WQ0033816_Application_20221102

ROY COOPER
Governor
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Director
M-B Industries, Inc.
Attn: Edwin Morrow, President
PO Box 1118
Rosman, NC 28772-1118
Subject: Permit Renewal
Application No. NC0000311
M-B Industries WWTP
Transylvania County
NORTH CAROLINA
Environmental Quality
May 02, 2022
Dear Applicant:
The Water Quality Permitting Section acknowledges the May 2, 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. 150E-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/perm it-guidance/environmental-appl ication-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.
ec: WQPS Laserfiche File w/application
LD_EQ�
Sincerely
vtg,
Wren Tedford
Administrative Assistant
Water Quality Permitting Section
North Carolina Department of Environmental Quality I Division of Water Resources
Asheville Regional Office 12090 US. Highway 70 I Swannanoa. North Carolina 28778
828.296.4500

11)
April 27, 2022
NCDENR
Division of Water Resources
WQ Permitting Section — NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
M - B INDUSTRIES, INC.
SERVING INDUSTRY SINCE 1894
9205 ROSMAN HWY., P.O. BOX 1118, ROSMAN, NC 28772REGEIVED
MANI 0 2 2022
NCDEQ/DWR/NPDES
PHONE [phone], FAX [phone]
Attn: Douglas Dowden
Subject: NPDES Permit Renewal Application for M-B Industries, Inc.
Permit # NC0000311
Doug,
Please find attached NPDES Permit Renewal Application for M-B Industries, Inc., waiver request, process
flow chart, and description of process for our WWTP. I hope you find this application complete and may
it serve its purpose well.
Best regards,
,
/> t-OL
Edwin Morrow
President
MITCHELL-BISSELL CO. DIVISION SUNBELT SPRING & STAMPING CORP. DIVISION
[phone] [phone]

EPA Identification Number
NCD055167324
NPDES Permit Number
NC0000311
Facility Name
M-B Industries, Inc.
Form Approved 03/05/19
OMB No. 2040-0004
El
Activities Requiring an NPDES Permit ,
kloEPA
U.S. Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
GENERAL INFORMATION
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
treatment works?
If yes. STOP. Do NOT complete
Form 1. Complete Form 2A.
owned
1.1.2
Is the facility a new
treating domestic
If yes, STOP. Do
complete Form
Form 2S.
or existing treatment works
sewage?
p No
NOT is No
1. Complete
1.2
Applicants Required to Submit Form 1
1.2.1
Is the facility a concentrated animal
operation or a concentrated aquatic
production facility?
Yes 4 Complete Form 1
and Form 2B.
feeding
animal
1.2.2
Is the facility an existing manufacturing,
commercial, mining, or silvicultural facility that is
currently discharging process wastewater?
✓ No
✓ Yes 4 Complete Form 1111 No
1 and Form 2C.
1.2.3
Is the facility a new manufacturing, commercial,
mining, or silvicultural facility that has
commenced to discharge?
Yes -4 Complete Form 1
and Form 2D.
not yet
1.2.4
Is the facility a new
commercial, mining,
discharges only
Yes 4 Complete
1
or existing manufacturing,
or silvicultural facility that
nonprocess wastewater?
p No
Form i No
and Form 2E.
1.2.5
Is the facility a new or existing facility
discharge is composed entirely of stormwater
associated with industrial activity
discharge is composed of both stormwater
non-stormwater?
Yes 4 Complete Form 1
and Form 2F
unless exempted by
40 CFR
122.26(b)(14)(x) or
b 15 .
whose
or whose
and
�E�EIVED
MAY 0 2 2022
NCDEQIDWNRINPDES
✓ No
N 2. NAME,
MAILING ADDRESS, AND LOCATION
(40 CFR 122.21(f)(2))
Name, Mailing Address, and Location
2.1
Facility Name
M-B Industries, Inc.
2.2
EPA Identification Number
NCD055167324
2.3
Facility Contact
Name (first and last)
Edwin Morrow
Title
President / Owner
Phone number
[phone]
Email address
[e-mail]
2.4
Facility Mailing Address
Street or P.O. box
PO Box 1118
City or town
Rosman
State
North Carolina
ZIP code
28772
EPA Form 3510-1 (revised 3-19)
Page 1

EPA Identification Number
NCD055167324
NPDES Permit Number
NC0000311
Facility Name
M-B Industries, Inc.
Form Approved 03/05/19
OMB No. 2040-0004
Name, Mailing Address,
and Location Continued
2.5
Facility Location
Street, route number, or other specific identifier
9205 Rosman Hwy
County name
Transylvania
County code (if known)
N 3. SIC
City or town
Rosman
AND NAICS CODES (40 CFR 122.21(f)(3))
State
North Carolina
ZIP code
28772
SIC and NAICS Codes
3.1
SIC Code(s)
Description (optional)
3469
3.2
NAICS Code(s)
Description (optional)
332119
N 4. OPERATOR
INFORMATION (40 CFR
122.21(f)(4))
Operator Information
4.1
Name of Operator
Conrad Stafford
4.2
Is the name you listed in Item 4.1 also the owner?
❑ Yes ✓ No
4.3
Operator Status
❑ Public —federal ❑ Public —state ❑ Other public (specify)
1 Private • Other (specify)
4.4
Phone Number of Operator
[phone]
Operator Information
Continued
4.5
Operator Address
Street or P.O. Box
PO Box 634
City or town
Rosman
State
NC
ZIP code
28772
Email address of operator
[e-mail]
N 5. INDIAN
5.1
LAND (40 CFR 122.21(f)(5))
Is the facility located on Indian Land?
❑ Yes ✓ No
c
J
EPA Form 3510-1 (revised 3-19)
Page 2

EPA Identification Number
NCD055167324
NPDES Permit Number
NC0000311
racwryivame
M-B Industries, Inc.
Form Approved 03/05/19
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)
• NPDES (discharges to surface
water)
RCRA (hazardous wastes)
❑ UIC (underground injection of
fluids)
❑� PSD (air emissions)
❑ Nonattainment program (CAA)
❑ NESHAPs (CAA)
O Ocean dumping (MPRSA)
0 Dredge or fill (CWA Section 404)
❑ Other (specify)
SECTION 7. MAP (40 CFR 122.21(f)(7))
7.1
c.
Have you attached a topographic map containing all required information to this application? (See instructions for
specific requirements.)
❑✓ Yes 0 No 0 CAFO—Not Applicable (See requirements in Form 2B.)
SECTION 8. NATURE OF BUSINESS (40 CFR 122.21(f)(8))
8.1
Nature of Business
Describe the nature of your business.
Metal Stampings, wire forms, and assemblies of such. Clear and Yellow Zinc plating, Hard Chrome plating, Matte Tin
plating, Burnishing, and Black Oxide finishing.
SECTION 9. COOLING WATER INTAKE STRUCTURES (40 CFR 122.21(f)(9))
9.1
Does your facility use cooling water?
❑✓ Yes 0 No 4 SKIP to Item 10.1.
9.2
Identify the source of cooling water. (Note that facilities that use a cooling water intake structure as described at
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.)
Cooling water is pumped from Ground water.
SECTION 10. VARIANCE REQUESTS (40 CFR 122.21(f)(10))
10.1
Variance Requests
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.)
❑ Fundamentally different factors (CWA ❑ Water quality related effluent limitations (CWA Section
Section 301(n)) 302(b)(2))
❑ Non -conventional pollutants (CWA ❑ Thermal discharges (CWA Section 316(a))
Section 301(c) and (g))
❑✓ Not applicable
EPA Form 3510-1 (revised 3-19)
Page 3

EPA Identification Number
NCD055167324
NPDES Permit Number
NC0000311
Facility Name
M-B Industries, Inc.
Form Approved 03/05/19
OMB No. 2040-0004
SECTION 11. CHECKLIST AND
CERTIFICATION STATEMENT (40
CFR 122.22(a) and (d))
you have completed and are submitting with your application.
that you are enclosing to alert the permitting authority. Note
Checklist and Certification Statement
11.1
In Column 1 below, mark the sections of Form 1 that
For each section, specify in Column 2 any attachments
that not all applicants are required to provide attachments.
Column 1
Column 2
1: Activities Requiring an NPDES Permit
✓ Section
• w/ attachments
2: Name, Mailing Address, and Location
❑ w/ attachments
1 Section
3: SIC Codes
❑ w/ attachments
1 Section
4: Operator Information
❑ w/ attachments
1 Section
5: Indian Land
IS Section
• w/ attachments
6: Existing Environmental Permits
❑ w/ attachments
1 Section
7: Map
❑ w/ additional attachments
1 Section
✓ map pographic
8: Nature of Business
❑ w/ attachments
1 Section
9: Cooling Water Intake Structures
❑ w/ attachments
1 Section
10: Variance Requests
❑ w/ attachments
1 Section
11: Checklist and Certification Statement
1 Section
■ w/ attachments
11.2
Certification Statement
I certify under penalty of law that this document and all attachments were prepared under my direction or supervision
in accordance with a system designed to assure that qualified personnel properly gather and evaluate the
information submitted. Based on my inquiry of the person or persons who manage the system, or those persons
directly responsible for gathering the information, the information submitted is, to the best of my knowledge and
belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including the possibility of fine and imprisonment for knowing violations.
Name (print or type first and last name)
Edwin Morrow
Official title
President / Owner
Signature j
»
.y//d / w y a ����
vvll G/c.7/
Date signed
04/27/2022
EPA Form 3510-1 (revised 3-19)
Page 4

i (w n
LEGEND:
DO Property Boundary
t 4\•+`j
V C191
n 1 A
NOTES:
U.S. Geological Survey Topographic Map -
Rosman Quadrangle 1945 (Revised 1990)
Eastatoe Gap Quadrangle 1946 (Revised 1969)
Publish Date: 2021/12/06, 12:28 PM I User: cpatterson
Fitepath: Q:\Jobs\MB_Industries_1486\Maps\2021\Figurel SiteLocationMap.mxd
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2,000
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.ANCHOR
QEA
Anchor QEA of North Carolina, PLLC
Figure 1
Site Location Map
2021 Groundwater Monitoring Report
M-B Industries, Inc.

EPA Identification Number
NCD05516324
NPDES Permit Number
NC0000311
Form
2C
NPDES
g,EPA
Facility Name
M-B Industries, Inc.
Form Approved 03/05/19
OMB No. 2040-0004
U.S Environmental Protection Agency
Application for NPDES Permit to Discharge Wastewater
EXISTING MANUFACTURING, COMMERCIAL, MINING, AND SILVICULTURE OPERATIONS
SECTION 1. OUTFALL LOCATION (40 CFR 122.21(g)(1))
1.1
Outfall Location
Provide information on each of the facilit 's outfalls in the table below
Outfall
Number
001
002
Receiving Water Name
West Fork French Broad
003
West Fork French Broad
West Fork French Broad
Latitude
82° 50' 56" N
82° 50' 56" N
82° 50' 56" N
Longitude
35° 8' 21"
W
35° 8' 21" W
35°
8'
21" W
SECTION 2. LINE DRAWING (40 CFR 122.21(g)(2))
tn
d .5
J A
2.1 Have you attached a line drawing to this application that shows the water flow through your facility with a water
balance? (See instructions for drawing requirements. See Exhibit 2C-1 at end of instructions for example.)
❑✓ Yes ❑ No
SECTION 3. AVERAGE FLOWS AND TREATMENT (40 CFR 122.21(g)(3))
Average Flows and Treatment
3.1 For each outfall identified under Item 1.1, provide average flow and treatment information. Add additional sheets if
necessary.
**Outfall Number** 001
Operations Contributing to Flow
Operation
Effluent results form Burnishing, Chrome Plating, Zinc
Plating, Tin Plating, and Black Oxide Finishing
Average Flow
017 mgd
mgd
mgd
mgd
Treatment Units
Description
(include size, flow rate through each treatment unit,
retention time, etc.
See Attachments A
EPA Form 3510-2C (Revised 3-19)
Code from
Table 2C•1
1G, 1U, 11,
1V, 2D, 4A
5M, 5R
Final Disposal of Solid or
Liquid Wastes Other Than
b Discharge
Page 1

EPA Identification Number
NCD05516324
NPDES Permit Number
NC0000311
Facility Name
M-B Industries, Inc.
Form Approved 03/05/19
OMB No. 2040-0004
Average Flows and Treatment Continued
3.1
cont.
**Outfall Number** 002
Operations Contributing
to Flow
Operation
Average Flow
Non Contact Cooling Water
.0003 mgd
mgd
mgd
mgd
Treatment
Units
Description
(include size, flow rate through each treatment unit,
retention time, etc.)
Code from
Table 2C-1
Final Disposal of Solid or
Liquid Wastes Other Than
by Discharge
No Treatment
4A
**Outfall Number**
Operations Contributing
to Flow
Operation
Average Flow
Ground Water Remediation
.04 mgd
mgd
mgd
mgd
Treatment
Units
Description
(include size, flow rate through each treatment unit,
retention time, etc.)
Code from
Table 2C•1
Final Disposal of Solid or
Liquid Wastes Other Than
by Discharge
Water pumped from ground and processed through
10,, 4A
air stripper and discharge to West Fork of French Broad
System
Users
3.2
Are
■
you applying for an NPDES permit to operate a privately owned
Yes
0
treatment works?
No -+ SKIP to Section 4.
3.3
Have
■
you attached a list that identifies each user of the treatment
Yes
GI
works?
No
EPA Form 3510-2C (Revised 3-19)
Page 2

EPA Identification Number
NCD05516324
NPDES Permit Number
NC0000311
Facility Name
M-B Industries, Inc.
Form Approved 03/05/19
OMB No. 2040-0004
SECTION 4. INTERMITTENT FLOWS
(40 CFR 122.21(g)(4))
4.1
Except for storm runoff, leaks, or spills, are any discharges described
❑ Yes
✓
in Sections 1 and 3 intermittent or seasonal?
No 4 SKIP to Section 5.
4.2
Provide information on intermittent or seasonal flows for each
applicable
outfall. Attach additional pages, if necessary.
Frequency
Flow
Rate
Outfall
Number
Operation
(list)
Average
DayslWeek
Average
Months/Year
Long -Term
Average
Maximum
Daily
Duration
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
c
m
days/week
months/year
mgd
mgd
days
€
a>
days/week
months/year
mgd
mgd
days
c
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
days/week
months/year
mgd
mgd
days
SECTION
5. PRODUCTION
(t40
CFR 122.21(g)(5))
5.1
Do any effluent limitation guidelines
❑ Yes
(ELGs) promulgated by EPA
✓
under Section
No 4
304 of the CWA apply to your facility?
SKIP to Section 6.
5.2
Provide the following information on applicable ELGs.
w
ELG Category
ELG Subcategory
Regulatory Citation
N
ca
0
`a
Q
a
Production -Based Limitations
5.3
Are any of the applicable ELGs expressed in terms of production
❑ Yes
✓
(or other measure of operation)?
No 4 SKIP to Section 6.
5.4
Provide an actual measure of daily production expressed in terms and units of applicable ELGs.
Outfall
Number
Operation, Product, or Material
Quantity per Day
Unit of
Measure
EPA Form 3510-2C (Revised 3-19)
Page 3

EPA Identification Number
NCD05516324
NPDES Permit Number
NC0000311
Facility Name
M-B Industries, Inc.
Form Approved 03/05/19
OMB No. 2040-0004
SECTION 6. IMPROVEMENTS
(40 CFR 122.21(g)(6))
or local authority
equipment or practices
to meet an implementation
or any other environmental
schedule for constructing,
programs that could
6.3.
1
o
a
E
c
m
w
N
v
E
0)
n.
6.1
Are you presently required by any federal, state,
upgrading, or operating wastewater treatment
affect the discharges described in this application?
❑ Yes
✓ No 4 SKIP to Item
6.2
Briefly identify each applicable project in the table below.
Brief Identification and Description of
Project
Affected
Outfalls
(list outfall
number)
Source(s) of
Discharge
Final Compliance Dates
Required
Projected
6.3
Have you attached
that may affect
❑ Yes
sheets describing any additional
your discharges) that you now
water pollution control programs (or other environmental projects
have underway or planned? (optional item)
No ❑ Not applicable
✓
SECTION
7. EFFLUENT
See the
complete.
AND INTAKE CHARACTERISTICS (40 CFR 122.21(g)(7))
instructions to determine the pollutants and parameters you are required to monitor and, in turn, the tables you must
Not all applicants need to complete each table.
0
N
°3
ca
03
t,
Y
c
C
0
w
w
Table A. Conventional and Non -Conventional Pollutants
7.1
Are you requesting
your outfalls?
a waiver from your NPDES permitting authority
IN
for one or more of
the Table A pollutants for any of
7.3.
II Yes
No 4 SKIP to Item
7.2
If yes, indicate
Outfall
the applicable outfalls below.
Number 001
Attach waiver request
Outfall Number
and other required
002
information to the application.
Outfall Number
003
7.3
Have you completed monitoring for all Table A pollutants at
requested and attached the results to this application package?
❑ Yes
each of your outfalls for which
No; has been
a waiver has not been
requested from my NPDES
for all pollutants at all outfalls.
151
a waiver
permitting authority
Table B.
Toxic Metals, Cyanide, Total Phenols, and Organic Toxic Pollutants
7.4
Do any of the
listed in Exhibit
facility's processes that contribute wastewater
2C-3? (See end of instructions for exhibit.)
fall into one or more of the
primary industry categories
7.8.
NI Yes
II No 4 SKIP to Item
7.5
Have you checked
"Testing Required" for all toxic metals,
cyanide, and total phenols in
Section 1 of Table B?
12 Yes
InNo
7.6
List the applicable primary industry categories and check the boxes indicating the required GC/MS fraction(s) identified
in Exhibit 2C-3.
PrimaryRequired
Industry Category
GC/MS Fraction(s)
(Check applicable boxes.)
Copper & Steel Manufacturing
❑ Volatile 0 Acid 0 Base/Neutral 0 Pesticide
0 Volatile 0 Acid 0 Base/Neutral 0 Pesticide
0 Volatile ❑ Acid 0 Base/Neutral 0 Pesticide
EPA Form 3510-2C (Revised 3-19)
Page 4

EPA Identification Number
NCD05516324
NPDES Permit Number
NC0000311
Facility Name
M-B Industries, Inc.
Form Approved 03/05/19
OMB No. 2040-0004
m
cp
Effluent and Intake Characteristics Continued
0
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?
12 Yes IN 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?
0 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 0 No
7.10
Does the applicant qualify for a small business exemption under the criteria specified in the instructions?
4 Note the top Table B,
0 Yes
that you qualify at of
then SKIP to Item 7.12.
II No
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 0 No
Table C. Certain Conventional and Non -Conventional Pollutants
7.12
Have you indicated whether pollutants are `Believed Present" or "Believed Absent" for all pollutants listed on Table C
for all outfalls?
✓ Yes ❑ No
7.13
Have you completed Table C by providing (1) quantitative data for those pollutants that are limited either directly or
indirectly in an ELG and/or (2) quantitative data or an explanation for those pollutants for which you have indicated
"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?
✓ 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. IS No 4 SKIP to Section 8.
7.17
Have you completed Table E by reporting qualitative data for TCDD?
❑ Yes ✓ No
8. USED
OR MANUFACTURED TOXICS (40 CFR 122.21(g)(9))
Used or Manufactured
Toxics
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?
❑ No 4 SKIP to Section 9.
p Yes
8.2
List the pollutants below.
1. Zinc 4. 7.
2. 5. 8.
3. 6. 9.
EPA Form 3510-2C (Revised 3-19)
Page 5

EPA Identification Number
NCD05516324
NPDES Permit Number
NC0000311
Facility Name
M-B Industries, Inc.
Form Approved 03/05/19
OMB No. 2040-0004
SECTION 9. BIOLOGICAL TOXICITY
TESTS (40 CFR 122.21(g)(11))
u,
N
9.1
Do you have any knowledge or reason to believe that any biological
within the last three years on (1) any of your discharges or (2)
❑ Yes
on
0
test for acute or chronic toxicity has been made
a receiving water in relation to your discharge?
No 4 SKIP to Section 10.
1-
9.2
Identify the tests and their
purposes below.
X
Test(s)
Purpose of Test(s)
Submitted to NPDE3
Permitting Authority.
Date Submitted
0
1—
To
U
0)
❑ Yes ❑ No
O
0
•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
❑ Yes
a
✓
contract laboratory or consulting firm?
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
y,
c
Q
...
0
12
c
Laboratory address
c0i
Phone number
Pollutant(s) analyzed
SECTION
11. ADDITIONAL
INFORMATION
(40 CFR 122.21(g)(13))
_
0
11.1
Has the NPDES permitting authority requested additional information?
❑ Yes
✓
No -.) SKIP to Section 12.
E
`o
R
11.2
List the information requested and attach it to this application.
1. 4.
c
0
-0
2. 5.
3. 6.
EPA Form 3510-2C (Revised 3-19)
Page 6

EPA Identification Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
Form Approved U3/Ub119
OMB No. 2040-0004
SECTION 12. CHECKLIST AND
CERTIFICATION STATEMENT
(40 CFR 122.22(a) and (d))
2C that you have completed and are submitting with your application.
attachments that you are enclosing to alert the permitting authority. Note
all sections or provide attachments.
Checklist and Certification Statement
12.1
In Column 1 below, mark the sections of Form
For each section, specify in Column 2 any
that not all applicants are required to complete
Column 1
Column 2
1: Outfall Location
❑ w/ attachments
✓ Section
2: Line Drawing
w/ line drawing ❑ w/ additional attachments
1 Section
✓
Section
3: Average Flows and
w/ attachments
w/ list of each user of
El
IS
• privately owned treatment
Treatment
works
4: Intermittent Flows
❑ w/ attachments
✓ Section
5: Production
❑ wi attachments
✓ Section
6: Improvements
w/ optional additional
❑ w/ attachments ❑ sheets describing any
additional pollution control
plans
1 Section
Section
7: Effluent and Intake
❑ w/ request for a waiver and ❑ w/ explanation for identical
supporting information ouffalls
w/ small business exemption w/ other attachments
❑ request ❑
❑ w/ Table A ❑ w/ Table B
❑ w/ Table C ❑ w/ Table D
❑ w/ Table E ❑ w/ analytical results as an
attachment
✓
Characteristics
Section
8: Used or Manufactured
w/ attachments
✓
•
Toxics
Section
9: Biological Toxicity
❑ w/ attachments
✓
Tests
10: Contract Analyses
❑ w/ attachments
✓ Section
11: Additional Information
❑ w/ attachments
✓ Section
Section
12: Checklist and
Statement
❑ w/ attachments
1
Certification
12.2
Certification Statement
1 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)
Edwin Morrow
Official title
President / Owner
Signature
,�
7a4.^,fr/(e44,
Date signed
04/27/2022
EPA Form 3510-2C (Revised 3-19)
Page 7

EPA Identification Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
0utfall Number
001, 002, & 003
Form Approved 03/05/19
OMB No. 2040-0004
TABLE A. CONVENTIONAL AND NON CONVENTIONAL
POLLUTANTS (40 CFR
122.21(g)(7)(iii))1
Effluent
Intake
(Optional)
Pollutant
Waiver
Requested
(if applicable)
Units
(specify)
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average Daily
Discharge
(if available)
Number of
Analyses
Long -Term
Average Value
Number of
Analyses
1A
Check here if you have applied to your NPDES permitting authority for a waiver for all of the pollutants listed on this table for the noted outfall.
1
Biochemical oxygen demand
(BODs)
❑
Concentration
Mass
2.
Chemical oxygen demand
(COD)
Concentration
IIIMass
3.
Total organic carbon (TOC)
Concentration
■
Mass
4.
Total suspended solids (TSS)
0
Concentration
Mass
5.
Ammonia (as N)
Concentration
■
Mass
6.
Flow
Rate
■
7.
Temperature (winter)
°C
°C
■
Temperature (summer)
°C
°C
■
8.
pH (minimum)
0
Standard units
s.u.
pH (maximum)
0
Standard units
s.u.
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 Fomi 3510-2C (Revised 3-19)
Page 9

EPA Identification Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
Outfall Number
001, 002, & 003
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS,
AND
ORGANIC TOXIC
or Absence
one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
PollutanUParameter
(and CAS Number, iravailable)
Testing
Required
Presence
(check
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(4 available)
Number
of
Analyses
Long -
Term
Average
Value
Number
of
Analyses
Check here if you qualify as a small business per the instructions to Form 2C and, therefore, do not need to submit quantitative da a 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
(7440-36-0)
0
Concentration
Mass
1.2
Arsenic, total
(7440-38-2)
Concentration
Mass
1 3
Beryllium, total
(7440-41-7)
0
Concentration
Mass
1.4
Cadmium, total
(7440-43-9)
0
Concentration
Mass
1.5
Chromium, total
(7440-47-3)
Concentration
Mass
1.6
Copper, total
(7440-50-8)
Concentration
Mass
1 7
Lead, total
(7439-92-1)
Concentration
II
III
0
Mass
1.8
Mercury, total
(7439-97-6)
Concentration
Mass
1.9
Nickel, total
(7440-02-0)
Concentration
Mass
1.10
Selenium, total
(7782-49-2)
0
Q
Concentration
Mass
1.11
Silver, total
(7440-22-4)
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 11

EPA Identification Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
0utfall Number
001, 002, & 003
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS.
AND ORGANIC TOXIC
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))t
Effluent
Intake
(optional)
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
Presence or Absence
(check one)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long -
Term
Average
Value
Number
of
Analyses
1.12
Thallium, total
(7440-28-0)
Concentration
Mass
1.13
Zinc, total
(7440-66-6)
Concentration
Mass
1 14
Cyanide, total
(57-12-5)
Concentration
•
Mass
1.15
Phenols, total
•
✓❑
Concentration
I
Mass
Section 2. Organic Toxic Pollutants (GC/MS Fraction —Volatile Compounds)
2.1
Acrolein
(107-02-8)
Concentration
Mass
2.2
Acrylonitrile
(107-13-1)
Concentration
Mass
2.3
Benzene
(71-43-2)
Concentration
Mass
2.4
Bromoform
(75-25-2)
0
0
❑✓
Concentration
Mass
2.5
Carbon tetrachloride
(56-23-5)
Concentration
Mass
2.6
Chlorobenzene
(108-90-7)
Concentration
III
III
51
Mass
2.7
Chlorodibromomethane
(124-48-1)
Concentration
IS
III
151
Mass
2.8
Chloroethane
(75-00-3)
ElMass
El
Concentration
III
EPA Form 3510-2C (Revised 3-19)
Page 12

EPA Identification Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
Outtall Number
001, 002, & 003
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS,
AND ORGANIC TOXIC
POLLUTANTS (40 CFR
Units
(specify)
122.21(9)(7)(v)),
Effluent
Intake
(optional)
Pollutant1Parameter
(and CAS Number, if available)
Testing
Required
Presence or Absence
(check one)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
AverageValue
Number
of
Analyses
2.9
2-chloroethylvinyl ether
(110-75-8)
Concentration
Mass
2.10
Chloroform (67-66-3)
❑
Concentration
■
0
Mass
2.11
Dichlorobromomethane
(75-27-4)
Concentration
Mass
2.12
1,1-dichloroethane
(75-34-3)
Concentration
MI
II
II
Mass
2.13
1,2-dichloroethane
(107-06-2)
❑
Concentration
II
Mass
2.14
1,1-dichloroethylene
(75-35-4)
Concentration
Mass
2.15
1 2-dichloropropane
(78-87-5)
0
0
❑
Concentration
Mass
2.16
13-dichloropropylene
(542-75-6)
Concentration
Mass
2.17
Ethylbenzene
(100-41-4)
❑
Concentration
ig
Mass
218
Methyl bromide
Concentration
•
II(74-83-9)
0
Mass
219
Methyl chloride
(74-87-3)
El
0
❑
Concentration
Mass
2.20
Methylene chloride
(75-09-2)
MIConcentration
II
NI
Mass
2.21
1,1,2 2- tetrachloroethane
(79-34-5)
0
0
❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 13

EPA Identification Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
Outfall Number
001, 002, & 003
Form Approved 03/05/19
OMB No. 2040-0004
TABLE
B. TOXIC METALS, CYANIDE,
PollutantiParameter
(and
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
122.21(9)(7)(v)),
Effluent
In ake
(optional)
Believed
Present
Believed
Absent
Units
(specify)
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
or available)
Number
of
Analyses
Long -
Term
Average
Value
of
Analyses
2 22
Tetrachloroethylene
(127-18-4)
II
■
12
Concentration
Mass
2.23
Toluene
(108-88.3)
■
■
■
Concentration
Mass
2 24
1 2-trans-dichloroethylene
(156-60-5)
IN
■
0
Concentration
Mass
225
11,1-trichloroethane
(71-55-6)
■
■
Concentration
Mass
2 26
1 1,2-trichloroethane
(79-00.5)
•■
■
Eil
Concentration
Mass
2•27
Trichloroethylene
(79-01-6)
■
■
12
Concentration
Mass
2 28
Vinyl chloride
(75-01-4)
•
■
Concentration
Mass
Section 3. Organic Toxic Pollutants (GCIMS Fraction —Acid Compounds)
31
2-chlorophenol
(95-57-8)
■
•
Concentration
Mass
3.2
2 4-dichlorophenol
(120-83-2)
•
•
12
Concentration
Mass
3.3
2 4-dimethylphenol
(105-67-9)
■
■
51
Concentration
Mass
3.4
4 6-dinitro-o-cresol
(534-52-1)
■
■
■
Concentration
Mass
3.5
2 4-dinitrophenol
(51-28-5)
0
■
Concentration
Mass
EPA Foem 3510-2C (Revised 3-19)
Page 14

EPA Identification Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
OutfaII Number
001, 002, & 003
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS, AND
ORGANIC TOXIC
or Absence
one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v)),
Effluent
Intake
(optonap
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
Presence
(check
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(f available)
Number
of
Analyses
-
Long -
Lon
Term
Average
Value
Number
of
Analyses
3.6
2-nitrophenol
(88-75-5)
El
0
Concentration
Mass
3.7
4-nitrophenol
(100-02-7)
Concentration
Mass
3 8
p-chloro-m-cresol
(59-50-7)
Concentration
Mass
3 9
Pentachlorophenol
(87-86-5)
Concentration
Mass
3.10
Phenol
(108-95-2)
El
0
Concentration
NI
Mass
311
24,6-trichlorophenol
(88-05-2)
E]
El
0
Concentration
Mass
Section 4. Organic Toxic Pollutants (GC/MS Fraction —Base /Neutral Compounds)
4.1
Acenaphthene
(83-32-9)
El
Concentration
IN
GI
Mass
4.2
Acenaphthylene
(208-96-8)
Concentration
Mass
4.3
Anthracene
(120-12-7)
Concentration
Mass
4.4
Benzidine
(92-87-5)
Concentration
Mass
4.5
Benzo (a) anthracene
(56-55-3)
Concentration
0
Mass
4.6
Benzo (a) pyrene
(50-32-8)
El
El
El
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 15

EPA Identification Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
Dutrall Number
001, 002, & 003
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS,
AND
Presence
(check
Believed
Present
ORGANIC TOXIC
or Absence
one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(opfional)
PollutanUParameter
(and CAS Number, if available)
Testing
Required
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long•Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
4 7
•
3 4-benzofluoranthene
(205-99-2)
El
Concentration
•
17
Mass
4.8
Benzo (ghi) perylene
(191-24-2)
Concentration
■
■
Ig
Mass
4 9
Benzo (k) fluoranthene
(207-08-9)
Concentration
■
■
GI
Mass
4.10
Bis (2-chloroethoxy) methane
(111-91-1)
Concentration
■
Mass
4.11
Bis (2-chloroethyl) ether
(111-44-4)
Concentration
MI
■
51
Mass
4.12
Bis (2-chloroisopropyl) ether
(102-80-1)
Concentration
Mass
4.13
Bis (2-ethylhexyl) phthalate
(117-81-7)
El
Concentration
II
■
Mass
4.14
4-bromophenyl phenyl ether
(101-55-3)
Concentration
IN
IIMass
51
4.15
Butyl benzyl phthalate
(85-68-7)
Concentration
■
Mass
4.16
2-chloronaphthalene
(91-58-7)
Concentration
■
■
Mass
4.17
4-chlorophenyl phenyl ether
(7005-72-3)
Concentration
■
■
12
Mass
4.18
Chrysene
(218-01-9)
El
0
Concentration
■
Mass
4.19
Dibenzo (a,h)anthracene
(53-70-3)
0
IIIConcentration
GI
Mass
EPA Form 3510-2C (Revised 3-19)
Page 16

EPA Identification Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
Outfall Number
001, 002, & 003
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS.
AND ORGANIC TOXIC
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v)),
Effluent
Intake
(optional)
Pollutant/Parameter
(and CAS Number, if available)
Testing
Required
q
Presence or Absence
(check one)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if available)
Number
of
Analyses
Long-
Term
Average
Value
Number
of
Analyses
4.20
12-dichlorobenzene
(95-50-1)
1
El
Concentration
MI
Mass
4.21
1 3-dichlorobenzene
(541-73-1)
Concentration
•
II
III
Mass
422
1,4-dichlorobenzene
(106-46-7)
El
Ei
Concentration
GI
Mass
4.23
3 3-dichlorobenzidine
(91-94-1)
III
Concentration
0
Mass
4.24
Diethyl phthalate
(84-66-2)
Concentration
Mass
4.25
Dimethyl phthalate
(131-11-3)
Concentration
0
Mass
4.26
Di-n-butyl phthalate
(84-74-2)
0
Concentration
Mass
4 27
2,4-dinitrotoluene
(121-14-2)
Concentration
Mass
2 6-dinitrotoluene
Concentration
Mass
4 29
Di-n-octyl phthalate
(117-84-0)
❑
Concentration
•0
Mass
4.30
1,2-Diphenylhydrazine
(as azobenzene) (122-66-7)
0
Concentration
Mass
4.31
Fluoranthene
(206-44-0)
Concentration
Mass
4.32
Fluorene
(86-73-7)
Concentration
Mass
EPA Form 3510.2C (Revised 3-19)
Page 17

EPA identification Number
NCD05516324
NPDES Pemmt Number
NC000031
Facility Name
M-B Industries, Inc.
Outfall Number
001, 002, & 003
Form Approved 03105/19
OMB No. 2940-0004
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS,
AND ORGANIC TOXIC
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Pollutant1Parameter
(and CAS Number, if available)
Testing
Required
Presence or Absence
(check one)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(if availab e)
Number
of
Analyses
Long -
Term
Average
Value
Number
of
Analyses
4.33
Hexachlorobenzene
(118-74-1)
0
Concentration
Mass
4
Hexachiorobutadiene
(87-68-3)
�
.
IN
Concentration
Mass
4.35
Hexachlorocyclopentadiene
(77-47-4)
Concentration
Mass
4.36
Hexachloroethane
(67-72-1)
Concentration
Mass
4.37
Indeno (1,2,3-cd) pyrene
(193-39-5)
Concentration
Mass
4 38
Isophorone
(78-59-1)
n
Concentration
Mass
4.39
Naphthalene
(91-20-3)
Concentration
Mass
4.40
Nitrobenzene
(98-95-3)
Concentration
Mass
4.41
N-nitrosodimethylamine
(62-75-9)
Concentration
n
Mass
4.42
N-nitrosodi-n-propylamine
(621-64-7)
Concentration
Mass
4.43
N-nitrosodiphenylamine
(86-30-6)
0
Concentration
Mass
4
Phenanthrene
(85-01-8)
Concentration
Mass
4.45
Pyrene
(129-00-0)
0
u
GI
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 18

EPA Identification Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-8 Industries, Inc.
Duffel) Number
001, 002, & 003
Form Approved 03105119
OMB No. 2040-0004
TABLE
B. TOXIC METALS. CYANIDE,
Pollutant/Parameter
(and
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
122.21(g)(7)(v))1
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Units
(svh)
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
pf available)
Number
of
Analyses
Long -
Term
Average
Value
Number
of
Analyses
4'46
1,2,4-trichlorobenzene
(120-82-1)
Concentration
Mass
Section 5. Organic Toxic Pollutants (GC/MS Fraction —Pesticides)
51
Aldrin
III(309-00-2)
❑
12
Concentration
Mass
5.2
a-BHC
(319 84-6)
❑
❑
0
Concentration
Mass
5.3
j3-BHC
(319-85-7)
Concentration
Mass
5.4
y-BHC
(58-89-9)
Concentration
Mass
5.5
0-BHC
(319-86-8)
III
❑
Concentration
Mass
5.6
Chlordane
(57-74-9)
•
❑
MI
Concentration
Mass
5 7
4,4'-DDT
(50-29-3)
•
❑
❑
Concentration
Mass
5.8
4,4'-DDE
(72-55-9)
III
Concentration
Mass
5 9
4,4'-DDD
(72-54-8)
❑•
GI
Concentration
Mass
5.10
Dieldnn
(60-57-1)
El
Concentration
Mass
5.11
a-endosulfan
(115-29-7)
El
❑
❑
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 19

EPA Identification Number
NC005516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
Outfall Number
001, 002, & 003
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE,
Pollutant/Parameter
(and CAS Number, if available)
TOTAL PHENOLS,
Testing
Required
AND ORGANIC TOXIC
Presence or Absence
(check one)
POLLUTANTS (40 CFR
Units
(specify)
122.21(g)(7)(v)),
Effluent
Intake
(optional)
Believed
Present
Believed
Absent
Maximum
Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average
Daily
Discharge
(d available)
Number
of
Analyses
Term
Average
Value
Number
of
Analyses
5.12
)3-endosulfan
(115-29-7)
III
Concentration
III
II
Mass
5.13
Endosulfan sulfate
(1031-07-8)
Concentration
0
Mass
5.14
Endrin
(72-20-8)
❑
❑
Concentration
•
Mass
5.15
Endrin aldehyde
(7421-93-4)
Concentration
Mass
5.16
Heptachlor
(76-44-8)
Concentration
Mass
5.17
Heptachlor epoxide
(1024-57-3)
Concentration
•
•
0
Mass
5.18
PCB-1242
(53469-21-9)
Concentration
II
•
IS
Mass
5.19
PCB-1254
(11097-69-1)
0
Concentration
•
•
Mass
5.20
PCB-1221
(11104-28-2)
0
Concentration
111
•
Mass
5.21
PCB-1232
(11141-16-5)
Concentration
•
•
0
Mass
5.22
PCB-1248
(12672-29-6)
El
0
ElMass
Concentration
5.23
PCB-1260
(11096-82-5)
El
❑
0
Concentration
Mass
5.24
PCB-1016
(12674-11-2)
El
0
E
Concentration
Mass
EPA Form 3510-2C (Revised 3-19)
Page 20

EPA Iden0ficabon Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
Outfall Number
001, 002, & 003
Form Approved 03/05/19
OMB No. 2040-0004
TABLE B. TOXIC METALS, CYANIDE, TOTAL PHENOLS,
AND
ORGANIC TOXIC
or Absence
one)
POLLUTANTS (40 CFR
Units
(speary)
122.21(g)(7)(0'
Effluent
Intake
(optional)
Pollutant/Parameter
(and CAS Number, if available)
(and
Testing
Required
q
Presence
(check
Believed
Present
Believed
Absent
Maximum
Daily
Drequ'ued)e
Maximum
Monthly
Of avalable)
Long -Tenn
Average
aily
Diharge sharge
[rf available)
Number
of
Analyses
Long -
Term
Average
Number
of
Analyses
Toxaphene
5.25 (8001-35-2)
Concentration
li
II
Ei
Mass
1 Sampling shall be conducted according to sufficiently sensitive test procedures (Le., 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 Fom13510-2C (Revised 3-19)
Page 21

EPA Identification Number
NCD05516324
TABLE C. CERTAIN CONVENTIONAL
NPDES Permit
NC000031
AND NON CONVENTIONAL
Number Facility
M-B
POLLUTANTS
Units
(specify)
Name
Industries, Inc.
(40 CFR 122.21(g)(7)(vi))'
Outfall Number
001, 002, & 003
Effluent
Form Approved 03/05/19
OMB No, 2040-0004
Intake
(Optional)
Pollutant
Presence or Absence
(check one)
Believed
Present
Believed
Absent
Maximum Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Tenn
Average Daily
Discharge
(if available)
Number of
Analyses
Long -Term
Average
Value
Number of
Analyses
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
(24959-67-9)
❑
❑
Concentration
Mass
2
Chlorine, total
residual
Concentration
Mass
3.
Color
Concentration
Mass
4.
Fecal coliform
Concentration
■
■
Mass
5
Fluoride
(16984-48-8)
❑
❑
Concentration
Mass
6
Nitrate -nitrite
Concentration
■
■
Mass
7.
Nitrogen, total
organic (as N)
❑
Concentration
Mass
8.
Oil and grease
Concentration
Mass
9.
Phosphorus (as
P), total (7723-14-0)
Concentration
Mass
10.Sulfate
(as SOa)
(14808-79-8)
0
0
Concentration
Mass
11.
Sulfide (as S)
❑
Concentration
•
Mass
EPA Form 3510-2C (Revised 3 19)
Page 23

EPA Identification Number
NCD05516324
TABLE C. CERTAIN CONVENTIONAL
NPDES Permit
NC000031
AND NON CONVENTIONAL
Number
POLLUTANTS
Facility
M-B
Name
Industries, Inc.
(40 CFR 122.21(g)(7)(vi))'
Outfall Number
001, 002, & 003
Effluent
Form Approved 03/05/19
OMB No. 2040-0004
Intake
(Optional)
Pollutant
Presence or Absence
(check one)
Units
(specify)
Believed
Present
Believed
Absent
Maximum Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average Daily
Discharge
(if available)
Number of
Analyses
Long•Term
Average
Value
Number of
Analyses
12'
Sulfite (as S03)
(14265-45-3)
Concentration
•
■
Mass
13.
Surfactants
Concentration
■
■
Mass
14.Aluminum,
total
(7429-90-5)
Concentration
•
•
Mass
15.Barium,
total
(7440-39-3)
Concentration
•
•
Mass
16.Boron,
total
(7440-42-9)
El
0
Concentration
Mass
17
Cobalt, total
(7440-48-4)
0
0
Concentration
Mass
18
Iron total
(7439-89 6)
Concentration
•
•
Mass
19
Magnesium, totalIIIill
(7439-95-4)
Concentration
Mass
20.
Molybdenum,
total
(7439-98-7)
•
•
Concentration
Mass
21.Manganese,
total
(7439-96-5)
Concentration
•
•
Mass
22 •
Tin, total
(7440-31-5)
El
E3
Concentration
Mass
23.Titanium,
total
(7440-32-6)
Concentration
•
•
Mass
EPA Form 3510-2C (Revised 3-19)
Page 24

EPA Identification Number
NCD05516324
TABLE C. CERTAIN CONVENTIONAL
NPDES Permit Number
NC000031
AND NON CONVENTIONAL POLLUTANTS
Facility
M-B
Name
Industries, Inc.
(40 CFR 122.21(g)(7)(vi))'
0uaall Number
001, 002, & 003
Effluent
Form Approved 03/05/19
OMB No. 2040-0004
Intake
(optional)
Pollutant
Presence or Absence
(check one)
Units
(specify)
Believed
Present
Believed
Absent
Maximum Daily
Discharge
(required)
Maximum
Monthly
Discharge
(if available)
Long -Term
Average Daily
Discharge
(if available)
Number of
Analyses
Long -Term
Average
Value
Number
Analyses
24.
Radioactivity
Alpha, total
Concentration
•
II
Mass
Beta, total
❑
Concentration
■
Mass
Radium, total
Concentration
■
■
Mass
Radium 226, total
Concentration
•
•
Mass
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

EPA Identification Number
NPDES Permit Number
Facility Name
Ouffall Number
Form Approved 03/05/19
OMB No. 2040-0004
W NUDD1b9Gµ NC000031
TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS
NI,
(40 CFR 12221(g)(7)(vii))'
Absence
one)
muuSurcS, ui,. V uu,
Reason Pollutant Believed Present in Discharge
Available Quantitative Data
(specify units)
Pollutant
Presence or
(check
Believed
Present
Believed
Absent
1.
Asbestos
■
ea
2.
Acetaldehyde
0
0
3.
Ally! alcohol
0
■
4.
Ally! chloride
❑
0
5.
Amyl acetate
■
0
6.
Aniline
■
0
7.
Benzonitrile
■
0
8.
Benzyl chloride
❑
151
9.
Butyl acetate
0
0
10.
Butylamine
■
IS
11.
Captan
■
12
12.
Carbaryl
0
0
13.
Carbofuran
0
0
14.
Carbon disulfide
■
O
15.
Chlorpyrifos
■
SI
16.
Coumaphos
❑
GI
17.
Cresol
0
0
18.
Crotonaldehyde
❑
0
19.
Cyclohexane
❑
51
EPA Form 3510-2C (Revised 3-19)
Page 27

EPA Identification Number
NCD05516324
TABLE D. CERTAIN HAZARDOUS
NPDES Permit Number
NC000031
SUBSTANCES AND ASBESTOS (40
M-B
CFR 12221(g)(7)(vii))'
Facility Name
Industries, Inc.
Reason Pollutant
Uuttan Number
001, 002, & 003
Believed Present in Discharge
rorni,vPPIuveu Wmoi In
OMB No. 2040-0004
Available Quantitative Data
(specify units)
Pollutant
Presence or Absence
(cbeckone)
Believed
Present
Believed
Absent
20.
2,4-D (2,4-dichlorophenoxyacetic acid)
■
51
21.
Diazinon
■
GI
22.
Dicamba
■
GI
23.
Dichlobenil
❑
51
24.
Dichlone
❑
GI
25.
2,2-dichloropropionic acid
■
51
26.
Dichlorvos
■
51
27.
Diethyl amine
■
51
28.
Dimethyl amine
■
O
29.
Dintrobenzene
■
GI
30.
Diquat
■
0
31.
Disulfoton
❑
51
32.
Diuron
❑
o
33.
Epichlorohydrin
❑
0
34.
Ethion
El
■
35.
Ethylene diamine
0
51
36.
Ethylene dibromide
❑
❑�
37.
Formaldehyde
❑
0
38.
Furfural
❑
0
EPA Form 3510-2C (Revised 3-19)
Page 28

EPA Identification Number
NPDES Permit Number
Facility Name
Duffel! Number
Form Approved 03/05/19
OMB No. 2040-0004
IVIUUJ3103LY iv,vvvv.++
TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS
eve—v
(40 CFR 12221(g)(7)(vii))'
Absence
one)
..uumu l , elm.. -----i -------
Reason Pollutant Believed Present in Discharge
Available Quantitative Data
(specify units)
Pollutant
Presence or
(check
Believed
Present
Believed
Absent
39.
Guthion
■
0
40.
Isoprene
❑❑
41.
Isopropanolamine
❑
❑✓
42. Kelthane
■
(51
43.
Kepone
❑
12
44.
Malathion
❑
O
45.
Mercaptodimethur
■
GI
46.
Methoxychlor
■
12
47.
Methyl mercaptan
El
0
48.
Methyl methacrylate
❑
0
49.
Methyl parathion
El
GI
50.
Mevinphos
❑
0
51.
Mexacarbate
❑
GI
52.
Monoethyl amine
■
GI
53.
Monomethyl amine
El
■
54.
Naled
❑
0
55.
Naphthenic acid
❑
✓❑
56.
Nitrotoluene
❑
O
57.
Parathion
■
IS
EPA Form 3510-2C (Revised 3-19)
Page 29

EPA Identification Number
NPDES Permit Number
Facility Name
Outfall Number
Form Approved 03/05/19
OMB No. 2040-0004
ril-111 ]LOOL4 IY\.VUVVJl
TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS
(40 CFR 122.21(g)(7)(vii))1
Absence
one)
.,,+, —
Reason Pollutant Believed Present In Discharge
Available Quantitative Data
(specify units)
Pollutant
Presence or
(check
Believed
Present
Believed
Absent
58.
Phenolsulfonate
■
GI
59.
Phosgene
❑
151
60.
Propargite
❑
0
61.
Propylene oxide
❑
r❑
62.
Pyrethrins
■
GI
63. Quinoline
■
Eil
64. Resorcinol
0
■
65.
Strontium
0
GI
66.
Strychnine
■
GI
67.
Styrene
0
■
68
2,4,5-T (2,4,5-trichlorophenoxyacetic
acid)
•
IS
69.
TDE (tetrachlorodiphenyl ethane)
0
0
70
2,4,5-TP [2-(2,4,5•trichlorophenoxy)
propanoic acid]
❑
71.
Trichlorofon
❑✓
■
72.
Triethanolamine
■
Ei
73.
Triethylamine
0
0
74.
Trimethylamine
0
0
75.
Uranium
El
■
76.
Vanadium
❑✓
■
EPA Form 3510-2C (Revised 3-19)
Page 30

•
EPA Identification Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
TABLE D. CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS (40 CFR 122.21(g)(7)(vii))'
Pollutant
Presence or Absence
(check one)
Believed
Present
Believed
Absent
77
78.
79
Vinyl acetate
Xylene
Xylenol
El
El
0
80. Zirconium ❑ ❑r
Outfall Number
001, 002, & 003
Reason Pollutant Believed Present in Discharge
Form Approved 03/05/19
OMB No 2040-0004
Available quantitative Data
(specify units)
' Sampling shall be conducted according to sufficiently sensitive tes 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 Forn 3510-2C (Revised 3-19) Page 31

•
EPA Identification Number
NCD05516324
NPDES Permit Number
NC000031
Facility Name
M-B Industries, Inc.
TABLE E. 2,3,7,8 TETRACHLORODIBENZO P DIOXIN (2,3.7,8 TCDD) (40 CFR 122.21(g)(7)(viii))
Pollutant
2,3,7,8-TCDD
EPA Form 3510-2C (Revised 3-19)
TCDD
Congeners
Used or
Manufactured
El
Presence or
Absence
(check one)
Believed Believed
Present Absent
Outfall Number
001, 002,& 003
Results of Screening Procedure
Form Approved 03/05/19
OMB No. 2040-0004
Page 33

M - B INDUSTRIES, INC.
SERVING INDUSTRY SINCE 1894
9205 ROSMAN HWY, P.O. BOX 1118, ROSMAN, NC 28772
PHONE [phone], FAX [phone]
April 27, 2022
NCDENR
Division of Water Resources
WQ Permitting Section — NPDES
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Request Waiver to EPA Application Form 2C Item Table A Item 7.1
Ladies and Gents,
Please accept our request for the following waiver pertaining to EPA Application Form 2C Item Table A
Item 7.1.
1) Outfall 001— Waiver all of the pollutants in Table A
2) Outfall 002 — Waiver all of the pollutants in Table A
3) Outfall 003 — Waiver all of the pollutants in Table A
Please find attached our March 15, 2022 Analytical Results from Pace Laboratories.
Your consideration in this matter is greatly appreciated.
King regards,
Zr..;CCti.. /71(44,-1----d
Edwin Morrow
President
MITCHELL-BISSELL CO. DIVISION SUNBELT SPRING & STAMPING CORP. DIVISION
[phone] [phone]

Attachment A
M-B Industries, Inc Wastewater Treatment Plant Process
Water from the lift station is pumped into a collection tank and into a 3 tier cascading treatment system.
See attachment B for treatment tank sizes and dimensions. The first treatment tank is where a coagulant
is added for precipitation and flocculation and an acid and base are added for Ph controls. Treatment
tanks 2 and 3 is where a polymer is added to aid in coagulation and flocculation. From this point water
is fed into a clarifier where solids are seperated and fed into a 630 gallon sludge holding tank where the
solids are pumped into a 4 cubic feet filter press forming a cake of sludge which is dropped into a 4
cubic feet sludge dryer for de -watering. The dried sludge is put into 55 gallon drums and shipped off
the property. Two 55 gallon drums(400 lbs each) of solids a month are disposed of in this manner. The
treated water from the clarifier is sent to a 700 gallon final settling tank and a sand filter system before
reaching the final treatment tank 4 (360 gallons) where Ph controls are added along with a foam down
system to knock out foam. From treatment tank 4 water is fed into a 60 degree notch weir and onto the
receiving stream. The flow rate is 50 gpm.

Ground Water
Treatment
M-B Industries, Inc. Waste Stream Flow Chart
NPDES Permit # NC0000311
Water Supply
Well
Cooling Water
Chrome
Plating
Vibratory
Finishing
Zinc Plating
WWTP
Tin Plating
Black Oxide
Finishing
Outfall 003 (40,000 gd)
Outfall 001
West Fork of the French Broad River
Outfall 002 (300gd)