni Adj.
Adult %Red Normal Dist? yes Method Kolmogorov
(L)ive
22.5% (D)ead L LLLLLLLL L 6.1% Statistic 0.894 Critical 0.895
Equal Var? yes Method Baffles
1 2 3 4 5 6 7 8 9 10 Mean Statistic 3.63 Critical 15.10
ffluent% #Young 21 21 23 23 22 19 22 20 23 22 21.6 Non-Parametric Analysis(if applicable):
Adult %Red Method: t Test w/Bonferroni Adi.
(L)ive
45.0% (D)ead L L L LLLLLL L 5.3% Effuent% Calc.t Critical -
11.3% 1.05 2.30
1 2 3 4 5 6 7 8 9 10 Mean 22.5% 1.85 2.30
•
(fluent% #Young 22 20 20 25 21 22 21 20 21 19 21.1 45.0% 1.58 2.30
Adult %Red 67.5% 2.24 2.30
(L)ive
67.5% (D)ead L L L L L L _L L L L 7.5% 90.0% 1.45 2.30
Overall Analysis IC25= >90.00%
1 2 3 4 5 6 7 8 9 10 Mean Result=PASS/FAIL or
'fluent% #Young 20 21 21 21 25 19 22 23 21 24 21.7 Test LOEC: >90.00% NOEC= 90.0%
-161 Adult
(L)ive
c (D)ead L L L L _ LLLLL L . Chronic Value= >90.00%
Environmental Sciences Branch *Should use highest test concentration or
'IA!L Division of Water Quality highest concentration with D.O.>5.0 mg/I
N.C.DENR %Reduction from Control Reproduction Mean
®: 1621 Mail Service Center
Raleigh, NC 27699-1621 DWQ form AT-3 (8/91)Rev. 11/95 Page 9 of 12
Page 2 of 5

•
Test Day
urce rep 1 2 3 4 5 6 7 8
I star a T58503
.1-Za A b +1u+11 zr ��nvol Client STATESVILLE
1-28 B +3+8 10 21 Sample ID 4TH CREEK '
I1-29 C -+4+7 10 21 NPDES# NC0031836
1-28 D 4 +9+12 . 25 County 0
11-28 E 4 +10+11 25 Month 2
1-29- ,F +3+8 9 20 Start&fed Date 10-Feb-21
-0 1,- ; 4 +8+10 22 Start&fed Time 03:30 PM
1-2 i +3+9 11 23 Started&fed By AM
1-28 I 5- +8+9 22 Test Organism Ceriodaphnia dubia
1-28 J +4+7 11 22 22.0 Neo.born date -09-Feb-21
A +J+/ 12 22 Neo.born time 1645-2200
B +4+6 11 21 Test Type NCCD
C +3+7 12 22 Dilution Water MHSF
D +3+8 10 21 Units for Conc.
.25 E 4 +9+11 24 %3rd BROOD
F +4+6 10 20 Test vessels 30 ml
G 3 +7+11 21 Test volume 15ml
H +4+8 11 23 Incubator# 1
I 5 +9+9 - 23 ivtc 1 Light 161t/8dk
J 4 +8+11 23 22.0 Initial Temp'C 25
A +3+8 12 2d Selenastrum 0.05 ml
B +4+6 10 20 YAT 0.05 ml
C +3+6 11 20 Test method EPA 621-R-02-013:1002
D +4+6 11 21
# E 3 +10+12 25
F +3+7 10 20
G +4+7 9 20
H -+4+7 10 21
I 4 +10+9 23 I C 1 Comments
J 4 +7+10 21 21.4 II
1 LI
B +4+8 9 21
C +2+9 12 23 Control ini temp
D 5- +7+11 23
E 4 +6+12 22
F +3+7 9 19
G +4+8 10 22
H +4+6 10 20
I +4+7 12 23 Tirni
J +4+7 11 22 21.6
A +J+d 11 22
B +3+6 11 20
-C _ +4+7 9 20
D 4 +8+13 25
E +3+6 12 21
F 3 +9+10 22
G +3+7 11 21
+3+8 9 • 20
4 +6+11 21 ry
1
IJ 4 +6+9 19 21.
A +3+b 11 0 .2Z
B - +2+9 10 21
C +4+7 10 21
D +4+6 11 21
E 4 +10+11 25
F 3 +6+10 19
G +3+7 12 22
H +3+8 12 23
-I —
_ y +4+7 - y ...
21i2
J 4 +10+10 244 1.7
JC JC I End Date
AM JC JC AM JC JC I 1/-I-eb-21
d&renew 04:50 PM 02:29 PM 06:59 AM 09:26 AM 01:06 PM 07:52 AM I`__ 01:19 PM I JC
New temp.'C 24.6 24./ D=Dead N/A-Lost or not used
p.•c 24.8 24.9 24.6
New temp.°c 24.4 24.b
Page 10 of 12
Page 3 of 5

, li� t •'��::..,.•may. Y ., . . •.
CHAIN LT CUSTO illY
u�7 liti���G iilr m-A 1 a i"�a'i ta..,,, RE`Li O y
i v. iii u� i�.1, l�u,l. l roily, .T _ npiN
ti
PO Box 16414,Greenville,SC 29606-7414 kpa;e of
[phone], [phone] Fax:[phone] t
Shipping Address:4 Craftsman Cl,Greer,SC 29650
W WW.ETTENVIRONMENTAL.COM
Client: 7, �. --
( lam- * �� ,i�`t } Proornm Containers 'Preservative
Facility:{ Lk.\-VN--)a (-- _�/. ' k — Parameters
1 "
r ,- 1 J
State: �� 1.1 ( Whole Effluent Tos;city _
NPDES I .�1f;()(-), ) ? ..:3C%�'
' - �� TrstOrGanisms C
rm
i � '
—
U° (Composite only) '3
(Crab or Composite) p
Sign,and Print below i-tic oa ti _
.. va ,�, e1, t Vi
^ N ✓
_ the dotted line a=tlr oa <G n=NaOFI ;; — _ _
SAMPLE ID ^ l Chemical Analysis&Other
1 1 PCollection Dille Time Collected by -7.Ac o _ LI !_•` ? —
;Composite Start Date Time Snmplc
�6i.a�r- �'L 6-Other < < • C, t_�2- rn i Y —
� tl^ IiII
i _
1
. , 1
, ,
mil.
1611LI-1 Aii
1 mill
i 1 r
,r1
i ,
1 i imi , iii .
_______mi
;Special Instructions-
(1 � .VI Roq : i I1a S1 2° S Lf50 E ,
;Sample Custody Transfer Record _
Secure Receipt Sample
• :Date? Time Relinquished By/Organization
Received Ely
!1..1 1't r .y ,-, p Area Temp°C Preserved?
170
2-1Q-2J )31� ''; �,). 7— 1' I I ol7) ii'.is 11..3
C&IPOSJTE SAMPLING PROCEDURES TEMPERATURE MONITORING PROCEDURES
HOLD TIME PROCEDURES
Composite samples must be collected over a 24 hour period. Sample temperature during collection and transport must be between For toxicity testing the sample must first be used within 36 hours
Tire Proportional:1 sample each hour for 24 hours.Equal volal 0.0 and 6.0°C.Samples must not be frozen.Use water ice in sealed bags. of sample collection(completion of composite sample).
or lat minimum 1 sample every 4 hours over 24 hours. Sample may not be used after 72 hours from sample collection.
Flow Proportional:As per instructions in NPDES permit.

,r...,+
„' `' CHAIN .i? CUSTODY CC
�;l:l rV e ,
Vi I n, ,� it PV,r .�65+11�7ir + �lrh��,,,,,,,11���e:f'yr"„,°.
1I r: II��Mn PI R V, y I p 1�Yi,Y �1 yltq 4'��' tti�'N'N?CX
V!i��lli Ir it 6h�a.;?la�R��...t!Iike,.� i•,y,l.I.o.am-I k n`G''.''�w t �
PO Box 16414,Greenville,SC 29606-7414
{Page of --1(864)877-6942, [phone] Fax:[phone] [
Shipping Address:4 Craftsman Ct,Greer,SC 29650
W W W.CTTENVIRq NMENTAL.COM
Client:
I ~ i ru, ` }ii= < 1 cc\ �e.-SO ki
�`? Program Containers Preservati�c 1,FacilitY:
i—/-1-+rl (y \r.- { Parameter! 1,: G 1 ----'...-7
State: [\ 0_,, NPDES,"-: /J�J Or.O 2)I R (tom Whole GfllucntToxici + Q
J , Acute Chronic Test Organisms •
•
1 it
a (Composite only) (Crab or Composite) 4 t:' _ p U $ Z
o u to�' U o
U ram.. t- - . C N . ^_ .^- �' , Z
= Sign,and Print below 3 co c 2 IBC oa c uf
t' EZ
c� the dotted line " U o �' s=NNo3 — o -- a -= o ^I E E
2 o s a o m ❑ u o'Na. = = .o •o '? 3 • ,Is' =! p ram'. .5 L
SAMPLE ID U Composite Stan Dr Time Sample Collection Dote Time Collected by U y `a - > U 3=7_e"e o ci _ • _ 0.. L•7 _
t.�,1--h ll t �v�� \ c fi=Odrcr < <(U U U C] L` 2 i� _ r, z Chemical Analysis Other
(_- ' lall 1 --9e cQiffia )
` 1
im
1
ICri 1
1
—I i •
)t
i 1
-
Special Instructions:�� �-- ` r)
•
Sample Custody Transfer Record
•Secure Receipt Sample
Date Time r---, Relinquished By/Organization" / Received By/Organization Area Temp°C Preserved?
�
ji it Al 1 ri r�� I' r, 9
.g01 ogqc ctc.v 4-7 6-u--- o.S
m
CO POSITE SAMPLING PROCEDURES TEMPERATURE MONITORING PROCEDURES HOLD TIME PROCEDURES
Composite samples must be collected over a 24 hour period. Sample temperature during collection and transport must be between • For toxicity testing the sample must first be used within 36 hours
Thik Proportional:1 sample each hour for 24 hours.Equal volut 0.0 and 6.0°C.Samples must not be frozen.Use water ice in sealed bags. of sample collection(completion of composite sample).
or tminimum I sample every 4 hours over 24 hours. Sample may not be used after 72 hours from sample collection.
Flow Proportional:As per instructions in NPDES permit.

0/
' Effluent Aquatic Toxicity Report Form/Phase II Chronic Ceriodaphnia
1
Facility: Statesville -4th Creek NPDES:# NC00 31836 Pipe#: 01 County: Iredell
x ratory Performing Test: Meritech, Inc. Comments:
x x 2 2 -
Signature of O.R.C/Email/Phone Number Signature of Laboratory Supervisor
Sample Information Sample 1 Sample 2 Control Test Start Date End Date Start Time End Time
Collection Start Date 2/8/21 2/10/21 Information•• 2/10/21 2/17/21 12:00 PM 11:09 AM
Start Renew 1 Renew 2 Start Renew 1 Renew 2
Grab
` ' Treatment 90 % 90 % 90 % Control Control Control
Composite
(Duration) 24.3 24.0 '. pH Initial 745.00 7.61 7.49 8.04 8.11 8.06
„r i � g "4 r pH Final 8.09 7.98 7.99 7.93 8.00 7.84
Hardness(m I) t - i .,.3 , 48 46
D.O.Initial 7.94 8.00 8.03 7.92 8.03 8.14
Spec.Cond.(pmhos/cm) 295 313 165 164 D.O.Final 7.67 7.76 7.31 7.83 7.97 7.45
1 t ,r
Chlorine(mg/I) <0.1 <0.1 2:1
Temp.Initial 24.2 24.9 24.3 24.2 24.3 24.3
°C ° a; p 24.4 24.3 24.9 24.3 24.7 24.8
Sample temp.at receipt 1.3 1.4 C ,7 . Temp.Final
Organism# Chronic Test Results
1 2 3 4 5 6 7 8 9 10 11 12 Mean Final Control Mortality% 0
Control #Young 22 20 25 27 21 20 23 23 21 23 22.5 %Control 3rd brood 100
Adult L L L L L L L L L L Control Repro CV 9.9
(L)ive(D)ead 48 Hour Mortality
Control IWC
1 2 3 4 5 6 7 8 9 10 11 12 Mean 0 of 10 0 of 10
Effluent% #Young 23 27 25 21 27 27 23 24 23 26 24.6 Significant? Y l
Adult L L L L L L L L L L S Redt Final Mortality Significant @
11.25 (L)ive(D)ead -9•3 % or (No ConC)
1 2 3 4 5 6 7 8 9 10 Mean
Reproduction Analysis:
Effluent% #Young 23 19 25 17 25 24 24 21 20 23 22.1 Repro.LOEC= >90 %; NOEC= 90 %
Adult L L L L L L L L L L Red Method: Dunnett's Test
22.5 (L)ive(D)ead 1.8 Normal Distrib? YES Method: Kolmogorov
1 2 3 4 5 6 7 8 9 10 Mean Statistic: 0.7671 Critical: 1.035
Equal Variances? YES Method: Bartlett
ffluent% #Young 26 24 19 21 21 18 23 28 27 28 23.5 Statistic: 7.7153- Critical: 15.09
Adult %Red
45 (L)ive(D)ead L L L L L L L L L L -4.4 Non-Parametric Analysis(if applicable):
Method:
1 2 3 4 5 6 7 8 9 10 Mean Effluent% Rank Sum Critical Sum
ffluent% #Young 23 22 26 27 30 21 26 28 26 28 25.7
Adult
67.5 (L)ive(D)ead L L L L L L L L L L 14ed
1 2 3 4 5 6 7 8 9 10 Mean
Overall Analysis:PASS/FAIL or
fluent% #Young 27 25 25 27 25 25 28 27 25 29 26.3
`! I Adult Red Test LOEC= >90 %; NOEC= 90 %
(L)ive(D)ead L L L L L L L L L L _16 9 >90 %
Chronic Value=
ATT: Water Sciences Section * Should use highest test concentration or highest
MAIL Aquatic Toxicology Branch concentration with D.O.>5.0 mg/I
Division of Water Resources t Reduction from Control Reproduction Mean
TO: 1621 Mail Service Center
Raleigh,N.C.27699-1621 DWQ form AT-3 (8/91)Rev. 11/95

„ i , ,
,,
Ai. 11,71e1:1•77WC7-11 11A1C-.
ENVIRONMENTAL L.ABaPgTORIES
� ai>of Wares Tecch�oic
9Yand Cori trod inc. _
-�
.4 O .d=
Multi-dilutional Ceriodaphnia dubia Chronic Definitive Test Data Sheet (Lab # 027)
Test Effluent Information:
Dilution Water:Lake Brandt
Client: r� 5I /tie f `
Hardness Conductivity
NPDES#: NCH 31 -)3; Batch# Transfer Day (mg/L CaCO3) (umhos/cm)
'i 1'v 0 y fS .
2 /- ,t
1L1i 5 y (0 /bLE
1st Sample 2nd Sample
Collection Start Date , -- 1 d\-A b—A Sample D.O.Adjustment:
Sample Type/Duration /gy,3 ' ?i-I .�?
- 7 Stirred Aerated None
? <`
Conductivity(umhos/cm) 95 1
Residual Chlorine (mg/I) `Q'/ 2, t: t
Temperature (°C) f, 3 1 ,u Neonates:
100% pH / 5' -,31 Tray#: 2
Transfer Date/Time: '-t 9--1 / P,.c7A-M
Incubator#: > -
Born Date/Time: J /A/:2 rpm -5: i.
Temp. of Stock: ” Li.,7°C Age at Start of Test: a...� 3 hours I
Randomization: Yes No
Test Start, Renewal, and End Dates/Times: Test Transferred by: Test Fed By:
Start Date: :;,-)'(0 I Time: )2.00/2,,\ Start: . /2., Start: LA/
Day 1: M'
1st Renewal Date: A Le-) - ._1 Time: -`�dip" Day 2: V j& Day 2: U V
Day 3: /F`s'
2nd Renewal Date:2 -iS` 'S s�
Time: �. �,,,-) Day 5: pri-- Day 4: &A-
Day 5: -1O
End Date: D -17r{91 Time: /I U'I A)-1A Terminated: /71N.__ Day6: ��
emical and Physical Determinations:
Test Start 1st Renewal 2nd Renewal
Start End Start End Start End
Control (`,` -�. ci?� 8, I 1 L,£;�� 2.Die 7,8Y
pH —
High Conc. 7 `its 2)J)r1 761 _q 3 -7, 0 7, 9
D.O. Control 7, g2 7. g 3 8.0 _ 7.(1-1 `,l'4 71(V 1)
—
High Conc. 7. 9 `_7.
8,0� - -, I
Control '.a �9_1 D-y-` 7 7 (Ii, 3 c
Temp.
High Conc. ,t.i.g— 7-q_9, . )M3 `D-'{• 3 ..m.. 1

Meritech, Inc. (Lab # 027)
Ceriodaphnia dubia Chronic Multi-dilutional Reproduction
Client: •(61`',e.V 17 1ic. Lill\ Start Date: 7 -' )0 71 Start Time: /9 ;C `r,13^n-
NPDES#: NC & I S'•7(,.+ End Date: ; - )7_ 9. End Time: // .• c(r
Analyst(s): MR, LV, KS, KL Reviewed by: /"
Replicates
Day# 1 2 3 4 5 6 7 8 9 10 %3rd Brood
2 0 0 0 0 0 0 0 0 0 0 • I /0e)
control 5 3/7 3/ / K/ c' / /// �(/6, 3/ri' c//(7 L1/^7 (l 3/9 L C.V. Mean
7 i; CC) L3 �2 ( I p� /� �}"�� // ' c�.t 1 Reproduction
Total 2 -0 Pc -`7 7.1 20 04-3 p-3 a1 1'3 Z%), . I
2 0 0 0 0 0 0 0 0 0 0
11•;.6 % 5 `1// Ll// '-//C '.113-' S
7 f� �� � /// sib rl� �J 3/� boo
t / 9 /1 ' 1,- I t0 /, . // 1> '4.i
Total ,3 gi-'� - 1 .0 `vim ' 9....3 ` ,i1 d4 `�-e,,, % RED. -tt.'3
2 0 0 0 0 0 0 0 0 0 0
a2.5 % 5 1-///a "3/ ) `l// ��s 6l//; T. "3/ L(/ �(/.7 '1/�.
(1( --II (- II /;-) ? 7 J /6 .}.a. I
Total S 1 i 2 `7 `<-;- y ;' a _ % RED. I I .u
2 0 0 0 0 0 0 0 0 0 0
(.-1S % 5 3/v 3/i Lf/"7 IV ' �.///P7 L i/ 3/?? / `////-9 li // e6-c . _ :-i%i-:z
7 1 3 r, V 1 '7._. 5`_ /c� 3 4�//� -, 3.
Total cn at/ / 9 (:),/ �/ :� ,i , , s 7 ' 7, - % RED. T:-iiii
i.✓ , -ici-aI
2 0 0 0 0 0 0 0 0 0 0
675% 5 3 8 3/ F 5 y//o ti/i i /q 3//o 34r) y/t // /
7 I 1/ /? _� .Jc ;5i � � _ '--
Total a.3 r�7 (47 c / cr6v 04,15 T /� —� �� % RED. 1+.5k ..)...
2 0 0 0 0 0 0 0 0 0
r % 5 y /! //(2 3/ `--//l/ 3/? '/ '-illy y//o '-1// I ra 16
7 (1 // /"3 /; /�4 ; /9 /3 ie) `ic- I ;�.�
Total ' , / '`, oik' A'7 ` . (:- j9:"' '0 Q' '; .'.-7 c-, Pam" Ly oc Dcn 1 , ,

_ _ _
MERITECH, INC. (Lab #027) Meritech Sample lD#: ODl/S)' lI
.„.,
At Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
Toxicity Supervisor email: [e-mail] Web Site: www.meritechlabs.com
i CLIENT INFORMATION
Client: 1' =—�-�`t,\4_�- �-�\�t\le "�'Li I ' 7� K PO#:
. Contact Person: t;-J�l' �t 'l— —�ll'�1 y')On NPDES#: NC (at>: i
Address: .p . 'Bo • (I it Phone: 70-12 (S 3-3LJ 3
City: , - �.i"e 5(S, 1l sz Pipe#: ')i
County: . -�•ede_.t 1 State: 4)e__, Zip: �1,r- 1C
SAMPLE INFORMATION 1� 1
Sample Site: y /�Th \"rce_v L� l -- -C u1 Oak- .\c.:* \.
Sample Type: ❑Grab M Composite #of containers: cap
Sampling Time: Start Date: ! � ' Cal Start Time: r+.: AM % PM
� ,, ,-
End Date: !r /a 1 End Time , - } AM PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
caI A ZILA....
J
Collector's Name: Print: cA J, A ("A l elf-�I� Signature:
v✓ TOXICITY TEST INFORMATION
Test Required: i Chronic(7 days) Test Organism: (Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: i S% ***FridaySamples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
� p Y
Comments: in L,L ( 7ta cA : / /; r 3 j `7 j 4,' v) , 9 C>
, SHIPPING INFORMATION I
Relinquished by: `�)` • �lL�•^'''� Date: C=1 ) r A I Time: e M
Received by:mG/ ' �`'.f Date: P/% ?1,- Time: PM
Relinquished by: '2 2- % _--� Date: c ig`/ Z) Time: i0C) AM COP
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
��ss� /y/� SAMPLE RECEIVING (Laboratory Use Only)
.elinquished by: I t/r t�-K / l` I cT IN
t
Received by: 'r1 i n�
(U ' Date: 2(((121 Time: D. a() AM ( M
Sample Temperatures(°C): [r5 I 11.3 / / Sample Condition: .L tid /
- �� WHITE= Laboratory copy YELLOW=Client copy •<,�zr

MERITECH, INC. (Lab #027) MeritechSampleID#: (/ `I )` �'' r
' A Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone] .
Toxicity Supervisor email: mike.reed(a)_meritechlabs.com Web Site: www.meritechlabs.com
CLIENT
INFORMATION
Client: C 1 l U\ 0 1-c 1 (_,L`e s U t k 1 cr_ -t fit-7 ti---ed, PO#:
Contact Person: r 3
, \ Oh f y r) NPDES#: NC[�(p)�� j E'3
t"Address: •O. s;>U ) � ' 1 Phone: 7CS4%8 7 8 3143,_p
City: 5 fa.�. ___53( t t I 'e, }} /Pipe#: 6
County: - -Y'2cr 2.l I State: /(L- Zip:(2867y-4-
U SAMPLE INFORMATION
Sample Site: I exe )_i< 6 1MPc"`fE'; 1�_( `-en-1- O{d i
f J I
Sample Type: CI Grab Composite C #of containers:
Sampling Time: Start Date: 110 1 at Start Time:1\ AM PM
End Date: ( I ► i la [ End Time: 1 AMTh' PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collectors Name: Print: �G tl .�e.f' 'ha✓'(�� Signaturebj " --'rll5-------
TOXICITY TEST INFORMATION
Test Required: hronic(7 days) Test Organism: Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
I IWC: 4-/5% ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments: II-- Q 5 �c e '-t 5l V I, 5, `�! C.) l( i I!_ 'R �
— c ce c
SHIPPING INFORMATION ,O f 11 �f� }J Time: 969 ,f 7 PM
Relinquished b : ;X- Date: L:�
Received by: Date: e2 /i �A. Time: G vl PM
by: —� Date: ��/�� Time: ,?-- AMB
Relinquished ��l� /Plat
/
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearl}r labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING (Laboratory Use Only)
//�� . E, nC. I.
fished by: ,r Ul�.k I O- 1ni 4 i l 5-
Received by: _ I_L V\ , \&_ Date: 2 I f-2 I Time: . ) AM �PM
"Sample Temperatures(°C): I t / i •4 / / Sample Condition: 11 coci
WHITE=Laboratory copy YELLOW=Client coov "

Title: Statesville 4th
File: Statesville Transform: NO TRANSFORMATION
Kolmogorov Test for Normality
D = 0. 0978 (p-value > 0. 100)
D* = 0. 7671
Critical D* = 1. 035 (alpha = 0. 01 , N = 60)
= 0 . 895 (alpha = 0 . 05 , N = 60)
Data PASS normality test (alpha = 0. 01) . Continue analysis.

Title: Statesville 4th
F e: Statesville Transform: NO TRANSFORMATION
Bartlett ' s Test for Homogeneity of Variance
Calculated Bl statistic = 7 .7155 (p-value = 0. 1726)
Data PASS Bi homogeneity test at 0 . 01 level. Continue analysis.
Critical B = 15 . 0863 (alpha = 0. 01, df = 5)
= 11. 0705 (alpha = 0 . 05, df = 5)

IA 1-a
1-3
I H. F.,- I I )F�1-- FH-
I H f1' I
I i a I - CD H 1 1 (DH -
t OI UI IP co No H I I: I •• (D I I (D (1) '
' Fri I .. I I •• ..
I I
I I I I I
' I H I En I I
CI I CI (t I O) Cy) FP W N.) F-r I I r�'r
I I p) I I rd I tll
Cfl Cr En cr
I H I CA O I I I En a)
SD
I I P I ' d I rt. (1)
0 t H t P3 rt I''- I 'O 1 n I (D F--, I i z I NN a i () H
H K
0) N HItc-r t - I (I-,D i I H I 'C m H
• K I H I CO F-'- I t ImiH' ' (D l0 • IP • NO I Q I C't' F--IIP I ' H rt I II
I O U1 01 U'I U1 I--I i Zi I 3 (D cr I 0 I a I P3 I--, (t
1
1 I H- I dl No H rr I 1-33 I Fes'- CD
crl I ' - I..) • K i H I to
1 ' ' r I l0 • IP • N O I O I Ct
H- I oO1U1Ul UtH I Z I p•
' I I
CO '
cn
1PoI
I 1--I I I I
I N.) 00 CO -....1 A. IP I H I 0 I HI 1-I HI HI I-1 I-I I I 0
I , • ,K I O O O o 0 0 I Z I p
I I I I I
NN co) IPIPlO I I I d
t WW1--' U) 0 '4 10 I go I I I p)
I W W F--I W o IP IM rtI I I-r
W W I-I W lO IP I I Pi H I N N 1-I I-+ CO N I I ¢) I.
' K I U1F-10o --.1H0 1 I K
p) I • I I p)
I 0 I o 0 0 0 o O I H I 0
' I I U) 1 00o000 I Z I Co
I HI t 0 0 0 0 0 0 1 I rh
I H N W N N N t I 0 1000000 I I 0
• I Cio I K I I I K
I5 I 5 I I 5
Ol 00 N H N I I •• I I I
I 41. l0l0O100 W I I I I I ••
I IPIPWI4=• -•401 1 I I N W N N N N I 1
I I I I l0000U1 -.l -.1 I I
II I
I I 1 0 0 0 0 0 0 I I
I
I ' I H 1000000 I "jyGGGG I y
' I 1 ,)y 1000000 I
I 00 H 00O I Cal] I W I 00000o I I
I ' I I ti
I ,P l0 1-1 00 Ol 7 II
I
tii
I -.1OOl0, - 0 I I
I N -.1 Ol N O W I I N I I i
I I I H
I OlIP �1N O N I I I N N N N N N I I
1 I I 0 I1,' I OIUIW NIPN I 10 Zi
' I I-f) 0 I I ,' I H) 0
I I I co --1 U1 H Ol Ulf
1 I I N I-3 I 000000 I I N IH
1 I I 10 0 0 0 0 0 I I
I H H HI I I 1000000 I I
1 U1 H U1 N CO l0 I Q I I I 1
1 I I Cl) I I C!]I Ol H Ol W Ol 00 1 4' I hrJ I I Iij
I o Ol l0 W H 00 I • I 0 I I Q
I N IP IO N OIN I I I I
W l0 U.) ---1 Ol ---1 I ow 1 I I
1 I I I I
1 I H I I
1 I H I I H
1 I 0 I 1 H
1 I Z I I 0
7

1
Title: Statesville 4th
Fti�e: Statesville Transform: NO TRANSFORMATION
ANOVA Table
SOURCE DF SS MS F
Between 5 145.6833 29.1367 4 .2697
Within (Error) 54 368 .5000 6.8241,
Total, 59 514 .1833
(p-value = 0. 0024)
Critical F = 3 .3769 (alpha = 0 . 01, df = 5, 54)
= 2 .3861 (alpha = 0 . 05, df = 5, 54)
Since F > Critical F REJECT Ho: All equal (alpha = 0 . 05)

Title: Statesville 4th
F3.-le: Statesville Transform: NO TRANSFORMATION
Dunnett ' s Test - TABLE 1 OF 2 Ho:Control<Treatment
TRANSFORMED MEAN CALCULATED IN SIG
GROUP IDENTIFICATION MEAN ORIGINAL UNITS T STAT 0. 05
1 Control 22 . 5000 22.5000
2 11 .25 24 . 6000 24.6000 -1. 7976
3 22 . 5 22 . 1000 22.1000 0 .3424
4 45 23 . 5000 23.5000 -0 . 8560
5 67.5 25 . 7000 25.7000 -2 . 7391
6 90 26 . 3000 26.3000 -3 .2527
Dunnett critical value = 2 . 3100 (1 Tailed, alpha = 0. 05, df [used] = 5, 40)
(Actual df = 5, 54)
Title: Statesville 4th
File: Statesville Transform: NO TRANSFORMATION
Dunnett ' s Test - TABLE 2 OF 2 Ho: Control<Treatment
NUM OF MIN SIG DIFF % OF DIFFERENCE
GROUP IDENTIFICATION REPS (IN ORIG. UNITS) CONTROL FROM CONTROL
Control 10
2 11 .25 10 2 . 6987 12 . 0 -2 . 1000
3 22 . 5 10 2 .6987 12. 0 0 .4000
4 45 10 2 . 6987 12 . 0 -1. 0000
5 67 .5 10 2 .6987 12 .0 -3 .2000
6 90 10 2 . 6987 12 . 0 -3 . 8000

e ' ' •
Fisher' s Exact Test
•
NUMBER OF
IDENTIFICATION ALIVE DEAD TOTAL ANIMALS
CONTROL 10 0 10
11.25 10 0 10
TOTAL 20 0 20
Critical Fisher' s value (10, 10, 10) (alpha=0. 05) is 6. 0. b value is 10 .
Since b is greater than 6 . 0 there is no significant difference
between CONTROL and TREATMENT at the 0. 05 level.
Fisher's Exact Test
NUMBER OF
DENTIFICATION ALIVE DEAD TOTAL ANIMALS
CONTROL 10 0 10
22 .5 10 0 10
TOTAL 20 0 20
'ritical Fisher's value (10, 10, 10) (alpha=0 . 05) is 6 .0. b value is 10.
Since b is greater than 6. 0 there is no significant difference
between CONTROL and TREATMENT at the 0 . 05 level .
Fisher' s Exact Test
NUMBER OF
IDENTIFICATION ALIVE DEAD TOTAL ANIMALS
CONTROL 10 0 10
45 9 1 10

e
TOTAL 19 1 20
7 ---==========================-==================_====_====_================
Critical Fisher' s value (10, 10, 10) (alpha=0 . 05) is 6.0. b value is 9 .
Since b is greater than 6. 0 there is no significant difference
between CONTROL and TREATMENT at the 0 . 05 level .
Fisher's Exact Test
NUMBER OF
IDENTIFICATION ALIVE DEAD TOTAL ANIMALS
CONTROL 10 0 10
67 .5 10 0 10
TOTAL 20 0 20
Critical Fisher' s value (10, 10, 10) (alpha=0. 05) is 6. 0 . b value is 10.
Price b is greater than 6 . 0 there is no significant difference
.:ween CONTROL and TREATMENT at the 0 . 05 level .
Fisher' s Exact Test
NUMBER OF
IDENTIFICATION ALIVE DEAD TOTAL ANIMALS
CONTROL 10 0 10
90 10 0 10
TOTAL 20 0 20
---------------------------------------------------------------------------
"ritical Fisher' s value (10, 10, 10) (alpha=0 . 05) is 6 .0. b value is 10.
Since b is greater than 6 . 0 there is no significant difference
between CONTROL and TREATMENT at the 0 . 05 level .
Summary of Fisher' s Exact Tests
NUMBER NUMBER SIG

6ROUP IDENTIFICATION EXPOSED DEAD 0. 05
CONTROL 10 0
11.25 10 0
22 .5 10 0
3 45 10 1
4 67. 5 10 0
5 90 10 0

,'f
4 Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 01/21/21/
Facility: STATESVILLE - FOURTH CREEK NPDES#: NC0031836 Pipe#: 01 County: IREDELL
Drat Perf ng Test: MERITECH LABS, INC.
Comments:r
Sign e o 0 ator in Responsible Charge
y� ,�
Signature o Laboratory Supervisor
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = 6.645
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = 38.33
% Mortality Avg.Reprod.
# Young Produced 27 24 27 25 24 22 23 27 25 23 18 22
0.00 23.92
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
16.67 14.75
Treatment 2 Treatment 2
Effluent %: 45%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
10.912% PASS FAIL
# Young Produced 11 13 10 18 21 18 15 14 11 19 18 9 % control orgs X
producing 3rd
brood Check One
ilt (L)ive (D)ead L L L L D L L L L D L L 100%
lst sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 01/13/21
Control 8.00 8.13 8.02 8 .16 8.15 8.08 Collection (Start) Date
Sample 1: 01/11/21 Sample 2: 01/13/21
Treatment 2 7.74 8.03 7.70 8.19 7.78 7.97 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.0 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample
D.o. Hardness(mg/1) 44 ..,...,..,
Control 8.22 7.92 8 .14 7.76 8.05 8.12
Spec. Cond. (pmhoa) 154 287 306
Treatment 2 8.35 7.99 8.19 7.95 8.22 8.14
Chlorine(mg/1) <0.1 <0.7.
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.5 1.2
(Mortality expressed as %, combining replicates)
Note: Please
% % % % % % % % % Concentration Complete This
Section Also
% % t % % % % o % % Mortality
start/end start/end
LC50 = % Method of Determination Control
95o Confidence Limits Moving Average Probit
-- _ o Spearman Karber - Other - High
Conc.
pH D.O.
LOrganism Tested: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Meritech, In _ab # 027)• _3
/ Mini Chronic Pass/Fail Cetiodaphnia dubia Incubator
Client: j r"".P5v1l//r 7 . Pipe#: D/ County: recll`, ( Date Start: l —/ 3 -2 Date End: / ,),-
NPDES#: NCG0_3/836 Date/Time of Culture Transfer. 7,' 11;3 6A-in Time Start l 1:,35,+ Time End: v,'D
Dilution Water: Lake Brandt Date/Time Neonates born: /r4#4.1-- �,1 r 1st Renewal Date:
/-'(.��� Time:Test Organism Source:Tray# , Age of onates at Test Start 9 _ f hours 2nd Renewal Date: / --/9-'' ( Time: e D I fir-
Stirred/Aerated for D.O.:Y/© Randomized:Y/N Culture Tray Temp: r j C Analyst(s): MR,Lv,Ks,KL Reviewed b
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Sample 1: ,� - i/- Sample 2: f-)3
Adults Live/Dead L ` -, Sample Information
Day#5 4 5 6 7 9 I J1 Iv, 100% pH G/C? Duration
#Young Produced ,� D /7 4 O II u 9VI li g U�jn 97 4 Sample 1 `1', i3{ ( �/ 7 �„�.. hours
Adults Live �'/Dead I._ L L_ __ L t I- Sample 2 7,la c 211, hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12
I Transferred by: Fed by:
#Young Produced i , 3 13 , /a, t( 1 0, 0 13 /2... /L Batch# LI B y �samp$e 1 Sample 2 Day 0 .��,� (,�/
Adults Live/Dead c L_ ( _ t✓ C__- C____. t- C., L Transfer Day 0 2 5 Day 1 --
Hardness l�_^� �� • Day 2/-f/ �
Total Produced '.�oZK �.'7 �tt (ms/y _1
a3 �� �`? 3. spec,cond. Day 3 _a
(umhoshan) 16
9.—., t t Y 287 Sat? Day 4 4f U
Percent of Control producing third brood: /Cc quo
Chlorine L��� fop, Day5/`"Z' - L-t/
Test Sample Organism Reproduction Day 6 77
Effluent%: 145 r pp,(t)
Terminated by: ,--V4
NH 1st Sample 2nd Sample 2nd Sample
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control 8.0c a .(J� 8(4, tar e?
Adults Live/Dead t— - _
Day#5 1 2 6 7 9 10i•1 12 Sample P<7`t 3 7�7� �c��( 7,7S 3 en
�+-- f +� Initial final ml4al final Initial final
#Young Produced J ! — '7 3 cod�g ` teo
9 1AcR 6 a D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/Dead t ///L_ 1` 1_.. l_.- L L L L- L / [j
DaY#7 1 2 3 4 5 6 7 8 9 10 11 12 Control 8 2. Via. g o 77(; 6,05' 8,12.
#Young Produced () ? 5 1 g i ti, ) q t D 7. Sample 8,3'J '1 1 , c((i 7`!S c.'2.� r',(((
Adults Live/Dead 1.---. u„Lal fits meal final initial final
Temp. 1st Sample 2nd Sample 2nd Sample
Total Produced i f L3 g le to is l fg 7 Control
Comments: Sample 91pi•Y ?4-b1 _ (`6 al/_7 21 .741
final initialfinal Initial final

•
MERITECH, INC. (Lab #027) Meritech Sample ID#: 61 J� 1 "">1S"
{ Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
Toxicity Supervisor email: rnike,[e-mail] Web Site: www.meritechlabs.com
OX(
CLIENT INFORMATION
mac-,
Client: 'i I ^C/ii��i� `� cL�.`sVltte, PO#: { {7
Contact Person: P,`C 'CN 1e (�SCn NPDES#: NC- 3l 0 ID
Address: ,O. �t jl, C 1 1 1 Phone: t 6 LI 17 S 3`I 3(S
City: , _-\-c_S ,1`1t' MC`._, Pipe#: (Th 1
County: jr-e_CI�( I State: /L) Zip: 9 b �-
S„ J Q SAMPLE INFORMATION
USample Site: 11/yQ Zt i
Sample Type: ElGrab 'Composite #of containers: O
8)
Sampling Time: Start Date: Start Time:) a PM
End Date: End Time: °% (" 0 PM
`"Triple rinse sample container with sample before filling completely with NO AIR SPACE Pack the sample cooler completely with Fee. The
sample must be<0.6°C upone receipt at Mgr/tech"'
Collector's Name: Print: f/��t� /J D/S I Signature: �'-- . Et
L1l� �//n "
TOXICITY TEST INFORMATION
Test Required: '41Chronic(7 days) Test Organism: Ceriodaphnla dubla (water flea)
I ❑Acute(24-48 hours) ❑ Pimephafes promelas (fathead minnow)
❑ Mysidopsis bahla (mysid shrimp)
IWC: Li 5 % `.,Fr►dey Samples for Chronic Fathead test must be collected after 9;00 e.m,on Friday`*'
Comments:
SHIPPING INFORM TION
Relinquished by Date: Time: AM (16
Received by: Date: //' , � Time: cY AM
Relinquished by: =y-'" Date: 1//:/�,2/ Time: oP.6—' AM 0
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
"Samples shipped on Friday must be FedEx and Must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED"
SAMPLE RECEIVING (Laboratory Use Only)
linquished by: I C k Nei n iti
Received by: (CJ \') , A'l, Date: 1(`� 2-2( Time: l AM �,I,1
I
Sample Temperatures(°C): C / t c ' / / Sample Condition: I�°.d
WHITE = Laboratory coov YELLOW=Client coov -411111111I111111•1111111111

MERITECH, INC. (Lab #027) Meritech Sample ID#: ClItk \ 41\
Bioassay Sample Chain of Custody 1•
A
_tiel 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
Toxicity Supervisor email: mike.reed(a)meritechlabs.com Web Site: www.meritechlabs.com
' l �J CLIENT INFORMATION
Client: c-'11 Of 4_�t� ~ Q. ti ( TT_S+ - $01 t\e. PO#: s�
Contact Person: , R`"C��t V, -I-oh f� NPDES#: NC Cr-,3 I g .)
Address: \ oa 1. X 7 ,i 4 ( ) Phone: 7 O yc_1 l a 3
City: ,‹_r'- -e,.h\1e. Pipe#: 01
County: =redc1( ( State: /0 C , Zip: Pjlelearl
i_ SAMPLE INFORMATION
t
Sample Site: ee L.J-1-P
Sample Type: El Grab Qomposite #of containers: ;3\
Sampling Time: Start Date: I ) 1 ` t al Start Time: 10 G do PM
End Date: 1 ' ` (--t )a I End Time:—74'Tft PM
•""Triple rinse sample container with sample before filling completely with NO AiR SPACE Pack the sample cooler completely with Ice. The
//��
sample must be<0.6°C upone receipt at Merltech"*'
Collectors Name: Print: ode.M,p/ ) 45# N Signature: 6_,4;9
TOXICITY TEST INFORMATION
Test Required: Chronic(7 days) Test Organism: 'Ceriodaphnla dubla (water flea)
❑Acute(24-48 hours) ❑ Plmephales promelas (fathead minnow)
❑ Mysldopsls bahia (mysid shrimp)
IWC: ! fJY° *—Friday Samples for Chronic Fathead test must be collected after 9;00 e:m,on Fridays'
Comments:
l SHIPPING INFORMATION
Relinquished y °Add, , d(JlP?¼ Date: I Time: �y(- g PM
YReceived b : Date: / '7 Time: _ /L/V c...62 PM
Relinquished by: Date: / ff- Time: 1/43 AM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up 0 Delivered ❑ Other
Samples shipped on Friday must be Fedi:x and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED"
SAMPLE RECEIVING(Laboratory Use Only)
Relinquished by: A/(C Ic t ' c'(14 11
Received by: (Y\, Jvut,, Date: ` \` I Time: ` 0 AM pM
I ((
Sample Temperatures(°C): , 2 / t 12 / I Sample Condition: 1 c rCI
1111911111111111 > WHITE=Laboratory copy YELLOW=Client copy ._

1
Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 01/21/21
Facility: STATESVILLE - FOURTH CREEK NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: 38.33% CONTROL 45% Effluent
# Replicates 12 12
Female Live 12 10
Adult Male 0 0
Adult Dead 0 2
Adult Mortality 0.00% 16.67%
# Neonates 287 177
Mean # Neonates 23.917 14.750
Standard Deviation 2.610 4.003
Coefficient of Variation 10.912%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 10
a/A = 1.00 b/B = 0.83
Success is: survival
Critical b value = 8
10 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 C 18 -5.9167 13 C 24 0.0833
2 E 9 -5.7500 14 E 15 0.2500
3 E 10 -4.7500 15 C 25 1.0833
4 E 11 -3.7500 16 C 25 1.0833
5 E 11 -3.7500 17 C 27 3.0833
6 C 22 -1.9167 18 C 27 3.0833
7 C 22 -1.9167 19 C 27 3.0833
8 E 13 -1.7500 20 E 18 3.2500
9 C 23 -0.9167 21 E 18 3.2500
10 C 23 -0.9167 22 E 18 3.2500
11 E 14 -0.7500 23 E 19 4.2500
12 C 24 0.0833 24 E 21 6.2500

SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.) t
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 6.2500 -5.9167 0.4493 12.1667
2 4.2500 -5.7500 0.3098 10.0000
3 3.2500 -4.7500 0.2554 8.0000
4 3.2500 -3.7500 0.2145 7.0000
5 3.2500 -3 .7500 0.1807 7.0000
6 3.0833 -1.9167 0.1512 5.0000
7 3.0833 -1.9167 0.1245 5.0000
8 3 .0833 -1.7500 0.0997 4.8333
9 1.0833 -0.9167 0.0764 2.0000
10 1.0833 -0.9167 0.0539 2.0000
11 0.2500 -0.7500 ' 0.0321 1.0000
12 0.0833 0.0833 0.0107 0.0000
1
W = X 241.0933
251.1667
Calculated W = 0.960 Critical W = 0.884
0.960 a 0.884
The reproduction data is normally distributed
evaluated at a 99%- confidence interval.
Test Passes!
F test for Homogeneity of Variance
Effluent variance 16.0227
F = _ = 2.35
Control variance 6.8106
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
2.35 s 5.32 = The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

.
EQUAL VARIANCE t TEST
23.9 - 14.8
t = = 6.645
1.379
Degrees-of—f-r-eedom...=. 22 - - -
Critical t = 2.508
6.645 a 2.508
Test fails. There is a significant difference in reproduction
between the Control and the effluent evaluated at a 9917 confidence interval.
Chronic Test FAILS
The mean # of young produced by each group is dissimilar
1

g
Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 10/22/20
(`,Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
P ing Test: MERITECH LABS, INC.
Comments:
X
Si ure of Olo t ator in Responsible Charge
X S-
��a of Laboratory Supervisor * PASSED: -8.46% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -4.005
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -8.46
% Mortality Avg.Reprod.
# Young Produced 20 22 21 20 23 21 22 23 23 22 21 22
0.00 21.67
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 23.50
Treatment 2 Treatment 2
Effluent %: 45%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
4.953% PASS FAIL
# Young Produced 24 23 24 24 25 24 24 21 22 23 23 25 % control orgs X
producing 3rd
brood Check One
(L)ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 10/14/20
Control 7.85 7.84 7.89 7.93 7.94 7.92 Collection (Start) Date
Sample 1: 10/12/20 Sample 2: 10/14/20
Treatment 2 7.79 8.03 7.80 7.99 7.71 7.91 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.0 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample
).o. Hardness(mg/1) 46
Control 8.11 7.63 7.98 7.48 8.07 7.50
Spec. Cond. (pmhos) 145 276 375
reatment 2 7.98 7.84 7.95 7.44 8.10 7.47
- Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.5 3 .3
Mortality expressed as %, combining replicates)
Note: Please
0 0 % %a o % % Concentration Complete This
% %
Section Also
% 0 % %% % Mortality
% o % % 0 %
start/end start/end
LC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit _ -
% -- % Spearman Karber _ Other High
- Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Meritech, Inc. (Lab # 027)
1 �h/ Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#: 3
Client: ,.5-1-0 e' ,//f fe-- C fdFe pipe#: 01 County: _tre 42,1 Date Start:
/0"/11- a() Date End: a/0--;?, " f
NPDES#: NC C A(R3' Date/Time of Culture Transfer: b•- -`0 - (7 ,M Time Start: / '• q t i
• 'NA- Time End:
Dilution Water: Lake Brandt Date/Time Neonates born: S- , )....11-N- :2V( 1 st Renewal Date: r'
��¢:�.,. ��° Time: //; `7l ".�,°ua
Test Organism Source: Tray# \ Age of eonates at Test Start: i `'°j hours 2nd Renewal Date: to [ `'1-- Time: Cr:L/i AP-•
Stirred/Aerated for D.O.: Y/© Randomized:( /N Culture Tray Temp:V.k.4 rG4I °C Analyst(s): MR,CD,LV,KS Reviewed by:
Control Organism Reproduction
Coll
ection ection (Sta
rt)rt) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 p Sample 1: %(7 % -A Sample 2: %'9 "/�'-: .p-~�
Adults Live/Dead fr Sample Information
Day#5 1 2 3J 4 5 6 7 8 9 10 11 12 100% pH G/C? Duration
#Young Produced 3/too It(.7 • o (7 41/_ i' l4 s1,iti. ttlro 3k ' 34,.7 Li�/.". Sample 1 7c 1,1�9 i-f . ()hours
r Adults Live/Dead L-- L_-- L.-- �_ r ,�
......- C...._- t_._. - L. L......- L.._-l. �.. . �..-�- Sample 2 i r
p �r � �- :2 Lt'y 0 hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced `7 �j" '/.", �j ,�/ } �-, F Batch# ('� Transferred by: Fed by:
U f , �1 \ 1 k) i ` . ..,X l6'C'..d) ,"�� Sample 1 Sample 2 Y r i \ `/
I
Da 0 /`f)
Adults Live/DeadTransfer Day :0 2 5
/ ( L Z - l C_. �..� _.- !_ Day 1 ,ev1l
Hardness 9�f� Da 2 +r
I Total Produced I CI 1 I/\r� I , \ I '•'�;.`)JI 3I I r .i I '?-",)1 (m9") L `�� `� y �� �..,
spec.Cond. Day 3 t�l
(umhos/cm) / 'r).--►'� "- 2 7() 7,1}-' Day 4 �-1 t•-
Percent of Control producing third brood: (r^'ff2 % Chlorine �� /
Test Sample Organism Reproduction (mg/�) '�:1�t �t�i Day 5��'L L �'
Receipt Sample ff _ Day 6 ��e.
I Effluent%: l��j I Temp.CC) /...r� �3 Terminated by: ram,,,•
pH 1st Sample 2nd Sample 2nd Sample
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control 7 r'Si Irt f r r;'13 r( 4,4
Adults Live/Dead - •--)
Sample 7/ L ZIA !(,')Q li 14 27' `f l:� 7 l
Day#5 1 2 3 4 5 6 7 8 9 10 11 1
initial final initial final initial final
#Young Produced 3/f (-( } 3J 5, 1/ 5I;� .5/i ? yyy / 5/„;T. 4-
f f t (�1�` D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/Dead 2., 1 f _, 1, L
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Control (/c(I 7 �, t f( 7f� tCi ' 71')
#Young Produced ,,,
0 f to (3 Sample .. 7A •
(e t i(`.i . * 'De-2
Adults Live/Dead (— / f , (� initial final initial final Alt (Linal
Temp. 1st Sample 2nd Sample (U2nd Sam ile
p
I Total Produced a ut 33 ; .tt b,(Ia'7 9 4,1 ' e) I, ."3 I .
`�-j Control �� � ;�P�'�A".:�� '• FW
� '� 1 )5i,3 I.?16‘
c, ; nents: Sample .�7.7 ?t/ ) .c lie r , 9ft 4

ci
` MERITECH, INC. (Lab #027) Meritech Sample ID#: 1 V I �
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
' Phone: [phone] Fax:[phone]
Toxicity Supervisor email: mike.reed(ameritechlabs.com Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: 0......., k'( d G�h 0 0 O-�'53O( ''�- 1 ' b ls-e�' PO#: �}
Contact Person: L `\ NPDES#: NC �r eg�
Address: "P.0 .. t I Phone: -fog
� 87(0.-3 j
?
City: << -`1- TeSO l\VQ Pipe#: 0 I
County: Irde,l ( State: I Ve..— Zip: ( gGA 7
SAMPLE INFORMATION
Sample Site: ---'{ ��K � "
Sample Type: ❑Grab Composite #of containers:
Sampling Time: Start Date: w!lati 'D StartTime:1OS PM
End Date: [0 1/ /a V End Time: e
PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print: (V CtLAS 1-t a:r'17, Signature: .r„,f-7,../V11.3
v
TOXICITY TEST INFORMATION
, 1.Required: hronic(7 days) Test Organism: Ceriodaphnia dubia (water flea)
' ❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: L , ) % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished ��\�. Date: to `3/�O lime: ) a T AM CP
Received by: ,iC Date: /9 // 7 Time: /?5 AM (.-
Relinquished by:� / j _�- Date: /12 40 Time: 3340. AM (�r��M'�)
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery, NO SIGNATURE REQUIRED**
�Vi /� SAMPLE RECEIVING(Laboratory Use Only)
R ahedby: (✓I0-. ill 07)1e,i r
Received by: kW) i\Mit` Date: Time: C' AM (FM
ample Temperatures(°C): (/ / 1/7 / / Sample Condition: 1 ceA \J
a II Il _ I _L_.__L__. \/r, 10,1A/� n1: . __ —®

MERITECH, INC. (Lab #027) Meritech Sample ID#: lEirc C.0 .
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
Toxicity Supervisor email: [e-mail] Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: C.f r PO#:
Contact Person:)cf `� O •C\S C\ NPDES#: NC �i 23,6
Address: .iJ. „ Phone:----Th`1 343P
City: \te e,S I \ I'P- Pipe#: O i
County: Ce de 1 ( State: JO C Zip: ,-)7. Z;
SAMPLE INFORMATION
Sample Site: /4 Q c ee K C J L•., S
Sample Type: ❑Grab ; Composite #of containers:
Sampling Time: Start Date: I al , Start Time: AM PM
End Date 6/fI� .<91CD End Time: ' ) A PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print: N l/K`k S p i, rr?oi. Signature:
TOXICITY TEST INFORMATION
est Required: /Chronic(7 days) Test Organism: �Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (rnysid shrimp)
IWC: 1 % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished ,i) Date: .-0 a\ Time: < AM
Received by: Date: 0 Time: /6 i) AM F
t
Relinquished by: Date: %' Time: AM ---e
Received by: Date: - Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery, NO SIGNATURE REQUIRED**
/� /� SAMPLE RECEIVING(Laboratory Use Only)
Relinquished by: 1 V i c k J IJ�r^.I 1 i ,t
Received by: 164". APPL" Date: 10 q 4 tv
Time: 1 ' 1 AM NM
'l '1
ample Temperatures(°C): 1,?,?� / ��.�
<T
/ / Sample Condition: i''C1Yt
WHITE=Laboratory cony YELLOW=Client ennv

. . q
Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 10/22/20
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -8.46% CONTROL 45% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 260 282
Mean # Neonates 21.667 23 .500
Standard Deviation 1.073 1.168
Coefficient of Variation 4.953%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 21 -2.5000 13 C 22 0.3333
2 C 20 -1.6667 14 C 22 0.3333
3 C 20 -1.6667 15 E 24 0.5000
4 E 22 -1.5000 16 E 24 0.5000
5 C 21 -0.6667 17 E 24 0.5000
6 C 21 -0.6667 18 E 24 0.5000
7 C 21 -0.6667 19 E 24 0.5000
8 E 23 -0.5000 20 C 23 1.3333
9 E 23 -0.5000 21 C 23 1.3333
10 E 23 -0.5000 22 C 23 1.3333
11 C 22 0.3333 23 E 25 1.5000
12 C 22 0.3333 24 E 25 1.5000

f ♦ �
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont. )
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 1.5000 -2.5000 0.4493 4.0000
2 1.5000 -1.6667 0.3098 3.1667
3 1.3333 -1.6667 0.2554 3.0000
4 1.3333 -1.5000 0.2145 2.8333
5 1.3333 -0.6667 0.1807 2.0000
6 0.5000 -0.6667 0.1512 1.1667
7 0.5000 -0.6667 0.1245 1.1667
8 0.5000 -0.5000 0.0997 1.0000
9 0.5000 -0.5000 0.0764 1.0000
10 0.5000 -0.5000 0.0539 1.0000
11 0.3333 0.3333 0.0321 0.0000
12 0.3333 0.3333 0.0107 0.0000
1
W = X 25.6567
27.6667
Calculated W = 0.927 Critical W = 0.884
0.927 z 0.884
The reproduction data is normally distributed
evaluated at a 9996 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Effluent variance 1.3636
F = _ = 1.18
Control variance 1.1515
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
1.18 s 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

• 4 .
j'
EQUAL VARIANCE t TEST
21.7 - 23.5
t = _ -4.005
0.458
Degrees of freedom = 22
Critical t = 2.508
-4.005 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 999,5 confidence interval.
Chronic Test PASSES

•
.,
AzEffluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 07/21/20
'Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
09.p7 Pe ming Test: MERITECH LABS, INC.
x Comments:
ignature o erator in Response e C arge
Signature of Laboratory Supervisor * PASSED: -1.10% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -0.321
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -1.10
% Mortality Avg.Reprod.
# Young Produced 19 24 20 24 21 20 25 22 25 24 26 23
0.00 22.75
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 23.00
Treatment 2 Treatment 2
affluent %: 45% _
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
10.115% PASS FAIL
# Young Produced 22 23 24 20 23 24 24 23 24 21 25 23 % control orgs X
producing 3rd
brood Check One
(L)ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
H Test Start Date: 07/15/20
Control 7.95 8.02 8.04 8.02 7.82 8.02 Collection (Start) Date
Sample 1: 07/13/20 Sample 2: 07/15/20
reatment 2 7.83 8.14 7.88 8.16 7.90 8.14 Sample Type/Duration
2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.0 hrs L A A
r d r d r d U M M
t t t Sample 2 x 24.0 hrs T P P
1st sample 1st sample 2nd sample
.0. Hardness(mg/1) 48
Control 8.22 7.71 8.16 7.55 8.15 7.54
Spec. Cond. (pmhos) 147 363 373
_eatment 2 8.09 7.79 8.00 7.66 8.11 7.65
Chlorine(mg/1) <0.1 <0.1 i
iC50/Acute Toxicity Test Sample temp. at receipt(°C) 3.0 1.9
Zortality expressed as %, combining replicates)
Note: Please
o 0 0 o a o o o a %a o Concentration Complete This
% % %
Section Also
a a a %a o 0 Mortality
% o a% s % 0 t
start/end start/end
,C50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit
% -- % Spearman Karber - Other - High
Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
opied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

_.1
Meritech, Inc. (Lab # 027)
Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#:
Client:5 {.� P 1/111P /`` Pipe#: 01 County: --~ Y� -�
y .-t-rt ,e- ., Date Start: I c'7 -;Y.) Date End: 7-,. 7.�,7 j
NPDES#: NCC;v`)3/:? ; Date/Time of Cult Transfer /L{-� I� ..� S' �
�
Culture 7 �d�, Time Start: l(�;i.. . •1 In Time End: (/',"�/I .•.4.
Dilution Water: Lake Brandt Date/Time Neonates born: 1.).:r>,1')c.. �11; O 1, 1st Renewal Date: 1:
` �� .. Time: j I .../rt9141
Test Organism Source: Tray# ij Age of eonates at Test Start: 9 ,,,d) hours 2nd Renewal Date:
Stirred/Aerated for D.O.: Y/© Randomized:Y/N Culture TrayTemp: E% �' , 7,-4' Time: c;:L/,./
-�''�.- 'f C Analyst(s): MR,co,LV,KS Reviewed by: �.,,�
Control Organism Reproduction
Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Sample 1: - I --f;2; Sample 2: (5• �'2�.:)
Adults Live/Dead L. L-. (._.. L,,,,_ L j L.-- L. L.. Sample Information
Day#5 2 3 4 5 6
7 8 9 1.0 11• 100% pH G/C? Duration
#Young Produced IttAr; �'/7 �/0 / '' , /j VI -1/1 (/ LI e' Sample 1
Adults Live/Dead 1---- �� x � � �/ � l' �� c �t-�� hours
L. . ar L___� _ �—
c �..__._ Sample 2 -f 7'� �, ,)e—i+, / ) hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced °`^� �nn J [� l 1) ) - ]} Batch # Transferred by: Fec
( �C/ 1 1 Gl` !t l( ( �*�- / I '�.J L� ( Lic7�.. Sample 1 Sample 2 Day Adults Live/Dead 7 ._._ /�r.. I,.�- L- /).._ 4_,... 1.____ t__
f.
- ___ 1 C- L.- L_._- Z.� Transfer Day 0 2 0 .r'
5 Day 1 L_._
I Hardness Li t
Total Produced I �'' 1 ` t' (mg/L) r�P�-�.---� Day 2 , /2 1,
1 / 19 12.,I I ( I .) 14=.7( 1`..)-4;1 ;All I .) I r)-;1' Spec.Cond. /� 1 ,� Day 3 ��'
(umhos/cm) "1 Y 15(). 3(,3 323
Percent of Control producing third brood: /f.9 j % Day 4 -- -
Chlorine
Test Sample Organism Reproduction (mg/L) L O/i 2--A j Day 5 -"' (--
Receipt Sample Day 6 /.,.
I Effluent%: Temp.cc) 3( ]�a
1 1 Terminated by: 1.
pH 1st Sample end Sample 2nd sample
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0
�
Control "tiI^' C?r t),fl (r.3 (ItE' 7tti t ,�'?
Adults Live/Dead L_ L. L__ L. L— C- C- �;
Day#5 r 2. 3, 4/ 5 6 7, Sample t' v tl,r Ct' ( '.' L ( ( '8 9 1 1'
+ t. I a 12 initial final initial final initial final
#Young Produced ,- `I/ V .� L�/g L/9S '1� t,l r1 106 t 1 W $ i , d/ �
Adults Live/Dead I_.. L 'L� 'L ( � 1 ��� I/'�' D.O. (fir 1st Sample 2nd Sample 2nd Sample e
Day#7 1 2 3 4 5 6 7 8 Control c `� ^�/ '
9 10 11 12 / 6 7 . (�C 7, 5c(
#Young Produced /ll // /1 ._.. 3 �, -,
(1� il I/, ,�� �� t� �,� /, Sample , 7 1pij 6f ' Qc it 7�T
Adults Live/Dead L— L_. L_. L_. L Z.— / /^ 1— 1- Z.— wtial final initial final
initial final
Temp. 1st Sample 2nd Sample 2nd Sample
Total Produced 'a' . a....?) ,.21 (..•,)0-') d.zif ed.-2) oil 1 " 1 ,...4,-; (-d �� �1
.�7 Control J•��� '�9•4 ,>4.,q `'x'(4^, 1 ,94.y� �'ti�'
omments:
Sample L/ Li ' t— d 111 ✓.. ,Il R 1 -.La r^ .-,..

•
MERITECH, INC. (Lab #027) Meritech Sample ID#: 0114.3 .' 1( ?
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
Toxicity Supervisor email: mike.reedAmeritechlabs.com Web Site: www.meritechlabs.com
/y j CLIENT INFORMATION
Client: �• _`1 O ,S1_ S 11 l e_ PO#:
Contact Person: /•'('C i( el i 1�Sr\��(1 NPDES#: NC -I3318�-) 1
l
Address: .0 t Ul )}�, 1 1 1 Phone: 70 j�p-3438
City: {_�'r.�S D\ \1'e /VC Pipe#: 0 t
County:` CCC1e I' State: Zip: a8(cn
SAMPLE INFORMATI
Sample Site: LI (ire L K* 03
Sample Type: ❑Grab Composite #of containers: a
Sampling Time: Start Date: / Start Time:.;+MOO 0 PM.
End Date: 1 `� End Time: f I 51 ell PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech'**
E. (
Collector's Name: Print: �` (1 � •� � � C‘ 1f n �t,rC/I t Signature: Mb Jam' ......<2 t---
TOXICITY TEST INFORMATION
Required: lgiChronic(7 days) Test Organism: "Ceriodaphnia dubia (water flea)
El Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: 6 % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished A Akiviy0 Date: —1/ Li I 0 Time: 93/ al, PM
Received b : Date: ' / Time: 9W
PM
Relinquished by: Date: 7 /. Time: l62 A P�
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING(Laboratory Use Only)
�
Relinquished by: ,.,.:rAck t in'�',,i 0 t
If a V .
Received by: i�+'\ /
_I.Date: `� (� f Time: l (.1� AM \p A
Sample Temperatures(°C): f tJ / / / Sample Condition: ! r f.

MERITECH, INC. (Lab #027) Meritech Sample ID#: 0 / �C aC'Vi
Bioassay Sample Chain of Custody
r 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedimeritechlabs.com Web Site: www.meritechlabs.com
C IENT INFORMATION Client: i !. 1 F.c.,i_c, ,\ �— PO#:
Contact Person: CC1` tl Oh CCT1.S r\ NPDES#: NC 00316 36
Address: .1-) Or' Ily2:1 Phone:-7 -e,&3q 38
City: \-C,. _s j\ \ Pipe#: 01
County: `T re di? , State: /D C, Zip: /3 t„R 1
i SAMPLE INFORMATION
Sample Site: CC�,`e.X �13— j0 ,� t�'i v1
1 ,
Sample Type: ❑Grab Composite #of containers:
Sampling Time: Start Dater S Start Time: 4 N I i AM PM
\ r End Date: End Time: • 1itt PM
**`Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print: \ Ck J ,A Ea r 1\ar rl 1— Signature: 6.___A '`"--.C''''''-----
TOXICITY TEST INFORMATION
Test Required: hronic(7 days) Test Organism: Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
_ ❑ Mysidopsis bahia (rnysid shrimp)
•IWC: % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION •
Date: � r� Time:Relinquished �/ /`� prj 1 q AM M
....
//
Received by: — Date: 7,(4' _�) Time: __ f1 PM
Relinquished by: -�:� -•__- Date: '7/�C V 3 Time:3.96 •AAM_ (PIPMyY
��
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up [Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
r SAMPLE RECEIVING (Laboratory Use Only)
Relinquished by: I1. l<l� ' °.:4 i d Cl,
r
n , >ti i( ; 0 ,I '),r)
Received by: !L.R� .._W:,I Date: r.., Time: 1 li l AM ''\PM
r .
Sample Temperatures CC): ' 't / i-d / / Sample Condition: I, ` .

,y
(" `-• Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 07/21/20
racility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC. ,
Reduction:' -1.10% CONTROL 45% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 273 276
Mean # Neonates 22.750 23.000
Standard Deviation 2.301 1.414
Coefficient of Variation 10.115%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups. ,
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 C 19 -3 .7500 13 C 23 0.2500
2 E 20 -3.0000 14 E 24 1.0000
3 C 20 -2.7500 15 E 24 1.0000
4 C 20 -2.7500 16 E 24 1.0000
5 E 21 -2.0000 17 E 24 1.0000
6 C 21 -1.7500 18 C 24 1.2500
7 E 22 -1.0000 19 C 24 1.2500
8 C 22 -0.7500 20 C 24 1.2500
9 E 23 0.0000 21 E 25 2.0000
10 E 23 0.0000 22 C 25 2.2500
11 E 23 0.0000 23 C 25 2.2500
12 E 23 0.0000 24 C 26 3.2500

h;
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont. )
COEFFICIENTS AND DIFFERENCES
i
x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
0.4493 7.0000
-3.7500
1 3.2500 5.2500
2 2.2500 -3.0000 0.3098 5.0000
-2.7500 0.2554
3 2.2500 4.7500
-2.7500 0.2145
4 2.0000 5 1.2500 -2.0000 0.1807 3 .25000.1512 3 .0000
-1.7500
6 1.2500 2.2500
7 1.2500 -1.0000 0.1245-0.7500 0.0997 1.7500
0.0764
1.00001.0000
80.0000
9 1.0000 1.0000
10 1.0000 0.0000 0.0539 0.0321 1.0000
0.0000
11 1.0000 12 0.2500 0.0000 0.0107 0.2500
1
W = X 76.1775
80.2500
Calculated W = 0.949 Critical W = 0.881
0.949 >_ 0.884
istributed
The repevroduction
ated atdat996 confidencea is normally
intervval.
Test Passes!
F test for Homogeneity of Variance
Control variance 5.2955 _ 2.65
F =
Effluent variance 2.0000
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
2.65 s 5.32 =► The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

EQUAL VARIANCE t TEST
22.8 23.0 t = -0.321.
0.780
Degrees of freedom = 22
Critical t = 2.508
0.321 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99a confidence interval.
Chronic 'Test PASSES

G
f
Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 04/22/20
br,cility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
story r rming Test: MERITECH LABS, INC.
Comments:
X
Signa ure of erator in Responsible Charge
X 2i --..
Signature of Laboratory Supervisor * PASSED: -3.13% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -1.092
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -3.13
% Mortality Avg.Reprod.
# Young Produced 23 24 23 20 25 24 27 26 25 21 24 26
0.00 24.00
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 24.75
Treatment 2 Treatment 2
Effluent %: 45%
CREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
8.521% PASS FAIL
# Young Produced 25 25 26 25 25 25 26 25 23 24 22 26 % control orgs X
- producing 3rd
brood Check One
ram. (L)ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
H Test Start Date: 04/15/20
Control 7.55 8.18 8.03 8.08 7.93 7.81 Collection (Start) Date
Sample 1: 04/13/20 Sample 2: 04/15/20
reatment 2 7.68 8.30 7.54 8.44 7.57 7.94 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.9 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample
.O. Hardness(mg/1) 44
Control 7.90 8.04 8.04 7.63 7.92 7.40
Spec. Cond. (pathos) 162 339 329
.reatment 2 7.99 8.35 8.13 8.15 7.98 7.43
Chlorine(mg/1) <0.1 <0.1
,C50/Acute Toxicity Test Sample temp. at receipt(°C) 2.6 2.4
Iortality expressed as %, combining replicates)
Note: Please
° % % % Concentration Complete This
Section Also
% % % % 'a % % % % Mortality
start/end start/end
C50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit
t -- % Spearman Karber - Other - High
Conc.
pH D.O.
3rganism Tested: Ceriodaphnia dubia Duration(hrs) :
Dpied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Meritech, Inc. (Lab # 027) `
/ Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#:
Client: � ��;1////F' /17* Pipe#:
p j County: .Lr�Se.1 Date Start: L( 15 M Date End: L - ,- 3-6>
NPDES#: NCO p73i Date/Time of Culture Transfer: 9,f •0.0 ' c-z'), Time Start: /0
Dilution Water: Lake Brandt Date/Time Neonates born: �i ,�. r � 1" i'�""SA1'� Time End: �-,• �/ -Al
��'�/O(""'S::S:S t°.r) 1st Renewal Date: e i.
Test Organism Source: Tray# �(--I`7` �^ Time: %= S }/�
fp Age of onatese at Test Start:�'��3 b hours 2nd Renewal Date: 4 '20 -:)// Time: /t "1--((,/{r,-
Stirred/Aerated for D.O.:Y/© Randomized:t /N Culture Tray Temp: 2't( 6°C Analyst(s): MR,CD,LV,KS Reviewed by:
Control Organism Reproduction Y '�L'
Collection (Start) Dates: t
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Sample 1: y ":-3 Sample 2: t-t -) ICJ
Adults Live/Dead ---= -- Sample Information
Day#5 3 4 5 6 7, 8 9, 1 11, 12 100% pH G/C?
#Youn Produced LI � Duration
g 'L /q by 3/714(g * i1�z' the v ' - /„... i ;, i' Sample 1 -7.1� J r�(�
Adults LiveL _ + >� f. p r � O 7� hours
/Dead I t_✓ L--
� � i .l __ ( Sample 2
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 �� �� hours
#Young Produced i h s /J p yTransferred by: Fed by
10 T 1 1 S, la III / r V Batch �Ll. `t"li Sample I Sample 2
i [ Day 0 fjr'.'
Adults Live/Dead ti.._ L.� L..._ l._._ L.y- L__ I_ L_ Transfer Day 0 2 5
Day 1 [._,
Da .Ara_ ,e-
I Total Produced I) 12-4 I -7` I f)15 12. --1 9-4I2712-6'I , ')-1 1 I '6, Sipe 9�'S �� �� y 2 —
�/ cy Day 3
/ r�G' Ykl
(mhos/cm) �j1 7/(;.' j' 3 / `�f--
Percent of Control producing third brood: % � ' Day 4 ��,�
Chlorine 10`( �f I Day 5 � �`�
Test Sample Organism Reproduction
(mg/L)
I Receipt Sample Day 6 L_,,-:Effluent%: I Temp.CC) Ay 22 I Terminated by:/1'L
pH 1st Sample 2nd Sample 2nd Sample
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control 7 1 � 3 i}r p6 7'13 I`
Adults Live/Dead — `�
Day#5 .J Sample rial (t i 90 , cy Pit 9 771
'J �j3 ]4 5 6 7 1 12#Youn Produced fl / fl �/ r � , r f 89/ 1 O } initial final initial final initial final
YAd g L / A l / 11 ; "1rt /t 13� L, " ��r/ D•O• 1st Sample 2ndSam le
Its Live/Deadrig
L. L L L L i._.. z p 2nd Sample
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 Control ?,1 'OgoY (l 7,0 7,y 2, r16
#Young Produced /,' /9 f' 0 2 ' rya lIi" lU 117 i •7qld ��• ,�� � l� Sample `( C�r�� �t1,� (�r�J� l•`l 6 X`'r
Adults Live/Dead L_ initial final initial final initial final
L.,_ 1 ._ L L^ C-- C_
-.
Temp. 1st Sample 2nd Sample 2nd Sample
}11 91
I
Total " educed y,_- A
)'> (Dec �,� I( _ _ it•1 api Control kI '
f•'9 . VJv.Th
Comments:

�' MERITECH, INC. (Lab #027) Meritech Sample ID#: Li'`Oti Mir
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
Toxicity Supervisor email: mike.reedAmeritechlabs.corn Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: (l 0 ,9 , SL;1 ``€_, PO#:
Contact Person: Cam? CC�,�C -� �1 Y1 t NPDES#: NC ()Q° I(� Co
Address: _z+'�� P.0 O . , ' y
i 1 ' 1 Phone: -mq g 7y 3i4.e
City: : _ �€_-i 3! \`e, Pipe#: 61
.- ('- CI County: —
ed I State: A.)(_,C_, Zip: A SlD S q
tt €E SAMPLE INFORMATION+11 Lrt: \ Q c }.�-1 ,.' '
Sample Type: D Grab %omposite #of containers: r.
Sampling Time: Start Date: L7 )/j/,Q 0 Start Time: I i i AM PM
End Date: -7 II 61/ et O End Time: 'J3 ' ,0-- PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
<1...,
Collectors Name: Print: r\f`L!;t� � i.5l'�4N 9 Signature: / -
TOXICITY TEST INFORMATION
Required:N Chronic(7 days) Test Organism: Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
JWC: I'"I cn % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished by: ) r Date: 7 Time: 9/7 e PM
` Date: l b Time: /7 PM
Receivedb :y e/
Relinquished by: Date: ` 7. Time: AM />M
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up El Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING(Laboratory Use Only)
...,....,,wished by: 1 v 1 K fc7 I i I 0/1;4
(,_^ J c
Received by: fly\ S Date: C " t! J-Q Time: 1C! \ AM PIv
Lf �
Sample Temperatures(°C): l l-G / `c6 / / Sample Condition: L i^L;
`A - ---- - ---- --- -.4'

.
MERITECH, INC. (Lab #027) Meritech Sample ID#: 04\ 'gt')vt-t5 1
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedmeritechiabs.com Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: a f ' 1 C j ( Ile, PO#:
Contact Person:,1 4T� )O Sc -m NPDES#: NC(DO??1 ? r_
i Y ,
Address: .•. �� I \ Phone: 70 ep 3 4
City: ` :� S�t,\ Pipe#:
County: —Xr ( I State: ' ) Zip: as(0?-1
SAMPLE INFORMATION
Sample Site: e &jV k.0 l;_ti 1 i c
Sample Type: ❑Grab l Composite #of containers: O�
Sj`
Sampling Time: Start Date: —1 I I 4 Start Time: OH PM
End Date: L 1.0 End Time: 0, - 414 PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print: iv tz.,.CLJ>:S FL";5'r cry Signature: J j,may '
TOXICITY TEST INFORMATION
est Required: Chronic(7 days) Test Organism: 1Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: Lis- % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
•
SHIPPING INFORMATIO
Relinquished by: ,,,fik^����.� Date: Time: y• /y M PM
Received by: ' — _ Date: "' Time: / M PM
Relinquished by: _do/ , Date: i Time: '� AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
•
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING(Laboratory Use Only)
Relinquished by: IVI CA /1'tcln/v,1,
:Received by: IC- kr i.fil f Date: L rl� Time: . (� , AM PMI
-/
Sample Temperatures(°C): L+ / )1( / / Sample Condition: 4 c-A.,;.

,
.1
Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 04/22/20
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -3.13o CONTROL 45o Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.000 0.000
# Neonates 288 297
Mean # Neonates 24.000 24.750
Standard Deviation 2.045 1.215
Coefficient of Variation 8.5210
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 C 20 -4.0000 13 E 25 0.2500
2 C 21 -3.0000 14 E 25 0.2500
3 E 22 -2.7500 15 E 25 0.2500
4 E 23 -1.7500 16 E 25 0.2500
5 C 23 -1.0000 17 C 25 1.0000
6 C 23 -1.0000 18 C 25 1.0000
7 E 24 -0.7500 19 E 26 1.2500
8 C 24 0.0000 20 E 26 1.2500
9 C 24 0.0000 21 E 26 1.2500
10 C 24 0.0000 22 C 26 2.0000
11 E 25 0.2500 23 C 26 2.0000
12 E 25 0.2500 24 C 27 3.0000

0
1
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) - a(i) x(n-i-1) x(i)
1 3.0000 -4.0000 0.4493 7.0000
2 2.0000 -3.0000 0.3098 5.0000
3 2.0000 -2.7500 0.2554 4.7500
4 1.2500 -1.7500 0.2145 3.0000
5 1.2500 -1.0000 0.1807 2.2500
6 1.2500 -1.0000 0.1512 2.2500
7 1.0000 -0.7500 0.1245 1.7500
8 1.0000 0.0000 0.0997 1.0000
9 0.2500 0.0000 0.0764 0.2500
10 0.2500 0.0000 0.0539 0.2500
11 0.2500 0.2500 0.0321 0.0000
12 0.2500 0.2500 0.0107 0.0000
1
W = X 58.4869
62.2500
Calculated W = 0.940 Critical W = 0.884
0.940 z 0.884
The reproduction data is normally distributed
evaluated at a 990 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Control variance 4.1818
F = _ = 2.83
Effluent variance 1.4773
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
2.83 s 5.32 => The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

EQUAL VARIANCE t TEST
24.0 - 24.8
t = _ -1.092
0.687
Degrees of freedom= 22
Critical t = 2.508
-1.092 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99%- confidence interval.
Chronic Test PASSES

l
Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 01/23/20
'Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
f
a ory P ng Test: MERITECH LABS, INC.
X Comments:
- Sfgnaturwe of Oper in Responsible Charge
X "F
Signature of Labo y Supervisor * PASSED: -4.21% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -0.722
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -4.21
% Mortality Avg.Reprod.
# Young Produced 21 22 14 17 18 20 18 16 18 19 11 20 -
0.00 17.83
Control Control
Adult Wive (D)ead L L L L L L L L L L L L
0.00 18.58
Treatment 2 Treatment 2
Effluent %: 45%
rREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
17.214% PASS FAIL
# Young Produced 18 19 19 18 17 18 19 20 15 19 18 23 % control orgs X
producing 3rd
brood Check One
(L)ive (D)ead L L L L L L L L L L L L 91.7%
1st sample 1st sample 2nd sample Complete This For Either Test
Ai Test Start Date: 01/15/20
Control 7.99 8.03 8.05 8.01 8.03 7.76 Collection (Start) Date
Sample 1: 01/13/20 Sample 2: 01/15/20
'reatmert 2 7.79 8.12 7.59 7.99 7.76 7.95 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.3 hrs L A A
r d r d r d U M M
t t t Sample 2 X 24 hrs T P P
1st sample 1st sample 2nd sample
.O. Hardness(mg/1) 46
Control 8.01 6.94 7.18 7.67 8.08 7.77
Spec. Cond. (pmhos) 166 301 307
reatmert 2 7.81 7.00 7.10 7.67 8.11 7.88
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 2.6 2.1
4Iortalicy expressed as %, combining replicates)
Note: Please
a o % %
o a %% Concentration Complete This
% % %
Section Also
% % % % % % % Mortality
0 0 0 o a o % 0 0 %
start/end start/end
4C50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit
% -- % Spearman Karber - Other - High
Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
'opied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

•
t
Meritech, Inc. (Lab ##027)
Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#:
Client: S"r/, !'��'1r ( v #: r1J`it'- Pipe l County:y _L T
v r ti Date Start: 7— j - ? Date End: 1-,Z -!Zo
NPDES#: NCi O 3i K>t0 Date/Time of Culture Transfer: (-) f 77ep4tA Time Start: /i s 0L1.4e 1
Time End: '
Dilution Water: Lake Brandt . Date/Time Neonates born: ,b ):tL� --e:,N55 i\„ 1st Renewal Date: 'l Time:
Test Organism Source:Tray# Age of eonates at Test Start: % 1 J. 7 hours i 2nd Renewal Date: / - 7-,2-r) Time: /6). 74,,4,v,
Stirred/Aerated for D.O.: Y/© Randomized: Y/N Culture Tray Temp: 3L1. C Analyst(s): MR,CD,LV,KS Reviewed by:
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Sample 1: /-/3•", ('� : Sample 2: J-75s:�/f`,)
Adults Live/ Dead L:::- _ `- =-- Sample Information
Day#5 1 2/ 3 4 5 6 7 8 9 10 11 12 100% pH G/C? Duration
#Young Produced 9/ ' S7S1 "A- /� 7 k� '�
3�< 1 � ��� �/.- � y� �-` y Sample 1 7, 6•� C••- _�P/ 3 hours
Adults Live/Dead L„__ t�_ L- �_ _. _ c__ , i_ c
L_ [.� Sample 2 tr � i �•.,, ,:2G(, (•) hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12
w � ` Transferred by: Fed by:
#Young Produced f 7 7 7 ��5 / ' 1 �.' .> ei 6 / Batch# Sample 1 Sample 2 Day 0 l"/r�� L�
Adults Live/Dead L- L- (_ (_ L__ / , i._.:- r✓ L✓ 1___ LW. L� Transfer Day 0 2 5 Day 1 A.-:)
.- ---
Hardness Ham /Lss %_ Day 2 1 (,a J
Total Produced L 1t,� '� ,�-? 20 r�, / p 9 ( s ) �2"---- 6
l J 1 �Sf 15 T•lJ Spec.Cond. l/, `,/ 1 / _ Day 3 r�```�
�• .. ° (umhos/cm) 1 liJ I :'/,7— �'7( 30.7
rt 2 ( Day 4 ,,�y+A.
Percent of Control producing third brood: (it 7 /o
Chlorine
Test Sample Organism Reproduction (mg/L) Le( ?.( Day 5 ,n,� L,.l
Receipt Sample 2 Day 6 /''
Effluent%: "lf-i I Temp.(°C) C Q- I Terminated by: /,,
pH 1 st Sample 2nd Sample 2nd Sample
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 i 0 0 0 1 0 0 1 0 I 0 0 Control 7 7 f ( Q3 (),O, (7j U 3 7 7E;Adults Live/Dead L..--
-4
p c
Day#5 1, 2 3 4 5 6. 7 8 g Sample 77/ c�� 759 Z 0) 7r76 195"
�i ^� �� � 1 10 11 12 initial final initial final
G, t� irnuai final
#YoungProduced l Yr$ 2y/1 /rf .776- D•O• 1st Sam leAdults Live/Dead i • ( ^P 2nd Sample 2nd Sample
Day#7 1 2 3 4 5 6 7_ �8. 9 L Control ( .Q' Gr9 i 7(1 7/67 {� Q 9 7i77
_ 10 11 12 J/ (t t tI•
#Young Produced -,ye. e( 5J2 / .) /0 9 Sample ��(�� 7iQ� 7�Q �0� r"l
CJ� I l �/ ��?r
Adults Live/Dead / ( _ lr lr initial final initial final initial final
j 1 Temp. 1st Sample ' i
1X f 4� ,9C/ 2nd Sample 2nd Sample
• Total Produced I (f fr2 /7 /.-8 rf� r�.) 12; 1 6 i r`(< ()-?� Control ', (�' RAI
1.01-0.3,5Th
I1/, 6•CL,,tments: Sample :2.4�7 VI.!7 R A ,.-- I,7q '•7_ ./; 1

MERITECH, INC. (Lab #027) Meritech Sample ID#: fr/I`\`�
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reedAmeritechlabs.com Web Site: www.meritechlabs.com
f / CLIENT INFORMATION
Client:�i l Q� ;c-I Lam.! (a S.0 1 I ( . PO#:
Contact Person: (r'i .,,r .11� j'��'�h'�n M NPDES#: NC 00 2 L$3
Address: •. O . \jC I 1 ( I Phone: 704 0i I 34436
City: TC01_e S C 1\ \Q Pipe#: C�
County: y-'C'� e.I/ State: A)` , Zip: 23(j
oA ` SAMPLE INFORMATION t
Sample Site: '�i' l C1�',_,�1� 63 C)Ld-,1 1
6
Sample Type: Cl Grab 1omposite #of containers: ;-�
Sampling Time: Start Date: ) 11.31a0 o Start Time:705 le PM
End Date: l y l aQ V End Time:__ �� 40 PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print W.ur,c.1 Felt A 44 Signature: N.. J tC
4"=..'
TOXICITY TEST INFORMATION
1....*Required: Chronic(7 days) Test Organism: X Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: Lis % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
�� � SHIPPING INFORMATION 1
Relinquish-" i y&„Ai—
r ai&A._. Date: _/ Time: 1/55/ rAM PM
Received by: 'P ArFW
�r Date: Time: f , a PM
Relinquished by: � ,..--------- Date: ` r" Time: �P1�11
Received by: Date: Time: AM C PPMM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
q
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING (Laboratory Use Only)
quished by: kid 5:\E t'i 0 k 6'&�i
Received by: '5 A'[rYY Date: 9 -.) Time: AM (PM
�s ff SaCO
Sample Temperatures(°C): / /�l. / / mple Condltlon: r
C "' WHITE= Lahnratnry cony YELLOW=Ciipnt r_nnv *AmAkt-.•r:.iztv.,,v

MERITECH, INC. (Lab #027) Meritech Sample ID#: (I 11k(3 t 4)� P
Bioassay Sample Chain of Custody
^- 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
Toxicity Supervisor email: mike.reedAmeritechlabs.com Web Site: www.meritechlabs.com
n CLIENT INFORMATION
Client: 1 A C) I SPEC. t 1c) PO#:
Contact Person: .)���. \rl i fl NPDES#: NCO() 3 IV
Address: p,0 . Q3c) y ) + 1 Phone: 7O4 s-7Fj 3 -
City: ,__ c*-esc \1— Pipe l
`0
County: __J--(•e d h
-e4 j State: ADC/ Zip: c 15 GR-7
SAMPLE INFORMATION
Sample Site: LIM Q.,...r ee V. o'C ;xu
Sample Type: ❑Grab , Composite #of containers: _—
Sampling Time: Start Date: I 1 f 5)acDOStart Time: • 9)�� (:.-1 PM
p
End Date: 1 ( ©� ) End Timer , a \ AM PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech*** 1
CO la. 6 Collector's Name: Print: f kjt A reit-
Signature:
TOXICITY TEST INFORMATION
Test Required: 'Chronic(7 days) Test Organism: Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: L4 CD% ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION ��
Relinquished by: Date: J1 / `i do /�Time: / 71 49PM
Received by: Date: / A, ® � Time: —9 w- //Av�l PM
Relinquished by: Date: �� `------ Time: %� / AMP�rt
,� i
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ['Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING (Laboratory Use Only)
k ,
Relinquished by: t). . K c,p f i L L1
I_I ; _ t� t.nn
Received by: r nT ,j ,j'4�\ Date: i I /-Al Time: (g J AM PM
r
,r .
Sample Temperatures(°C): •-? I / - l / / Sample Condition: i l Pd.
li'Z='rf:'•' ,',dr:.4'4x,` ss=r WHITE= Laboratory coov YELLOW=Client cony

,1
Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 01/23/20
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -4.21% CONTROL 45% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 214 223
Mean # Neonates 17.833 18.583
Standard Deviation 3 .070 1.881
Coefficient of Variation 17.214%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 C 11 -6.8333 13 C 18 0.1667
2 C 14 -3 .8333 14 E 19 0.4167
3 E 15 -3.5833 15 E 19 0.4167
4 C 16 -1.8333 16 E 19 0.4167
5 E 17 -1.5833 17 E 19 0.4167
6 C 17 -0.8333 18 C 19 1.1667
7 E 18 -0.5833 19 E 20 1.4167
8 E 18 -0.5833 20 C 20 2.1667
9 E 18 -0.5833 21 C 20 2.1667
10 E 18 -0.5833 22 C 21 3 .1667
11 C 18 0.1667 23 C 22 4.1667
12 C 18 0.1667 24 E 23 4.4167

,
(
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 4.4167 -6.8333 0.4493 11.2500
2 4.1667 -3.8333 0.3098 8.0000
3 3.1667 . -3.5833 0.2554 6.7500
4 2.1667 -1.8333 0.2145 4.0000
5 2.1667 -1.5833 0.1807 3.7500
6 1.4167 -0.8333 0.1512 2.2500
7 1.1667 -0.5833 0.1245 1.7500
8 0.4167 -0.5833 0.0997 1.0000
9 0.4167 -0.5833 0.0764 1.0000
10 0.4167 -0.5833 0.0539 1.0000
11 0.4167 0.1667 0.0321 0.2500
12 0.1667 0.1667 0.0107 0.0000
1
W = X 134.2980
142.5833
Calculated W = 0.942 Critical W = 0.884
0.942 0.884
The reproduction data is normally distributed
evaluated at a 999,5 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Control variance 9.4242
F = _ = 2.66
Effluent variance 3 .5379
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
•
2.66 s 5.32 =0- The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

i
EQUAL VARIANCE t TEST
17.8 - 18.6
t = _ -0.722
1.039
Degrees of freedom = 22
Critical t = 2.508
-0.722 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99% confidence interval.
Chronic Test PASSES

il
• Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 10/24/19
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
atom Per r ' g Test: MERITECH LABS, INC.
X 7 Comments:
'igna o pera in Response e Charge
X
Signature o Laboratory Supervisor * PASSED: -5.41% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia _
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -1.173
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -5.41
# Young Produced 16 20 17 18 19 17 16 19 23 21 20 16
0.00 18.50
Adult (L)ive (D)ead L L L L L L L L L L L L % Mortality
Control Avg.Reprod.
Control
0.00 19.50
Treatment 2 Treatment 2
1Effluent %: 45%
ITREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
12.087% PASS FAIL
# Young Produced 16 18 23 17 20 18 20 20 20 20 21 21 % control orgs X
producing 3rd
brood Check One
(L)ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
'H Test Start Date: 10/16/19
Control 8.04 8.03 8.00 7.93 7.91 7.96 Collection (Start) Date
1:
reatment 2 7.85 7.95 7.85 7.96 7.83 8.08 Sample Tp e Sample 2: 10/16/19
ype/Durat9 Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.0 hrs L A A
r d r d r d U M M
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample
O. Hardness (mg/1) 50
Control 7.94 7.47 8.02 7.44 7.96 7.54
I -eatment 2 7.92 7.63 7.92 7.47 8.03 7.55 Spec. Cond. (lamhos) 152 420 413
Chlorine(mg/1) <0.1 <0.1
uC50/Acute Toxicity Test Sample temp. at receipt(°C) 2.4 2.7
:ortality expressed as %, combining replicates) 1
% Note: Please
° % % % % a % % Concentration Complete This
Section Also
% % % 0 % Mortality
start/end start/end
.750 = % Method of Determination Control
)5% Confidence Limits Moving Average Probit% -- % Spearman Karber - _
Other High
Conc.
pH D.O.
)rganism Tested: Ceriodaphnia dubia Duration(hrs) :
pied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Meritech, Inc. (Lab # 027)
5 �/t'11 y� Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#:`
Client: , S Pipe#: 01 County: ("- Date Start: /0--/6--I ei Date End: -,22_ ell
NPDES#: NC(J33 . ,3( Date/Time of Cu
lture Transfer t0 '� AMR,); Time Start:
Time
/� � End:
Dilutiont}-i�
Water: � �Lake Brandt Date/Time Neonates born: a (9 1st Renewal Date: J
r ,� .- .. ��'19'-)q Time: / `S
Test Organism Source: Tray# Age of eonates at Test Start: (0,9-0-hours 2nd Renewal Date: ., 9)-J 1 Time: ' �,�Stirred/Aerated for D.O.:Y/© Randomized:TY/ N Culture Tray Temp: -)AA.;OrC Analyst(s): MR,CD,LV,KS Reviewe by:
Control Organism Reproduction Y —
Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Sample 1: /U_�-/-/6" Sample 2i /D`/( �f(
r
Adults Live/Dead — Sample Information
Day#5, 1 2 3 4 5 6 7 8 9 10 11 12
/ I l / 100% pH G/C? Duration
#Young Produced 3/ / '(l f ale �(/-7 �� 3�� a//r. tt/f t/1'?�"/67 3/1� Sample 1 ?(77
Adults Live/Dead �- ( , (�{ L—
� "��,0 hours
L � L._- (� Sample 2 7
Day#7 p i7n ��� (� hours
1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 7 btBatch # ) ,�, Sample 1 Sample Transferred by: Fed_
Adults Live/Dead / (, i ! L- 1 -1-7
_ ( - ( _ Z J 1___ Transfer Day 0
.- 2 5 AiC 'a1 Day 1 /42--\
I Hardness r 4
Total Produced l� I I (`7 I ICI/r 1 /7 I T� I/ I I I I a I ,, (mg/L) �U -7 4,*,, i Day 2Al....... L//
Spec.Cond. Day 3 kS
Percent of Control producing third brood: f-�,�� % (umhos/cm) l�j �Jr� Z� �,� Day 4
c Chlorine r- z . ,�
-dir w e,�7 l�:
Test Sample Organism Reproduction (mg/1-) � � ,4, QI ��I Day 5 �� �11,'p
Receipt Sample ` Day 6 \
I Effluent%: 1�6 I
Temp.am , s ,r� �.- ,r�
y4 '` ` `X' (2 I Terminated by: ,e��.
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 pH 1st Sample 2nd Sample 2nd Sample
#Young Produced 0 0 0 0 0 0
0 0 0 0 0 0 Control 8D5 .03 �,Of ?,/3 ' Z, 2/ 7/�g
Adults Live/Dead ��-�-- (}
Dav#5 . 1 2 3 4 5 6 7 8 9 10 11 1
Sample �r( j ���� 7; j l6 1. �'��
#YoungProduced 3/ y )� initial final initial final mina final
l5 3/4 VA) 3/ / f 5 ( (�
Adults Live/Dead �- � �( ��l �" t `�/�) D.O. 1st Sample 2nd Sample 2nd Sample
L 1., L- .1--- _ 77 Y�[ ���
Day#7 1 2 3 4 5 6 7 8 g Control /i�� [ 7 �,�L 7 rl Z�� �ir
#Young Produced 4 /' �/ 10 11 1r�2 / (} n n
(�� I / Sample 7/1-= 71�� 7l� r � Q��� �C� �t� S
Adults Live/Dead L-- � / 2-- /- L- /„._ 1. L initial final initial final
initi4yal final
Temp. 1st Sample 2nd Sample 1 2ha Sample
Toal Prod
t '^ed 1 2,-) /7 PO(� �� p
/A a /R J ate i' / a', Control ; . "3 I2j4 1 D'%
Comments: l X7 ,�

INC. � I
MERITECH, N (Lab #027) Meritech SamplelD#: �v�����3 J
(
..5 Bioassay Sample Chain of Custody
- 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
'- Toxicity Supervisor email: [e-mail] Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: g,- S--\---(k_Tw----vv-Q- PO#:
Contact Person: '11Oe. \ L D\ c' (") NPDES#: NC 0 6 3 ( (, n
p 0 . VJ t _ (�,
Address: -1 t�}� t Phone: �f�� ��C`jS<I 3
City: S--- JC'�-L,.) 1\\ Q i )� pPip/e#:
County: __---If -e CIE J I Stater( Zip: a O (p ,-1
. SA LE IN O ATION
Sample Site: y
Sample Type: ❑GrabSomposite #of containers: Q(
Sampling Time: Start Date: f 0/14 /I g Start Time: 0 • PM`
End Date: /a/lb I f CI End Time: '—I Li AM PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C apone receipt at Meritech***
Collector's Name: Print: i,I)(4z-L AZ-, 14 5; Signature:
TOXICITY TEST INFORMATION
Test Required:>KIChronic(7 days) Test Organism: Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: I % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION ] //
Relinquishe y: Date: v Time: 1;k (, Cf.6
Received by: Date: lQ / Time: /2 7 AM 4310
Relinquished by: _ Date: ��/r Time: 9(6--- AM ai
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be Ex and must be clearly labeler-or Saturday delivery,NO STGNATURE REQUERED**
r' �} SAMPLE RECEIVING(Laboratory Use Only)
shed by: fl�r,k / ' •�c1!tj Q
Received by: ' Date: iQ111)yg Time: (7/ AM �A
J.1
ample Temperatures(°C): 2•Y / 11� / / Sample Condition: t W
,`� = .,i~ WHITE=Laboratory copy YELLOW=Client copy -..‹-mo.amisvzcotm

MERITECH, INC. (Lab #027) Meritech Sample ID#: VO T)1CI
Bioassay Sample Chain of Custody 1
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
r. ---- Toxicity Supervisor email: mike reed@meritechlabs coin Web Site: www.mentechlabs.com
•
r CLIENT INFORMA
� TIO
Client • ' , �� l 1 1 PO#:
Contact Person C NPDES#: NC &3
Address: ,O .t )C) • 1.\ \ Phone: 704 P 3'43
City � 1 5� ,,1� QPipe#: I
County: . .re de:) 'I State:...: /D C Zip:c' 0 6
j • SAMPLE INFO TION
Sample Site: `--� &ee I
Sample Type: ❑Grab Composite #of containers: c-.),R
Sampling Time: Start Date: ID J /6 I.0 Start Time: `-� PM
1 h
- 45
End Date: /O/1 7 I/. End Time : V 0 PM
*'*Triple rinse sample container with sample before filling completely with NO AIR SPACE Pack the sample cooler completely with ice. The l
sample must be<0.6°C upone receipt at Meritech***
Collector%Name: Print N
i CKLA 1?4 90 a Signature: ii- eZi2'
TOXICITY TEST INFORMATION
Test Required: `Chronic(7 days) Test Organism: Ceriodaphnla dubia (water flea)
x
❑Acute 24-48 hours Pime hales romela( ) ❑ p p s (fathead minnow)
ks
Mysidopsis bahia (mysid shrimp)
IWC: 1. E5 % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
^_ ,` i SHIPPING INFORMA ION u ..
Relinquishe f r..41_-(Alt J ;1j\_, ft.,v, i Date: (j: Time: 2: '�� AM
-, =:- � � / -� CO
Received by: 6 �-�d 11 Date: P 9 Time: 7/j y /_ A
Relinquished by: Date: ` /2 / - Time: l AM
`
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up 0 Delivered 0 Other
**Samp es shippe on Fn ay mus e e x an mus e c ear y a e e or Saturday a every, OSTGNATl1REREQUIRED.A
SAMPLE RECEIVING(Laboratory Use Only)
inquishedby: 44.k /.ett;l(5,,
Received by: cm l Date: I 1/iI
t` Time: V AM M
ample Temperatures(°C): ?r' / r7 / / Sample Condition: 'LW
i =u � WHITE= Laboratory copy YELLOW= Client copy

Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 10/24/19
< Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 • County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -5.41% CONTROL 45% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0 III
Adult Dead 0 0 •
Adult Mortality 0.00% 0.00%
# Neonates 222 234
Mean # Neonates 18.500 19.500
Standard Deviation 2.236 1.931
Coefficient of Variation 12.087%
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 16 -3.5000 13 E 20 0.5000
2 C 16 -2.5000 14 E 20 0.5000
3 C 16 -2.5000 15 E 20 0.5000
4 C 16 -2.5000 16 E 20 0.5000
5 E 17 -2.5000 17 E 20 0.5000
6 C 17 -1.5000 • 18 C 20 1.5000
7 C 17 -1.5000 19 C 20 1.5000
8 E 18 -1.5000 20 E 21 1.5000
9 E 18 -1.5000 21 E 21 1.5000
10 C 18 -0.5000 22 C 21 2.5000
11 C 19 0.5000 23 E 23 3.5000
12 C 19 0.5000 24 C 23 4.5000

.
s. 1
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 4.5000 -3.5000
0.4493 8.0000
2 3.5000 -2.5000
0.3098 6.0000
3 2.5000 -2.5000 0.2554 5.0000
4 1.5000 -2.5000 0.2145 4.0000
5 1.5000 -2.5000 0.1807 4.0000
6 1.5000 -1.5000 0.1512 3.0000
7 1.5000 -1.5000 0.1245 3.0000
8 0.5000 -1.5000 0.0997 2.0000
9 0.5000 -1.5000 0.0764 2.0000
10 0.5000 -0.5000 0.0539 1.0000
11 0.5000 0.5000 0.0321 0.0000
12 0.5000 0.5000 0.0107 0.0000
1
W = X 91.0918
96.0000
Calculated W = 0.949 Critical W = 0.884
0.949 a 0.884
The reproduction data is normally distributed
evaluated at a 9917 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Control variance 5.0000
F = _ = 1.34
Effluent variance 3.7273
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
1.34 s 5.32 =® The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

I It
•
•
EQUAL. VARIANCE t TEST I
• 1 •
•
• 18.5 19 5,
• t = _ -1.173 . . •
•0.8 •
53
Degrees. of freedom 22
Critical t _ 2.508 •
1.173 c 2.508 •
•
•
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99% confidence interval.
•
• Chronic'Test PASSES

. Ill HI
COPY
3
Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 07/26/19
F -?i.lity: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
L ato Per g Test: MERITECH LABS, INC.
Comments:
X,
Signature o Op ra an Response le Charge
X
Signature of Laboratory Supervisor * PASSED: -0.45% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -0.113
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -0.45
Mortality Avg.Reprod.
# Young Produced 16 18 21 20 18 20 20 17 19 17 18 19
0.00 18.58
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 18.67
Treatment 2 Treatment 2
'Effluent %: 45%
CREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
8.099% PASS FAIL
# Young Produced 14 21 18 19 20 20 20 17 19 20 16 20 % control orgs X
producing 3rd
brood Check One
(L)ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
E Test Start Date: 07/17/19
Control 8.10 8.01 8.05 8.19 7.85 7.96 Collection (Start) Date
Sample 1: 07/15/19 Sample 2: 07/17/19
reatment 2 7.81 8.16 7.91 8.36 7.90 8.17 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.1 hrs L A A
✓ d r d r d U M M
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample
.O. Hardness (mg/1) 44
Control 7.88 7.02 7.94 7.94 7.83 7.48
Spec. Cond. (pmhos) 155 379 398
reatment 2 7.91 6.92 7.65 7.94 7.73 7.25
Chlorine(mg/1) <0.1 <0.1
1,C50/Acute Toxicity Test Sample temp. at receipt(°C) 0.9 1.1
Mortality expressed as %, combining replicates)
Note: Please
%% %o 0 0 0 Concentration Complete This
o a % % 0% 0 0 0
Section Also
% % o 0 0° %0 % Mortality
% 0% 0 0
start/end start/end
I ,C50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit _
96 -- % Spearman Karber _ Other High
- Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
'opied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Meritech, li (Lab # 027)
Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#:,.Client: ,5-7 / ,V;jie L/f"14- Pipe#: (4 j County: .7-re ,,,(,/(6)1/ Date Start:
7'1 7'"( 1 Date End: --7_ „ y—(i.
NPDES#: NC )3/' 6 Date/Time of Culture Transfer: 7-('-•-(Y 7 0.7.c,40.1 Time Start:
Dilution Water: Lake Brandt Date/Time Neonates born: , /�'�>> Time End: �'jdi frti
�a'Lop,--5:00/,;,, 1st Renewal Date: 7--�lj-/q Time: l 7 (�
1
Test Organism Source: Tray# 6 Age of onatese at Test Start: .r2t hours 2nd Renewal Date: 1
Stirred /Aerated for D.O.: Y/U Randomized:( / N Culture Tray ��` ,�1 Time: G�;
Temp: ���, l °C Analyst(s): MR,CD,l v,KS Reviewed by: .if-C_,
Control Organism Reproduction
Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Sample 1: 1' -( Sample 2: /�/�
Adults Live/Dead - -----' "- Sample Information
Day#5 1 2 3 4 5 6 7 8 9 10 11 12
100% pH G/C? Duration
#Young Produced j/z 3/(, >/7 3/7 ti/3 'j`7 C(/'"37r, '��r 3/s 4 /.. ' �, Sample 1 7i j 7
C._ ( r��i / hours
Adults Live/Dead
L— L-- t— L_ /. L L.- L, Sample 2 7/66 yi'.Q hours
Day#7 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced n `u i it to It C Batch# 1 1111,,' Samplel Sample Transferred by: Fed by:
Adults Live/Dead CV 1-- 1— L- L- L _ L I-- l__ G-- Transfer Day 0 2 a� of m t'
5 �, �: -�! , :,1 Day 1
p �p c� Hardnessell try awa ,' Day 2 fl�
Total Produced 11 I1 � 1 I�� �tl / l Al- (mg/L) 7•�-h �" :sq��,�,'
1` ` 1 l Spec.Cond. c, Day 3 ,�ivr,
Percent of Control producing third brood:/(,� % (umhos/cm) MEM
��J ��g Day 4 1.{S
Chlorine °'
( ,>< �, 40�k Day 5,442.... L//Test Sample Organism Reproduction (m9/�) FTM,,v,;,v ,
Receipt Sample ti Day 6
Effluent%: 1/6 I Temp.CC) �y y " �
Terminated by. tic/
pH 1st Sample 2nd Sample 2nd Sample
Day#2 1 2 3 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control 6),(" Cf10/ 6,o); (q(19 74�i}' 7 P 6
Adults Live/ Dead 1 ----- __.._ y> 1/
Day#5 1 2 3 4 5 6 7 8 9 10 11 1� Sample 7c(°( ('rlU 7?/ (f,5C �(�p 8d7
l initial final initial final initial final
#Young Produced �l'7 5A 2/7 1/4; 3// 10 3/i L(f 1 . �,/
�� - Z._ f. -77 D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/ Dead Z_ I... � � � � G-. Lr"- t
C
Day#7 1 2 3 4� 5 6 7 8 9 10 11 12 Control 7 l a 77(/ 799 743 7 o'
#Young Produced 11 ( /6 i 9 Tl Sample 7 9( 6,92, 76.j Z?? (73 l.2SS`
r 9 // 9 /
Adults Live/Dead L 1_ L_ L- L L. p initial final initial final tnpa final
�^ L
Temp. 1st Sample 2nd Sample 2nd Sample
. Total Produced (y( � f q /Gl � ✓ ) i 17 I J f) 1/ a Control w ('
'4
Comes �-`s: Sample a4,�3 ::, t{,�� 0U ;1P/41

C•
• MERITECH, INC.. (Lab #027) MeritechSamplelD#: 1)1\�.Y'_`cf� t
4 Bioassay Sample Chain of Custody
i
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone] I
` Toxicity Supervisor email: mike.reed(a)meritechlabs.com Web Site: www.meritechlabs.com
1
I CLIENT INFORMATION
Clien• a , 1, PO.:
Contact Person: ,CC"` Cjh(�',O(Th NPDES#: NC 00 31 ea6
Address: .0,, G(T 1 (t t Phone: 1 L4- -18-3 U 38
City: S e_ ,t ,\ e tjC Pipe# 1
County (�d•l 1 State: Nc Zip: to e'
SAMPLE INFORMATION
Sample Site: L4 C''xeei\ UM I.t )
Sample Type: ❑Grab ''Composite #of containers: ,-
Sampling Time: Start Date: I- 1 i.b ) 'q Start TimeTO QWilliPM
End Date: 7 I I V)1 k End Time: h e a PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collectors Name: Print bdv itk f {j c rc!f Signature: [ /
cu:ILLutir 1
1
1
1
TOXICITY TEST INFORMATION
Test Required: Chronic(7 days) Test Organism: Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: q5 % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION� /J r _
Relinquished b . � Date: .. /i J 9 Time: t AM ili
Received by. c Date: //'jL /� Time: / !3 AM g
Relinquished by: Date: "/� Time: 3�36— AM 'M
w
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING (Laboratory Use Only)
F ied by: rfirck
Received by: !f�� A IV) Date: 1 l/CJ^I C, Time: 3- 5 AM GPM
'mole Temperatures(°C): Gi I / 0, I / / Sample Condition: !vc
�� r
WHITE=Laboratory copy YELLOW=Client cony =_ . w

° MERITECH, INC. (Lab #027) Meritech Sample ID#: 01 1 ill I‘1J i
Bioassay Sample Chain of Custody
- 4011,1 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
Toxicity Supervisor email: mike.reedftmeritechlabs.com Web Site: www.meritechlabs.com
c CLIENT INFORMATION
Client , I C� ?4 4 SC I ' 1 PO#:
Contact Person: ` J hrcj{� NPDES#: NC ' IP No
Address: ?.0(^�,�'?j�1 I ' t Phone: t V LI en a 38
• City: � C\--e Sy'A r 1`.r Pipe#: f
County: Cc- ,I I State: /U C Zip: ag(,---1-
SAMPLE INFORMATION
Sample Site: L,�-h ( iE _K L
Sample Type: ❑Grab Composite #of containers: __
Sampling Time: Start Date: 'F ' f -4 Jr / Start Time7r 0 7 40 PM
End Date: ',)) 8 I r C End Time: ."6 (,) /F►=, PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collectors Name: Print ....A LI ax J,� F-4,P ,r1 �A ✓' qT Signature:
.A.L.....t----
TOXICITY TEST INFORMATION
Test Required: Chronic(7 days) Test Organism: ]Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: �% ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished y: 'IA- Date: `7- a (( Time: 1 9 AM 0
_
Received by: • Date: 7 Time: C 379 AM
Relinquished by: Date: 7 / Timer AM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING (Laboratory Use Only)
t quished by: Or Iu'
Received by: 1 Date: / q1q ( ' �
�(( ,� �_1��l I Time: '1 �� AM l�
ample Temperatures(°C): I i ( / 1 I I / / Sample Condition: J(l d
== WHITE=Laboratory copy YELLOW=Client coot/

v i
Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 07/26/19
'acility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -0.45% CONTROL 45% Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00% 0.00%
# Neonates 223 224
Mean # Neonates 18.583 18.667
. Standard Deviation 1.505 2. 060 1
Coefficient of Variation 8.099% 0
.Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 14 -4.6667 13 C 19 0.4167
2 E 16 -2.6667 14 C 19 0.4167
3 C 16 -2.5833 15 E 20 1.3333
4 E 17 -1.6667 16 E 20 1.3333
5 C 17 -1.5833 17 E 20 1.3333
6 C 17 -1.5833 18 E 20 1.3333
7 E 18 -0.6667 19 E 20 1.3333
8 C 18 -0.5833 20 C 20 1.4167
9 C 18 -0.5833 21 C 20 1.4167
10 C 18 -0.5833 22 C 20 1.4167
11 E 19 0.3333 23 E 21 2.3333
12 E 19 0.3333 24 C 21 2.4167

SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 2.4167 -4.6667 0.4493 7.0834
2 2.3333 -2.6667 0.3098 5.0000
3 1.4167 -2.5833 0.2554 4.0000
4 1.4167 -1.6667 0.2145 3.0834
5 1.4167 -1.5833 0.1807 3.0000
6 1.3333 -1.5833 0.1512 2.9166
7 1.3333 -0.6667 0.1245 2.0000
8 1.3333 -0.5833 0.0997 1.9166
9 1.3333 -0.5833 0.0764 1.9166
10 1.3333 -0.5833 0.0539 1.9166
11 0.4167 0.3333 0.0321 0.0834
12 0.4167 0.3333 0.0107 0.0834
1
W = X 65.4649
71.5833
Calculated W = 0.915 Critical W = 0.884
0.915 >_ 0.884
The reproduction data is normally distributed
evaluated at a 990 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Effluent variance 4.2424
F = = = 1.87
Control variance 2.2652
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
•
1.87 s 5.32 =r The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

o . .
EQUAL VARIANCE t TEST
18.6 18.7
t = -0.113
0.736
Degrees of freedom = 22
Critical t = 2.508
-0.113 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 996 confidence interval.
Chronic Test PASSES

4th CREEK QUALIFICATION
MONTH: July 2019
-n._�rw. BOD-BLANK , ._.
DATE SAMPLE REASON QUALIFIED
7/9/2019, ALL Rule#1-DO depletion greater than 0.20 mg/I
7/15/2019 ALL Rule#1-DO depletion greater than 0.20 mg/I
•
BOD-STANDARD
DATE _...� y SAMPLE REASON QUALIFIED
BOD-INFLUENT
'DATE SAMPLE REASON QUALIFIED
LIM
BOD-EFFLUENT .,....�� _ _�_. _.
sDATE SAMPLE REASON QUALIFIED •
17/12/2019i E4 ;Duplicates out of range
____ BOD-SEED
DATE .e_. . - _ SAMPLEREASON QUALIFIED
ow
11111.1.
i
_ _ __ _ ____ FECAL
;DATESAMPLE REASON QUALIFIED
07/11/19 Fecal ;Duplicates out of range
07/23/19 Fecal_ =Duplicates out of range
_., _ a�� .-.._,_.�._�. w_ .._--Y a_.____
_ T.S.S.
DATE— SAMPLE REASON QUALIFIED
07/05/19 TSS Duplicates out of range
07/12/19 TSS Duplicates out of range
19-Jul TSS Duplicates out of range .
T.S.
;DATE SAMPLE REASON QUALIFIED
_.._.-.
-£

•
+
Analytical Results l , STATESVILLE
ANALYTICAL
of Statesville WWTP
PO Box 1111
Statesville, NC 28687
Receive Date: 07/08/2019
Reported: 07/19/2019
For:
Comments:
Sample Number Parameter Sample ID Result Unit Method Analyzed Analyst
190708-19-01 Copper E4 <0.002 mg/L EPA200.7 07/18/2019 MD
Respectfully submitted,
Dena Myers �7
NC Cert#440,
NCDW Cert#37755,
Er C00909
PO Box 228 • Statesville, NC 28687 • 704/872/4697
Page 1 of 3

Condition of Receipt •
Sple Number 190708-19-01 Temp on Arrival: 3.2
pH on Arrival: <2 Parameter Schedule: Copper
Nitric Acid Received on Ice
Chemicals in containers, lab
PO Box 228 e Statesville, NC 28687 e 704/872/4697
Page 2 of 3

N
Lo
N p
N co
co
Client: m
Address: ream i S'ATESVILLEANALYTICAL
122 Luur[Street • P.O.Uox 228 •
r Su lcsvillc,NC 2$687 N
(70i)872-I697
ealidigi
Contact Person: Phone N FAXN °No
Po It
� , — -- — STAES Chain of u
Requisitioned by: (rime Ddlr), A Atl
Ti Custody Record z
Customer Lab-ID N Time Sonipleu Date Sampled Ii --- •
—
Sample(Dr firab Only) (Caen Only) n ►Attiit>6 I';umrrch-rr rnlucareJ rur,urulvM,
•
co
N
N
X
t O
I cod
1 1.. _L. --1.
Relinquished by: ,",, Time `12 Cam,pm Dale 7/ 6 /`7 Sampled by: Or-
Received by: ` _ gam,Time /72 S— pm Date 7/ /I� V 12.
--- Transported by:
Relinquished by: _______ Time am,pm Date _/ /_
Holding times met:
Received by: Time am,pm Date /V/ �s
-- Compliance work:
Composite Sampling#1;
Time begin am,pm Date / / Non-compliance work:
—
Time end am,pm Date /`/
Lab Comments: Samples Transported On Ice:
Cornposi.t9 Samp In #2_ — •_`
Time begin am,pm Date /_—/
Time end am,pm Date_ /_/ et/
Initials:

•
C.
I v ,
Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 04/18/19
'Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
oratory Perfo, ing Test: MERITECH LABS, INC.
.4.,---- - Comments:
Sig ure o 0 ator in Responsible C arge
X '274 - _
Signatureof Laboratory Supervisor * PASSED: -39.61% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -10.384
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -39.61
Mortality Avg.Reprod.
# Young Produced 17 19 16 16 19 17 15 19 16 16 19 18
0.00 17.25
Control Control
Adult (L)ive (D)ead L L L L L L L L L L L L
0.00 24.08
Treatment 2 Treatment 2
Effluent %: 45%
TREATMENT 2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
8.607% PASS FAIL
# Young Produced 26 22 24 24 21 24 23 26 25 27 24 23 % control orgs X
producing 3rd
brood Check One
It (L)ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
pH Test Start Date: 04/10/19
Control 8.22 7.97 8.39 8.05 8.13 7.91 Collection (Start) Date
Sample 1: 04/08/19 Sample 2: 04/10/19
Treatment 2 7.64 7.99 7.61 8.06 7.64 8.04 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 23.9 hrs L A A
r d r d r d U M M
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample
D.O. Hardness(mg/1) 45
Control 7.65 7.42 7.74 7.16 7.56 7.20
Spec. Cond. (pmhos) 160 348 340
Treatment 2 7.58 7.32 7.57 7.09 7.44 7.45
Chlorine(mg/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 1.6 1.3
(Mortality expressed as %, combining replicates) I
Note: Please
o % Concentration Complete This
% % % % % 0 % % %
Section Also
t % % Mortality
% % % % % % o 0 o %
start/end start/end
LLC50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit
-- % Spearman Karber - Other - High
Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
Copied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

•
Meritech, Inc. (Lab # 027) 3
Client: S'�1-C-NI Iff A Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#:
Pipe#: O 1 County: re.c1 L U Date Start: i Date End: y 1 f
NPDES#: NC bt93 I�3i Date/Time of Culture Transfer:y'•- -f� lG
Dilution Water: Lake Brandt Date/Time Neonates born: /2: -�1�,,-U ,00 A Time Start: //:0 Le �1- Time End: ; P1/4�.,
�, .,1^ 1st Renewal Date: g
Test Organism Source: Tray# , Age of 3onates at Test Start:�`v�. �_/'� � � Time:-3 hours 2nd Renewal Date: L
Stirred/Aerated for D.O.:Y/© Randomized: / N Culture TrayTem / / / ' Time: ���
p:r"�.� °C Analyst(s): MR,CD,LV,SB Reviewed by: /ws--
Control Organism Reproduction
D 2 3 Collection (Start) Dates:
aLf#2 1
_-, 4 5 6 7 8 9 10 11 12
#Young Produced 0 0 0 0 0 0 0 0 Sample 1: �{-0 ��G� Sample 2: �1 "�U"�10 0 0 0
Adults Live/Dead L,- C.-, L_-. L.-- C.-
p_ av#5 1 Sample Information
Q#Young Produced `� ,.y 5, 6 � 1 11, 12 100% pH G 1 C? Duration
ry -Sy �6 `t� 3f .3 is„ 3/7 S"`f .S �; f Adults Live/Dead �. 9 � � �U Sample 1 ��(� (�,,
I t—, L-1 L., `_ t_ t— G ( hours
L--�t--� � Sample 2
p-aM 61 2 3 4 p �''`� ', % rc c) hours
1 8 9 10 11 12
#YOUn� Produced c� 5 6 7 Transferred by: Fed by:
` 6 6 9 7 .7 9- q Batch# f3-i^ %c(( Sample 1 Sample2
Adults Live/Dead l_- L L r_ _}(�J Day 0 }-�� LA/
L L-- ..- t,_._ L-- (� Transfer Day 0 2 . ,
r� �� /, I i f�y I 1 t-t Hardness if
Total Produced 11 l ( I !el 10 I ( Ii l` I I I1 (WI) 1�' ..1�`� pf4; Day 2 j�-1(7, L1�
ISpec.Cond. t Day 3 /`��
Percent of Control producing third brood: AO% (umhos/cm) 1 '���----7 ��� 1 G Day 4
Chlorine ���"`
Test Sample Oraanism Reproduction (ms/L) ��I -, Day 5 ./�"In'� (--�
•
Ii'<v.
Effluent%: Receipt Sample Day 6 /l/Z
Temp.CC) - �,p f, ),/3 Terminated by: pv-
D— � 1 2 3 4 5 6 7 8 9 10 11 12 pH 1st sample 2nd Sample 2nd Sample
#Young Produced 0 0 0 0 0 0 0
0 I 0 0 0 I 0 Control q � 'a - 3 ci ! Ell: C
Adults Live/Dead L. C
D_av#5 1 3 5 6 7 8 g Sample -i�9 ' Lv
#Young Produced 1 �I/ in tial final A�
1 1 12
/ 3 / initial final initial final
`t( 191 f` �� Tv et Li �1 / r� �I 0� VI D.O.
Adults Live/Dead 1_ t ! 1st Sample 2nd Sample 2nd
� L L. � Sample
D_ay#7 1 2 3 4 5 6 7 8 9 10 11 12 Control k.15 ; .39q , S(b
#Young Produced VI f(j f2 f 6) it r f /6 -��
/ t 3 f( LR /0 / 7;Sample 767 �5 3 LEI 3145
initial
,adults Live/Dead L. / L_ L j L Jinitial final initial
niia final
fy l._ 1 1. L., L mtua final
Temp. 1st Sample 2nd Sample 2nd Sample
Total Prodi-ed of r Ix/045 'fComments: � /,Sample , L .(n t,1.a-•`3�1!i;— op/t •'ri II

• MERITECH, INC. (Lab #i61j Meritech Sample ID#:
7Jt t��a
Bioassay Sample Chain of Custody
° A1151/f
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
Toxicity Supervisor email: mike.reedAmeritechlabs.com Web Site: www.meritechlabs.com
,....fut CLIENT INFORMATION
Client ) ,S. �C" � ( PO#:
Contact Person: 1'� ( ncc�n NPDES#: NC c C 3 192
Address: l Phone: 1011 B7 R 2M 2
City: s e so i if Pipe#: I 1
County:y '-Q State: CC) Zip: 6R !
(� SAMPLE INFORMATION
Sample Site: y (\�j�Xi Q k.AD c i ) 67-..,-n-ILA442.14
Sample Type: ❑Grab Composite #of containers:
op t
Sampling Time: Start Date: y/8 I)q Start Time: T ' r i AM PM
End Date: Li 19 I 1 -J End Time: 7. 0 4D PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech*'*
Collector's Name: Print c,,,�ei E.(v 11 co.v_ol f SignatureZ&D\ r— L'‘---------
,
TOXICITY TEST INFORMATION
Test Required: Chronic(7 days) Test Organism: ❑Ceriodaphnla dubia (water flea)
.-❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
0 Mysidopsis batik (rnysid shrimp)
IWC: 4 5 % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION/
Relinquished /i1K( Date: `"7 r� af' er Time: _� 0 AM PM
•Received by: �� Date: T® �/ Time: /2c 30 AM
..—r
Relinquished by: ,� Date: tf��l� Time: /� AM10
Received by: 1' Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING(Laboratory Use Only)
nquished by:
Received by: Date: - i 4 Time: L1,/,5- AM 6
Sample Temperatures(°C): I I /v I I Sample Condition: 7 ((°
WHITE=Laboratory copy YELLOW=Client rrinv

•
MERITECH, INC, (Lab #027) Meritech Sample ID#: OTW-1 `) 1 2
• Bioassay Sample Chain of Custody
4.0 642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
Toxicity Supervisor email: mike.reedAmeritechlabs.corn Web Site: www.meritechlabs.com
'1 CLIENT INFORMATION
Client: 1 1\ PO#:
Contact Person: 'Cd � �6�h sex) NPDES#: NC� . !() 6
Address: 0. f I i ) Phone: ` 01-1 bil 83L-}
City: z eSt3 I lie_ Pipe#: 4
County: i r . ( i State: /0C Zip: 0A
SAMPLE INFORMATION
Sample Site: Ltie\)"..) NV� \ Z4-) I t_A-ei
Sample Type: ❑Grab >6 Composite #of containers:
Sampling Time: Start Date: 14 / 10 I ri Start Time: ellPM
End Date: L ) 1 J 'i 9 End Time:.9� a PM
't**Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print b ,,:c.)Ac-c,y,„ (-h 4 r� Signature:9 ,...A c.....A.,
TOXICITY TEST INFORMATION
Test XRequired: hronic(7 days) Test Organism: ❑Ceriodaphnia dubia (water flea)
❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (mysid shrimp)
IWC: 1 ' 5% ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished )UNsDA, Date: q 1 Time: /2; /►�j A
Received by: Date:
Time: f>;60 AM WI
Relinquished by: Date: Time: l�(TZ., A 416)
s`
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING(Laboratory Use Only)
squished by: /•.r>
Received by: rr Date: t f c 1,i 4/ Time: -{S L) AM V
Sample Temperatures(°C): P `_�/ !� j / / Sample Condition:
MSIniumazet WHITE= Laboratory copy YE! I nonY=rila..f.,.,...,, ageg �..

E
1
Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 04/18/19
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL i
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -39.610 CONTROL 459s Effluent
# Replicates 12 12
Female Live 12 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.000 0.000
# Neonates 207 289
Mean # Neonates 17.250 24.083
Standard Deviation 1.485 1.730
Coefficient of Variation 8.6079e
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 21 -3.0833 13 E 24 -0.0833
2 C 15 -2.2500 14 E 24 -0.0833
3 E 22 -2.0833 15 E 24 -0.0833
4 C 16 -1.2500 16 C 18 0.7500
5 C 16 -1.2500 17 E 25 0.9167
6 C 16 -1.2500 18 C 19 1.7500
7 C 16 -1.2500 19 C 19 1.7500
8 E 23 -1.0833 20 C 19 1.7500
9 E 23 -1.0833 21 C 19 1.7500
10 C 17 -0.2500 22 E 26 1.9167
11 C 17 -0.2500 23 E 26 1.9167
12 E 24 -0.0833 24 E 27 2.9167

i.
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 2.9167 -3.0833 0.4493 6.0000
2 1.9167 -2.2500 0.3098 4.1667
3 1.9167 -2.0833 0.2554 4.0000
4 1.7500 -1.2500 0.2145 3.0000
5 1.7500 -1.2500 0.1807 3.0000
6 1.7500 -1.2500 0.1512 - 3.0000
7 1.7500 -1.2500 0.1245 3.0000
8 0.9167 -1.0833 0.0997 2.0000
9 0.7500 -1.0833 0.0764 1.8333
10 -0.0833 -0.2500 0.0539 0.1667
11 -0.0833 -0.2500 0.0321 0.1667
12 -0.0833 -0.0833 0.0107 0.0000
1
W = X 54.3868
57.1667
Calculated W = 0.951 Critical W = 0.884
0.951 a 0.884
The reproduction data is normally distributed
evaluated at a 99.9s confidence interval.
Test Passes!
F test for Homogeneity of Variance
Effluent variance 2.9924
F = _ = 1.36
Control variance 2.2045
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
1.36 s 5.32 =- The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

• 9
O ♦ •
O
EQUAL VARIANCE t TEST
17.3 - 24.1
t = - -10.384
0.658
Degrees of freedom = 22
Critical t = 2.508
-10.384 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99% confidence interval.
Chronic Test PASSES

1
Effluent Toxicity Report Form - Chronic Pass/Fail and Acute LC50 Date: 01/16/19
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County: IREDELL
ator Pe f ing Test: MERITECH LABS, INC.
X Comments:
Sign re of , or in Response e C arge
X mil .
Signature of Laboratory Supervisor * PASSED: -37.89% Reduction *
Work Order: Environmental Sciences Branch
MAIL ORIGINAL TO: Div. of Water Quality
N.C. DENR
1621 Mail Service Center
Raleigh, North Carolina 27699-1621
North Carolina Ceriodaphnia
Chronic Pass/Fail Reproduction Toxicity Test Chronic Test Results
Calculated t = -5.884
Tabular t = 2.508
CONTROL ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 % Reduction = -37.89
Mortality Avg.Reprod.
# Young Produced 16 26 21 21 16 17 17 16 17 19 17 24 -
0.00 18.92
Control Control
Adult (L) ive (D)ead L L L L L L L L L L L L -
0.00 26.08
Treatment 2 Treatment 2
Effluent ° 45%
TREATMENT2 ORGANISMS 1 2 3 4 5 6 7 8 9 10 11 12 Control CV
17.814% PASS FAIL
# Young Produced 29 26 26 26 26 22 27 29 30 24 22 26 % control orgs X
producing 3rd
brood Check One
(L)ive (D)ead L L L L L L L L L L L L 100%
1st sample 1st sample 2nd sample Complete This For Either Test
?H Test Start Date: 01/09/19
Control 8.15 7.98 8.10 7.95 8.01 8.06 Collection (Start) Date
Sample 1: 01/07/19 Sample 2: 01/09/19
Treatment 2 7.69 8.01 7.78 7.92 7.61 7.96 Sample Type/Duration 2nd
1st P/F
s s s Grab Comp. Duration D
t e t e t e I S S
a n a n a n Sample 1 X 24.2 hrs L A A
r d r d r d U M M
t t t Sample 2 X 24.0 hrs T P P
1st sample 1st sample 2nd sample
.0. Hardness(mg/1) 47
Control 7.47 7.78 7.67 7.76 8.02 7.35
Spec. Cond. (pmhos) 191 316 291
reatment 2 7.44 7.62 7.80 7.85 8.02 7.32
Chlorine(mq/1) <0.1 <0.1
LC50/Acute Toxicity Test Sample temp. at receipt(°C) 2.1 2.0
Mortality expressed as %, combining replicates)
Note: Please
% % % % % Concentration
° %° °% Complete This
Section Also
% % % % % % % % % % Mortality
° ° ° ° ° ° ° ° ° °
start/end start/end
,C50 = % Method of Determination Control
95% Confidence Limits Moving Average Probit
% -- % Spearman Karber Other - High
- Conc.
pH D.O.
Organism Tested: Ceriodaphnia dubia Duration(hrs) :
opied from DWQ form AT-1 (3/87) rev. 11/95 (DUBIA ver. 4.41)

Meritech, Inc. (Lab # 027)
Mini Chronic Pass/Fail Test: Ceriodaphnia dubia Incubator#:, I
Client: -5�A.2S� C r'« - 1 Pipe#: DO County: i yea e.11 Date Start: C^7 '�/9 Date End: / (6"' / I
NPDES#: NC 003133(o Date/Time of Culture Transfer: 14-1 C/: 1C9,4 M Time Start: �}n Time End: di �/�
Dilution Water: Lake Brandt Dpte/Time Neonates born: ti )�:t-{5yrm-4., -Licisen 1st Renewal Date: J -//-11 Time:
Test Organism Source: Tray# Age of f eonates at Test Start: o.2,33 hers 2nd Renewal Date: )- f l-1 leiTime: /0,•._`?o A.."Stirred/Aerated for D.O.: Y/© Randomized: Y/ N Culture Tray Temp:0._14,S °C Analyst(s): MR,CD,Lv,ss Reviewed by: /Wu ,
Control Organism Reproduction Collection (Start) Dates:
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 J
#Young Produced 0 0 0 0 0 • 0 0 0 0 0 0 0 Sample 1: I 2/ - 9 Sample 2: 1-- --(�(
Adults Live/Dead L L- L- L- (�. L.- 1.-- Sample Information
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 100% pH G /C? Duration
#Young Produced Zi��., �/( 3/�, 4) ;�Jr ��Jy �1g Sam le 1 JAdults Live!Dead 12/0
�- 1....- x 1 Z' p ��� C _ �(� � hours
L_ L_15/1/,71
L- L-- 4,--
1-347_16A-
Sam ,
Sample 2 7'+%S�j C� ;� ,0 hours
Day#7 1 2 3 4 5'j I6-6' 71 8 9 10 11 12
#Young Produced 1 1. c LI ,---- i Batch # Sample, Sample 2 Transferred by: Fed by:
E, .� �� Day 0 M t:V
Adults Live/Dead t__ L___ L_ c_.__ t._ L_ L t— L., Transfer Day 0 2 5 Day 1 Nk
l{ Hardness LI r� Day 2 n ik_ LA/
I Total Produced I I IA) 1 -1 I I I �1 e I f- I n`I k0 I I I IC) I I �-19, ( I Spec.9Co)nd. �J� %� Day 3 I-V 5
(umhos/cm) I LI l --3 / 31(D I Day 4 Percent of Control producing third brood: 1 CD
Chlorine y � Day 5 Lt✓
Test Sample Organism Reproduction (m9/�) ;r . , ,; °ti
Receipt Sample Day 61-
I Effluent%: �t-j I Temp.(CC)
.. di i 210 Terminated by: 7.14
Day#2 1 2 3 4 5 6 7 8 9 10 11 12 pH 1st Sample 2nd Sample 2nd Sample
#Young Produced 0 0 0 0 0 0 0 0 0 0 0 0 Control v,IS,
719 .31 r
Adults Live/Dead � �� �/� r�!,'mil� L !'
L / L- (_._- /_ L,- L_ (....-- C_._. �']� (,�
Day#5 1 2 3 4 5 6 7 8 9 10 11 12 Sample '71[0 1 igo I "�-3-� �� �j(1)) ,'
ll initial final' initial final initial final
#Young Produced /�/// 6p J�(p/(! q44J c�e, //,C7//1 ;�l� G//f t.1//[ 6001
/ I n 1// . D.O. 1st Sample 2nd Sample 2nd Sample
Adults Live/Dead L- � �' 2_ �(C/ I
/ L Control el( a
Day#7 1 2 3 4 5 6 7 8 9 10 11 12 "�� 1���-���
#YoungProduced � Y `
Imo_ I' 1 I 1( /�0 0 (.p_ 1�; .R 1 9' C p, Sample ; N T11Da ;1K t 71 c R " ,3,9-
Adults Live/Dead L, L i-- C.- L (- j c_ L-
initial final Initia final Willa final
• .(d (�` Temp. 1st Sample 2nd Sample 2nd Sample
Total Produced
r
q // - � 0-
?In Cla ! 36 zi arz.9, Control 1 , .1,3 '1-15,)L),y 1?),112-1.LI
•Comments: AIL) -/(D' 1g 1 in,Sample �-�(� ����f o�"�,n/ _7�-/ 1 �y, 911 1e-

MERITECH, INC. (Lab #027) Meritech Sample ID#: Fcvtt 11c
• A
Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax: [phone]
Toxicity Supervisor email: mike.reed(a?meritechlabs.com Web Site: www.meritechlabs.com
CLIENTC INFORMATION
Client(51 O-V ` fic *eS V \ I'Q, PO#:
Contact Person:_ sc�'n� c)�r\ Y l \ NPDES#: NC l )�C) 18 (n
y
Address: ' C _ cI Ili ( Phone: -l0(-1 8-12.43P
City: C e s c 1 we, Pipe#: O'
County: t ed`tu I / State: h?C Zip: a 8 VR-1
LE SAMP INFORMATION
Sample Site: Ltth OAr (
Sample Type: ❑Grab )omposite #of containers: ,
1) 7IJ9
Sampling Time: Start Date: j Start Time: ,.A AM PM
End Date: / /811 q End Time: ., 1 9 0 PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print: i'Ul ki-Al !t(r4l,TpN Signature: ../ Z/���
TOXICITY TEST INFORMATION
Test Required: JL�Chronic(7 days) Test Organism: Ceriodaphnia dubia (water flea)
�❑Acute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (rnysid shrimp)
IWC: Li t) % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished b j Date: 1 l F31, Time:ci 3 q AM PM
Received by Date: 5 Time: ,Pic.?i' PMPM�
Relinquished by: .�—' Date: -, Time: ,••O 6 AM per/
/'
Received by: Date: / �" ^p/ Time: /: D 6AM
Relinquished by: Date: 7 c' 17 Time: 3% AM M`
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ['Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING(Laboratory Use Only)
fished by /1,2,/-
r �`
Received by: Date: f'ifi161 Time: 7 AM
Sample Temperatures(°C): ( / ci 1 / / Sample Condition: `—`��iy 7,
: WHITE=Laboratory copy YELLOW=Client cony

•
•
. _ MERITECH, INC. (Lab #027) Meritech Sample ID#: 4' `1��I 1 ` �Bioassay Sample Chain of Custody
642 Tamco Rd,Reidsville NC 27320
Phone: [phone] Fax:[phone]
Toxicity Supervisor email: mike.reedmeritechlabs.com Web Site: www.meritechlabs.com
CLIENT INFORMATION
Client: L LI 0-F , e s \\e, PO#:
Contact Person:RDr0..�'`I 6h'(\ C) NPDES#: NCP) 1B'D)
I Address: '. C . ' I II Phone: f cy-/8 7S 3` 1 B
City: �_ e3U\\\Q. _PiPe#: 01
County: c-e..G\21 I State: AD G Zip: A V 1
MPL I ORMATION
Sample Site: q--/----k7 ejicsa .1 I
Sample Type: El Grab \gfComposite #of containers: C _,
Sampling Time: Start Date: I I(I/ I/q Start Time: .'•1 ) M PM
End Date: l l in 11 9 End Time:-4 V 9 AM PM
***Triple rinse sample container with sample before filling completely with NO AIR SPACE.Pack the sample cooler completely with ice. The
sample must be<0.6°C upone receipt at Meritech***
Collector's Name: Print: viz Fovs7n.v Signature:
TOXICITY TEST INFORMATION`
Test Required: `
Chronic(7 days) - Test Organism: '�j Ceriodaphnia dubia (water flea)
CIAcute(24-48 hours) ❑ Pimephales promelas (fathead minnow)
❑ Mysidopsis bahia (rnysid shrimp)
IWC: ,5. % ***Friday Samples for Chronic Fathead test must be collected after 9:00 a.m.on Friday***
Comments:
SHIPPING INFORMATION
Relinquished by: Date: 1 J I 0 I q Time: 09,g_a__ AM eip
Received by' .� ✓ _ Date: /r / 6 ,/ .9 Time: a,y 2/ AM PM
a
Relinquished by: Date: /--/t -/ % Time: t >I Pe- AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Relinquished by: Date: Time: AM PM
Received by: Date: Time: AM PM
Sample Temperature(°C):
Method of Shipment:❑ UPS ❑ Fed EX ❑ Meritech Pick-up ❑Delivered ❑ Other
**Samples shipped on Friday must be FedEx and must be clearly labeled for Saturday delivery,NO SIGNATURE REQUIRED**
SAMPLE RECEIVING(Laboratory Use Only)
G
.<elinquished by: , v
Received by: Date: 14 L h c`- Time: c( 0 AM PN
Sample Temperatures(°C): :fit U / ✓`-u / / Sample Condition: `"
-=r..=,-`"-" .� WHITE=LaboratorycopyYELLOW=Client copy
- -

$ I
Effluent Toxicity Statistical Results - Chronic Pass/Fail Date: 01/16/19
Facility: STATESVILLE FOURTH CREEK WWTP NPDES#: NC0031836 Pipe#: 01 County:IREDELL
Laboratory Performing Test: MERITECH LABS, INC.
Reduction: -37.89. CONTROL 45a Effluent
# Replicates 12 12
Female Live 12 ' 12
Adult Male 0 0
Adult Dead 0 0
Adult Mortality 0.00%- 0.000
# Neonates 227 313
Mean # Neonates 18.917 26.083
Standard Deviation 3.370 2.539
Coefficient of Variation 17.81496
Fisher's Exact Test
A = 12 B = 12 a = 12 b = 12
a/A = 1.00 b/B = 1.00
Success is: survival
Critical b value = 8
12 > 8
The test concludes that the proportion of survival is not
significantly different for the control and the effluent groups.
Test Passes!
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA
ORDERED OBSERVATIONS
i Group Neonates Centered i Group Neonates Centered
1 E 22 -4.0833 13 E 26 -0.0833
2 E 22 -4.0833 14 E 26 -0.0833
3 C 16 -2.9167 15 E 26 -0.0833
4 C 16 -2.9167 16 C 19 0.0833
5 C 16 -2.9167 17 E 27 0.9167
6 E 24 -2.0833 18 C 21 2.0833
7 C 17 -1.9167 19 C 21 2.0833
8 C 17 -1.9167 20 E 29 2.9167
9 C 17 -1.9167 21 E 29 2.9167
10 C 17 -1.9167 22 E 30 3.9167
11 E 26 -0.0833 23 C 24 5.0833
12 E 26 -0.0833 24 C 26 7.0833

i
.
SHAPIRO-WILK'S TEST FOR NORMAL DISTRIBUTION OF DATA (cont.)
COEFFICIENTS AND DIFFERENCES
i x(n-i-1) x(i) a(i) x(n-i-1) - x(i)
1 7.0833 -4.0833 0.4493 11.1666
2 5.0833 -4.0833 0.3098 9.1666
3 3.9167 -2.9167 0.2554 6.8334
4 2.9167 -2.9167 0.2145 5.8334
5 2.9167 -2.9167 0.1807 5.8334
6 2.0833 -2.0833 0.1512 4.1666
7 2.0833 -1.9167 0.1245 4.0000
8 0.9167 -1.9167 0.0997 2.8334
9 0.0833 -1.9167 0.0764 2.0000
10 -0.0833 -1.9167 0.0539 1.8334
11 -0.0833 -0.0833 0.0321 0.0000
12 -0.0833 -0.0833 0.0107 0.0000
1
W = X 184.1361
195.8333
Calculated W = 0.940 Critical W = 0.884
0.940 >_ 0.884
The reproduction data is normally distributed
evaluated at a 9996 confidence interval.
Test Passes!
F test for Homogeneity of Variance
Control variance 11.3561
F = _ = 1.76
Effluent variance 6.4470
Numerator degrees of freedom: 11 Denominator degrees of freedom: 11
Critical F = 5.32
1.76 s 5.32 =� The Test PASSES, the variances of the two groups
are significantly the same, homogeneous.

1
EQUAL VARIANCE t TEST
18.9 - 26.1
t = _ -5.884
1.218
Degrees of freedom = 22
Critical t = 2.508
-5.884 < 2.508
Test passed. There is not a significant difference in reproduction
between the Control and the effluent evaluated at a 99% confidence interval.
Chronic Test PASSES
I "
1