NC0088897_Renewal (Application)_20230710

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ROY COOPER 2
Governor p . , `t
ELIZABETH S.BISER ""�n
Secretary a`
RICHARD E.ROGERS,JR. NORTH CAROLINA
Director Environmental Quality
July 10, 2023
City of King
Attn: Benjamin S. Marion, Engineer Intern
PO Box 1132
King, NC 27021
Subject: Permit Renewal
Application No. NC0088897
King WTP
Forsyth County
Dear Applicant:
The Water Quality Permitting Section acknowledges the July 10, 2023, 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.
SincerelyXIWALWC111(46
Wren Thedford
Administrative Assistant
Water Quality Permitting Section
ec: WQPS Laserfiche File w/application
Q^�Up North Carolina Department of Environmental Quality I Division of Water Resources
—J/ Winston-Salem Regional Office 1450 West Hanes Miii Road Suite 300 I Winston-Salem,North Carolina 27105
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��'� 336.776.9800

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United States Office of Water EPA Form 3510-1
Environmental Protection Agency Washington,D.C. Revised March 2019
Water Permits Division
EPA Application Form 1
General Information
NPDES Permitting Program
3RS-C;
NSIC)
0- 10
Note: All applicants to the National Pollutant Discharge Elimination System (NPDES)permits
program, with the exception of publicly owned treatment works and other treatment works treating
domestic sewage, must complete Form 1. Additionally, all applicants must complete one or more of the
following forms: 2B, 2C, 2D, 2E, or 2F. To determine the specific forms you must complete, consult the
"General Instructions" for this form.

•
Paperwork Reduction Act Notice
The U.S. Environmental Protection Agency estimates the average burden to collect information
and complete Form 1 to be 2.9 hours for new applicants and 0.9 hours for applicants renewing
existing permits. This estimate includes time to review instructions, search existing data sources,
gather and maintain the needed data, and complete and review the collection of information.
New respondents must also prepare a topographic map. Send comments about the burden
estimate or any other aspect of this collection of information to the Chief, Information Policy
Branch(PM-223), U.S. Environmental Protection Agency, 1200 Pennsylvania Avenue,NW,
Washington,DC 20460,and to the Office of Information and Regulatory Affairs, Office of
Management and Budget, 725 17th Street,NW, Washington, DC 20503, marked"Attention:
Desk Officer for EPA."

DESCRIPTION OF NPDES PERMIT APPLICATION FORMS CONTENTS OF FORM 1 PACKAGE
The application forms for individual National Pollutant Discharge Form 1—General Instructions
Elimination System(NPDES)permits include the following: Form 1—Line-by-Line Instructions
Form 1—General Information(included in this package). Form 1—Activities That Do Not Require Permits
Form 2—Forms Based on Facility or Activity Type(not included Form 1—Glossary
in this package): Form 1—Application
2A. New and Existing Publicly Owned Treatment Works
2B. Concentrated Animal Feeding Operations and
Concentrated Aquatic Animal Production Facilities
2C. Existing Manufacturing, Commercial,Mining,and
Silvicultural Operations
2D. New Manufacturing,Commercial, Mining,and Silvicultural
Operations That Have Not Yet Commenced Discharge of
Process Wastewater
2E. Manufacturing,Commercial,Mining,and Silvicultural
Facilities Which Discharge Only Nonprocess Wastewater
2F. Stormwater Discharges Associated with Industrial Activity
2S. New and Existing Treatment Works Treating Domestic
Sewage
FORM 1—GENERAL INSTRUCTIONS
Who Must Apply for an NPDES Permit? Upon your request,and based on information supplied by you,
With the exceptions described in"Form 1—Activities That Do Not EPA or the authorized NPDES state will determine whether you
Require Permits,"the federal Clean Water Act(33 U.S.C. 1251 et are required to obtain a permit for a particular facility or activity.
seq.)prohibits any person from discharging pollutants into waters Be sure to contact EPA or your state if you have a question.
of the United States without first having been issued a permit Form 1 collects general information only.You must also complete
under the NPDES program. a more detailed application based on your proposed discharge
Who Must Complete Form 1? activity,as follows:
• If your facility is a concentrated animal feeding operation
All applicants,other than publicly owned treatment works or a concentrated aquatic animal production facility,you
(POTWs)and treatment works treating domestic sewage must also complete Form 2B.
(TWTDS),must submit Form 1. If you operate one of the
following facilities,you must submit Form 1:concentrated animal • If your facility is an existing manufacturing,commercial,
feeding operations and aquatic animal production facilities; mining,or silvicultural facility that currently discharges
manufacturing,commercial,mining,and silvicultural operations; process wastewater,you must also complete Form 2C.
or other industrial facilities. • If your facility is a new manufacturing,commercial,mining,
At the state level,either the U.S. Environmental Protection or silvicultural facility that has yet to commence discharge of
Agency(EPA)or an approved state agency administers the process wastewater,you must also complete Form 2D.
NPDES permit program. If you are located in a jurisdiction in • If your facility is a new or existing facility(including
which an EPA regional office administers the NPDES permit manufacturing,commercial,mining,and silvicultural
program,you should use Form 1 and all other applicable forms facilities)that discharges only nonprocess wastewater,
described in these instructions. If you are located in a jurisdiction you must also complete Form 2E.
where a state administers the NPDES permit program,contact • If your facility is a new or existing facility whose discharge
the state to determine the forms you should complete.States is composed entirely of stormwater associated with industrial
often develop their own application forms rather than use the activity—excluding discharges from construction activity
federal forms.See http://www.epa.qov/npdes/npdes-state- under 122.26(b)(14)(x)or(b)(15)—you must also complete
program-information for a list of states that have approved Form 2F.If the discharge is composed of stormwater and
NPDES permit programs and those that do not. non-stormwater,you must complete Form 2F and you must
Exhibit 1-1 (see end of this section)provides contact information also complete Forms 2C,2D,and/or 2E,as appropriate.See
for each of EPA's 10 regional offices.Since the exhibit's content is Form 2F's instructions for further details.
subject to change,consult EPA's website for the latest information:
http://www.epa.gov/aboutepa#regional.
1-1

FORM 1—GENERAL INSTRUCTIONS CONTINUED
Where to File Your Completed Form Completion of Forms
• If you are in a jurisdiction with an approved state NPDES Print or type in the specified areas only.If you do not have enough
permit program,file according to the instructions on the state space on the form to answer a question,you may continue on
forms. additional sheets,as necessary, using a format consistent with the
• If you are in a jurisdiction where EPA is the NPDES form.
permitting authority(i.e.,the state is not an NPDES- The NPDES permitting authority could consider your application
authorized state),mail the completed application forms to the incomplete if you do not provide an answer(or indicate"NA"for
EPA regional office that covers the state in which your facility "not applicable")for all questions on Form 1 and the applicable
is located(see Exhibit 1-1). Form 2.
When to File Your Completed Form Provide your EPA Identification Number from the Facility Registry
Because of statutory and regulatory requirements,the deadlines Service, NPDES permit number,and facility name at the top of
for filing applications vary according to your facility or activity type each page of Form 1 and any attachments. If your facility is new
and the type of permit you need.The various permit application (i.e.,not yet constructed),write or type"New Facility"in the space
deadlines are listed in Exhibit 1-2 at the end of this section. provided for the EPA Identification Number and NPDES number.
If you do not know your EPA Identification Number,contact your
Fees NPDES permitting authority.See Exhibit 1-1 for contact
EPA does not require applicants to pay a fee for applying for information.
NPDES permits.However,states that administer the NPDES Do not leave any response areas blank unless the form directs
permit program may charge fees.Consult with state officials for you to skip them. If the form directs you to respond to an item that
further information. does not apply to your facility or activity,enter"NA"for"not
Public Availability of Submitted Information applicable"to show that you considered the item and determined
a response was not necessary for your facility.
EPA will make information from NPDES permit application forms
available to the public for inspection and copying upon request. The NPDES permitting authority will consider your application
You may not claim any information on Form 1 (or related complete when it and any supplementary material are received
attachments)as confidential. and completed according to the authority's satisfaction.The
NPDES permitting authority will judge the completeness of any
You may make a claim of confidentiality for any information that application independently of the status of any other permit
you submit to EPA that goes beyond the information required by application or permit for the same facility or activity.
Form 1. If you do not assert a claim of confidentiality at the time
you submit your information to the NPDES permitting authority,
EPA may make the information available to the public without
further notice to you.EPA will handle claims of confidentiality in
accordance with the Agency's business confidentiality regulations
at Part 2 of Title 4 of the Code of Federal Regulations(CFR).
1-2

FORM 1—GENERAL INSTRUCTIONS CONTINUED
Exhibit 1-1.Addresses of EPA Regional Contacts and Covered States
REGION 1 REGION 6
U.S.Environmental Protection Agency,Region 1 U.S.Environmental Protection Agency,Region 6
5 Post Office Square,Suite 100,Boston,MA 02109-3912 1445 Ross Avenue,Suite 1200,Dallas,TX 75202-2733
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Fax:[phone]
Website:http://www.epa.gov/abouteoaieoa-region-1-new-enaland Website:http://www.eoa.gov/abouteoa/epa-region-6-south-central
Covered states:Connecticut,Maine,Massachusetts,New Hampshire,Rhode Covered states:Arkansas,Louisiana,New Mexico,Oklahoma,and Texas
Island,and Vermont
REGION 2 REGION 7
U.S.Environmental Protection Agency,Region 2 U.S.Environmental Protection Agency,Region 7
290 Broadway,New York,NY 10007-1866 11201 Renner Boulevard,Lenexa,KS 66219
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Website:http://www.epa.gov/aboutepa/epa-region-7-midwest
Website:http://www.eoa.gov/aboutepa/eoa-region-2 Covered states:Iowa,Kansas,Missouri,and Nebraska
Covered states:New Jersey,New York,Virgin Islands,and Puerto Rico
REGION 3 REGION 8
U.S.Environmental Protection Agency,Region 3 U.S.Environmental Protection Agency,Region 8
1650 Arch Street,Philadelphia,PA 19103-2029 1595 Wynkoop Street,Denver,CO 80202-1129
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Fax:[phone]
Website:http://www.eoa.gov/aboutepa/eoa-region-3-mid-atlantic Website:http://www.epa.qov/aboutepa/epa-region$-mountains-and-plains
Covered states:Delaware,District of Columbia,Maryland,Pennsylvania,Virginia, Covered states:Colorado,Montana,North Dakota,South Dakota,Utah,and
and West Virginia Wyoming
REGION 4 REGION 9
U.S.Environmental Protection Agency,Region 4 U.S.Environmental Protection Agency,Region 9
Sam Nunn Atlanta Federal Center 75 Hawthorne Street,San Francisco,CA 94105
61 Forsyth Street,SW,Atlanta,GA 30303-8960 Phone:[phone];toll free:(866)EPA-WEST
Phone:[phone];toll free:[phone] Fax:[phone]
Fax:[phone] Website:http://www.epa.qov/abouteoa/eoa-reqion-9-pacific-southwest
Website:http://www.epa.qov/abouteoa/about-epa-region-4-southeast Covered states:Arizona,California,Hawaii,Nevada,Guam,American Samoa,
Covered states:Alabama,Florida,Georgia,Kentucky,Mississippi,North Carolina, and Trust Territories
South Carolina,and Tennessee
REGION 5 REGION 10
U.S.Environmental Protection Agency,Region 5 U.S.Environmental Protection Agency,Region 10
77 West Jackson Boulevard,Chicago,IL 60604-3507 1200 Sixth Avenue,Suite 900,Seattle,WA 98101
Phone:[phone];toll free:[phone] Phone:[phone];toll free:[phone]
Fax:[phone] Fax:[phone]
Website:http://www.epa.gov/aboutepa/epa-region-5 Website:http://www.epa.gov/aboutepa/epa-region-10-pacific-northwest
Covered states:Illinois,Indiana,Michigan,Minnesota,Ohio,and Wisconsin Covered states:Alaska,Idaho,Oregon,and Washington
Exhibit 1-2.Filing Dates for NPDES Permit Applications
Permit Application When to File
180 days before your present NPDES permit expires or,if you are a
2A new discharger,180 days before the date on which the discharge is
to commence unless the NPDES permitting authority has granted
permission for a later date.
2B 180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.
2C 180 days before your present NPDES permit expires.
2D 180 days prior to startup.
2E 180 days before your present NPDES permit expires,or 180 days
prior to startup if you are a new facility.
Construction:90 days prior to date construction is to commence.
2F Nonconstruction:180 days before your present NPDES permit
expires or 180 days prior to startup if you are a new facility.
2S 180 days before your present NPDES permit expires or 180 days
prior to startup if you are a new facility.
1-3

FORM 1—LINE-BY-LINE INSTRUCTIONS
Section 1.Activities Requiring an NPDES Permit You can find SIC code numbers and descriptions in the
Item 1.1.Review the questions in Item 1.1 to determine if you are 1987 Standard Industrial Classification Manual,prepared by the
required to submit Form 1.Be sure to check the Form 1— Executive Office of the President, Office of Management and
Glossary for the legal definitions of any key terms. Budget.This document is available from the Government Printing
Office,Washington,D.C.An online version of the manual is also
If you answer"Yes"to a question in Item 1.1,then you do not available courtesy of the Occupational Safety and Health
need to complete Form 1,but you must comply with the Administration at htto:l/www.osha.00v/plslimis/sic manual.html.
application requirements specified.
You can find NAICS code numbers and descriptions in the North
Item 1.2.Respond to the questions in Items 1.2.1 to 1.2.5. If you American Industrial Classification System Manual prepared by the
answer"Yes"to any question,you must complete Form 1 and the Executive Office of the President,Office of Management and
Form 2 application specified.See Exhibit 1-2 for filing deadlines. Budget.This document is available from the National Technical
If you answer"No"to every question in Items 1.1 and 1.2,then Information Service(NTIS)in Alexandria,Virginia.It is also
you do not need an NPDES permit,and you do not need to available online at http:l/www.census.Qov/eos/www/naics/.
complete and return any of the NPDES application forms. Use the latest edition of the manuals.If you have any questions
Section 2.Name,Mailing Address,and Location about the appropriate SIC or NAICS codes for your facility,
Item 2.1.Enter the facility's official or legal name.Do not use a contact your NPDES permitting authority.
colloquial name. Section 4.Operator Information
Item 2.2.Provide your EPA Identification Number from the Item 4.1.Give the legal name of the person,firm,public
Facility Registry Service if you have an existing facility. If you do organization,or other entity that operates the facility described in
not know your EPA Identification Number,contact your NPDES this application.This may or may not be the same as the facility's
permitting authority.If your facility is new(i.e.,not yet name.The operator of the facility is the legal entity that controls
constructed),write or type"New Facility." the facility's operation rather than the plant or site manager.Do
not use a colloquial name.
Item 2.3.Give the name(first and last),title,work telephone
number,and email address of the person who is thoroughly Item 4.2.Indicate whether the entity listed in response to Item 4.1
familiar with the operation of the facility and with the facts also owns the facility by marking the appropriate box.
reported in this application.The NPDES permitting authority will Item 4.3.Indicate the ownership status of the operator of the
contact the person listed if they have questions on the material facility by marking the appropriate box. If the facility is a federal
submitted. facility(i.e.,owned by the U.S.government),check the box for
Item 2.4.Give the complete mailing address of the office to which "Public—federal."If the facility is owned by a state government,
the NPDES permitting authority should send correspondence. check the box for"Public—state."If the facility is owned by a
This often is not the address used to designate the location of the county government,municipal(e.g.,city or town)government,
facility or activity. tribal government,school district,water district,or other local
government entity,check the box for"Other public"and specify
Item 2.5.Give the address or location of the facility identified the type of government entity.If the facility is owned by a
under Item 2.1.If the facility lacks a street name or route number, corporation or other private entity,check the box for"Private."If
give the most accurate,alternative geographic information(e.g., the facility has mixed ownership(e.g.,public/private)or is not
section number or quarter section number from county records or owned by an entity of the types previously listed,check the box
"at intersection of Routes 425 and 22").Also provide the county for"Other"and specify the type of entity.
name,county code(if known),city or town,state,and zip code.
Items 4.4 to 4.6.Enter the telephone number,address,and email
For concentrated aquatic animal production facilities,provide the address of the operator identified in Item 4.1.
address or location of the production area(i.e.,the location where
the animals are contained,grown,or held). Section 5.Indian Land
Section 3.SIC and NAICS Codes Item 5.1.Indicate whether the facility is located on Indian Land.
Items 3.1 and 3.2.List,in descending order of significance,up to Section 6.Existing Environmental Permits
four 4-digit standard industrial classification(SIC)codes and Item 6.1.Check the appropriate boxes and provide the permit
North American Industrial Classification System(NAICS)codes numbers for all relevant federal,state,and local environmental
that best describe your facility in terms of the principal products or permits or construction approvals received or applied for under
services it produces or provides.If the SIC or NAICS codes do any of the programs listed below. If you have more than one
not adequately describe your facility's products or services,you currently effective permit under a particular permit program for
have the option to provide additional descriptive information. your facility,list the additional permit numbers on the application
form or on a separate sheet of paper.
1-4

FORM 1—LINE-BY-LINE INSTRUCTIONS CONTINUED
• Hazardous waste management program under the Resource (e.g.,residential,commercial).An example of an acceptable
Conservation and Recovery Act(RCRA). location map is shown as Exhibit 1-3 at the end of these
• Underground Injection Control(UIC)program under the Safe instructions.Note:Exhibit 1-3 is provided for illustration only;it
Drinking Water Act(SDWA). does not show an actual facility.
• NPDES program under the Clean Water Act(CWA). If the facility is a concentrated animal feeding operation,you are
• Prevention of Significant Deterioration(PSD)program under not required to provide the topographic map required by this
the Clean Air Act(CAA). section of Form 1. Instead,you are required to provide a
topographic map as specified in Section 4 of Form 2B.
• Nonattainment program under the CM.
Item 7.1.Note that you have completed your topographic map
• National Emission Standards for Hazardous Pollutants and attached it to the application.
(NESHAPs)preconstruction approval under the CAA.
Section 8.Nature of Business
• Ocean dumping permits under the Marine Protection Briefly describe the nature of your business(e.g.,products
Research and Sanctuaries Act(MPRSA). produced or services provided).See Examples 1 and 2.
• Dredge or fill permits under Section 404 of the CWA.
• Other federal,state,or local environmental permits. Example 1
Facilities Subject to 40 CFR 426,Subparts F and G
Section 7.Map Industry A is an auto tempered and auto laminated glass
Unless the facility is a concentrated animal feeding operation, manufacturing facility subject to effluent limitation guidelines
provide a topographic map(s)of the area extending at least one (ELGs)for the"Automotive Glass Tempering"and"Automotive
mile beyond the property boundaries of the facility that clearly Glass Laminating"subcategories of the"Glass Manufacturing"
shows the following: point source category at 40 CFR 426,subparts F and G.At the
• The legal boundaries of the facility. facility,glass is cut and then passed through a series of
processes that grind and polish the edges,bend the glass,and
• The location and serial number of each of your existing and then temper the glass to produce side and back windows for
proposed intake and discharge structures. automobiles.Tempering involves heating the glass near the
• All hazardous waste management,storage,and disposal melting point,then rapidly cooling it to increase its mechanical
facilities. and thermal endurance.The facility also produces automobile
• Each well where you inject fluids underground. windshields and undertakes processes that laminate a plastic
sheet between two layers of glass and that prepare the glass for
• All wells,springs,surface water bodies,and drinking water lamination(e.g.,cutting,bending,and washing).
wells that are in the public record or otherwise known to you
and that are located in the map area. Example 2
Facility Not Subject to ELGs
If the facility has associated water intakes,discharge structures,
hazardous waste disposal sites,or injection wells and these items Industry B undertakes batch-type resin manufacturing operations.
are located more than one mile from the facility,include them on It has aboveground storage tanks for raw materials and finished
the map if possible.If you cannot,attach additional sheets goods,resin loading operations,and warehouses for 55-gallon
describing the location of the structures,disposal site(s),or well(s) drums of finished product. Industry B manufactures alkyd,
and identify the U.S.Geological Survey(USGS)or other map saturated and unsaturated polyester resins in batches using
corresponding to the location(s). reactor vessels and mix tanks.Most of the feedstock liquids are
pumped from storage tanks to the kettles and mixers via a closed
On each map,include the map scale,a meridian arrow showing piping system.Additional feedstocks are added manually as
north,and latitude and longitude to the nearest second.Latitude solids from bags and sacks via manways,which are located on
and longitude coordinates may be obtained in a variety of ways, top of the kettles.The resin is then chemically reacted in the
including use of hand held devices(e.g.,a GPS enabled kettles.After the reaction step finishes,the resin is transferred
smartphone),internet mapping tools(e.g., from the kettles to the mix tanks,where solvents are added to
https://mvnasadata.larc.nasa.gov/latitudelonoitude-finder/), thin it.The primary byproduct of the reaction is water vapor
geographic information systems(e.g.,ArcView),or paper maps containing condensed soluble organics.The byproduct flows to
from trusted sources(e.g.,USGS). an isolation tank where the vapors are directed to an onsite
On all maps of rivers,show the direction of the current. In tidal thermal oxidizer.The finished resin is then pumped through one
waters,show the directions of ebb and flow tides. of three types of filtration systems into finished goods storage
tanks,55-gallon drums,350-gallon intermediate bulk container
You may develop your map by going to USGS's National Map totes,or directly into tanker trucks.A typical batch takes about 30
website at htto://nationalmao.gov/.(For a map from this site,use hours to complete.
the traditional 7.5-minute quadrangle format.If none is available,
use a USGS 15-minute series map.)You may also use a plat or
other appropriate map.Briefly describe land uses in the map area
1-5

FORM 1—LINE-BY-LINE INSTRUCTIONS CONTINUED
Section 9.Cooling Water Intake Structures FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
Item 9.1.Indicate whether the facility uses cooling water. If yes, APPLICATION TO BE SIGNED AS FOLLOWS:
continue to Item 9.2. If no,skip to Item 10.1. A. For a corporation,by a responsible corporate officer.For the
Item 9.2.Identify the source of the cooling water.For example, purpose of this section,a responsible corporate officer
indicate whether the cooling water is from a surface water, means:(1)a president,secretary,treasurer,or vice-president
groundwater well,public water system,or treated effluent that of the corporation in charge of a principal business function,
would otherwise be discharged to a water of the U.S. or any other person who performs similar policy-or decision-
making functions for the corporation,or(2)the manager of
If the facility uses a cooling water intake structure as described in one or more manufacturing,production,or operating facilities,
40 CFR 125,Subparts I and J,the facility may have additional provided the manager is authorized to make management
application requirements under 40 CFR 122.21(r).Note that the decisions which govern the operation of the regulated facility
information required by 40 CFR 122.21(r)is not requested as part including having the explicit or implicit duty of making major
of Form 1.Contact your NPDES permitting authority to determine capital investment recommendations,and initiating and
the specifics of what you should provide and when. directing other comprehensive measures to assure long term
Section 10.Variance Requests environmental compliance with environmental laws and
An applicant(other than a POTW)may request a variance from regulations;the manager can ensure that the necessary
otherwise applicable effluent limitations under certain conditions systems are established or actions taken to gather complete
described at 40 CFR 122.21(m). and accurate information for permit application requirements;
and where authority to sign documents has been assigned or
Item 10.1.If known at the time of application,check all of the delegated to the manager in accordance with corporate
authorized variances that you plan to request or renew.Note that procedures.
you are not being asked to submit any other information at this B. For a partnership or sole proprietorship,by a general partner
time.Contact your NPDES permitting authority to determine the or the proprietor,respectively.
specifics of what you should provide and when.The ability to
request a variance is not limited to the time of application,and an C. For a municipality,state,federal,or other public facility,by
applicant may request a variance consistent with statutory and either a principal executive officer or ranking elected official.
regulatory requirements. For purposes of this section,a principal executive officer of a
federal agency includes:(1)The chief executive officer of the
Section 11.Checklist and Certification agency,or(2)a senior executive officer having responsibility
Item 11.1.Review the checklist provided.In Column 1,mark the for the overall operations of a principal geographic unit of the
sections of Form 1 that you have completed and are submitting agency(e.g.,Regional Administrators of EPA).
with your application. In Column 2,indicate for each section
whether you are submitting attachments.
Item 11.2.The Clean Water Act provides for severe penalties for
submitting false information on this application form.CWA Section
309(c)(2)provides that,"Any person who knowingly makes any
false statement,representation,or certification in any application,
...shall upon conviction,be punished by a fine of no more than
$10,000 or by imprisonment for not more than six months,or
both."
1-6

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1-7 C
1-7

FORM 1—ACTIVITIES THAT DO NOT REQUIRE PERMITS
You are not required to obtain an NPDES permit if your discharge • Any discharge in compliance with the instructions of an On-
is in one of the following categories,as provided by the CWA and Scene Coordinator pursuant to 40 CFR 300(The National Oil
NPDES regulations at 40 CFR 122 to 125.(However,under CWA and Hazardous Substances Pollution Contingency Plan)or
Sections 510 and 312,some discharges exempted from the 33 CFR 153.10(e)(Pollution by Oil and Hazardous
federal NPDES requirements may still be regulated by a state Substances).
permitting authority.) • Any introduction of pollutants from non point-source
• Any discharge of sewage from vessels and any effluent from agricultural and silvicultural activities,including stormwater
properly functioning marine engines,laundry,shower,and runoff from orchards,cultivated crops,pastures,range lands,
galley sink wastes,or any other discharge incidental to the and forest lands,but not discharges from concentrated
normal operation of a vessel,including vessels of the Armed animal feeding operations as defined in 40 CFR 122.23,
Forces within the meaning of section 312 of the CWA and discharges from concentrated aquatic animal production
recreational vessels within the meaning of section 502(25)of facilities as defined in 40 CFR 122.23,discharges from
the CWA. None of these exclusions apply to rubbish,trash, concentrated aquatic animal production facilities as defined
garbage,or other such materials discharged overboard;nor in 40 CFR 122.24,discharges to aquaculture projects as
to other discharges when the vessel is operating in a defined in 40 CFR 122.25,and discharges from silvicultural
capacity other than as a means of transportation such as point sources as defined in 40 CFR 122.27.Note:Per 40
when used as an energy or mining facility,a storage facility CFR 122.26(b)(14)(ii),facilities classified within SIC 24,
or a seafood processing facility,or when secured to a Industry Group 241,that are rock crushing,gravel washing,
storage facility or a seafood processing facility,or when log sorting,or log storage facilities operated in connection
secured to the bed of the ocean,contiguous zone or waters with silvicultural activities defined in 40 CFR 122.27(b)(2)—(3)
of the United States for the purpose of mineral or oil and Industry Groups 242 through 249;26(except 265 and
exploration or development. 267),28(except 283),29,311,32(except 323),33,3441,
Discharges of dredged or fill material into waters of the and 373(not included are all other types of silviculture
• United States that are regulated under CWA Section 404. facilities)are considered stormwater discharges associated
with industrial activity,and are required to obtain an NPDES
• The introduction of sewage,industrial wastes,or other permit.
pollutants into publicly owned treatment works by indirect • Return flows from irrigated agriculture.
dischargers.Plans or agreements to switch to this method of
disposal in the future do not relieve dischargers of the • Discharges into a privately owned treatment works,except as
obligation to have and comply with permits until all the NPDES permitting authority may otherwise require under
discharges of pollutants to waters of the United States are 40 CFR 122.44(m).
eliminated.(See also 40 CFR 122.47(b).)This exclusion • Discharges from a water transfer.'Water transfer"means an
does not apply to the introduction of pollutants to privately activity that conveys or connects waters of the United States
owned treatment works or to other discharges through pipes, without subjecting the transferred water to intervening
sewers,or other conveyances owned by a state,municipality, industrial,municipal,or commercial use.This exclusion does
or other party not leading to treatment works. not apply to pollutants introduced by the water transfer
activity itself to the water being transferred.
1-8

FORM 1—GLOSSARY
Note:This glossary includes terms used in the various NPDES application forms,including Form 1.The definitions are from the NPDES
regulations at 40 CFR 122.2 unless otherwise specified.If you have any questions concerning the meaning of any of these terms,contact
your NPDES permitting authority.
ANIMAL FEEDING OPERATION(defined at§122.23)means a lot or facility(other than an aquatic animal production facility)where the
following conditions are met;
• Animals(other than aquatic animals)have been,are,or will be stabled or confined and fed or maintained for a total of 45 days or
more in any 12-month period;and
• Crops,vegetation,forage growth,or post-harvest residues are not sustained in the normal growing season over any portion of the lot
or facility.
APPLICATION means the EPA standard national forms for applying for a permit,including any additions,revisions,or modifications to the
forms;or forms approved by EPA for use in approved states,including any approved modifications or revisions.
APPROVED PROGRAM or APPROVED STATE means a State or interstate program which has been approved or authorized by EPA
under part 123.
AQUACULTURE PROJECT(defined at§122.25)means a defined managed water area which uses discharges of pollutants into that
designated area for the maintenance or production of harvestable freshwater,estuarine,or marine plants or animals.DESIGNATED
PROJECT AREA means the portions of the waters of the United States within which the permittee or permit applicant plans to confine the
cultivated species,using a method or plan or operation(including,but not limited to,physical confinement)which,on the basis of reliable
scientific evidence,is expected to ensure that specific individual organisms comprising an aquaculture crop will enjoy increased growth
attributable to the discharge of pollutants,and be harvested within a defined geographic area.
AVERAGE MONTHLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar month,
calculated as the sum of all daily discharges measured during that month divided by the number of daily discharges measured during that
month.
AVERAGE WEEKLY DISCHARGE LIMITATION means the highest allowable average of daily discharges over a calendar week,
calculated as the sum of all daily discharges measured during a calendar week divided by the number of daily discharges measured during
that week.
BEST MANAGEMENT PRACTICES(BMPs)means schedules of activities,prohibitions of practices,maintenance procedures,and other
management practices to prevent or reduce the pollution of waters of the United States. BMPs include treatment requirements,operation
procedures,and practices to control plant site runoff,spillage or leaks,sludge or waste disposal,or drainage from raw material storage.
BIOSOLIDS(see sewage sludge).
BYPASS(defined at§122.41(m))means the intentional diversion of waste streams from any portion of a treatment facility.
COMBINED SEWER OVERFLOW(CSO)means a discharge from a combined sewer system(CSS)at a point prior to the Publicly Owned
Treatment Works(POTW)Treatment Plant(defined at§403.3(r)).
COMBINED SEWER SYSTEM(CSS)means a wastewater collection system owned by a State or municipality(as defined by section
502(4)of the CWA)which conveys sanitary wastewaters(domestic,commercial and industrial wastewaters)and storm water through a
single-pipe system to a Publicly Owned Treatment Works(POTW)Treatment Plant(as defined at§403.3(r)).
CONCENTRATED ANIMAL FEEDING OPERATION(defined at§ 122.23)means an animal feeding operation that is defined as a Large
CAFO or as a Medium CAFO by the terms of(A)or(B)below,or that is designated as a CAFO in accordance with 40 CFR 122.23(c).Two
or more AFOs under common ownership are considered to be a single AFO for the purposes of determining the number of animals at an
operation,if they adjoin each other or if they use a common area or system for the disposal of wastes.
A. LARGE CONCENTRATED ANIMAL FEEDING OPERATION(LARGE CAFO)means an AFO that stables or confines as many as or
more than the numbers of animals specified in any of the following categories:
1. 700 mature dairy cows,whether milked or dry;
2. 1,000 veal calves;
3. 1,000 cattle other than mature dairy cows or veal calves.Cattle includes but is not limited to heifers,steers,bulls and cow/calf
pairs;
4. 2,500 swine each weighing 55 pounds or more;
5. 10,000 swine each weighing less than 55 pounds;
1-9

FORM 1—GLOSSARY CONTINUED
6. 500 horses;
7. 10,000 sheep or lambs;
8. 55,000 turkeys;
9. 30,000 laying hens or broilers,if the AFO uses a liquid manure handling system;
10. 125,000 chickens(other than laying hens),if the AFO uses other than a liquid manure handling system;
11. 82,000 laying hens,if the AFO uses other than a liquid manure handling system;
12. 30,000 ducks(if the AFO uses other than a liquid manure handling system);or
13. 5,000 ducks(if the AFO uses a liquid manure handling system).
B. MEDIUM CONCENTRATED ANIMAL FEEDING OPERATION(MEDIUM CAFO)means any AFO with the type and number of
animals that fall within any of the ranges listed below and which has been defined or designated as a CAFO.An AFO is defined as a
Medium CAFO if:
1. The type and number of animals that it stables and confines falls within any of the following ranges:
a. 200 to 699 mature dairy cows,whether milked or dry;
b. 300 to 999 veal calves;
c. 300 to 999 cattle other than mature dairy cows or veal calves. Cattle includes but is not limited to heifers,steers,bulls and
cow/calf pairs;
d. 750 to 2,499 swine each weighing 55 pounds or more;
e. 3,000 to 9,999 swine each weighing less than 55 pounds;
f. 150 to 499 horses;
g. 3,000 to 9,999 sheep or lambs;
h. 16,500 to 54,999 turkeys;
i. 9,000 to 29,999 laying hens or broilers,if the AFO uses a liquid manure handling system;
j. 37,500 to 124,999 chickens(other than laying hens),if the AFO uses other than a liquid manure handling system;
k. 25,000 to 81,999 laying hens,if the AFO uses other than a liquid manure handling system;
I. 10,000 to 29,999 ducks(if the AFO uses other than a liquid manure handling system);ore
m. 1,500 to 4,999 ducks(if the AFO uses a liquid manure handling system);and
2. Either one of the following conditions are met:
a. Pollutants are discharged into waters of the United States through a man-made ditch,flushing system,or other similar man-
made device;or
b. Pollutants are discharged directly into waters of the United States which originate outside of and pass over,across,or
through the facility or otherwise come into direct contact with animals confined in the operation.
CONCENTRATED AQUATIC ANIMAL PRODUCTION FACILITY(defined at§122.24)means a hatchery,fish farm,or other facility which
contains,grows,or holds aquatic animals in either of the following categories,or which the Director designates as such on a case-by-case
basis:
A. Cold water fish species or other cold water aquatic animals including,but not limited to,the Salmonidae family of fish(e.g.,trout and
salmon)in ponds,raceways,or other similar structures which discharge at least 30 days per year but does not include:
1. Facilities which produce less than 9,090 harvest weight kilograms(approximately 20,000 pounds)of aquatic animals per year;
and
2. Facilities which feed less than 2,272 kilograms(approximately 5,000 pounds)of food during the calendar month of maximum
feeding.
B. Warm water fish species or other warm water aquatic animals including,but not limited to,the Ameiuridae, Cetrarchiclae,and
Cyprinidae families of fish(e.g.,respectively,catfish,sunfish,and minnows)in ponds,raceways,or other similar structures which
discharge at least 30 days per year,but does not include;
1. Closed ponds which discharge only during periods of excess runoff;or
2. Facilities which produce less than 45,454 harvest weight kilograms(approximately 100,000 pounds)of aquatic animals per year.
1-10

FORM 1—GLOSSARY CONTINUED
CWA means the Clean Water Act(formerly referred to as the Federal Water Pollution Control Act or Federal Water Pollution Control Act
Amendments of 1972)Public Law 92-500,as amended by Public Law 95-217,Public Law 95-576,Public Law 96-483 and Public Law
97-117,33 U.S.C. 1251 et seq.
CWA AND REGULATIONS means the Clean Water Act(CWA)and applicable regulations promulgated thereunder.In the case of an
approved State program,it includes State program requirements.
DAILY DISCHARGE means the"discharge of a pollutant"measured during a calendar day or any 24-hour period that reasonably
represents the calendar day for purposes of sampling. For pollutants with limitations expressed in units of mass,the"daily discharge"is
calculated as the total mass of the pollutant discharged over the day.For pollutants with limitations expressed in other units of
measurement,the"daily discharge"is calculated as the average measurement of the pollutant over the day.
DIRECT DISCHARGE means the"discharge of a pollutant."
DIRECTOR means the Regional Administrator or the State Director,as the context requires,or an authorized representative.When there
is no"approved State program,"and there is an EPA administered program,"Director"means the Regional Administrator.When there is
an approved State program,"Director"normally means the State Director. In some circumstances,however,EPA retains the authority to
take certain actions even when there is an approved State program.(For example,when EPA has issued an NPDES permit prior to the
approval of a State program, EPA may retain jurisdiction over that permit after program approval,see§123.1.)In such cases,the term
"Director"means the Regional Administrator and not the State Director.
DISCHARGE(OF A POLLUTANT)means:
• Any addition of any pollutant or combination of pollutants to waters of the United States from any point source;or
• Any addition of any pollutant or combination of pollutants to the waters of the contiguous zone or the ocean from any point source
other than a vessel or other floating craft which is being used as a means of transportation.
This definition includes discharges into waters of the United States from:surface runoff which is collected or channelled by man;
discharges through pipes,sewers,or other conveyances owned by a State,municipality,or other person which do not lead to a treatment
works;and discharges through pipes,sewers,or other conveyances,leading into privately owned treatment works.This term does not
include an addition of pollutants by any"indirect discharger".
DISCHARGE MONITORING REPORT means the EPA uniform national form,including any subsequent additions,revisions,or
modifications for the reporting of self-monitoring results by permittees.DMRs must be used by"approved States"as well as by EPA. EPA
will supply DMRs to any approved State upon request.The EPA national forms may be modified to substitute the state agency name,
address,logo,and other similar information,as appropriate,in place of EPA's.
DRAFT PERMIT means a document prepared under§124.6 indicating the Director's tentative decision to issue or deny,modify,revoke
and reissue,terminate,or reissue a"permit."A notice of intent to terminate a permit,and a notice of intent to deny a permit,as discussed
in§124.5,are types of"draft permits."A denial of a request for modification,revocation and reissuance,or termination,as discussed in
§124.5,is not a"draft permit."A"proposed permit"is not a"draft permit."
EFFLUENT LIMITATION means any restriction imposed by the Director on quantities,discharge rates,and concentrations of"pollutants"
which are"discharged"from"point sources"into"waters of the United States,"the waters of the"contiguous zone,"or the ocean.
EFFLUENT LIMITATIONS GUIDELINES means a regulation published by the Administrator under section 304(b)of the CWA to adopt or
revise"effluent limitations."
ENVIRONMENTAL PROTECTION AGENCY(EPA)means the United States Environmental Protection Agency.
FACILITY or ACTIVITY means any NPDES"point source"or any other facility or activity(including land or appurtenances thereto)that is
subject to regulation under the NPDES program.
GENERAL PERMIT means an NPDES"permit"issued under§122.28 authorizing a category of discharges under the CWA within a
geographical area.
HAZARDOUS SUBSTANCE means any substance designated under 40 CFR part 116 pursuant to section 311 of the CWA.
INDIAN COUNTRY(or INDAN LANDS)means:
• All land within the limits of any Indian reservation under the jurisdiction of the United States Government,notwithstanding the
issuance of any patent,and,including rights-of-way running through the reservation;
• All dependent Indian communities with the borders of the United States whether within the originally or subsequently acquired territory
thereof,and whether within or without the limits of a state;and
• All Indian allotments,the Indian titles to which have not been extinguished,including rights-of-way running through the same.
1-11

FORM 1—GLOSSARY CONTINUED
INDIAN TRIBE means any Indian Tribe,band,group,or community recognized by the Secretary of the Interior and exercising
governmental authority over a Federal Indian reservation.
INDIRECT DISCHARGE means a nondomestic discharger introducing"pollutants"to a"publicly owned treatment works."
LARGE MUNICIPAL SEPARATE STORM SEWER SYSTEM(defined at§122.26(b)(4))means all municipal separate storm sewers that
are either:
(i)Located in an incorporated place with a population of 250,000 or more as determined by the 1990 Decennial Census by the Bureau of
the Census(Appendix F of 40 CFR 122);or
(ii)Located in the counties listed in appendix H of 40 CFR 122,except municipal separate storm sewers that are located in the
incorporated places,townships or towns within such counties;or
(iii)Owned or operated by a municipality other than those described in paragraphs(i)or(ii)and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraphs(i)or(ii).In making this determination
the Director may consider the following factors:
(A)Physical interconnections between the municipal separate storm sewers;
(B)The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph(i);
(C)The quantity and nature of pollutants discharged to waters of the United States;
(D)The nature of the receiving waters;and
(E)Other relevant factors;or
(iv)The Director may,upon petition,designate as a large municipal separate storm sewer system,municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional,watershed,or
other appropriate basis that includes one or more of the systems described in paragraphs(i),(ii),(iii).
LOG SORTING AND LOG STORAGE FACILITIES(defined at§122.27)means facilities whose discharges result from the holding of
unprocessed wood,for example,logs or roundwood with bark or after removal of bark held in self-contained bodies of water(mill ponds or
log ponds)or stored on land where water is applied intentionally on the logs(wet decking).(See 40 CFR 429,subpart I,including the
effluent limitations guidelines.)
MAJOR FACILITY means any NPDES"facility or activity"classified as such by the Regional Administrator,or,in the case of"approved
State programs,"the Regional Administrator in conjunction with the State Director.
MAXIMUM DAILY DISCHARGE LIMITATION means the highest allowable"daily discharge."
MEDIUM MUNICIPAL SEPARATE STORM SEWER SYSTEM(defined at§122.26(b)(7))means all municipal separate storm sewers that
are either:
(i)Located in an incorporated place with a population of 100,000 or more but less than 250,000,as determined by the 1990 Decennial
Census by the Bureau of the Census(appendix G of 40 CFR 122);or
(ii)Located in the counties listed in appendix I of 40 CFR 122,except municipal separate storm sewers that are located in the incorporated
places,townships or towns within such counties;or
(iii)Owned or operated by a municipality other than those described in paragraph(i)or(ii)and that are designated by the Director as part
of the large or medium municipal separate storm sewer system due to the interrelationship between the discharges of the designated
storm sewer and the discharges from municipal separate storm sewers described under paragraph(i)or(ii).In making this determination
the Director may consider the following factors:
(A)Physical interconnections between the municipal separate storm sewers;
(B)The location of discharges from the designated municipal separate storm sewer relative to discharges from municipal separate storm
sewers described in paragraph(i);
(C)The quantity and nature of pollutants discharged to waters of the United States;
(D)The nature of the receiving waters;or
(E)Other relevant factors;or
1-12

FORM 1—GLOSSARY CONTINUED
(iv)The Director may,upon petition,designate as a medium municipal separate storm sewer system,municipal separate storm sewers
located within the boundaries of a region defined by a storm water management regional authority based on a jurisdictional,watershed,or
other appropriate basis that includes one or more of the systems described in paragraphs(i),(ii),(ill)of this section.
MUNICIPALITY means a city,town,borough,county,parish,district,association,or other public body created by or under State law and
having jurisdiction over disposal of sewage,industrial wastes,or other wastes,or an Indian tribe or an authorized Indian tribal organization,
or a designated and approved management agency under section 208 of the CWA.
MUNICIPAL SEPARATE STORM SEWER(defined at§122.26(b)(8))means a conveyance or system of conveyances(including roads
with drainage systems,municipal streets,catch basins curbs,gutters,ditches,man-made channels,or storm drains):
• Owned or operated by a State,city,town,borough,county,parish,district,association,or other public body(created by or pursuant to
State law)having jurisdiction over disposal of sewage,industrial wastes,stormwater,or other wastes,including special districts under
State law such as a sewer district,flood control district or drainage district,or similar entity,or an Indian tribe or an authorized Indian
tribal organization,or a designated and approved management agency under section 208 of the CWA that discharges to waters of the
United States.
• Designed or used for collecting or conveying stormwater.
• Which is not a combined sewer;and
• Which is not part of a POTW as defined at 40 CFR 122.2.
MUNICIPAL SLUDGE(see sewage sludge)
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM(NPDES)means the national program for issuing,modifying,revoking
and reissuing,terminating,monitoring and enforcing permits,and imposing and enforcing pretreatment requirements,under sections 307,
402,318,and 405 of the CWA.The term includes an"approved program."
NEW DISCHARGER means any building,structure,facility,or installation:
• From which there is or may be a"discharge of pollutants;"
• That did not commence the"discharge of pollutants"at a particular"site"prior to August 13, 1979;
• Which is not a"new source;"and
• Which has never received a finally effective NPDES permit for discharges at that"site."
This definition includes an"indirect discharger"which commences discharging into"waters of the United States"after August 13, 1979. It
also means any existing mobile point source(other than an offshore or coastal oil and gas exploratory drilling rig or a coastal oil and gas
developmental drilling rig)such as a seafood processing rig,seafood processing vessel,or aggregate plant,that begins discharging at a
"site"for which it does not have a permit;and any offshore or coastal mobile oil and gas exploratory drilling rig or coastal mobile oil and gas
developmental drilling rig that commences the discharge of pollutants after August 13, 1979,at a"site"under EPA's permitting jurisdiction
for which it is not covered by an individual or general permit and which is located in an area determined by the Regional Administrator in
the issuance of a final permit to be an area of biological concern. In determining whether an area is an area of biological concern,the
Regional Administrator shall consider the factors specified in 40 CFR 125.122(a)(1)through(10).
An offshore or coastal mobile exploratory drilling rig or coastal mobile developmental drilling rig will be considered a"new discharger"only
for the duration of its discharge in an area of biological concern.
NEW SOURCE means any building,structure,facility,or installation from which there is or may be a"discharge of pollutants,"the
construction of which commenced:
• After promulgation of standards of performance under section 306 of the CWA which are applicable to such source,or
• After proposal of standards of performance in accordance with section 306 of the CWA which are applicable to such source,but only
if the standards are promulgated in accordance with section 306 within 120 days of their proposal.
OWNER OR OPERATOR means the owner or operator of any"facility or activity"subject to regulation under the NPDES program.
PERMIT means an authorization,license,or equivalent control document issued by EPA or an"approved State"to implement the
requirements of this part and parts 123 and 124."Permit"includes an NPDES"general permit"(§122.28).Permit does not include any
permit which has not yet been the subject of final agency action,such as a"draft permit"or a"proposed permit."
PESTICIDE DISCHARGES TO WATERS OF THE UNITED STATES FROM PESTICIDE APPLICATION means the application of
biological pesticides,and the application of chemical pesticides that leave a residue,from point sources to waters of the United States. In
the context of this definition of pesticide discharges to waters of the United States from pesticide application,this does not include
1-13

FORM 1—GLOSSARY CONTINUED
agricultural storm water discharges and return flows from irrigated agriculture,which are excluded by law(33 U.S.C. 1342(1);33 U.S.C.
1362(14)).
PESTICIDE RESIDUE for the purpose of determining whether a NPDES permit is needed for discharges to waters of the United States
from pesticide application,means that portion of a pesticide application that is discharged from a point source to waters of the United
States and no longer provides pesticidal benefits.It also includes any degradates of the pesticide.
POINT SOURCE means any discernible,confined,and discrete conveyance,including but not limited to,any pipe,ditch,channel,tunnel,
conduit,well,discrete fissure,container,rolling stock,concentrated animal feeding operation,landfill leachate collection system,vessel or
other floating craft from which pollutants are or may be discharged.This term does not include return flows from irrigated agriculture or
agricultural stormwater runoff.(See§122.3).
POLLUTANT means dredged spoil,solid waste,incinerator residue,filter backwash,sewage,garbage,sewage sludge,munitions,
chemical wastes,biological materials,radioactive materials(except those regulated under the Atomic Energy Act of 1954,as amended(42
U.S.C.2011 et seq.)),heat,wrecked or discarded equipment,rock,sand,cellar dirt and industrial,municipal,and agricultural waste
discharged into water.It does not mean:
• Sewage from vessels;or
• Water,gas,or other material which is injected into a well to facilitate production of oil or gas,or water derived in association with oil
and gas production and disposed of in a well,if the well used either to facilitate production or for disposal purposes is approved by
authority of the State in which the well is located,and if the State determines that the injection or disposal will not result in the
degradation of ground or surface water resources.Note:Radioactive materials covered by the Atomic Energy Act are those
encompassed in its definition of source,byproduct,or special nuclear materials.Examples of materials not covered include radium
and accelerator-produced isotopes.See Train v. Colorado Public Interest Research Group,Inc.,426 U.S. 1 (1976).
PRIMARY INDUSTRY CATEGORY means any industry category listed in the NRDC settlement agreement(Natural Resources Defense
Council et al.v. Train,8 E.R.C.2120(D.D.C. 1976),modified 12 E.R.C. 1833(D.D.C. 1979));also listed in appendix A of part 122.
PRIVATELY OWNED TREATMENT WORKS means any device or system which is(1)used to treat wastes from any facility whose
operator is not the operator of the treatment works and(2)not a"POTW."
PROCESS WASTEWATER means any water which,during manufacturing or processing,comes into direct contact with or results from the
production or use of any raw material,intermediate product,finished product,byproduct,or waste product.
PROPOSED PERMIT means a state NPDES"permit"prepared after the close of the public comment period(and,when applicable,any
public hearing and administrative appeals)which is sent to EPA for review before final issuance by the State.A"proposed permit"is not a
"draft permit."
PUBLICLY OWNED TREATMENT WORKS or POTW(defined at§403.3)means a treatment works as defined by CWA Section 212,
which is owned by a state or municipality(as defined by CWA Section 502(4)).This definition includes any devices or systems used in the
storage,treatment,recycling,and reclamation)of municipal sewage or industrial wastes of a liquid nature.This definition also includes
sewers,pipes,and other conveyances only if they convey wastewater to a POTW.The term also means the municipality as defined in
CWA Section 502(4),which has jurisdiction over the indirect discharges to and the discharges from such a treatment works.
REGIONAL ADMINISTRATOR means the Regional Administrator of the appropriate Regional Office of the Environmental Protection
Agency or the authorized representative of the Regional Administrator.
ROCK CRUSHING AND GRAVEL WASHING FACILITIES(defined at§122.27)means facilities which process crushed and broken
stone,gravel,and riprap(See 40 CFR 436,subpart B,including the effluent limitations guidelines).
SCHEDULE OF COMPLIANCE means a schedule of remedial measures included in a"permit",including an enforceable sequence of
interim requirements(for example,actions,operations,or milestone events)leading to compliance with the CWA and regulations.
SECONDARY INDUSTRY CATEGORY means any industry category which is not a primary industry category.
SEWAGE FROM VESSELS means human body wastes and the wastes from toilets and other receptacles intended to receive or retain
body wastes that are discharged from vessels and regulated under section 312 of the CWA,except that with respect to commercial
vessels on the Great Lakes this term includes graywater.For the purposes of this definition,"graywater"means galley,bath,and shower
water.
SEWAGE SLUDGE means any solid,semi-solid,or liquid residue removed during the treatment of municipal waste water or domestic
sewage.Sewage sludge includes,but is not limited to,solids removed during primary,secondary,or advanced waste water treatment,
scum,septage,portable toilet pumpings,type III marine sanitation device pumpings(33 CFR 159),and sewage sludge products.Sewage
sludge does not include grit or screenings,or ash generated during the incineration of sewage sludge.
1-14

FORM 1—GLOSSARY CONTINUED
SILVICULTURAL POINT SOURCE(defined at§122.27)means any discernible,confined,and discrete conveyance related to rock
crushing,gravel washing,log sorting,or log storage facilities which are operated in connection with silvicultural activities and from which
pollutants are discharged into waters of the United States.This term does not include non-point source silvicultural activities such as
nursery operations,site preparation,reforestation and subsequent cultural treatment,thinning,prescribed burning,pest and fire control,
harvesting operations,surface drainage,or road construction and maintenance from which there is natural runoff. However,some of these
activities(such as stream crossing for roads)may involve point source discharges of dredged or fill material which may require a CWA
Section 404 permit(see 33 CFR 209.120 and part 233).
SITE means the land or water area where any"facility or activity"is physically located or conducted,including adjacent land used in
connection with the facility or activity.
SLUDGE-ONLY FACILITY means any"treatment works treating domestic sewage"whose methods of sewage sludge use or disposal are
subject to regulations promulgated pursuant to section 405(d)of the CWA and is required to obtain a permit under§122.1(b)(2).
STANDARDS FOR SEWAGE SLUDGE USE OR DISPOSAL means the regulations promulgated pursuant to section 405(d)of the CWA
which govern minimum requirements for sludge quality,management practices,and monitoring and reporting applicable to sewage sludge
or the use or disposal of sewage sludge by any person.
STATE means any of the 50 States,the District of Columbia,Guam,the Commonwealth of Puerto Rico,the Virgin Islands,American
Samoa,the Commonwealth of the Northern Mariana Islands,the Trust Territory of the Pacific Islands,or an Indian Tribe as defined in
these regulations which meets the requirements of§123.31 of this chapter.
STATE DIRECTOR means the chief administrative officer of any State or interstate agency operating an"approved program,"or the
delegated representative of the State Director. If responsibility is divided among two or more State or interstate agencies,"State Director"
means the chief administrative officer of the State or interstate agency authorized to perform the particular procedure or function to which
reference is made.
STORMWATER(or STORM WATER)(defined at§122.26(b)(13))means stormwater runoff,snow melt runoff,and surface runoff and
drainage.
STORMWATER DISCHARGE ASSOCIATED WITH INDUSTRIAL ACTIVITY(defined at§122.26(b)(14))means the discharge from any
conveyance that is used for collecting and conveying stormwater and that is directly related to manufacturing,processing or raw materials
storage areas at an industrial plant.The term does not include discharges from facilities or activities excluded from the NPDES program
under this part 122.For the categories of industries identified in this section,the term includes,but is not limited to,stormwater discharges
from industrial plant yards;immediate access roads and rail lines used or traveled by carriers of raw materials,manufactured products,
waste material,or by-products used or created by the facility;material handling sites;refuse sites;sites used for the application or disposal
of process waste waters(as defined at 40 CFR 401);sites used for the storage and maintenance of material handling equipment;sites
used for residual treatment,storage,or disposal;shipping and receiving areas;manufacturing buildings;storage areas(including tank
farms)for raw materials,and intermediate and final products;and areas where industrial activity has taken place in the past and significant
materials remain and are exposed to stormwater.For the purposes of this paragraph,material handling activities include storage,loading
and unloading,transportation,or conveyance of any raw material,intermediate product,final product,by-product or waste product.The
term excludes areas located on plant lands separate from the plant's industrial activities,such as office buildings and accompanying
parking lots as long as the drainage from the excluded areas is not mixed with stormwater drained from the above described areas.
Industrial facilities(including industrial facilities that are federally,State,or municipally owned or operated that meet the description of the
facilities listed in paragraphs 1 through 14 below)include those facilities designated under the provisions of 40 CFR 122.26(a)(1)(v).The
following categories of facilities are considered to be engaging in"industrial activity"for purposes of 40 CFR 122.26(b)(14):
1. Facilities subject to stormwater effluent limitations guidelines,new source performance standards,or toxic pollutant effluent standards
under 40 CFR Subchapter N(except facilities with toxic pollutant effluent standards which are exempted under paragraph 11 below);
2. Facilities classified as Standard Industrial Classification 24, Industry Group 241 that are rock crushing,gravel washing,log sorting,or
log storage facilities operated in connection with silvicultural activities defined in 40 CFR 122.27(b)(2)-(3)and Industry Groups 242
through 249;26(except 265 and 267),28(except 283),29,311,32(except 323),33,3441,373;(not included are all other types of
silvicultural facilities);
3. Facilities classified as Standard Industrial Classifications 10 through 14(mineral industry)including active or inactive mining
operations(except for areas of coal mining operations no longer meeting the definition of a reclamation area under 40 CFR 434.11(1)
because the performance bond issued to the facility by the appropriate SMCRA authority has been released,or except for areas of
non-coal mining operations which have been released from applicable State or Federal reclamation requirements after
December 17, 1990)and oil and gas exploration,production,processing,or treatment operations,or transmission facilities that
discharge stormwater contaminated by contact with or that has come into contact with,any overburden,raw material,intermediate
products,finished products,byproducts or waste products located on the site of such operations;(inactive mining operations are
mining sites that are not being actively mined,but which have an identifiable owner/operator;inactive mining sites do not include sites
1-15

FORM 1-GLOSSARY CONTINUED
where mining claims are being maintained prior to disturbances associated with the extraction,beneficiation,or processing of mined
materials,nor sites where minimal activities are undertaken for the sole purpose of maintaining a mining claim);
4. Hazardous waste treatment,storage,or disposal facilities,including those that are operating under interim status or a permit under
subtitle C of RCRA;
5. Landfills,land application sites,and open dumps that receive or have received any industrial wastes(waste that is received from any
of the facilities described under this subsection)including those that are subject to regulation under subtitle D of RCRA;
6. Facilities involved in the recycling of materials,including metal scrapyards,battery reclaimers,salvage yards,and automobile
junkyards,including but limited to those classified as Standard Industrial Classification 5015 and 5093;
7. Steam electric power generating facilities,including coal handling sites;
8. Transportation facilities classified as Standard Industrial Classifications 40,41,42(except 4221-25),43,44,45,and 5171 which have
vehicle maintenance shops,equipment cleaning operations,or airport deicing operations.Only those portions of the facility that are
either involved in vehicle maintenance(including vehicle rehabilitation,mechanical repairs,painting,fueling,and lubrication),
equipment cleaning operations,airport deicing operations,or which are otherwise identified under paragraphs 1-7 or 9-11 are
associated with industrial activity;
9. Treatment works treating domestic sewage or any other sewage sludge or wastewater treatment device or system,used in the
storage treatment,recycling,and reclamation of municipal or domestic sewage,including land dedicated to the disposal of sewage
sludge that are located within the confines of the facility,with a design flow of 1.0 mgd or more,or required to have an approved
pretreatment program under 40 CFR 403.Not included are farm lands,domestic gardens or lands used for sludge management
where sludge is beneficially reused and which are not physically located in the confines of the facility,or areas that are in compliance
with section 405 of the CWA;
10. Construction activity including clearing,grading and excavation,except operations that result in the disturbance of less than five acres
of total land area.Construction activity also includes the disturbance of less than five acres of total land area that is a part of a larger
common plan of development or sale if the larger common plan will ultimately disturb five acres or more;
11. Facilities under Standard Industrial Classifications 20,21,22,23,2434,25,265,267,27,283,285,30,31 (except 311),323,34
(except 3441),35,36,37(except 373),38,39,and 4221-25.
TOXIC POLLUTANT means any pollutant listed as toxic under section 307(a)(1)or,in the case of"sludge use or disposal practices,"any
pollutant identified in regulations implementing section 405(d)of the CWA.
TREATMENT WORKS TREATING DOMESTIC SEWAGE(TWTDS)means a POTW or any other sewage sludge or waste water
treatment devices or systems,regardless of ownership(including federal facilities),used in the storage,treatment,recycling,and
reclamation of municipal or domestic sewage,including land dedicated for the disposal of sewage sludge.This definition does not include
septic tanks or similar devices.For purposes of this definition,"domestic sewage"includes waste and waste water from humans or
household operations that are discharged to or otherwise enter a treatment works. In States where there is no approved State sludge
management program under section 405(f)of the CWA,the Regional Administrator may designate any person subject to the standards for
sewage sludge use and disposal in 40 CFR 503 as a"treatment works treating domestic sewage,"where he or she finds that there is a
potential for adverse effects on public health and the environment from poor sludge quality or poor sludge handling,use or disposal
practices,or where he or she finds that such designation is necessary to ensure that such person is in compliance with 40 CFR 503.
UPSET(defined at§122.41(n))means an exceptional incident in which there is unintentional and temporary noncompliance with
technology based permit effluent limitations because of factors beyond the reasonable control of the permittee.An upset does not include
noncompliance to the extent caused by operational error,improperly designed treatment facilities,inadequate treatment facilities,lack of
preventive maintenance,or careless or improper operation.
VARIANCE means any mechanism or provision under section 301 or 316 of the CWA or under 40 CFR 125,or in the applicable"effluent
limitations guidelines"which allows modification to or waiver of the generally applicable effluent limitation requirements or time deadlines of
the CWA.This includes provisions which allow the establishment of alternative limitations based on fundamentally different factors or on
sections 301(c),301(g),301(h),301(i),or 316(a)of the CWA.
WATERS OF THE UNITED STATES as defined at§ 122.2.
WHOLE EFFLUENT TOXICITY(WET)means the aggregate toxic effect of an effluent measured directly by a toxicity test.
1-16

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088897 City of King OMB No.2040-0004
Form U.S.Environmental Protection Agency
1 \=.EPA 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
Is the facility a new or existing publicly owned Is the facility a new or existing treatment works
1.1.1 1
treatment works? 1. .2 treating domestic sewage?
If yes,STOP. Do NOT complete ❑ No If yes,STOP.Do NOT D 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?
oYes 4 Complete Form 1 ❑ No �✓ Yes 4 Complete Form ❑ No
n. 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,
rn mining,or silvicultural facility that has not yet commercial,mining,or silvicultural facility that
commenced to discharge? discharges only nonprocess wastewater?
g ❑ Yes 4 Complete Form 1 No Yes 4 Complete Form ❑ No
ce and Form 2D. 1 and Form 2E.
. 1.2.5 Is the facility a new or existing facility whose
'— discharge is composed entirely of stormwater
a associated with industrial activity or whose
discharge is composed of both stormwater and
non-stormwater?
❑ Yes 4 Complete Form 1 ❑ 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
City of King Water Treatment Plant
O 2.2 EPA Identification Number
:a
0
O
J
2.3 Facility Contact
Name(first and last) Title Phone number
43-v Benjamin S.Marion City Engineer Intern [phone]
Email address
[e-mail]
2.4 Facility Mailing Address
CZStreet or P.O.box
PO Box 1132
City or town State ZIP code
King NC 27021
EPA Form 3510-1(revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088897 City of King OMB No.2040-0004
2.5 Facility Location
wStreet,route number,or other specific identifier
Q o 6949 Donnaha Road
o County name County code(if known)
Forsyth
a - City or town State ZIP code
z R Tobaccoville NC 27050
SECTION 3.SIC AND NAICS CODES(40 CFR 122.21(f)(3))
3.1 SIC Code(s) Description(optional)
U)
-
0
0
U
co
z 3.2 NAICS Code(s) Description(optional)
N
SECTION 4.OPERATOR INFORMATION(40 CFR 122.21(f)(4))
4.1 Name of Operator
William Mark Danley
4.2 Is the name you listed in Item 4.1 also the owner?
`o ❑ Yes ❑✓ No
4.3 Operator Status
0 Public—federal ✓❑ Public—state ❑ Other public(specify)
L.
❑ Private ❑ Other(specify)
4.4 Phone Number of Operator
[phone]
= 4.5 Operator Address
Street or P.O. Box
E 0 PO Box 1132
o E
City or town State ZIP code
`o 0 King NC 27021
o U
a Email address of operator
[e-mail]
SECTION 5.INDIAN LAND(40 CFR 122.21(f)(5))
0 5.1 Is the facility located on Indian Land?
5 al
❑Yes ❑✓ No
EPA Form 3510-1(revised 3-19) Page 2

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088897 City of King 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)
7,5
m NPDES(discharges to surface ❑ RCRA(hazardous wastes) ❑ UIC(underground injection of
water) fluids)
o
•€ NC0088897
a ❑ PSD(air emissions) ❑ Nonattainment program(CM) ❑ NESHAPs(CM)
w 0 Ocean dumping(MPRSA) 0 Dredge or fill(CWA Section 404) 0 Other(specify)
SECTION 7.MAP(40 CFR 122.21(f)(7))
7.1 Have you attached a topographic map containing all required information to this application?(See instructions for
specific requirements.)
❑✓ Yes ❑ No ❑ CAFO—Not Applicable(See requirements in Form 2B.)
SECTION 8.NATURE OF BUSINESS(40 CFR 122.21(f)(8))
8.1 Describe the nature of your business.
Water Treatment Facility
U)
d
c
.y
co
u-
O
Z
SECTION 9.COOLING WATER INTAKE STRUCTURES(40 CFR 122.21(f)(9))
9.1 Does your facility use cooling water?
a) ❑ Yes ❑✓ No-3 SKIP to Item 10.1.
It 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
o NPDES permitting authority to determine what specific information needs to be submitted and when.)
o ca
U C
SECTION 10.VARIANCE REQUESTS(40 CFR 122.21(f)(10))
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.)
❑ Fundamentally different factors(CWA ❑ Water quality related effluent limitations(CWA Section
e 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 NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088897 City of King OMB No.2040-0004
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 0 w/attachments
❑✓ Section 2:Name,Mailing Address,and Location 0 w/attachments
❑✓ Section 3: SIC Codes 0 w/attachments
❑✓ Section 4:Operator Information ❑ w/attachments
❑✓ Section 5: Indian Land ❑ w/attachments
❑✓ Section 6: Existing Environmental Permits 0 wl attachments
w/topographic
© Section 7:Map ❑✓ map ❑ w/additional attachments
co
o ❑✓ Section 8:Nature of Business 0 w/attachments
w ❑✓ Section 9:Cooling Water Intake Structures ❑ wl attachments
© Section 10:Variance Requests ❑ w/attachments
a
❑✓ Section 11:Checklist and Certification Statement 0 w/attachments
a) 11.2 Certification Statement
U
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. lam 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 titles
Benjamin S.Marion City Engineer Intern
Signature Date signed
gClaMte 07/03/2023
EPA Form 3510-1(revised 3-19) Page 4

DocuSign Envelope ID:86632DE6-B34C-42FE-9282-00F8F0C06041
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City of King
Water Treatment Plant (WTP) Facility
6949 Donnaha Road,Tobaccoville 27050 Location
Receiving Stream: Old Richmond Creek Stream Segment: 12-79 Scale 1:24,000
Drainage Basin: Yadkin-Pee Dee River Basin Sub-Basin: 03-07-02
Latitude: 36°13'22" Longitude: 80°25'39" .} NPDES Permit NC0088897
Stream Class: WS-IV HUC: 03040/01 North
County:Forsyth Forsyth County
1

4'
United States Office of Water EPA Form 3510-2C
Environmental Protection Agency Washington,D.C. Revised March 2019
Water Permits Division
&EPA Application Form 2C
Existing Manufacturing ,
Commercial, Mining, and
Silvicultural Operations
NPDES Permitting Program
10 7513
DOI **IQpES
Note: Complete this form and Form 1 if your facility is an existing manufacturing, commercial, mining,
or Silvicultural facility that currently discharges process wastewater.

Paperwork Reduction Act Notice
The U.S. Environmental Protection Agency estimates the average burden to collect information and
complete Form 2C to be 32.5 hours. This estimate includes time for reviewing instructions, searching
existing data sources, gathering and maintaining the needed data, and completing and reviewing the
collection of information. Send comments about the burden estimate or any other aspect of this
collection of information to the Chief, Information Policy Branch(PM-223),U.S. Environmental
Protection Agency, 1200 Pennsylvania Avenue,NW, Washington,DC 20460, and to the Office of
Information and Regulatory Affairs, Office of Management and Budget, 725 17th Street,NW,
Washington,DC 20503,marked"Attention: Desk Officer for EPA."

FORM 2C—INSTRUCTIONS
General Instructions Definitions
Who Must Complete Form 2C? The legal definitions of all key terms used in these instructions and
Form 2C are in the"Glossary"at the end of the"General
You must complete Form 2C if you answered"Yes"to Item 1.2.2 on Instructions"in Form 1.
Form 1—that is,if you are an existing manufacturing,commercial,
mining,or silvicultural facility that currently discharges process Line-by-Line Instructions
wastewater. Section 1.Outfall Location
Where to File Your Completed Form Item 1.1.Identify each of the facility's outfall structures by number.
For each outfall,specify the latitude and longitude to the nearest
Submit your completed application package(Forms 1 and 2C)to 15 seconds and name of the receiving water.The application form
your National Pollutant Discharge Elimination System(NPDES) provides reporting space for three outfalls. If your facility has more
permitting authority.Consult Exhibit 1-1 of Form 1's"General than this number,attach additional sheets as necessary.The
Instructions"to identify your NPDES permitting authority. location of each outfall(i.e.,where the coordinates are collected)
Public Availability of Submitted Information shall be the point where the discharge is released into a water of
the United States.Latitude and longitude coordinates may be
The U.S.Environmental Protection Agency(EPA)will make obtained in a variety of ways,including use of hand held devices
information from NPDES permit application forms available to the (e.g.,a GPS enabled smartphone),internet mapping tools(e.g.,
public for inspection and copying upon request.You may not claim httos:/Imynasadata.larc.nasa.gov/latitudelongitude-finder/),
any information on Form 2C(or related attachments)as geographic information systems(e.g.,ArcView),or paper maps
confidential. from trusted sources(e.g.,U.S.Geological Survey or USGS).For
You may make a claim of confidentiality for any information that you further guidance,refer to
submit to EPA that goes beyond the information required by Form http:l/www.eoa.govlgeospatial/latitudelonoitude-data-standard.
2C.Note that NPDES authorities will deny claims for treating any Section 2.Line Drawing
effluent data as confidential. If you do not assert a claim of Item 2.1.Attach a line drawing showing water flow through your
confidentiality at the time you submit your information to the facility,from intake to discharge. Indicate the sources of intake
NPDES permitting authority,EPA may make the information water(e.g.,city,well,stream,other);operations contributing
available to the public without further notice to you.EPA will handle wastewater to the effluent including process and production areas,
claims of confidentiality in accordance with the Agency's business sanitary flows,cooling water,and stormwater runoff;and treatment
confidentiality regulations at Part 2 of Title 40 of the Code of units labeled to correspond to the more detailed descriptions under
Federal Regulations(CFR). Section 3.You may group similar operations into a single unit.
Completion of Forms Construct a water balance on the line drawing by showing average
Print or type in the specified areas only.If you do not have enough flows(specify units)between intakes,operations,treatment units,
space on the form to answer a question,you may continue on and outfalls.Show all significant losses of water to products,the
additional sheets,as necessary,using a format consistent with the atmosphere,and discharge.You should use actual measurements
form. wherever available;otherwise use your best estimate.If you cannot
determine a water balance for your activities(such as mining
Provide your EPA Identification Number from the Federal Registry activities),provide a pictorial description of the nature and amount
Service,NPDES permit number,and facility name at the top of of anysources of water and anycollection and treatment measures.
each page of Form 2C and any attachments. If you do not know An example of an acceptable line drawing is provided in Exhibit
your EPA Identification Number,contact your NPDES permitting 2C-1 at the end of these instructions.
authority.See Exhibit 1-1 of Form l's"General Instructions"for
contact information.Additionally,for Tables A through E,provide Section 3.Average Flows and Treatment
the applicable outfall number at the top of each page. Item 3.1.For each outfall identified under Item 1.1,provide the
Do not leave anyresponse areas blank unless the form directs you
following information:(1)all processes,operations,or production
P Y wastewater o the effluent for the outfall,
areas that contributet
to skip them.If the form directs you to respond to an item that does including process wastewater,sanitary wastewater,cooling water,
not apply to your facility or activity,enter"NA"for"not applicable"to and stormwater runoff;(2)average flow of wastewater contributed
show that you considered the item and determined a response was by each operation in million gallons per day(mgd);(3)a description
not necessary for your facility. of the treatment unit(including size of each treatment unit,flow rate
The NPDES permitting authority will consider your application through each treatment unit,retention time,etc.);(4)the applicable
complete when it and any supplementary material are received and treatment code(s)from Exhibit 2C-2(see end of instructions);and
completed according to the authority's satisfaction.The NPDES (5)the ultimate disposal of any solid or fluid wastes that are not
permitting authority will judge the completeness of any application discharged to the receiving water.You may describe processes,
independently of the status of any other permit application or permit operations,or production areas in general terms(e.g.,"dye-making
for the same facility or activity. reactor"or"distillation tower").You may estimate the average flow
of point sources composed of stormwater;however,you must
2C-1

- 1
FORM 2C—INSTRUCTIONS CONTINUED
indicate the basis of the rainfall event and the method of estimation. Item 5.3.Indicate if the limitations in the applicable ELGs are
Add additional sheets as necessary. expressed in terms of production or other measure of operation.For
Item 3.2.Answer whether you are applying for an NPDES permit to operational parameter,it is expressed in terms of production(e.g.,
operate a privately owned treatment works.If yes,continue to Item "pounds of biological oxygen demand per cubic foot of logs from
3.3. If no,skip to Section 4. which bark is removed,"or"pounds of total suspended solids per
megawatt hour of electrical energy consumed by smelting
Item 3.3.Attach a list to your application that includes the identity of furnace").An example of an ELG not expressed in terms of a
each user of the treatment works,then answer"Yes"to Item 3.3. measure of operation is one that limits the concentration of
Section 4.Intermittent Flows pollutants.If yes,continue to Item 5.4. If no,skip to Section 6.
Item 4.1.Answer"Yes"or"No"to indicate whether any of the Item 5.4.Indicate the operations,products,or materials produced
discharges you described in Sections 1 and 3 of Form 2C are at the facility for each outfall. For each operation,product,or
intermittent or seasonal,except for stormwater runoff,spillage,or material produced,denote the quantity produced per day using the
leaks.An intermittent discharge is one that is not continuous.A measurement units specified in the applicable ELG.The NPDES
continuous discharge is one that occurs without interruption during permitting authority will use the production information to apply
the operating hours of the facility,except for infrequent shutdowns ELGs to your facility.You may not claim that the production
for maintenance,process changes,or other similar activities.A information you submit is confidential.You do not need to indicate
discharge is seasonal if it occurs only during certain parts of the how you calculated the reported information.The production figures
year. If yes,continue to Item 4.2. If no,skip to Section 5. provided must be based on a reasonable measure of actual daily
Item 4.2.By relevant outfall number,identify each operation that production,not on design capacity or on predictions of future
operations.To obtain alternate limits under 40 CFR 122.45(b)(2)(ii),
has intermittent or seasonal discharges. Indicate the average
you must define your maximum production capability and
frequency(days per week and months per year),the long-term
average and maximum daily flow rates in mgd,and the duration of demonstrate to the NPDES permitting authority that your actual
production is substantially below maximum production capability
the intermittent or seasonal discharges. Base your answers on and that there is a reasonable potential for an increase above
actual data if available.Otherwise,provide your best estimate. actual production during the duration of the permit.
Report the average of all daily values measured during days when
the discharge occurred for"Long-Term Average,"and report the Section 6.Improvements
highest daily value for"Maximum Daily." Item 6.1.Indicate if you are required by any federal,state,or local
Section 5.Production authority to meet an implementation schedule for constructing,
Item 5.1.Indicate whether any effluent limitation guidelines(ELGs) upgrading,or operating wastewater treatment equipment or
practices or any other environmental programs that could affect the
promulgated under Section 304 of the Clean Water Act(CWA)
apply to your facility.If yes,continue to Item 5.2.If no,skip to discharges described in your application.The requirements include,
Section 6.All ELGs promulgated by EPA appear in the Federal but are not limited to,permit conditions,administrative enforcement
Register and are published annually in 40 CFR Subchapter N.An orders,enforcement compliance schedule letters,stipulations,court
orders,and grantor loan conditions. If yes,continue to Item 6.2. If
ELG applies if you have any operations contributing process no,skip to Item
wastewater in any subcategory covered by a Best Practicable 6.3.
Control Technology Currently Available(BPT), Best Conventional Item 6.2.Briefly identify and describe each applicable project(e.g.,
Pollutant Control Technology(BCT),or Best Available Technology consent decree,enforcement order,or permit condition). For each
Economically Achievable(BAT)guideline. If you are unsure condition,specify the affected outfall number(s),the source(s)of
whether you are covered by a promulgated ELG,consult your the discharge,the projected final compliance date,and the
NPDES permitting authority(see Exhibit 1-1 of the"General required final compliance date.
Instructions"of Form 1).You must check"Yes"if an applicable ELG Item 6.3.OPTIONAL ITEM. If desired,attach descriptions of any
has been promulgated,even if the ELG is being contested in court. additional water pollution control programs(or other environmental
If you believe that a promulgated ELG has been remanded for projects that could affect your discharges)that are now underway
reconsideration by a court and does not apply to your operations, or planned. Indicate in your attachments whether each program is
you may answer"No"to Item 5.1 and skip to Section 6. actually underway or is planned,and indicate your actual or
Item 5.2.Complete Item 5.2 by indicating the applicable ELG planned schedule for construction.
category,ELG subcategory,and corresponding regulatory citation. Section 7.Effluent and Intake Characteristics
See the example below.
Items 7.1 to 7.17.These items require you to collect and report
5.2 ELG Category ELG Regulatory data for the parameters and pollutants listed in Tables A through E,
w Subcategory Citation located at the end of Form 2C.The instructions for completing the
0Pulp,Paper, Secondary Fiber 40 CFR 430, tables are table-specific in addition to the criteria for determining
and Non-Deink Subpart J Paperboard Subcategory who should complete them. In general,the following conditions
aPoint Source apply:
Category
2C-2

FORM 2C—INSTRUCTIONS CONTINUED
Table Pollutants/Parameters j Who Completes? Item 7.5.Because you indicated in Item 7.4 that the facility's
A Conventional and non- All applicants from all outfalls unless a processes contribute wastewater that falls into one or more of the
conventional pollutants waiver is obtained from the NPDES primary industry categories,check"Testing Required"for all toxic
Applicantspeming authority.
primary
metals,cyanide,and total phenols in Section 1 of Table B.Answer
B Toxic metals,cyanide,total in the primary industry Y
phenols,and organic toxic categories listed in Exhibit 2C-3 at the "Yes"to Item 7.5 once you have completed this task.
pollutants end of these instructions.
C Certain conventional and Applicants subject to ELGs that limit Item 7.6.Because you indicated in Item 7.4 that the facility's
non-conventional pollutants pollutants directly or indirectly and processes contribute wastewater that falls into one or more of the
applicants who believe pollutants may primary industry categories,list the primary industry categories
be present in their facility's discharge. applicable to your facility. Next,review Exhibit 2C-3 to determine
D Certain hazardous Applicants who believe pollutants may
substances and asbestos be present in their facility's discharge. whether testing is required and for which GC/MS fraction(s):volatile
E 2,3,7,8-tetrachlorodibenzo- Applicants that use or manufacture the compounds,acid compounds,base/neutral compounds,and
p-dioxin(2,3,7,8-TCDD) pollutant or believe the pollutant may pesticides.Check the applicable boxes for each GC/MS fraction
be present in the facility's discharge. I requiring testing.
Important note:Read the"General Instructions for Reporting,
Sampling,and Analysis"on pages 2C-5 and 2C-6 before Item 7.7.For each of the required GC/MS fractions,check"Testing
completing Section 7 and Tables A through E. Required"for each of the pollutants in the required fraction in
Sections 2 through 5 of Table B.Answer"Yes"to Item 7.7 once you
Item 7.1 and Table A.All applicants must report at least one have completed this task.
analysis for each conventional and non-conventional pollutant listed
in Table A for each outfall(one table per outfall).This includes Item 7.8 and Sections 1 through 5 of Table B.For all other cases
outfalls discharging only noncontact cooling water or stormwater (secondary industries,nonprocess wastewater outfalls,and
runoff.However,at your request,the NPDES permitting authority nonrequired GC/MS fractions)and remaining pollutants,check
may waive the requirement to test for one or more of the listed "Believed Present"or"Believed Absent"in Sections 1 through 5 of
pollutants for specific outfalls,upon a determination that available Table B to indicate whether you have reason to believe that any of
information is adequate to support issuance of your NPDES permit the pollutants listed are discharged from your outfalls.Answer"Yes"
with less stringent reporting requirements.You may also request a to Item 7.8 after you have completed this step.
waiver from your NPDES permitting authority for one or more of the Item 7.9 and Section 1 of Table B.For each pollutant you know or
Table A pollutants for your industry category or subcategory. have reason to believe is present in your discharge from each
Indicate whether you are requesting a waiver in response to Item applicable outfall in concentrations of 10 parts per billion(ppb)or
7.1. If yes,continue to Item 7.2.If no,skip to Item 7.3. greater,you must report quantitative data.For every pollutant
Item 7.2.Specify the outfalls for which you are requesting a waiver. expected to be discharged in concentrations less than 10 ppb,you
Next,indicate on Table A for the applicable outfalls the pollutants must submit quantitative data or briefly describe the reasons the
for which the waiver is being requested.Attach your waiver request pollutant is expected to be discharged.For pollutants in intake
and supporting information to your completed Form 2C. water,see the discussion under"General Instructions for Reporting,
Sampling,and Analysis"below.Answer"Yes"to Item 7.9 once you
Item 7.3.Test your effluent from each outfall for each pollutant have completed Section 1 of Table B.
listed in Table A for which you have not requested a waiver.You
may also conduct optional tests of your intake water for the Table A Item 7.10.This item asks if you qualify as a"small business."If so,
pollutants.See the"General Instructions for Reporting,Sampling, you are exempt from submitting quantitative data for the organic
and Analysis"on pages 2C-5 and 2C-6 for further information. toxic pollutants on Table B(Sections 2 through 5).You still must
indicate,though,whether you believe any of the pollutants listed in
Item 7.4 and Table B.This item asks whether any of the facility's Sections 1 through 5 are present in your discharge per the
processes that contribute wastewater fall into one or more of the Instructions at Item 7.8 above.
primary industry categories listed in Exhibit 2C-3. If you are
applying for a permit for a privately owned treatment works, You can qualify as a small business in two ways:(1)If your facility
determine your testing requirements based on the industrial is a coal mine and if your probable total annual production is less
categories of your contributors.This exercise is simply to determine than 100,000 tons per year,you may submit past production data
your testing requirements only.You are not giving up your right to or estimated future production(such as a schedule of estimated
challenge your inclusion in the category determined for testing(e.g., total production under 30 CFR 795.14(c))instead of conducting
for deciding whether an ELG is applicable)before your permit is analyses for the organic toxic pollutants.(2)If your facility is not a
issued. If yes,continue to Item 7.5.If no,skip to Item 7.8. coal mine and if your gross total annual sales for the most recent
three years average less than$100,000 per year(in second
Complete a separate Table B for each outfall.Section 1 of Table B quarter 1980 dollars),you may submit sales data for those years
lists toxic metals,cyanide,and total phenols.Sections 2 through 5 instead of conducting analyses for the organic toxic pollutants.
of Table B list the pollutants in each of the gas
chromatography/mass spectrometry(GC/MS)fractions.Note that The production or sales data must be for the facility that is the
inclusion of total phenols in Section 1 of Table B does not mean source of the discharge.The data should not be limited to
that EPA is classifying the group as toxic pollutants. production or sales for the process or processes that contribute to
the discharge,unless those are the only processes at your facility.
2C-3

FORM 2C—INSTRUCTIONS CONTINUED
For sales data,in situations involving intra-corporate transfer of Item 7.14 and Table D.For each outfall,indicate if you believe that
goods and services,the transfer price per unit should approximate any pollutant listed in Table D is"Believed Present"or"Believed
market prices for those goods and services as closely as possible. Absent"in your facility's effluent.Check the boxes in the applicable
Sales figures for years after 1980 should be indexed to the second columns on Table D next to each pollutant.For every pollutant
quarter of 1980 by using the gross national product price deflator believed present,you must briefly describe the reasons the
(second quarter of 1980=100).This index is available online from pollutant is expected to be discharged and report any quantitative
the U.S. Department of Commerce,Bureau of Economic Analysis data you have for that pollutant. Note that you are not required to
at http:llbea.qov/nationallpdf/SNTables.pdf. perform analytical tests for any of the Table D pollutants at this time.
If you qualify as a small business according to the criteria above, However,if you have prior test results,you must report them.
answer"Yes"to Item 7.10.Check the box at the top of Table B to Item 7.15.Answer"Yes"to this Item when you have completed
show that you are not required to submit quantitative data for the Table D.
organic toxic pollutants(Sections 2 through 5 of Table B),then
skip to Item 7.12.Otherwise,answer"No"and continue to Item Under 40 CFR 117.12(a)(2),certain discharges of hazardous substances
7.11. (listed in Exhibit 2C-4 at the end of these instructions)may be exempted from
the requirements of Section 311 of the CWA,which establishes reporting
Item 7.11 and Sections 2 through 5 of Table B.Unless you requirements,civil penalties,and liability for cleanup costs for spills of oil and
qualify as a small business(see Item 7.10),you must provide hazardous substances.A discharge of a particular substance can be exempted
quantitative data for all pollutants for which you marked"Testing if the origin,source,and amount of the discharged substances are identified in
Required"in Sections 2 through 5 of Table B.You must also the NPDES permit application or in the permit,if the permit contains a
provide quantitative data for all pollutants you marked as"Believed requirement for treatment of the discharge,and if the treatment is in place.
Present"in Sections 2 through 5 of Table B if you discharge those Exemptions are allowed from the requirements of CWA Section 311.
pollutants in concentrations of 10 ppb or greater,except for Applications for exemptions must set forth the following information:
acrolein,acrylonitrile,2,4-dinitrophenol,and 2-methyl-4,6- 1. The substance and the amount of each substance that may be discharged.
dinitrophenol. If you discharge any of the four latter pollutants in 2. The origin and source of the discharge of the substance.
concentrations of 100 ppb or greater,you must report quantitative 3. The treatment to be provided for the discharge by:
data. If you discharge the pollutants in Sections 2 through 5 of a. An onsite treatment system separate from any treatment system
i.e. <100ppb for acrolein treating your normal discharge;
Table B less than these thresholds
( b. A treatment system designed to treat your normal discharge and that is
acrylonitrile,2,4-dinitrophenol,and 2-methyl-4,6-dinitrophenol and additionally capable of treating the amount of the substance identified
<10 ppb for all others),you must submit quantitative data or briefly under paragraph 1 above;or
describe the reasons the pollutant is in your discharge. c. Any combination of the above.
For pollutants in intake water,see the discussion under"General See 40 CFR 117.12(a)(2)and(c)or contact your NPDES permitting authority
Instructions for Reporting,Sampling,and Analysis"on pages for further information on exclusions from CWA Section 311.
2C-5 and 2C-6 for further information.
Once you have completed these tasks,answer"Yes"to Item 7.11, Item 7.16.Indicate whether:
Item 7.12 and Table C.For each outfall(including outfalls • Your facility uses or manufactures 2,4,5-trichlorophenoxy
containing only noncontact cooling water or stormwater runoff), acetic acid(2,4,5-T);2-(2,4,5-trichlorophenoxy)propanoic acid
indicate whether you know or have reason to believe that any of (Silvex,2,4,5-TP);2-(2,4,5-trichlorophenoxy)ethyl 2,2-dichloro-
the pollutants listed on Table C are present in your discharge. If propionate(Erbon);0,0-dimethyl 0-(2,4,5-trichlorophenyl)
so,mark the box in the"Believed Present"column for each phosphorothioate(Ronnel);2,4,5,-trichlorophenol(TCP);or
applicable pollutant. If not,mark the box in the"Believed Absent" hexachlorophene(HCP).
column for each applicable pollutant.Answer"Yes"to Item 7.12 • You know or have reason to believe that 2.3.7,8-
once you have completed the required task for each outfall. tetrachlorodibenzo-p-dioxin(TCDD)is or may be present in an
Item 7.13 and Table C.You are required to report quantitative effluent.
data for any Table C pollutants that are directly limited in an If yes,continue to Item 7.17. If no,skip to Section 8.
applicable ELG or are indirectly limited in an applicable ELG
through an expressed limitation on an indicator(e.g.,use of total Item 7.17 and Table E.If you answered"Yes"to Item 7.16,you
suspended solids(TSS)as an indicator to control the discharge must report qualitative data,generated using a screening procedure
of iron and aluminum). For all other pollutants that you marked as not calibrated with analytical standards,for TCDD.Your screening
"Believed Present,"you must either report quantitative data or analyses must be performed using gas chromatography with an
briefly describe the reasons the pollutant is expected to be electron capture detector.A TCDD standard for quantitation is not
discharged. required.Describe the results of your screening analysis(e.g.,"no
measurable baseline deflection at the retention time of TCDD"or"a
For pollutants in intake water,see the discussion under"General measurable peak within the tolerances of the retention time of
Instructions for Reporting,Sampling,and Analysis"on pages TCDD.")on Table E.The NPDES permitting authority may require
2C-5 and 2C-6 for further information. you to perform a quantitative analysis if you report a positive result.
Answer"Yes"to Item 7.13 when you have fully completed the Answer"Yes"to Item 7.17 when you have completed Table E.
tasks associated with Table C and Items 7.12 and 7.13 above.
2C-4

General Instructions for Reporting,Sampling,and Analysis
Important note:Read these instructions before completing Tables All reporting of values for metals must be in terms of"total
A through E and Section 7 of Form 2C. recoverable metal,"unless:
General Items • An applicable,promulgated ELG specifies the limitation for
Complete the applicable tables for each outfall at your facility.Be the metal in dissolved,valent,or total form;
sure to note the EPA Identification Number,NPDES permit number, • All approved analytical methods for the metal inherently
facility name,and applicable outfall number at the top of each page measure only its dissolved form(e.g.,hexavalent chromium);
of the tables and any associated attachments. or
You may report some or all of the required data by attaching • The permitting authority has determined that in establishing
separate sheets of paper instead of completing Tables A through E case-by-case limitations it is necessary to express the
for each of your outfalls so long as the sheets contain all of the limitations of the metal in dissolved,valent,or total form to
required information and are similar in format to Tables A through carry out the provisions of the CWA.
E.For example,you may be able to print a report in a compatible Note that you are not required to complete the"Maximum Monthly
format from the data system used in your GC/MS analysis Discharge"and the"Long-Term Average Daily Discharge"columns
completed under Table B. of Tables A through C;however,these fields should be completed
Table A requires you to report at least one analysis for each if data are available.
pollutant listed.Tables B through D require you to report analytical If measure you onlydailyvalue,complete the"Maximum Daily
one
data in two ways.For some pollutants,you may be required to Discharge"columns of the tables and enter"1"in the"Number of
check the box in the"Testing Required"column and test and report Analyses"columns.The NPDES permitting authority may require
the levels of the pollutants in your discharge whether or not you additional analyses to further characterize your discharges.
expect them to be present in your discharge.For all other
p g For composite samples,the daily value is the total mass or
pollutants,you must check the box in either the"Believed Present" average concentration found in a composite sample taken over the
or"Believed Absent"columns based on your best estimate and test operating hours of the facility during a 24-hour period.For grab
for those you believe to be present(with some exceptions).Base samples,the daily value is the arithmetic or flow weighted total
your determination that a pollutant is present in or absent from your mass or average concentration found in a series of at least four
discharge on your knowledge of your raw materials,maintenance grab samples taken over the operating hours of the facility during a
chemicals,intermediate and final products and byproducts,and any 24-hour period.
previous analyses known to you of your effluent or similar effluent.
For example,if you manufacture pesticides,you should expect If you measure more than one daily value for a pollutant and those
those pesticides to be present in contaminated stormwater runoff. values are representative of your wastestream,you must report
If you would expect a pollutant to be present solely because of its them.You must describe your method of testing and data analysis.
presence in your intake water,you must mark"Believed Present" When an applicant has two or more outfalls with substantially
but you are not required to analyze for that pollutant. Instead,mark identical effluents,the NPDES permitting authority may allow the
an"X"in the long-term average value of the"Intake"column; applicant to test only one outfall and report those quantitative data
optionally,you may instead provide intake data. as applying to the substantially identical outfall.If the permitting
Reporting of Effluent Data authority grants your request,attach a separate sheet to the
application form identifying the outfall tested and describing why the
Report sampling results for all pollutants in Tables A through C as other outfall(s)are substantially identical.
concentration and total mass,except for flow,temperature,pH, Reporting of Intake Data
color,and fecal coliform organisms. If you are reporting
quantitative data under Table D,report concentration only. You are not required to report data under the"Intake"columns of
Flow,temperature,pH,color,and fecal coliform organisms must be Tables A through C unless you wish to demonstrate your eligibility
reported as mgd,degrees Celsius(°C),standard units,color units, for a"net"effluent limitation for one or more pollutants in Tables A
and most probable number per 100 milliliters(MPN/100 mL), through C(i.e.,an effluent limitation adjusted by subtracting the
respectively.Use the following abbreviations in the columns average level of the pollutant(s)present in your intake water).
requiring"units"in Tables A through D. NPDES regulations allow net limitations only in certain
circumstances.To demonstrate your eligibility,under the"Intake"
Concentration Mass columns report the average of the results of analyses of your intake
ppm=parts per million lbs=pounds water and discuss the requirements for a net limitation with your
mg/L=milligrams per liter ton=tons(English tons) NPDES permitting authority.If your water is treated before use,test
the water after it has been treated.
ppb=parts per billion mg=milligrams
pg/L=micrograms per liter g=grams
MPN=most probable number per kg=kilograms
100 milliliters T=tonnes(metric tons)
2C-5

General Instructions for Reporting,Sampling,and Analysis Continued
Sampling Aliquots may be collected manually or automatically.For"GC/MS
The collection of samples for the reported analyses should be Fraction—Volatile Compounds"in Table B,aliquots must be
supervised by a person experienced in performing sampling of combined in the laboratory immediately before analysis.Four
industrial wastewater.You may contact your NPDES permitting (rather than eight)aliquots or grab samples should be collected for
authority for detailed guidance on sampling techniques and for this fraction.These four samples should be collected during actual
answers to specific questions.See Exhibit 1-1 of Form 1 for hours of discharge over a 24 hour period and need not be flow
contact information.Any specific requirements in the applicable proportioned.Only one analysis is required.
analytical methods—for example,sample containers,sample Use of Historical Data
preservation,holding times,and the collection of duplicate
samples—must be followed. Existing data may be used,if available,in lieu of sampling
conducted solely for the purposes of this application,provided that:
The time when you sample should be representative of your normal all data requirements are met;sampling was performed,collected,
operation,to the extent feasible,with all processes that contribute and analyzed no more than 4.5 years prior to submission;all data
wastewater in normal operation,and with your treatment system are representative of the discharge;and all available representative
operating properly with no system upsets.Collect samples from the data are considered in the values reported.
center of the flow channel,where turbulence is at a maximum,at a
site specified in your present NPDES permit,or at any site Analysis
adequate for the collection of a representative sample. Except as specified below,all required quantitative data shall be
Grab samples must be used for pH,temperature,cyanide,total collected in accordance with sufficiently sensitive analytical
phenols,residual chlorine,oil and grease,fecal coliform(including methods approved under 40 CFR 136 or required under 40 CFR
E.coli),and enterococci(previously known as fecal streptococcus chapter I,subchapter N or 0.A method is"sufficiently sensitive"
at 40 CFR 122.26(d)(2)(iii)(A)(3)),and volatile organic compounds. when:
For all other pollutants,a 24-hour composite sample,using a • The method minimum level(ML)is at or below the level of the
minimum of four grab samples,must be used unless specified applicable water quality criterion for the measured pollutant or
otherwise at 40 CFR 136.However,a minimum of one grab pollutant parameter.
sample may be taken for effluents from holding ponds or other • The method ML is above the water quality criterion,but the
impoundments with a retention period greater than 24 hours. amount of the pollutant or pollutant parameter in the facility's
For stormwater discharges,a minimum of one to four grab discharge is high enough that the method detects and
samples must be taken,depending on the duration of the quantifies the level of the pollutant or pollutant parameter in
discharge.One grab sample must be taken in the first hour(or the discharge.
less)of discharge,with one more grab sample(up to a minimum of • The method has the lowest ML of the analytical methods
four)taken in each succeeding hour of discharge for discharges approved under 40 CFR 136 or required under 40 CFR
lasting four hours or more. chapter I,subchapter N or 0 for the measured pollutant or
pollutant parameter.
Except for stormwater discharges,the NPDES permitting authority
may waive composite sampling requirements for any outfall for Consistent with 40 CFR 136,you may provide matrix-or sample-
which you demonstrate that use of an automatic sampler is specific MLs rather than the published levels.Further,where you
infeasible and that the minimum of four grab samples will be can demonstrate that,despite a good faith effort to use a method
representative of your discharge.Results of analyses of individual that would otherwise meet the definition of"sufficiently sensitive,"
grab samples for any parameter may be averaged to obtain the the analytical results are not consistent with the quality assurance
daily average.Grab samples that are not required to be analyzed (QA)/quality control(QC)specifications for that method,then the
immediately may be composited in the laboratory,if the container, NPDES permitting authority may determine that the method is not
preservation,and holding time requirements are met and if sample performing adequately and the NPDES permitting authority should
integrity is not compromised during compositing.See Table II at 40 select a different method from the remaining EPA-approved
CFR 136.3 for further information. methods that is sufficiently sensitive consistent with 40 CFR
122.21(e)(3)(i).Where no other EPA-approved methods exist,you
A grab sample is an individual sample of at least 100 milliliters must select a method consistent with 40 CFR 122.21(e)(3)(ii).
collected at a randomly chosen time over a period not exceeding
15 minutes. When there is no analytical method that has been approved under
40 CFR 136;required under 40 CFR chapter I,subchapter N or 0,
A composite sample is a combination of at least eight sample and is not otherwise required by the NPDES permitting authority,
aliquots of at least 100 milliliters,collected at periodic intervals you may use any suitable method but shall provide a description of
during the operating hours of a facility over a 24-hour period.The the method.When selecting a suitable method,other factors such
composite must be flow proportional;either the time interval as a method's precision,accuracy,or resolution,may be
between each aliquot or the volume of each aliquot must be considered when assessing the performance of the method.
proportional to either the stream flow at the time of sampling or the
total stream flow since the collection of the previous aliquot.
2C-6

FORM 2C—INSTRUCTIONS CONTINUED
Section 8.Used or Manufactured Toxics Section 12.Checklist and Certification Statement
Item 8.1.Indicate if any pollutant listed in Table B is used or Item 12.1.Review the checklist provided.In Column 1,mark the
manufactured in your facility as an intermediate or final product or sections of Form 2C that you have completed and are submitting
byproduct. If yes,continue to Item 8.2.If no,skip to Section 9. with your application.In Column 2,indicate for each section
Item 8.2.List the applicable toxic pollutants.Note that the NPDES whether you are submitting attachments.
permitting authority may waive or modify the requirement if you Item 12.2.The CWA provides for severe penalties for submitting
demonstrate that it would be unduly burdensome to identify each false information on this application form.Section 309(c)(2)of the
toxic pollutant and the permitting authority has adequate CWA provides that"Any person who knowingly makes any false
information to issue you a permit.You may not claim this statement,representation,or certification in any application, ...shall
information as confidential.Note that you do not need to distinguish upon conviction,be punished by a fine of no more than$10,000 or
between use or production of the pollutants or list amounts. by imprisonment for not more than six months or both."
Section 9.Biological Toxicity Tests FEDERAL REGULATIONS AT 40 CFR 122.22 REQUIRE THIS
Item 9.1.Indicate if you have any knowledge or reason to believe APPLICATION TO BE SIGNED AS FOLLOWS:
that any biological test for acute or chronic toxicity has been made A. For a corporation,by a responsible corporate officer. For the
on any of your discharges or on a receiving water in relation to your purpose of this section,a responsible corporate officer means:
discharge within the last three years. If yes,continue to Item 9.2.If (1)a president,secretary,treasurer,or vice-president of the
no,skip to Section 10. corporation in charge of a principal business function,or any
Item 9.2.Identify the tests known to have been performed and the other person who performs similar policy or decision making
purposes of each.For each test,check"Yes"or"No"to indicate if functions for the corporation,or(2)the manager of one or
you have submitted the test results to the NPDES permitting more manufacturing,production,or operating facilities,
authority and the date the results were submitted.The NPDES provided the manager is authorized to make management
permitting authority may ask you to provide additional details after decisions which govern the operation of the regulated facility
reviewing your application. including having the explicit or implicit duty of making major
capital investment recommendations,and initiating and
Section 10.Contract Analyses directing other comprehensive measures to assure long term
Item 10.1.Indicate if any of the analyses reported in Section 7 were environmental compliance with environmental laws and
performed by a contract laboratory or consulting firm. If yes, regulations;the manager can ensure that the necessary
continue t Itemya 10.2 f n skip to or Sectiono 11. systems are established or actions taken to gather complete
and accurate information for permit application requirements;
Item 10.2.Identify each laboratory or firm used in the table and where authority to sign documents has been assigned or
provided.For each,provide the name,address,and phone number delegated to the manager in accordance with corporate
of the laboratory or firm and the pollutants analyzed. procedures.
Section 11.Additional Information B. For a partnership or sole proprietorship,by a general partner
or the proprietor,respectively.
Item 11.1.In addition to the information reported on the application C. For a municipality,state,federal,or other public facility,by
form,the NPDES permitting authority may request additional either a principal executive officer or ranking elected official.
information reasonably required to assess the discharges of the For purposes of this section,a principal executive officer of a
facility and to determine whether to issue an NPDES permit.The federal agency includes:(1)The chief executive officer of the
additional information may include additional quantitative data and agency,or(2)a senior executive officer having responsibility
bioassays to assess the relative toxicity of discharges to aquatic life for the overall operations of a principal geographic unit of the
and requirements to determine the cause of the toxicity. Indicate agency(e.g.,Regional Administrators of EPA).
under Item 11.1 whether the NPDES permitting authority has END
requested additional information from you. If yes,continue to Item
11.2. If no,skip to Section 12. Submit your completed Form 1,Form 2C,and
Item 11.2.List the items requested and attach the required all associated attachments
information to the application. (and any other required NPDES application forms)
to your NPDES permitting authority.
2C-7

Exhibit 2C-1.Example Line Drawing
Blue River Municipal
Iv
90,000 GPO Water Supply Blue River
10,000 GPD
145,000 GPD 45,000 GPD 136,000 GPD Cooling Water
Raw Materials Fiber 15,000 Dyeing10,000 5,000 GPD
10,000 GPD
Preparation GPD GPD Washing GPD Y Drying To Atmosphere
40,000 GPD 40,000 GPD 40,000 10,000 To Product
GPD GPD 5,000 GPD
Solid Waste Grit Neutralization Loss Waste
Separator Tank 6 000 GPD ► Treatment I
4,000 GPD Plant#2
36,000 GPD 34,000 GPO Outfall 002
50,000 GPD
Waste
OutfaII
Stomwater Treatment 70,000 GPD S ormwati!er
Max:20,000 GPO Plant#1
Schematic of Water Flow
Brown Mills,Inc.
City,County,State
2C-8

Exhibit 2C-2.Codes for Treatment Units and Disposal of Wastes Not Discharged
1. PHYSICAL TREATMENT PROCESSES
1—A Ammonia stripping 1—M Grit removal
1—B Dialysis 1—N Microstraining
1—C Diatomaceous earth filtration 1-0 Mixing
1—D Distillation 1—P Moving bed filters
1—E Electrodialysis 1—Q Multimedia filtration
1—F Evaporation 1—R Rapid sand filtration
1—G Flocculation 1—S Reverse osmosis(hyperfiltration)
1—H Flotation 1—T Screening
1—I Foam fractionation 1—U Sedimentation(settling)
1—J Freezing 1—V Slow sand filtration
1—K Gas—phase separation 1—W Solvent extraction
1—L Grinding(comminutors) 1—X Sorption
2. CHEMICAL TREATMENT PROCESSES
2—A Carbon adsorption 2—G Disinfection(ozone)
2—B Chemical oxidation 2—H Disinfection(other)
2—C Chemical precipitation 2—I Electrochemical treatment
2—D Coagulation 2—J Ion exchange
2—E Dechlorination 2—K Neutralization
2—F Disinfection(chlorine) 2—L Reduction
3. BIOLOGICAL TREATMENT PROCESSES
3—A Activated sludge 3—E Pre-aeration
3—B Aerated lagoons 3—F Spray irrigation/land application
3—C Anaerobic treatment 3—G Stabilization ponds
3—D Nitrification—denitrification 3—H Trickling filtration
4. WASTEWATER DISPOSAL PROCESSES
4—A Discharge to surface water 4—C Reuse/recycle of treated effluent
4—B Ocean discharge to outfall 4—D Underground injection
5. SLUDGE TREATMENT AND DISPOSAL PROCESSES
5—A Aerobic digestion 5—M Heat drying
5—B Anaerobic digestion 5—N Heat treatment
5—C Belt filtration 5-0 Incineration
5—D Centrifugation 5—P Land application
5—E Chemical conditioning 5—Q Landfill
5—F Chlorine treatment 5—R Pressure filtration
5—G Composting 5—S Pyrolysis
5—H Drying beds 5—T Sludge lagoons
5—I Elutriation 5—U Vacuum filtration
5—J Flotation thickening 5—V Vibration
5—K Freezing 5—W Wet oxidation
5—L Gravity thickening
2C-9

Exhibit 2C-3.Testing Requirements for Organic Toxic Pollutants Industry Categories*
INDUSTRY CATEGORY GC/MS FRACTIONt
Volatile Acid Base/Neutral Pesticide
Adhesives and sealants X X X ❑
Aluminum forming X X X ❑
Auto and other laundries X X X X
Battery manufacturing X ❑ X ❑
Coal mining ❑ ❑ ❑ ❑
Coil coating X X X ❑
Copper forming X X X ❑
Electric and electronic compounds X X X X
Electroplating X X X ❑
Explosives manufacturing ❑ X X ❑
Foundries X X X ❑
Gum and wood chemicals(all subparts except D and F) X X ❑ ❑
Gum and wood chemicals, Subpart D(tall oil rosin) X X X 0
Gum and wood chemicals, Subpart F(rosin-based X X X ❑
derivatives)
Inorganic chemicals manufacturing X X X ❑
Iron and steel manufacturing X X X ❑
Leather tanning and finishing X X X ❑
Mechanical products manufacturing X X X ❑
Nonferrous metals manufacturing X X X X
Ore mining,Subpart B(base and precious metals) ❑ X ❑ ❑
Organic chemicals manufacturing X X X X
Paint and ink formulation X X X ❑
Pesticides X X X X
Petroleum refining X ❑ ❑ 0
Pharmaceutical preparations X X X ❑
Photographic equipment and supplies X X X ❑
Plastic and synthetic materials manufacturing X X X X
Plastic processing X ❑ ❑ ❑
Printing and publishing X X X X
Pulp and paperboard mills X X X X
Rubber processing X X X ❑
Soap and detergent manufacturing X X X ❑
Steam electric power plants X X ❑ ❑
Textile mills(except Subpart C,Greige Mills) X X X ❑
Timber products processing X X X X
* See note at conclusion of 40 CFR 122,Appendix D(1983)for explanation of effect of suspensions on testing requirements for primary
industry categories.
r The pollutants in each fraction are listed in Table B.
X=Testing is required.
❑=Testing is not required.
2C-10

Exhibit 2C-4.Hazardous Substances
1.Acetaldehyde 73.Captan 144.Ferrous sulfate
2.Acetic acid 74.Carbaryl 145.Formaldehyde
3.Acetic anhydride 75.Carbofuran 146.Formic acid
4.Acetone cyanohydrin 76.Carbon disulfide 147.Fumaric add
5.Acetyl bromide 77.Carbon tetrachloride 148.Furfural
6.Acetyl chloride 78.Chlordane 149.Guthion
7.Acrolein 79.Chlorine 150.Heptachlor
8.Acrylonitrile 80.Chlorobenzene 151.Hexachlorocyclopentadiene
9.Adipic acid 81.Chloroform 152.Hydrochloric acid
10.Aldrin 82.Chloropyrifos 153.Hydrofluoric acid
11.Allyl alcohol 83.Chlorosulfonic acid 154.Hydrogen cyanide
12.Allyl chloride 84.Chromic acetate 155.Hydrogen sulfide
13.Aluminum sulfate 85.Chromic acid 156.Isoprene
14.Ammonia 86.Chromic sulfate 157.Isopropanolamine dodecylbenzenesulfonate
15.Ammonium acetate 87.Chromous chloride 158.Kelthane
16.Ammonium benzoate 88.Cobaltous bromide 159.Kepone
17.Ammonium bicarbonate 89.Cobaltous formate 160.Lead acetate
18.Ammonium bichromate 90.Cobaltous sulfamate 161.Lead arsenate
19.Ammonium bifluoride 91.Coumaphos 162.Lead chloride
20.Ammonium bisulfite 92.Cresol 163.Lead fluoborate
21.Ammonium carbamate 93.Crotonaldehyde 164.Lead fluorite
22.Ammonium carbonate 94.Cupric acetate 165.Lead iodide
23.Ammonium chloride 95.Cupric acetoarsenite 166.Lead nitrate
24.Ammonium chromate 96.Cupric chloride 167.Lead stearate
25.Ammonium citrate 97.Cupric nitrate 168.Lead sulfate
26.Ammonium fluoroborate 98.Cupric oxalate 169.Lead sulfide
27.Ammonium fluoride 99.Cupric sulfate 170.Lead thiocyanate
28.Ammonium hydroxide 100.Cupric sulfate ammoniated 171.Lindane
29.Ammonium oxalate 101.Cupric tartrate 172.Lithium chromate
30.Ammonium silicofluoride 102.Cyanogen chloride 173.Malathion
31.Ammonium sulfamate 103.Cydohexane 174.Maleic acid
32.Ammonium sulfide 104.2,4-D acid(2,4-dichlorophenoxyacetic acid) 175.Maleic anhydride
33.Ammonium sulfite 105.2,4-D esters(2,4-dichlorophenoxyacetic acid esters) 176.Mercaptodimethur
34.Ammonium tartrate 106.DDT 177.Mercuric cyanide
35.Ammonium thiocyanate 107.Diazinon 178.Mercuric nitrate
36.Ammonium thiosulfate 108.Dicamba 179.Mercuric sulfate
37.Amyl acetate 109.Dichlobenil 180.Mercuric thiocyanate
38.Aniline 110.Dichlone 181.Mercurous nitrate
39.Antimony pentachloricle 111.Dichlorobenzene 182.Methoxychlor
40.Antimony potassium tartrate 112.Dichloropropane 183.Methyl mercaptan
41.Antimony tribromide 113.Dichloropropene 184.Methyl methacrylate
42.Antimony trichloride 114.Dichloropropene-dichloproropane mix 185.Methyl parathion
43.Antimony trifluoride 115.2,2-dichloropropionic acid 186.Mevinphos
44.Antimony trioxide 116.Dichlorvos 187.Mexacarbate
45.Arsenic disulfide 117.Dieldrin 188.Monoethylamine
46.Arsenic pentoxide 118.Diethylamine 189.Monomethylamine
47.Arsenic trichloride 119.Dimethylamine 190.Naled
48.Arsenic trioxide 120.Dinitrobenzene 191.Naphthalene
49.Arsenic trisulfide 121.Dinitrophenol 192.Naphthenic acid
50.Barium cyanide 122.Dinitrotoluene 193.Nickel ammonium sulfate
51.Benzene 123.Diquat 194.Nickel chloride
52.Benzoic acid 124.Disulfoton 195.Nickel hydroxide
53.Benzonitrile 125.Diuron 196.Nickel nitrate
54.Benzoyl chloride 126.Dodecylbenzesulfonic acid 197.Nickel sulfate
55.Benzyl chloride 127.Endosulfan 198.Nitric acid
56.Beryllium chloride 128.Endrin 199.Nitrobenzene
57.Beryllium fluoride 129.Epichlorohydrin 200.Nitrogen dioxide
58.Beryllium nitrate 130.Ethion 201.Nitrophenol
59.Butylacetate 131.Ethylbenzene 202.Nitrotoluene
60.n-butylphthalate 132.Ethylenediamine 203.Paraformaldehyde
61.Butylamine 133.Ethylene dibromide 204.Parathion
62.Butyric acid 134.Ethylene dichloride 205.Pentachlorophenol
63.Cadmium acetate 135.Ethylene diaminetetracetic acid(EDTA) 206.Phenol
64.Cadmium bromide 136.Ferric ammonium citrate 207.Phosgene
65.Cadmium chloride 137.Ferric ammonium oxalate 208.Phosphoric acid
66.Calcium arsenate 138.Ferric chloride 209.Phosphorus
67.Calcium arsenite 139.Ferric fluoride 210.Phosphorus oxychloride
68.Calcium carbide 140.Ferric nitrate 211.Phosphorus pentasulfide
69.Calcium chromate 141.Ferric sulfate 212.Phosphorus trichloride
70.Calcium cyanide 142.Ferrous ammonium sulfate 213.Polychlorinated biphenyls(PCB)
71.Calcium dodecylbenzenesulfonate 143.Ferrous chloride 214.Potassium arsenate
72.Calcium hypochlorite 215.Potassium arsenite
2C-11

Exhibit 2C-4.Hazardous Substances
216.Potassium bichromate 245.Sodium phosphate(dibasic) 271.Uranyl acetate
217.Potassium chromate 246.Sodium phosphate(tribasic) 272.Uranyl nitrate
218.Potassium cyanide 247.Sodium selenite 273.Vanadium penoxide
219.Potassium hydroxide 248.Strontium chromate 274.Vanadyl sulfate
220.Potassium permanganate 249.Strychnine 275.Vinyl acetate
221.Propargite 250.Styrene 276.Vinylidene chloride
222.Propionic add 251.Sulfuric acid 277.Xylene
223.Propionic anhydride 252.Sulfur monochloride 278.Xylenol
224.Propylene oxide 253.2,4,5-T acid(2,4,5-trichlorophenoxyacetic acid) 279.Zinc acetate
225.Pyrethrins 254.2,4,5-T amines(2,4,5-trichlorophenoxy acetic acid 280.Zinc ammonium chloride
226.Quinoline amines) 281.Zinc borate
227.Resorcinol 255.2,4,5-T esters(2,4,5-trichlorophenoxy acetic acid 282.Zinc bromide
228.Selenium oxide esters) 283.Zinc carbonate
229.Silver nitrate 256.2,4,5-T salts(2,4,5-trichlorophenoxy acetic acid salts) 284.Zinc chloride
230.Sodium 257.2,4,5-TP acid(2,4,5-trichlorophenoxy propanoic acid) 285.Zinc cyanide
231.Sodium arsenate 258.2,4,5-TP acid esters(2,4,5-trichlorophenoxy propanoic 286.Zinc fluoride
232.Sodium arsenite acid esters) 287.Zinc formate
233.Sodium bichromate 259.TDE(tetrachlorodiphenyl ethane) 288.Zinc hydrosulfite
234.Sodium bifluoride 260.Tetraethyl lead 289.Zinc nitrate
235.Sodium bisulfite 261.Tetraethyl pyrophosphate 290.Zinc phenolsulfonate
236.Sodium chromate 262.Thallium sulfate 291.Zinc phosphide
237.Sodium cyanide 263.Toluene 292.Zinc silicofluoride
238.Sodium dodecylbenzenesulfonate 264.Toxaphene 293.Zinc sulfate
239.Sodium fluoride 265.Trichlorofon 294.Zirconium nitrate
240.Sodium hydrosulfide 266.Trichloroethylene 295.Zirconium potassium fluoride
241.Sodium hydroxide 267.Trichlorophenol 296.Zirconium sulfate
242.Sodium hypochlorite 268.Triethanolamine dodecylbenzenesulfonate 297.Zirconium tetrachloride
243.Sodium methylate 269.Triethylamine
244.Sodium nitrite 270.Trimethylamine
2C-12
1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088897 City of King OMB No.2040-0004
Form U.S.Environmental Protection Agency
2C \'*"../EPA Application for NPDES Permit to Discharge Wastewater
NPDES 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 Nu belr Receiving Water Name Latitude Longitude
0
001 Old Richmond Creek 36° 13' 22' N 81:1' 25' 31' E
3
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
c .3 balance?(See instructions for drawing requirements.See Exhibit 2C-1 at end of instructions for example.)
R
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**001
Operations Contributing to Flow
Operation Average Flow
ck wash of filter and sludge collection of sedimentation basil .68 mgd
c —
mgd
mgd
mgd
Treatment Units
Description Code from Final Disposal of Solid or
(include size,flow rate through each treatment unit, Liquid Wastes Other Than
retention time,etc.) Table 2C-1 by Discharge
.3MG Decan Tank,retenion time=iday,average flow rate.( 5-C Landfill
EPA Form 3510-2C(Revised 3-19) Page 1

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088897 City of King OMB No.2040-0004
3.1 **Outlet'Number**
cont. Operations Contributin• to Flow
Operation Average Flow
mgd
mgd
mgd
and
9
Treatment Units
Description Final Disposal of Solid or
Code from
(include size,flow rate through each treatment unit, Table 2C-1 Liquid Wastes Other Than
retention time,etc.) by Discharge
d
0
U
c
E:
is
m
F--
**Outfall Number**
Operations Contributing to Flow
Operation Average Flow
cn mgd
R
' 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?
❑ Yes ❑✓ No 4 SKIP to Section 4.
N CD
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
NC0088897 City of King 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 in Sections 1 and 3 intermittent or seasonal?
❑ 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
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
days/week months/year mgd mgd days
days/week months/year mgd mgd days
days/week months/year mgd mgd days
SECTION 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 ❑✓ No 4 SKIP to Section 6.
u) 5.2 Provide the following information on applicable ELGs.
w ELG Category ELG Subcategory Regulatory Citation
co
co
a
5.3 Are any of the applicable ELGs expressed in terms of production(or other measure of operation)?
0 Yes 0 No 4 SKIP to Section 6.
0
.173 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
U)
Number Measure
0
U
73
O
L
d
EPA Form 3510-2C(Revised 3-19) Page 3

EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088897 City of King 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 4 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
Project (list outfall Discharge Required Projected
`o number)
N
N
a)
Q-
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 4 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
u 7.3 Have you completed monitoring for all Table A pollutants at each of your outfalls for which a waiver has not been
y requested and attached the results to this application package?
❑✓ Yes ❑ No;a waiver has been requested from my NPDES
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
listed in Exhibit 2C-3?(See end of instructions for exhibit.)
❑ Yes ❑✓ No 4 SKIP to Item 7.8.
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 GC/MS Fraction(s)
(Check applicable boxes.)
❑Volatile 0 Acid 0 Base/Neutral 0 Pesticide
❑Volatile ❑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
NC0088897 City of King OMB No.2040-0004
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—> 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
o 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?
I y
❑✓ Yes ❑ 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?
us
❑✓ Yes ❑ No
R
1= 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
W 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. ❑✓ 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
d an intermediate or final product or byproduct?
❑ Yes ❑✓ No 4 SKIP to Section 9.
8.2 List the pollutants below.
C ._
1. 4. 7.
0
U)
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
NC0088897 City of King 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 ElNo+ SKIP to Section 10.
ILD 9.2 Identify the tests and their aurposes below.
Test(s) Purpose of Test(s) Submitted to NPDES Date Submitted
o Permitting Authority?
s ❑ Yes ❑ No
0
'm ❑ Yes ❑ No
❑ Yes ❑ No
SECTION 10.CONTRACT ANALYSES(40 CFR 122.21 12
(g)l ))
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 Pace Analytical
d
>. Laboratory address 1377 South Park Dr.
c Kernersville,NC 27284
0
0 Phone number
[phone]
Pollutant(s)analyzed Total Suspended Solids,
Turbidity(NTU),Total
Aluminum,Total Fluoride,
Toal Zinc,Total Copper,Total
Phosphorous,Total Nitrogen,
Chronic WET Testing,Total
SECTION 11.ADDITIONAL INFORMATION(40 CFR 122.21(g)(13))
11.1 Has the NPDES permitting authority requested additional information?
o ElYes ❑✓ No 4 SKIP to Section 12.
E 11.2 List the information requested and attach it to this application.
1. 4.
R
2. 5.
3. 6.
EPA Form 3510-2C(Revised 3-19) Page 6

1
EPA Identification Number NPDES Permit Number Facility Name Form Approved 03/05/19
NC0088897 City of King 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
O Section 1:Outfall Location ❑ wl attachments
O Section 2:Line Drawing ❑ w/line drawing ❑ wl additional attachments
rA Section 3:Average Flows and w/list of each user of
Treatment 0 w/attachments 0 privately owned treatment
works
O Section 4: Intermittent Flows ❑ w/attachments
0 Section 5:Production ❑ w/attachments
w/optional additional
© Section 6:Improvements ❑ w/attachments 0 sheets describing any
additional pollution control
plans
❑ w/request for a waiver and ❑ wl explanation for identical
supporting information outfalls
w/small business exemption w/other attachments
0 requestca ❑
❑ Section 7:Effluent and Intake
"' 0 w/Table A ❑ w/Table B
Characteristics
0
❑ wl Table C ❑ w/Table D
w/Table E w/analytical results as an
c.> ❑ ❑ attachment_ _ _
❑ Section 8:Used or Manufactured ❑ w/attachments
Toxics
Section 9:Biological Toxicity
❑ Tests ❑ w/attachments
❑✓ Section 10:Contract Analyses ❑ w/attachments
❑✓ Section 11:Additional Information 0 w/attachments
❑✓ Section 12:Checklist and 0 wl 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.lam 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
Benjamin S.Marion City Engineer Intern
Signature Date signed
ao�sy�yyZ 7/11 07/03/2023
EPA Form 3510-2C(Revised 3-19) Page 7

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088897 City of King OMB No.2040-0004
TABLE A.CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(iii))1
Intake
Effluent
(Optional)
Waiver
Units Maximum Maximum Long-Term
Pollutant Requested
(if applicable) (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.
1 Biochemical oxygen demand ❑ Concentration
g
ODs
( ) Mass
Chemical oxygen demand Concentration
2` (COD) ❑ Mass
Concentration
3. Total organic carbon(TOC) ❑
Mass
Concentration
4. Total suspended solids(TSS) ❑
Mass mg/L 45 30 2/month
Concentration
5. Ammonia(as N) ❑
Mass
6. Flow ❑ Rate MGD daily
Temperature(winter) ❑ °C °C 2/month
7.
Temperature(summer) ❑ °C °C 2/month
pH (minimum) ❑ Standard units S.u. 6.0 2/month
8.
pH(maximum) ❑ Standard units S.u. 9.0 2/month
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
NC0088897 City of King 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
Dreghed) ifavalablle) aily of of
iscarge Discharge
Discharge Analyses AValuee Analyses
(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
Antimony,total Concentration
1.1 (7440 36 0) 0
Mass
Arsenic,total Concentration
1.2 (7440-38-2) 0 � 0 Mass
Beryllium,total Concentration
1.3 0
(7440-41-7) Mass
Cadmium,total Concentration
1.4 (7440-43-9) Mass
Chromium,total Concentration
1.5 (7440-47-3) 0 0 Mass
1.6 Copper,total El © Concentration
(7440-50-8) Mass mg/L 1/quarter
Lead,total Concentration
1.7 El
(7439-92-1) Mass
Mercury,total Concentration
1.8 (7439-97-6) Mass
Nickel,total Concentration
1'9 (7440-02-0) 0 El Mass
Selenium,total Concentration
1.10 (7782 49 2) Mass
Silver,total Concentration
1.11 (7440-22-4) 0 0 0 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
NC0088897 City of King 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
Discharge
(required) Dt available) Diischarge scharge Analyses AverageValue Analyses
( q ) ( (if available)
Thallium,total Concentration
1.12 (7440-28-0) El ❑ El Mass
Zinc,total Concentration
1.13 El El 1=1
(7440-66-6) Mass mg/L 1/quarter
1.14 Cyanide,total Concentration
(57-12-5) Mass
1.15 Phenols,total 0 ❑ Concentration
Mass
Section 2.Organic Toxic Pollutants(GC/MS Fraction—Volatile Compounds)
Acrolein Concentration
2.1 (107-02-8) 0 ❑ ❑ Mass
2.2 Acrylonitrile Concentration
0 0 0
(107-13-1) Mass
2.3 Benzene Concentration
El El El
(71-43-2) Mass
2.4 Bromoform ElConcentration
El I:I(75-25-2) Mass
2.5 Carbon tetrachloride Concentration
El El El
(56-23-5) Mass
Chlorobenzene Concentration
2.6 (108-90-7) El 0 0
Mass
Chlorodibromomethane Concentration
2.7 (124-48-1) ❑ 0 0
Mass
2.8 Chloroethane Concentration
(75-00-3) Mass
EPA Form 3510-2C(Revised 3-19) Page 12

EPA Identification Number NPDES Permit Number Faality Name Outfall Number Form Approved 03/05/19
NC0088897 City of King 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
E(req fireischargd a (if available) Discharge i D harge Analyses aily . AValuee Analyses
(if available)
2.9 2-chloroethylvinyl ether El
Concentration
(110-75-8) Mass
2.10 Chloroform(67-66-3) Concentration
Mass
2.11 Dichlorobromomethane 1:1Concentration
El 0
(75-27-4) Mass
1,1-dichloroethane 1:1Concentration
2.12 (75-34-3) Mass
2.13 1,2-dichloroethane © Concentration
(107-06-2) Mass
2.14 1,1-dichloroethylene 0 El Concentration
(75-35-4) Mass
12-dichloropropane ElEl
2.15 (78-87-5) Mass
2.16 13-dichloropropylene 0 0 El Concentration
(542-75-6) Mass
217 Ethylbenzene ID Concentration
0 El
(100-41-4) Mass
2.18 Methyl bromide 1=1 Concentration
El 0
(74-83-9) Mass
2.19 Methyl chloride ci Concentration
0 El
(74-87-3) Mass
2.20 Methylene chloride 1=1 Concentration
(75-09-2) Mass
2.21 1 1,2,2 tetrachloroethane Concentration
0 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
NC0088897 City of King 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 Term
of of
Discharge Discharge DisDcharge Analyses Average Analyses
(required) (if available) Value
(if available)
Tetrachloroethylene ❑ Concentration
2.22 (127-18-4) Mass
Toluene Concentration
2.23 (108-88-3) 0 0 0Mass
2.24 1,2-trans-dichloroethylene ❑ ❑ Concentration
(156-60-5) Mass
1,1,1-trichioroethane Concentration
2.25 (71-55-6) Mass
2.26 1,1,2-trichioroethane Concentration
(79-00-5) Mass
Trichloroethylene 0 ElConcentration
2.27 0
(79-01-6) Mass
Vinyl chloride Concentration
2.28 (75-01-4) Mass
Section 3.Organic Toxic Pollutants(GC/MS Fraction—Acid Compounds)
3.1 2-chlorophenol Concentration
(95-57-8) Mass
3.2 2,4-dichlorophenol 0 0 Concentration
(120-83-2) Mass
3.3 2,4-dimethylphenol 0 0 0Concentration
(105-67-9) Mass
3.4 4,6-dinitro-o-cresol Concentration
0 0 0
(534-52-1) Mass
3.5 2,4-dinitrophenol ❑ Concentration
(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
NC0088897
City of King 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
Dof of
Discharge Discharge Di Average
a An lyses Average Analyses
(required) (if available) g Value
(if available)
3.6 2-nitrophenol Concentration
(88-75-5) Mass
3.7 4-nitrophenol Concentration
(100-02-7) Mass
3.8 p-chloro-m-cresol ElConcentration
El 0
(59-50-7) Mass
3.9 Pentachlorophenol ❑ Concentration
(87-86-5) Mass
Phenol Concentration
3.10 (108-95-2) 0 Mass
3.11 2,4,6-trichlorophenol 0 Concentration
(88-05-2) Mass
Section 4.Organic Toxic Pollutants(GC/MS Fraction—Base/Neutral Compounds)
4.1 Acenaphthene Concentration
(83-32-9) Mass
4.2 Acenaphthylene 0 Concentration .
(208-96-8) Mass
4.3 Anthracene Concentration
(120-12-7) Mass
4.4 Benzidine Concentration
(92-87-5) Mass
4.5 Benzo(a)anthracene 0 Concentration
(56-55-3) Mass
4.6 Benzo(a)pyrene ElConcentration
(50-32-8) 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
NC0088897 City of King 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) Average Number Number
Present Absent Daily Monthly Term
of of
Discharge Discharge Di a Analyses Average Analyses
(required) (if available) (if avails rg Value
3,4-benzofluoranthene Concentration
4.7 (205-99-2) Mass
4.8 Benzo(ghi)perylene Concentration
(191-24-2) Mass
4.9 Benzo(k)fluoranthene 0 0 Concentration
(207-08-9) Mass
Bis(2-chloroethoxy)methane � 0 Concentration
4.10 (111-91-1) Mass
4.11 Bis(2-chloroethyl)ether 0 Concentration
Ei El
(111-44-4) Mass
4.12 Bis(2-chloroisopropyl)ether El 0 Concentration
CI
(102-80-1) Mass
4.13 Bis(2-ethylhexyl)phthalate 0 0 Concentration
(117-81-7) Mass
4-bromophenyl phenyl ether � � Concentration
4.14 (101-55-3) Mass
Butyl benzyl phthalate El � Concentration
4.15 CI
(85-68-7) Mass
2-chloronaphthalene � � Concentration
4.16 (91 58 7) Mass
4-chlorophenyl phenyl ether Concentration
4.17 (7005-72-3) Mass
Chrysene Concentration
4.18 El 0 CI
(218 01 9)
Mass
4.19 Dibenzo(a,h)anthracene 0 0 Concentration
CI
(53-70-3) Mass
EPA Form 3510-2C(Revised 3-19) Page 16

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088897 City of King 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)
PollutantlParameter 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 DisDcharge An lyses Average Analyses
(required) (if available) Value
(if available)
4.20 1,2-dichlorobenzene Concentration
(95-50-1) Mass
4.21 1,3-dichlorobenzene Concentration
(541-73-1) Mass
4.22 1,4-dichlorobenzene Concentration
(106-46-7) Mass
0
3,3-dichlorobenzidine 0 0 Concentration
4.23 (91-94-1) Mass
4.24 Diethyl phthalate ❑ 0 Concentration
(84-66-2) Mass
4.25 Dimethyl phthalate 0 0 Concentration
(131-11-3) Mass
4.26 Di-n-butyl phthalate Concentration
0 0 0
(84-74-2) Mass
4.27 2,4-dinitrotoluene Concentration
(121-14-2) Mass
2,6-dinitrotoluene Concentration
4.28 (606-20-2) Mass
4.29 Di-n-octyl phthalate 0 Concentration
(117-84-0) Mass
1,2-Diphenylhydrazine Concentration
4.30 (as azobenzene)(122-66-7) Mass
4.31 Fluoranthene Concentration
0 0 0
(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
NC0088897 City of King 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
Discharge Discharge Discharge Analyses Average Analyses
(required) (if available) Value
(if available)
4.33 Hexachlorobenzene ElConcentration
0 0(118-74-1) Mass
4.34 Hexachlorobutadiene Concentration
(87-68-3) Mass
4.35 Hexachlorocyclopentadiene 0 0 Concentration
(77-47-4) Mass
4.36 Hexachloroethane Concentration
0 0 0
(67-72-1) Mass
4.37 Indeno(1,2,3-cd)pyrene ❑ Concentration
(193-39-5) Mass
4.38 lsophorone ElConcentration
(78-59-1) Mass
4.39 Naphthalene ElConcentration
(91-20-3) Mass
4.40 Nitrobenzene Concentration
0 0 0
(98-95-3) Mass
4.41 N-nitrosodimethylamine 0 0 Concentration
(62-75-9) Mass
4.42 N-nitrosodi-n-propylamine ❑ Concentration
(621-64-7) ✓ Mass
4.43 N-nitrosodiphenylamine ❑ El Concentration
(86-30-6) 0 Mass
4.44 Phenanthrene Concentration
El 0
(85-01-8) 0 Mass
Pyrene Concentration
4.45 0 El El
(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 03105/19
NC0088897 City of King 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
D(required) (iischarge favalablDischarge) Discharge Analyses AverageValue Analyses
(if available)
1,2,4-trichlorobenzene Concentration
4.46 (120-82-1) Mass
Section 5.Organic Toxic Pollutants(GC/MS Fraction—Pesticides)
Aldrin Concentration
5.1 (309-00-2) Mass
a-BHC Concentration
5.2 (319-84-6) 0 Mass
(3-BHC Concentration
5.3 (319-85-7) Mass
y-BHC Concentration
5.4 (58 89 9) Mass
6-BHC Concentration
5.5 0 0 0
(319-86-8) Mass •
5.6 Chlordane Concentration
(57-74-9) Mass
4,4'-DDT Concentration
5.7 (50-29-3) Mass
5.8 4,4'-DDE Concentration
(72-55-9) Mass
4,4'-DDD Concentration
5.9 (72-54-8) Mass
Dieldrin Concentration
5.10 El ❑(60-57-1) Mass
5.11 a-endosulfan Concentration
(115-29-7) Mass
EPA Form 3510-2C(Revised 3-19) Page 19

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088897 City of King 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
regre Discharge (ifavalablge
e) DiDharge Analyses Averageaily of Value Analyses
(if available)
-
R-endosulfan El 0 0 Concentration
5.12 (115-29-7) Mass
Endosulfan sulfate El ❑ ❑ Concentration
5.13 (1031-07-8) Mass
5.14 Endrin El 0
0
Concentration
(72-20-8) Mass
Endrin aldehyde ❑ ❑ ❑ Concentration
5.15 (7421-93-4) Mass
Heptachlor ❑ ❑ ❑ Concentration
5.16 (76 44 8) Mass
Heptachlor epoxide Concentration
5.17 (1024-57-3) 0 ❑ 0 Mass
PCB-1242 Concentration
5.18 (53469-21-9) 0 ❑ ✓❑ Mass
PCB-1254 Concentration
5.19 (11097-69-1) 0 0 ❑✓
Mass
PCB-1221 Concentration
5.20 (11104-28-2) 0 0
Mass
PCB-1232 Concentration
5-21 (11141-16-5) 0 0 0 Mass
PCB-1248 Concentration
5.22 (12672-29-6) 0 0 0 Mass
PCB-1260 Concentration
5.23 (11096-82-5) 0 0 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 Facility Name Outfall Number Form Approved 03/05/19
NC0088897 City of King 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 char a Analyses Average Analyses
(required) (if available) Value
(if available)
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

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088897 City of King 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)
Units
Pollutant Maximum Lon Term
Believed Believed (specify) Maximum Daily Monthly Average Daily Number of Long-Term Number of
Present Absent Discharge Discharge Discharge Analyses Average Analyses
(required) Value
(if available) (if available)
❑ 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.
ri❑ 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 ❑ ❑ Concentration
(24959-67-9)
Mass
Chlorine,total ❑ Concentration
2. residual Mass ug/L 28 50 2/month
3. Color ❑ Concentration
Mass
Concentration
4. Fecal coliform ❑ 0
Mass
5 Fluoride 0 0 Concentration mg/L 1/quarter
(16984-48-8) Mass
6 Nitrate-nitrite 0 0
Concentration
Mass
Nitrogen,total Concentration
7' 1 organic(as N) El ❑ Mass mg/L 1/quarter
8. Oil and grease 0 0
Concentration
Mass
Phosphorus(as ❑ Concentration
9' P),total(7723-14-0) Mass mg/L 1/quarter
10. Sulfate(as SO4) 0 0 Concentration
(14808-79-8) Mass
Concentration
11. Sulfide(as S) ❑ ✓❑ - -
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
NC0088897 City of King 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
(required) Value
(if available) (if available)
12. Sulfite(as SO3) 0 0 Concentration
(14265-45-3) Mass
Concentration
13. Surfactants 0 0 Mass
14. Aluminum,total E✓ 0 Concentration
(7429-90-5) Mass mg/L 1/quarter
15. Barium,total ❑ Concentration
(7440-39-3) Mass
16. Boron,total ❑ ❑✓ Concentration
(7440-42-8) Mass
17. Cobalt,total Concentration
(7440-48-4) Mass
18 Iron,total ❑ ❑ Concentration
(7439-89-6) Mass
19 Magnesium,total ❑ ✓� Concentration
(7439-95-4)
Mass
Molybdenum, Concentration
20. total 0 0 Mass
(7439-98-7)
21. Manganese,total ❑ ✓❑ Concentration
(7439-96-5) Mass
22 Tin,total Concentration
0 El
(7440-31-5) Mass
23 Titanium,total Concentration
El El
(7440-32-6) Mass
EPA Form 3510-2C(Revised 3-19) Page 24

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088897 City of King OMB No.2040-0004
TABLE C.CERTAIN CONVENTIONAL AND NON CONVENTIONAL POLLUTANTS(40 CFR 122.21(g)(7)(vi))l
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
Discharge Discharge Analyses Analyses
(required) Value
(if available) (if available)
24. Radioactivity
•
Alpha,total 0 Concentration
Mass
Beta,total Concentration
Mass
Radium,total Concentration
Mass
Radium 226,total 0
Concentration
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

This page intentionally left blank.

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088897 City of King OMB No.2040-0004
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
1. Asbestos ❑ ❑✓
2. Acetaldehyde ❑ ❑✓
3. Allyl alcohol ❑ ❑�
4. Allyl chloride ❑ El
5. Amyl acetate ❑ ❑✓
6. Aniline ❑ ❑✓
7. Benzonitrile ❑ ❑✓
8. Benzyl chloride ❑ ❑✓
9. Butyl acetate ❑ ❑✓
10. Butylamine ❑ ❑✓
11. Captan ❑ ❑✓
12. Carbaryl ❑ ❑✓
13. Carbofuran ❑ ❑✓
14. Carbon disulfide ❑
15. Chlorpyrifos ❑
16. Coumaphos ❑ ❑�
17. Cresol El El
18. Crotonaldehyde ❑ ❑✓
19. Cyclohexane ❑ ❑✓
EPA Form 3510-2C(Revised 3-19) Page 27
L

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088897 City of King OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND 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 _
20. 2,4-D(2,4-dichlorophenoxyacetic acid) 0 ❑✓
21. Diazinon 0 ✓❑
22. Dicamba 0 0
23. Dichlobenil ❑ ❑✓
24. Dichlone 0 ❑✓
25. 2,2-dichloropropionic acid 0 0
26. Dichlorvos 0 ❑✓
27. Diethyl amine 0 ❑✓
28. Dimethyl amine ❑ ❑✓
29. Dintrobenzene 0 ❑✓
30. Diquat ❑ ❑✓
31. Disulfoton 0 0
32. Diuron 0 ❑✓
33. Epichlorohydrin 0 0
34. Ethion 0 0
35. Ethylene diamine 0 0
36. Ethylene dibromide 0 ❑✓
37. Formaldehyde 0 ❑✓
38. Furfural 0 ❑✓
EPA Form 3510-2C(Revised 3-19) Page 28

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088897 City of King OMB No.2040-0004
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
39. Guthion ❑ ❑✓
40. Isoprene ❑ ❑✓
41. Isopropanolamine ❑ ❑✓
42. Kelthane ❑ ❑✓
43. Kepone ❑ ❑✓
44. Malathion 0
45. Mercaptodimethur 0 ❑✓
46. Methoxychlor ❑ ❑✓
47. Methyl mercaptan 0 ❑✓
48. Methyl methacrylate 0
49. Methyl parathion ❑ ❑✓
50. Mevinphos ❑ ✓❑
51. Mexacarbate 0 0
52. Monoethyl amine 0 ❑✓
53. Monomethyl amine 0 ❑✓
54. Naled ❑ ❑✓
55. Naphthenic acid 0 ❑✓
56. Nitrotoluene ❑ ❑✓
57. Parathion ❑ ❑✓
EPA Form 3510-2C(Revised 3-19) Page 29

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088897 City of King OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 12221(g)(7)(vii))1
Presence or Absence
Pollutant (check one) Reason Pollutant Believed Present in Discharge Available Quantitative Data
Believed Believed (specify units)
Present Absent
58. Phenolsulfonate ❑ 0
59. Phosgene ❑ 0
60. Propargite ❑ 0
61. Propylene oxide 0 0
62. Pyrethrins ❑ 0
63. Quinoline ❑ 0
64. Resorcinol ❑
65. Strontium ❑ 0
66. Strychnine ❑ 0
67. Styrene ❑ 0
68. 2,4,5-T(2,4,5-trichlorophenoxyacetic ❑ 0
acid)
69. TDE(tetrachlorodiphenyl ethane) ❑ 0
70. 2,4,5-TP[2-(2,4,5-trichlorophenoxy) ❑ ❑
propanoic acid]
71. Trichlorofon ❑ 0
72. Triethanolamine ❑ 0
73. Triethylamine ❑ 0
74. Trimethylamine ❑ 0
75. Uranium ❑ 0
76. Vanadium ❑ 0
EPA Form 3510-2C(Revised 3-19) Page 30

EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088897 City of King OMB No.2040-0004
TABLE D.CERTAIN HAZARDOUS SUBSTANCES AND ASBESTOS(40 CFR 122.21(g)(7)(vii))l
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 ❑
79. Xylenol ❑ ❑✓
80. Zirconium ❑ ❑✓
I Sampling shall be conducted according to sufficiently sensitive test procedures(i.e.,methods)approved under 40 CFR 136 for the analysis of pollutants or pollutant parameters or
required under 40 CFR chapter I,subchapter N or 0.See instructions and 40 CFR 122.21(e)(3).
EPA Form 3510-2C(Revised 3-19) Page 31
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EPA Identification Number NPDES Permit Number Facility Name Outfall Number Form Approved 03/05/19
NC0088897 City of King 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