NC0046302_Renewal (Application)_20220926

� t
ROY COOPER A�
Governor
ELIZABETH S.BISER • °"
Secretary Hsu vn*-`s
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
September 26, 2022
Town of Mayodan
Attn: William Sears
210 W Main St
Mayodan, NC 27027-2019
Subject: Permit Renewal
Application No. NC0046302
Mayodan WTP
Rockingham County
Dear Applicant:
The Water Quality Permitting Section acknowledges the September 26, 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.
Sirerely 0
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
D_E Q North Carolina Department of Environmental Quality Division of Water Resources
Winston-Salem Regional Office 450 West Hanes MIII Road.Suite 300 Winston-Salem.North Carolina 27105
336.7769800

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EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0046302 Town of Mayodan TP OMB No.2040-0004
W
Form U.S.Environmental Protection Agency
1 aEPA Application for NPDES Permit to Discharge Wastewater
NPDES GENERAL INFORMATION
SECTION 1.ACTIVITIES REQUIRING AN NPDES PERMIT(40 CFR 122.21(f)and(f)(1))
1.1 Applicants Not Required to Submit Form 1
1.1.1 Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
treatment works? 1.1.2 treating domestic sewage?
If yes, STOP. Do NOT complete g] No If yes, STOP. Do NOT ® No
Form 1. Complete Form 2A. complete Form 1. Complete
Form 2S.
1.2 Applicants Required to Submit Form 1
1.2.1 Is the facility a concentrated animal feeding 1.2.2 Is the facility an existing manufacturing,
operation or a concentrated aquatic animal commercial, mining,or silvicultural facility that is
a production facility? currently discharging process wastewater?
o Yes 4 Complete Form 1 gj No gJ Yes 4 Complete Form IDNo
and Form 2B. 1 and Form 2C.
R1.2.3 Is the facility a new manufacturing,commercial, 1.2.4 Is the facility a new or existing manufacturing,
mining,or silvicultural facility that has not yet commercial, mining,or silvicultural facility that
commenced to discharge? discharges only nonprocess wastewater?
aEl Yes 4 Complete Form 1 g] No El Yes 4 Complete Form gi No
andForm 2D. ^E i V ID
° 1.2.5 Is the facility a neww K
or existing facility whose
> discharge is composed entirely of stormwater
L.) associated with industrial activity or whose S[I P •6 2022
discharge is composed of both stormwater and
non-stormwater? NCDEQIDWRINPDES
ElYeses + Complete Form 1 gJ No
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x)or
b 15 .
SECTION 2. NAME, MAILING ADDRESS,AND LOCATION (40 CFR 122.21(f)(2))
2.1 Facility Name
Town of Mayodan WTP
2.2 EPA Identification Number
C)
0
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2.3 Facility Contact
cri
Name(first and last) Title Phone number
451
William Sears Water Plant Supervisor [phone]
rn Email address
a
[e-mail]
ai
2.4 Facility Mailing Address
Street or P.O. box
210 W. Main Street
City or town State ZIP code
Mayodan NC 27027
EPA Form 3510-1(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0046302 Town of Mayodan TP OMB No.2040-0004
W
(6.2, 2.5 Facility Location
-0 ., Street,route number,or other specific identifier
a 0 501 Utility St. (old address 500 W. Roach St.; new road was built)
m o County name County code(if known)
u Rockingham
E c 3
City or town State ZIP code
z R Mayodan NC. 27027
SECTION 3. SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
a,
d
0
N
U
z 3.2 NAICS Code(s) Description(optional)
n3
U
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SECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
4.1 Name of Operator
Michael R. Amos
`o 4.2 Is the name you listed in Item 4.1 also the owner?
❑ Yes 0 No
4.3 Operator Status
R ❑ Public—federal ® Public—state ❑ Other public(specify)_
0- ❑ Private ❑ Other(specify)
4.4 Phone Number of Operator
[phone]
4.5 Operator Address
Street or P.O. Box
€ a 501 Utility Street
c .= City or town State ZIP code
R 0 Mayodan NC 27027
Email address of operator
0 [e-mail]
SECTION 5. INDIAN LAND(40 CFR 122.21(f)(5))
0 5.1 Is the facility located on Indian Land?
c co
❑ Yes ® No
EPA Form 3510-1(revised 3-19) Page 2
L -

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0046302 Town of Mayodan VVTP OMB No.2040-0004
SECTION 6.EXISTING ENVIRONMENTAL PERMITS(40 CFR 122.21(f)(6))
6.1 Existing Environmental Permits(check all that apply and print or type the corresponding permit number for each)
Tvi
NPDES(discharges to surface ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
o en
water) fluids)
NC0046302
a ❑ PSD(air emissions) El Nonattainment program(CAA) ❑ NESHAPs(CAA)
w ❑ Ocean dumping(MPRSA) ❑ Dredge or fill(CWA Section 404) ❑ Other(specify)
4122.21f 7
SECTION 7.MAP( 0 CFRO( ))
7.1 Have you attached a topographic map containing all required information to this application?(See instructions for
specific requirements.)
0 Yes ❑ No ❑ CAFO—Not Applicable(See requirements in Form 26.)
SECTION 8.NATURE OF BUSINESS(40 CFR 122.21(f)(8))
8.1 Describe the nature of your business.
We are a conventional water treatment plant: Alum coagulation(seasonal polyaluminum chloride) followed
flocculation, sedimentation, filtration and disinfection.
Wastewater is produced by wasting the settle solids and filter backwash solids to the lagoon where solids
m are allowed to settle with no chemical treatment. However dechlorinate tablets are used at the effluent prior
to discharge into receiving stream.
z
co
0
7
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SECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
L ; ❑ Yes No 3 SKIP to Item 10.1.
g
9.2 Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
cr,w 40 CFR 125, Subparts I and J may have additional application requirements at 40 CFR 122.21(r).Consult with your
NPDES permitting authority to determine what specific information needs to be submitted and when.)
o
o
U C
10.VARIANCE REQUESTSCFR 122.21 10
SECTION f
(40
()1 ))
10.1 Do you intend to request or renew one or more of the variances authorized at 40 CFR 122.21(m)?(Check all that
apply.Consult with your NPDES permitting authority to determine what information needs to be submitted and
when.)
d ❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
Section 301(n)) 302(b)(2))
❑ Non-conventional pollutants(CWA ❑ Thermal discharges(CWA Section 316(a))
Section 301(c)and(g))
gJ Not applicable
EPA Form 3510-1(revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0046302 Town of Mayodan TP OMB No.2040-0004
W
SECTION 11.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
11.1 In Column 1 below, mark the sections of Form 1 that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to provide attachments.
Column 1 Column 2
® Section 1:Activities Requiring an NPDES Permit ❑ w/attachments
® Section 2: Name, Mailing Address,and Location ❑ w/attachments
❑ Section 3: SIC Codes ❑ w/attachments
® Section 4: Operator Information ❑ wl attachments
❑ Section 5: Indian Land ❑ w/attachments
® Section 6: Existing Environmental Permits ❑ w/attachments
w/topographic
CO �] Section 7: Map ® map ❑ w/additional attachments
in
® Section 8: Nature of Business ❑ w/attachments
.773
�._ ❑ Section 9:Cooling Water Intake Structures ❑ w/attachments
❑ Section 10:Variance Requests ❑ wl attachments
N ® Section 11: Checklist and Certification Statement ❑ wl attachments
11.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true. accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Name(print or type first and last name) Official title
William Sears Water Plant Supervisor
Signature Date signed
— z /— z.a Z
EPA Form 3510-1(revised 3-19) Page 4

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Town of Mayodan ti , ;
Mayodan WTP
NPDES Permit NC0046302 A
Facility Location
Receiving Stream: UT to Mayo River Stream Claw WS-IV;CA scale not shown
1 Stream Segment: 22-30-(9.5) Sub-Basin#:03-02-02
River Basin: Roanoke HUC:0301010304 SCALE USGS Quad: Mayodan
County: Rockingham 1:24,000 36.421667°,-79.96777778°

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0046302 Town of Mayodan TP OMB No.2040-0004
W
Form U.S.Environmental Protection Agency
2C `.'iCPA Application for NPDES Permit to Discharge Wastewater
NPDES L EXISTING MANUFACTURING,COMMERCIAL, MINING,AND SILVICULTURE OPERATIONS
SECTION 1.OUTFALL LOCATION(40 CFR 122.21(g)(1))
1.1 Provide information on each of the facility's outfalls in the table below.
o Outfall Receiving Water Name Latitude Longitude
Number
J 1 unknown tributary of the Mayo River 36 ° 25 18 79 ° 58 ' 04 ..
0
SECTION 2. LINE DRAWING(40 CFR 122.21(g)(2))
a, 2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
a .3 balance?(See instructions for drawing requirements. See Exhibit 2C-1 at end of instructions for example.)
J �
o ® Yes ❑ No
SECTION 3.AVERAGE FLOWS AND TREATMENT(40 CFR 122.21(g)(3))
3.1 For each outfall identified under Item 1.1, provide average flow and treatment information.Add additional sheets if
necessary.
**Outfall Number** 1
Operations Contributing to Flow
Operation Average Flow
Sedimentation Basin flushing 0.0058 mgd
c
Filter washing and rewashing 0.0064 mgd
Daily Filter rewash 0.0045 mgd
a
c
mgd
3
o Treatment Units
Description Final Disposal of Solid or
(include size,flow rate through each treatment unit, Code rom Wastes Other Than
a retention time,etc.) RETEIV by Discharge
Sedimentation(settling) 1-U
S P P 2.6 Z022
NCDEQ1DVV1-INPUES
EPA Form 3510-2C(Revised 3-19) Page 1

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EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05719
NC0046302 Town of Mayodan WTP OMB No.2040-0004
3.1 **Outfall Number**
cont. Operations Contributing to Flow
Operation Average Flow
mgd
mgd
mgd
- - -- mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
CU
0
E
F=
-0 **Outfall Number**
N Operations Contributing to Flow
o Operation Average Flow
Q, mgd
d
a' mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit. Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
3.2 Are you applying for an NPDES permit to operate a privately owned treatment works?
CUai ❑ Yes ® No 9 SKIP to Section 4.
�nul
3.3 Have you attached a list that identifies each user of the treatment works?
❑ Yes ❑ No
EPA Form 3510-2C(Revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0046302 Town of Mayodan TP OMB No.2040-0004
W
SECTION 4.INTERMITTENT FLOWS(40 CFR 122.21(g)(4))
4.1 Except for storm runoff, leaks,or spills,are any discharges described in Sections 1 and 3 intermittent or seasonal?
x❑ Yes ❑ No 4 SKIP to Section 5.
4.2 Provide information on intermittent or seasonal flows for each applicable outfall.Attach additional pages,if necessary.
Outfall Operation Frequency Flow Rate
Number (list) Average Average Long-Term Maximum Duration
Days/Week Months/Year Average Daily
Sedimentation Basin flushing 1 days/week 12 months/year 0,0058 mgd 0.0058 mgd .042 days
0 1 Filter washing and rewashing 2 days/week 12 months/year 0.011 mgd 0.074 mgd 0.022 days
LL
c Daily Filter rewash 7 days/week 12 months/year 0.0045 mgd 0.0056 mgd 0.0028 days
ai
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
SECTIOW 5. PRODUCTION(40 CFR 122.21(g)(5))
5.1 Do any effluent limitation guidelines(ELGs)promulgated by EPA under Section 304 of the CWA apply to your facility?
❑ Yes $i No 4 SKIP to Section 6.
5.2 Provide the following information on applicable ELGs.
ELG Category ELG Subcategory Regulatory Citation
n
•
5.3 Are any of the applicable ELGs expressed in terms of production(or other measure of operation)?
❑ Yes ® No 4 SKIP to Section 6.
0
5.4 Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
Outfall Operation, Product,or Material Quantity per Day Unit of
Number Measure
a)
N
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).
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EPA Form 3510-2C(Revised 3-19) Page 3

•
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0046302 Town of Mayodan VVTP OMB No.2040-0004
SECTION 6.IMPROVEMENTS(40 CFR 122.21(g)(6))
6.1 Are you presently required by any federal,state,or local authority to meet an implementation schedule for constructing,
upgrading,or operating wastewater treatment equipment or practices or any other environmental programs that could
affect the discharges described in this application?
❑ Yes ® No 3 SKIP to Item 6.3.
6.2 Briefly identify each applicable project in the table below.
Affected Final Compliance Dates
E Brief Identification and Description of Outfalls Source(s)of
o Project (list outfall Discharge Required Projected
n number)
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6.3 Have you attached sheets describing any additional water pollution control programs(or other environmental projects
that may affect your discharges)that you now have underway or planned?(optional item)
❑ Yes ❑ No ❑ Not applicable
SECTION 7. EFFLUENT AND INTAKE CHARACTERISTICS(40 CFR 122.21(g)(7))
See the instructions to determine the pollutants and parameters you are required to monitor and, in turn,the tables you must
complete. Not all applicants need to complete each table.
Table A.Conventional and Non-Conventional Pollutants
7.1 Are you requesting a waiver from your NPDES permitting authority for one or more of the Table A pollutants for any of
your outfalls?
❑ Yes ® No 3 SKIP to Item 7.3.
7.2 If yes, indicate the applicable outfalls below.Attach waiver request and other required information to the application.
Outfall Number Outfall Number Outfall Number
7.3 Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
requested and attached the results to this application package?
No;a waiver has been requested from my NPDES
cL.o ❑ Yes ® permitting authority for all pollutants at all outfalls.
Table B.Toxic Metals,Cyanide,Total Phenols,and Organic Toxic Pollutants
7.4 Do any of the facility's processes that contribute wastewater fall into one or more of the primary industry categories
co
listed in Exhibit 2C-3?(See end of instructions for exhibit.)
❑ Yes 2 No + SKIP to Item 7.8.
co
7.5 Have you checked"Testing Required"for all toxic metals,cyanide, and total phenols in Section 1 of Table B?
❑ Yes No
7.6 List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s)identified
in Exhibit 2C-3.
Primary Industry Category Required GCIMS Fraction(s)
(Check applicable boxes.)
❑Volatile 0 Acid 0 Base/Neutral 0 Pesticide
❑Volatile 0 Acid 0 Base/Neutral 0 Pesticide
0 Volatile 0 Acid 0 Base/Neutral 0 Pesticide
EPA Form 3510-2C(Revised 3-19) Page 4

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0O463O2 Town of Mayodan TP OMB No.2040-0004
W
7.7 Have you checked "Testing Required"for all required pollutants in Sections 2 through 5 of Table B for each of the
GC/MS fractions checked in Item 7.6?
❑ Yes ❑ No
7.8 Have you checked"Believed Present"or"Believed Absent"for all pollutants listed in Sections 1 through 5 of Table B
where testing is not required?
• Yes ❑ No
7.9 Have you provided(1)quantitative data for those Section 1, Table B, pollutants for which you have indicated testing is
required or(2)quantitative data or other required information for those Section 1. Table B, pollutants that you have
indicated are"Believed Present"in your discharge?
® Yes ❑ No
7.10 Does the applicant qualify for a small business exemption under the criteria specified in the instructions?
❑ Yes 4 Note that you qualify at the top of Table B. ❑ No
then SKIP to Item 7.12.
7.11 Have you provided(1)quantitative data for those Sections 2 through 5, Table B, pollutants for which you have
determined testing is required or(2)quantitative data or an explanation for those Sections 2 through 5,Table B,
pollutants you have indicated are"Believed Present"in your discharge?
® Yes ❑ No
ap Table C.Certain Conventional and Non-Conventional Pollutants
al 7.12 Have you indicated whether pollutants are"Believed Present"or'Believed Absent"for all pollutants listed on Table C
for all outfalls?
® Yes ❑ No
l6
c 7.13 Have you completed Table C by providing(1)quantitative data for those pollutants that are limited either directly or
indirectly in an ELG and/or(2)quantitative data or an explanation for those pollutants for which you have indicated
;° "Believed Present"?
® Yes ❑ No
Table D.Certain Hazardous Substances and Asbestos
7.14 Have you indicated whether pollutants are"Believed Present"or"Believed Absent"for all pollutants listed in Table D for
all outfalls?
❑x Yes ❑ No
7.15 Have you completed Table D by(1)describing the reasons the applicable pollutants are expected to be discharged
and(2)by providing quantitative data,if available?
® Yes ❑ No
Table E.2,3,7,8-Tetrachlorodibenzo-p-Dioxin(2,3,7,8-TCDD)
7.16 Does the facility use or manufacture one or more of the 2,3,7,8-TCDD congeners listed in the instructions,or do you
know or have reason to believe that TCDD is or may be present in the effluent?
❑ Yes 4 Complete Table E. ® No 4 SKIP to Section 8.
7.17 Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes ❑ No
SECTION 8.USED OR MANUFACTURED TOXICS(40 CFR 122.21(g)(9))
8.1 Is any pollutant listed in Table B a substance or a component of a substance used or manufactured at your facility as
an intermediate or final product or byproduct?
❑ Yes ® No 4 SKIP to Section 9.
U
cn 8.2 List the pollutants below.
1. 4. 7.
d 2. 5. 8.
3. 6. 9.
EPA Form 3510-2C(Revised 3-19) Page 5

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0046302 own of Mayodan WTP OMB No.2040-0004
SECTION 9.BIOLOGICAL TOXICITY TESTS(40 CFR 122.21(g)(11))
9.1 Do you have any knowledge or reason to believe that any biological test for acute or chronic toxicity has been made
within the last three years on(1)any of your discharges or(2)on a receiving water in relation to your discharge?
Yes ❑ No 4 SKIP to Section 10.
9.2 Identify the tests and their purposes below.
Test(s) Purpose of Test(s) Submitted to NPDES Date Submitted
x Permitting Authority?
0
Acute Toxicity Ceriodaphnia ® Yes ❑ No Quarterly
•a)
m ❑ Yes ❑ No
❑ Yes ❑ No
SECTION 10.CONTRACT ANALYSES(40 CFR 122.21(g)(12))
10.1 Were any of the analyses reported in Section 7 performed by a contract laboratory or consulting firm?
❑ Yes ❑ No 4 SKIP to Section 11.
10.2 Provide information for each contract laboratory or consulting firm below.
Laboratory Number 1 Laboratory Number 2 Laboratory Number 3
Name of laboratory/firm Environmental Testing
Solutions
yr
Laboratory address 351 Depot St.
c Ashville, NC.28802
0
CO
a+
0 Phone number
828-350-9364
Pollutant(s)analyzed
Acute Toxicity
SECTION 11.ADDITIONAL INFORMATION(40 CFR 122.21(g)(13))
11.1 Has the NPDES permitting authority requested additional information?
❑ Yes ❑x No 4 SKIP to Section 12.
E 11.2 List the information requested and attach it to this application.
1. 4.
c,
0
2. 5.
-0
3. 6.
EPA Form 3510-2C(Revised 3-19) Page 6

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0046302 Town of Mayodan WTP OMB No.2040-0004
SECTION 12.CHECKLIST AND CERTIFICATION STATEMENT(40 CFR 122.22(a)and(d))
12.1 In Column 1 below,mark the sections of Form 2C that you have completed and are submitting with your application.
For each section,specify in Column 2 any attachments that you are enclosing to alert the permitting authority. Note
that not all applicants are required to complete all sections or provide attachments.
Column 1 Column 2
© Section 1: Outfall Location ® w/attachments
® Section 2: Line Drawing 0 w/line drawing ❑ w/additional attachments
Section 3:Average Flows and w/list of each user of
0 Treatment ❑ w/attachments El privately owned treatment
works
® Section 4: Intermittent Flows ❑ wl attachments
j Section 5: Production ❑ w/attachments
w/optional additional
Section 6: Improvements Elw/attachments ❑ sheets describing any
additional pollution control
plans
❑ w/request for a waiver and ❑ w/explanation for identical
supporting information outfalls
w/small business exemption❑ request w/other attachments❑
et) ® Section 7: Effluent and Intake ❑ w/Table A ❑x w/Table B
Characteristics
0
.0 x❑ w/Table C ❑x w/Table D
w/Table E wl analytical results as an
c3 El ❑ attachment
Section 8: Used or Manufactured
Toxics ❑ w/attachments
© Section 9: Biological Toxicity ❑ wl attachments
d Tests
U
® Section 10: Contract Analyses ❑ w/attachments
Section 11:Additional Information ❑ w/attachments
❑ Section 12:Checklist and ❑ w/attachments
Certification Statement
12.2 Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in
accordance with a system designed to assure that qualified personnel properly gather and evaluate the information
submitted. Based on my inquiry of the person or persons who manage the system. or those persons directly
responsible for gathering the information. the information submitted is, to the best of my knowledge and belief, true.
accurate,and complete. 1 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
c.
EX/1;//'4 ii Jezzr—S 60/ P .5,,pc o, 5cr-
Signature Date signed
9-2 /-2022
EPA Form 3510-2C(Revised 3-19) Page 7

This page intentionally left blank.

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Town of Mayodan
Mayodan WTP
NPDES Permit NC0046302A ,
Facility Location
Receiving Stream: UT to Mayo River Stream Class:WS-IV;CA scale not shown
Stream Segment: 22-30-(9.5) Sub-Basin#:03-02-02
River Basin: Roanoke HUC:0301010304 SCALE USGS Quad:Mayodan
County: Rockingham 1:24,000 36.421667°,-79.96777778°

Mayodan WTP
Schematic
Flash Mix
Alum&
Sodium hydroxide r
SEL PAC(seasonal) ♦
Flushed&Cleaned
quarterly ► Lagoon#2
Dechlor
tablets used
Floccculation prior to
Basins discharge.
Flushed&Cleaned ► �____► NPDES
quarterly. 0046302
LLagoon#1 a)
Sedimentation
Basins Currently
Not In Use.
Flushed weekly
Cleaned quarterly.
• ►
♦
Multimedia
Filters
Pre-Chlorine
Added
Backwash Solids. ►.
Daily discharge.
Clearwell High Level
Tank Storage
Sodium Hydroxide, Tank
Polyphosphate,
& Post Chlorine Drinking
added upstream of Water
this tank.
Raw
Pump
Station
•
�/ Mayo River 4

EPA Identification Number NPDES Permit Number F.9cility Name Outfall Number Form Approved 03/05/19
2 C 1 ' ( OMB No.2040-0004
���C.' NFJJ JL .� C.. j Gus.).l E'T I�c.y��:� ��( '
l
TABLE A.CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(iii))I •
Effluent Intake
Waiver V (Optional)
Pollutant Requested Units Maximum Maximum Long-Term
(if apulestle) (specify) Daily Monthly Average Daily Number of Long-Term Number of
Discharge Discharge Discharge Analyses Average Value Analyses
(required) (if available) (if available)
❑ Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
Biochemical oxygen demand Concentration
1' ❑(BOD5)
Mass
Chemical oxygen demand Concentration
2' El(COD) Mass
Concentration
3. Total organic carbon(TOC) El
Mass
Concentration mg/L 4.6 2.8 2.7 23
4. Total suspended solids(TSS) EZ
Mass
Concentration
5. Ammonia(as N) ❑
Mass
6. Flow ® Rate MGD 0.200
Temperature(winter) J °C °C
7. 9.7 6.2 6
Temperature(summer) ® °C °C 25.0
23.9 6
pH(minimum) VI Standard units s.u. 6.9 7.1 7.2 23
8.
pH(maximum) IZ] Standard units s.u. 7.7 7.7 7.4 23
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 9

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19 •
AK
0 0 y .50
C Z 4„h t L (Vie, `J. , V P ) OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1 .
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
Daily
Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) Value
(if available)
❑ Check here if you qualify as a small business per the instructions to Form 2C and,therefore,do not need to submit quantitative data for any of the organic toxic pollutants in Sections
2 through 5 of this table. Note, however,that you must still indicate in the appropriate column of this table if you believe any of the pollutants listed are present in your discharge.
Section 1.Toxic Metals,Cyanide,and Total Phenols
1.1 Antimony,total g Concentration
(7440-36-0) Mass
1.2 Arsenic,total Concentration
(7440-38-2) Mass
Beryllium,totalE2r Concentration
1.3 1:1 11
(7440-41-7) Mass
1.4 Cadmium,total ,--,/ Concentration
(7440-43-9) L✓� Mass
Chromium,total g Concentration
1.5 (7440-47-3) � CIMass
1.6 Copper,total —_I Concentration ug/L <10 <10 <10 12
RI Er
(7440-50-8) Mass
1.7 Lead,total e Concentration
(7439-92-1) Mass
Mercury,total Concentration
1.8 (7439-97-6) Mass
Nickel,total Concentration
1.9 (7440-02-0) 0 0 Mass
Selenium,total Concentration
1.10 El 0
(7782-49-2) Mass
Silver,total Concentration
1.11 (7440-22-4) Mass
EPA Form 3510-2C(Revised 3-19) Page 11

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

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Term
of of
Discharge Discharge
req(required) (if available) DisDcharge Analyses AverageValue Analyses
(if available)
2-chloroethylvinyl ether Concentration
2'9 El El
(110-75-8) Mass
2.10 Chloroform(67-66-3) Concentration
Mass
2.11 Dichlorobromomethane 0/ Concentration
El ID
(75-27-4) Mass
2.12 1,1-dichloroethane ,—./ Concentration
El I=1
(75-34-3) �►d Mass
2.13 1,2-dichloroethane 0/ Concentration
0 El
(107-06-2) L�� Mass
2.14 1,1-dichloroethylene � El
Concentration
(75-35-4) or
Mass
2.15 1,2-dichloropropane El El0/ Concentration
(78-87-5) Mass
2.16 1,3-dichloropropylene 0/ Concentration
1:1 ID
(542-75-6) Mass
2.17 Ethylbenzene 1=1 Elvr Concentration
(100-41-4) Mass
2.18 Methyl bromide El Elii Concentration
(74-83-9) Mass
2.19 Methyl chloride El El vy Concentration
(74-87-3) Mass
2.20 Methylene chloride 0 El ,-,( Concentration
(75-09-2) L�J Mass
2.21 1,1,2,2-tetrachloroethane id Concentration
El El
(79-34-5) Mass
EPA Form 3510-2C(Revised 3-19) Page 13

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS.AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
Dreq fired) ifschlabge) Discharge Analyses AValuee Analyses
(if available)
2.22 Tetrachloroethylene El El 121/ Concentration
(127-18-4) Mass
2.23 Toluene v Concentration
El El
(108-88-3) Mass
2.24 1,2-trans-dichloroethylene El Concentration
(156-60-5) Mass
2.25 1,1,1-trichloroethane 12/ Concentration
(71-55-6) Mass
2.26 1,1,2-trichloroethane 0 Concentration
(79-00-5) Mass
2.27 Trichloroethylene 0 ❑ 0/ Concentration
(79-01-6) �1 Mass
2.28 Vinyl chloride ❑ ❑ 0/ Concentration
(75-01-4) Lid Mass
Section 3.Organic Toxic Pollutants(GC/MS Fraction—Acid Compounds)
3.1 2-chlorophenol ID ❑ r21/ Concentration
(95-57-8) U Mass
3.2 2,4-dichlorophenol ❑ 0 04 Concentration
(120-83-2) Mass
3.3 2,4-dimethylphenol El ❑ Concentration
(105-67-9) Mass
3.4 4,6-dinitro-o-cresol ,--,/ Concentration
(534-52-1) l,d Mass
2,4-dinitrophenol Concentration
3.5 (51-28-5) Mass
EPA Form 3510-2C(Revised 3-19) Page 14 ,

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))' •
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Dailyof Term of
Discharge Discharge
available) Discharge Analyses AverageValue Analyses
(required)
(if available)
3.6 2-nitrophenol Q. Concentration
CI CI
(88-75-5) Mass
4-nitrophenol Ili Concentration
3.7 El El
(100-02-7) Mass
3.8 p-chloro-m-cresol CI ❑ 0 Concentration
(59-50-7) Mass
3.9 Pentachlorophenol L� Concentration
(87-86-5) Mass
3.10 Phenol El0/ Concentration
El
(108-95-2) ll�� Mass
3.11 2,4,6-trichlorophenol Elid Concentration
(88-05-2) Mass
Section 4.Organic Toxic Pollutants(GCIMS Fraction—Base(Neutral Compounds)
4.1 Acenaphthene 0 Concentration
(83-32-9) Mass
4.2 Acenaphthylene 0 ❑ 12/ Concentration
(208-96-8) Mass
4.3 Anthracene El IDidConcentration
(120-12-7) Mass
4.4 Benzidine ID Concentration
(92-87-5) Mass
4.5 Benzo(a)anthracene El ,3/ Concentration
El
(56-55-3) tYY�� Mass
Benzo(a)pyrene Concentration
4.6 (50-32-8) � ❑ ��iiiiaaaa
Mass
EPA Form 3510-2C(Revised 3-19) Page 15

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence
(check one) Effluent Intake
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Present Absent Daily Monthly Daily of Term of
Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) (if available) Value
4.7 3,4-benzofluoranthene Concentration
(205-99-2) Mass
4.8 Benzo(ghi)perylene 0 Concentration
(191-24-2) Mass
4.9 Benzo(k)fluoranthene 0 0 Concentration
(207-08-9) Mass
4.10 Bis(2-chloroethoxy)methane 0 0/ Concentration
(111-91-1) t�l Mass
4.11 Bis(2 chloroethyl)ether ,�/ Concentration
(111444) El 0
tea Mass
4.12 Bis(2-chloroisopropyl)ether � 0 Concentration
(102-80-1) Mass
4.13 Bis(2-ethylhexyl)phthalate 0/ Concentration
El El
(117-81-7) Mass
4.14 4-bromophenyl phenyl ether El Concentration
El(101-55-3) Mass
4.15 Butyl benzyl phthalate El ElLta Concentration
(85-68-7) Mass
4.16 2-chloronaphthalene 0 ❑ s Concentration
(91-58-7) Mass
4-chlorophenyl phenyl ether Concentration
4.17 CI 0
(7005-72-3) Mass
Chrysene Concentration
4.18 (218-01-9) Mass
4.19 Dibenzo(a,h)anthracene Concentration •
0 El
(53-70-3) ua Mass
EPA Form 3510-2C(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05119
OMB No.2040-0004
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1 •
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed Maximum Maximum Long-
q (specify) Daily Monthly Average Number Term Number
Present Absent
D(regisch(required) (if ava labs) Di ValueAn lyses Averagearge Discharge Value Analyses
(if available)
4.20 1,2-dichlorobenzene ofConcentration
(95-50-1) Mass
4.21 1,3-dichlorobenzene ofConcentration
(541-73-1) Mass
4.22 1,4-dichlorobenzene Concentration
(106 46-7) Mass
4.23 3,3-dichlorobenzidine Concentration
(91-94-1) Mass
4.24 Diethyl phthalate 2( Concentration
(84-66-2) Mass
4.25 Dimethyl phthalate Concentration
(131-11-3) Mass
4.26 Di-n-butyl phthalate 0/ Concentration
(84-74-2) Mass
4.27 2,4-dinitrotoluene 0/ Concentration
0 CI
(121-14-2) Mass
4.28 2,6-dinitrotoluene 13/ Concentration
(606-20-2) L�� Mass
4 29 Di-n-octyl phthalate � Concentration
(117-84-0) Mass
4.30 1,2-Diphenylhydrazine El Elry Concentration
(as azobenzene)(122-66-7) Mass
4.31 Fluoranthene izr Concentration
(206-44-0) Mass
4.32 Fluorene ❑ ❑ Concentration
(86-73-7) Mass
EPA Form 3510-2C(Revised 3-19) Page 17

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
OMB No.2040-0004
TABLE B.TOXIC METALS, CYANIDE,TOTAL PHENOLS AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))'
Presence or Absence Intake
(check one) Effluent (optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed (specify) Maximum Maximum Average Number Long- Number
Daily Monthly Term
Present Absent Daily of of
Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) Value
(if available)
4.33 Hexachlorobenzene 2/ Concentration
0 El
(118-74-1) Mass
4 Hexachlorobutadiene d Concentration
(87-68-3) Mass
4.35 Hexachlorocyclopentadiene Eld Concentration
El
(77-47-4) l�l Mass
4.36 Hexachloroethane Concentration
0 El
(67-72-1) Mass
Indeno(1,2,3-cd)pyrene Concentration
4.37 (193-39-5) Mass
4.38 Isophorone ❑ Concentration
(78-59-1) Mass
4.39 Naphthalene Ex Concentration
El D
(91-20-3) Mass
4.40 Nitrobenzene if" Concentration
El I=1
(98-95-3) Mass
4.41 N-nitrosodimethylamine d Concentration
(62-75-9) Mass
4.42 N-nitrosodi-n-propylamine El2( Concentration
(621-64-7) Mass
4.43 N-nitrosodiphenylamine El El , ,u( Concentration
(86-30-6) Mass
Phenanthrene ui Concentration
4.44 El 0
(85-01-8) Mass
Pyrene Concentration
•
4.45 El 0
(129-00-0) Mass
•
EPA Form 3510-2C(Revised 3-19) Page 18 •

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

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

EPA Identification Number NPDES Permit Number acility Name Outfall Number Form Approved 03/05/19
`On 4/G 30 2. K /t� e. J .P OMB No.2040-0004
N
TABLE B.TOXIC METALS,CYANIDE,TOTAL PHENOLS,AND ORGANIC TOXIC POLLUTANTS(40 CFR 122.21(g)(7)(v))1
Presence or Absence Intake
(check one) Effluent
(optional)
Pollutant/Parameter Testing Units Long-Term
(and CAS Number,if available) Required Believed Believed Maximum Maximum Long-
q (specify) Daily Monthly Average Number Term Number
Present Absent
Discharge Discharge DischargeDofof
Analyses Average Analyses
(required) (if available) (if available) Value y
Toxaphene Concentration
5.25 (8001-35-2) ❑ ❑
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 21

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EPA Identification Number NPDES Permit Number F.cility Name Outfall Number Form Approved 03/05/19
}C (JO y4, L T6-' t 11 c .r OP 1 OMB No.2040-0004
TABLE C. CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(4G CFR 122.21(g)(7)(vi))1
Presence or Absence
(check one) Effluent Intake
(Optional)
Pollutant Units Maximum Long-Term
Believed Believed (specify) Maximum Daily Long-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
(required) Discharge Discharge Analyses Analyses
(if available) (if available) Value
❑ Check here if you believe all pollutants on Table C to be present in your discharge from the noted outfall.You need not complete the"Presence or Absence"column of Table C for
each pollutant.
❑
Check here if you believe all pollutants on Table C to be absent in your discharge from the noted outfall.You need not complete the"Presence or Absence"column of Table C for
each pollutant.
1 Bromide ❑ Q, Concentration
(24959-67-9) Mass
2 Chlorine,total 0 Concentration ug/L 43 21 15 23
El
residual Mass
3. Color 0 ❑/ Concentration
Mass
Concentration
4. Fecal coliform ElMass
5 Fluoride Ey Concentration
(16984-48-8) 0 Mass
6 Nitrate nitrite El
Concentration
Mass
Nitrogen,total Concentration
7' organic(as N) ❑ Mass
8. Oil and grease 11Concentration
Mass
9 Phosphorus(as 0 i Concentration
P),total(7723-14-0) Mass
10. Sulfate(as SO4) ❑ di Concentration
(14808-79-8) Mass
Concentration
11. Sulfide(as S) 0
Mass
EPA Form 3510-2C(Revised 3-19) Page 23

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
5` cs T OMB No.2040-0004
TABLE C. CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi),
Presence or Absence Intake
(check one) Effluent (Optional)
Pollutant Units Maximum Long-Term
Believed Believed (specify) Maximum DailyLong-Term
Present Absent Discharge Monthly Average Daily Number of Average Number of
(required) Discharge Discharge Analyses Value Analyses
(if available) (if available)
12. Sulfite(as SO3) El
ra Concentration
(14265-45-3) Mass
13. Surfactants CJ Concentration
Mass
LiZ
Aluminum,total Concentration ug/L 690 345 4 _
14. (7429-90-5) Mass
15. Barium,total o Concentration
(7440-39-3) Mass
16. Boron,total ❑ L�12/ Concentration
(7440-42-8) Mass
1 Cobalt,total aConcentration
(7440-48-4) Mass
18 Iron,total 1 Concentration
(7439-89-6) Mass
19 Magnesium,total ❑ Ly Concentration
(7439-95-4) Mass
Molybdenum, Concentration
20. total 0 Mass
(7439-98-7) _
Manganese,total al Concentration ug/L 180 73 4
21. (7439-96-5) Mass
ED
Tin,total Concentration
22. (7440-31-5)
Mass
23 Titanium,total L, Concentration
(7440-32-6) Mass
EPA Form 3510-2C(Revised 3-19) Page 24 -

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

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h

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
), ccZ.)4/6'5ez: ` 17a ) Cilrif
OMB No.2040-0004
TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent
1. Asbestos ❑ 2
2. Acetaldehyde ❑ [v'
3. Allyl alcohol ❑ [Y
4. Allyl chloride ❑ g
5. Amyl acetate ❑ g
6. Aniline ❑ [t"
7. Benzonitrile ❑ 1Z
8. Benzyl chloride ❑ 0/
9. Butyl acetate ❑ 12/
10. Butylamine ❑ Et/
11. Captan ❑ 12
12. Carbaryl ❑ 12/
13. Carbofuran 0 [2'
14. Carbon disulfide 0 [Z"
15. Chlorpyrifos 0 [,d
16. Coumaphos ❑ [/
17. Cresol 0 Eli
18. Crotonaldehyde 0 F2/
19. Cyclohexane 0 [2Ij
EPA Form 3510-2C(Revised 3-19) Page 27

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
Nil,Co y,3c L r ,1 , j )%IP OMB No.2040-0004
Gk;._ct �� G �n W
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(g)(7)(vii)►1
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent
20. 2,4-D(2,4-dichlorophenoxyacetic acid) ❑ Q'
21. Diazinon ❑ [2f"
22. Dicamba ❑ El
23. Dichlobenil ❑ Lid"
24. Dichlone ❑ Ud
25. 2,2-dichloropropionic acid ❑ El
26. Dichlorvos ❑ 1:04
27. Diethyl amine ❑ Er.
28. Dimethyl amine ❑ l2"
29. Dintrobenzene El
30. Diquat 0 I:2
31. Disulfoton ❑ E17
32. Diuron ❑ Li
33. Epichlorohydrin ❑ Et
34. Ethion ❑
35. Ethylene diamine ❑
36. Ethylene dibromide ❑ II
37. Formaldehyde ❑
38. Furfural ❑ [r ,
EPA Form 3510-2C(Revised 3-19) Page 28

EPA Identification Number NPDES Permit Number acili Nam Outfall Number Form Approved 03/05/19 '.'
1Jc CO 4, 3e 2- 4,„, w D d0AAPAL CJ7P OMB No.2040-0004 0
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))r
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge
(specify units)
Present Absent
39. Guthion ❑ 0
40. Isoprene ❑ [r
41. Isopropanolamine ❑ Et
42. Kelthane ❑ [
43. Kepone ❑ 12/
44. Malathion ❑ Li/
45. Mercaptodimethur ❑ 1=2'
46. Methoxychlor ❑ Elf
47. Methyl mercaptan 0 Et/
48. Methyl methacrylate ❑ Q/
49. Methyl parathion ❑ O
50. Mevinphos ❑ Et/
51. Mexacarbate El [
52. Monoethyl amine ❑ 12/
53. Monomethyl amine ❑ V
54. Naled ❑ [a/
55. Naphthenic acid ❑ [/
56. Nitrotoluene ❑ [I
57. Parathion Ely IT/
EPA Form 3510-2C(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
Ti" ( OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES ANC ASBESTOS(40 CFR 122.21(g)(7)(vii)►'
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge (specify units)
Present Absent ,
58. Phenolsulfonate ❑ 12/
59. Phosgene ❑ [_,, /
60. Propargite ❑ E31
61. Propylene oxide D a
62. Pyrethrins El [2(
63. Quinoline El d
64. Resorcinol El 1:2/
/
65. Strontium El lid
66. Strychnine ❑ El
67. Styrene ❑ C2(
68. 2,4,5-T(2,4,5-trichlorophenoxyacetic El a
acid) /
69. TDE(tetrachlorodiphenyl ethane) El Lid"
70. 2,4,5-TP[2-(2,4,5-trichlorophenoxy) El
propanoic acid]
71. Trichlorofon El DI
72. Triethanolamine El 12
73. Triethylamine 0 Ell
74. Trimethylamine 0 L/
75. Uranium ❑ Ml
76. Vanadium ❑ a .
EPA Form 3510-2C(Revised 3-19) Page 30

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
�— OMB No.2040-0004
��4�y63�Z �,.n /g >�1 gip, I
TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Available Quantitative Data
Believed Believed Reason Pollutant Believed Present in Discharge
specify units)
Present Absent
77. Vinyl acetate ❑
78. Xylene ❑ [vr
79. Xylenol ❑ [�.
80. Zirconium ❑
1 Sampling shall be conducted according to sufficiently sensitive test procedures(i.e., methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0. See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 31

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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19 �'
nlL Dv y�50 Tvi, d n/IG r OMB No.2040-0004
TABLE E.2,3,7,8 TETRACHLORODIBENZO P DIOXIN(2,3,7,8 TCDD)(40 CFR 122.21(g)(7)(viii))
TCDD Presence or
Congeners Absence
Pollutant Used or (check one) Results of Screening Procedure
Manufactured Believed Believed
Present Absent
2,3,7,8-TCDD ❑
EPA Form 3510-2C(Revised 3-19) Page 33